Plastic Surgery after Massive Weight Loss

After massive weight loss, many individuals are left with excess, sagging skin. Often times, the skin has lost elasticity and it cannot naturally shrink to the body’s new, smaller shape. Sagging skin can be an emotional burden and physically uncomfortable for some patients, especially for those left with a large amount of extra skin after weight loss. In cases like this, body lift surgery by a board certified plastic surgery is an excellent way to permanently remove excess skin and fat deposits to further slim and redefine the body.

What is Body Lift Surgery?

The term Body Lift encompasses a wide range of “lifts” that can be performed on various regions of the body to remove excess sagging skin. For example, a buttock lift, like the term suggests, “lifts” sagging buttocks. A thigh lift removes and tightens sagging skin on the thighs. An arm lift removes excess skin from the back of the upper arms. Multiple lift surgeries can normally be done in one trip to the operating room.

The popular Tummy Tuck, also called an abdominoplasty, is done on either the lower abdomen (below the naval), which is referred to as a mini-abdominoplasty or mini-tummy tuck. This procedure can be performed both above and below the naval, if needed.

Since many people lose weight in their face and neck area, a facelift is another form of plastic surgery that is sometimes requested after massive weight loss.

Mini vs. Full Abdominoplasty – What is the difference?

Below, Dr. Usha Rajagopal of the San Francisco Plastic Surgery & Laser Center talks about abdominoplasty surgery, which is popularly known as tummy tuck surgery. Abdominoplasty produces permanent results that slim down the stomach by removing excess fat deposits and sagging skin in the lower and upper abdomen region. Pregnancy, especially multiple pregnancies, can stretch out the abdomen muscles to the point of no return for some women. Since diet and exercise are often not enough for eliminating excess tissue and separated muscles, a tummy tuck is usually the best option.

“As a plastic surgeon, patients often ask me about the difference between a full abdominoplasty and a mini-abdominoplasty. A mini-abdominoplasty usually leaves a smaller scar than a full-abdominoplasty. As the name suggests, a mini-abdominoplasty is a tummy tuck that affects a smaller portion of the abdomen than a full abdominoplasty,” says Dr. Rajagopal.

A mini-abdominoplasty is performed on patients who have loose abdominal muscles and droopy skin only below the naval, in the lower abdomen. A full-abdominoplasty is performed on patients who have loose skin and abdominal muscles extending both above and below the naval. For full-abdominoplasty surgeries, the rectus muscle, sometimes called the “six pack muscle,” is also tightened. This is the muscle that often separates after pregnancy and leaves a permanent bulge on the stomach. Since more skin and excess fat is removed during a full-abdominoplasty, the scar is larger than with a mini-abdominoplasty. The scar from a complete abdominoplasty spans from hipbone to hipbone, just along the top of the pubic area. Conservative bikini bottoms can usually cover the scar from a full abdominoplasty.

The following should be kept in mind when considering a tummy tuck:

• Women should also wait until they are completely done having children before undergoing abdominoplasty. Women need to wait at least six months after giving birth to have a tummy tuck. The results of an abdominoplasty are permanent, but pregnancy or major weight gain can offset the results.
• Ideal candidates for tummy tuck surgery are usually at a normal, healthy weight with excess skin and/or separated abdominal muscles that do not respond to diet and exercise.
• It is important to note that a tummy tuck is meant to help with body contouring and not actual weight loss. Although patients look like they have lost weight due to a new and improved shape, actual weight loss, in terms of pounds, is minimal.
• Being normal weight and in good health prior to having abdominoplasty can significantly lessen recovery time afterward.

How much does a tummy tuck cost?

For a mini-abdominoplasty, the price ranges from $6,500-$7,500 at Dr. Rajagopal’s office, the San Francisco Plastic Surgery & Laser Center.  The price of a full abdominoplasty ranges from $7,500 – $10,000. Since each patient has different needs, the final cost of the surgery depends on the amount of excess skin and fat deposits that are removed.  The price ranges quoted above are all inclusive.

Sculptra, a Newly FDA Approved Filler, Works Wonders on the Face

Sculptra, an injectable poly-l-lactic acid filler that is sometimes referred to as a “liquid facelift,” has just been FDA approved for restoring volume to the face. Dr. Usha Rajagopal of the San Francisco Plastic Surgery and Laser Center treats a large number of her patients with Sculptra. “Sculptra is a great product for facial volume restoration. The results last much longer than with other fillers. An allergy test is not needed since the ingredients in Sculptra do not come from a human or animal source,” says Dr. Rajagopal.

Although Sculptra’s results last much longer than other injectable fillers, the results do not appear immediately. Instead, the effects emerge gradually. It typically takes at least 2-3 months for the desired fullness to appear. The actual procedure is rather quick. First, a topical numbing cream is applied to the area of the face that will receive the injection approximately an hour before the treatment. Ice can be applied to the injection site afterward to help with swelling and bruising. Patients can return to normal activities the same day. After care instructions involve massaging the treated area for five minutes, five times a day, for five days after treatment (The saying “five-five-five” helps patients remember this important rule). Multiple treatments that are spaced out six to twelve weeks apart are usually needed. Individuals with very little to no fat in the face will need more treatments and vials than someone with moderate to mild facial wasting.

Before the recent FDA approval, Sculptra had been used for years for treating HIV-associated facial lipoatrophy in HIV and AIDs patients. Now it is approved for use in patients who are looking to restore volume and fullness to the face that has been lost during the normal aging process. Poly-l-lactic acid

The cost of Sculptra, much like the cost of other cosmetic procedures, varies greatly by region of the country. At the San Francisco Plastic Surgery and Laser Center, Sculptra costs $1,200 per vial. For a patient wanting to treat the entire face, 3-4 vials are typically needed. Fewer vials are needed for someone looking to only treat a portion of the face, such as underneath the eyes, for example.

Below are some recent patient testimonials

Great consultation and pre-surgery instructions w/ Dr. Rajagopal – she answered all of my questions. When I brought up procedures that other doctors recommended during consults, she was very honest and told me I really didn’t need them! Never felt like I was being sold anything. Prices were very reasonable compared to others I checked out and I didn’t feel like anything was compromised for it.

Morning of surgery: the nurse gave me something like Valium to help calm my nerves before I went in to the OR. Anesthesiologist was friendly and did a great job – don’t remember a thing! Surgery itself went smoothly. Great results! They have their own OR, which was great.

After surgery: Dr. Rajagopal was very interested in my post-op recovery – she made sure I had filled my prescriptions for pain killers before surgery and that I had enough to get me through (though I didn’t use them all anyway). Had a beautiful bouquet of flowers for me in the recovery room, plus follow up phone calls to make sure I was doing well once home. Staff was great and communicated with my ride while I was out of it, and they helped me to my car.

They seem very conscious of making sure patients are as comfortable as possible before, during, and after procedures. I felt like I could trust Dr. Rajagopal completely with her professional experience, artistry, and judgment. Overall, GREAT EXPERIENCE! Highly recommended.

Dr. Rajagopal performed rhinoplasty on me about a month ago. I was extremely nervous and self-conscious (so much so, in fact, that I had not done this till I was 37 years-old!). But she and her medical team showed SO much kindness and patience with me while explaining every part of the surgery & what to expect post surgery. I never felt uncomfortable during the entire process. While I was recuperating, I even had to call her cell with a question during her off hours, and she was there, confident & helpful… And then I was back to work in 7 days! Everything looked great, just like she had explained. It seriously changed my life. They were so professional & experienced. They really know what they are doing there. I trust Dr. Rajagopal completely and would recommend her & her staff to anyone.

Otoplasty (Ear Pinning) and Earlobe Repair Surgery

Dr. Usha Rajagopal, plastic surgeon at the San Francisco Plastic Surgery and Laser Center, has seen an increase in patients who are seeking earlobe repair surgery. This is most likely related to the ear plug trend that has become more widepsread in the United States in recent years. Once the earlobe is stretched to a certain degree by large ear gauges, the area is damaged and the earlobe can not naturally return to its original size. When the jewelery is removed, an obvious and permanent hole remains in the earlobe. This can be a problem for people who no longer want their piercings.

Earlobe repair surgery can also be used for patients with earlobes that have stretched downwards due to years of wearing heavy, dangling earrings. Gravity and the weight of earrings can sometimes stretch and enlarge the earlobes of people with “regular” size ear piercings.

Otoplasty, also referred to as ear pinning, is another common surgical procedure performed on the ears. Using sutures, the ears are ”pinned back” to the head, making them less noticeable when the face is viewed from the front. Otoplasty is an outpatient procedure performed under general anesthesia. Scarring is mostly hidden behind the ear and/or by the folds of the ear. The results are permanent.

Is Fat Grafting Safe for Breasts?

Dr. Usha Rajagopal, Board Certified Plastic Surgeon at the San Francisco Plastic Surgery and Laser Center, is a leading specialist in breast augmentation surgery. Dr. Rajagopal performs fat grafting (also known as fat transfer) for various parts of the body, including transferring fat to the breasts. Many patients ask Dr. Rajagopal about performing a fat transfer to the breasts to create larger and fuller breasts.

Recently, the American Society of Plastic Surgeons (ASPS) has announced that there is no indication that fat grafting for breast augmentation is an unsafe procedure. For years, the safety of using fat grafting as a way of increasing breast size was shrouded in medical controversy. The main debate surrounding the procedure centered on breast cancer detection. Medical experts worried that the grafted fat could hide breast cancer during cancer screenings, further hindering early and essential cancer detection. It is very important to note that no scientific evidence had ever been found to prove that theory in the past and it was only speculated. Further scientific tests and trials are still needed in the not so far off future, but after reviewing a multitude of evidence-based results, no evidence has been found to show that fat grafting for breast enhancement is unsafe.

Fat grafting can be a great breast enhancement option for some women. Other women might have better results with saline and silicone breast implants. The advantages and disadvantages of fat grafting are listed below.

Advantages:

• Use of own bodily tissue.
• The patient does not have implants or other unnatural devices inserted into the chest.
• Unwanted fat from other areas of the body, such as the hips, flanks/lower back (“love handles”), thighs, and/or buttocks, is removed for transplantation to the breast area. This can even out certain problem areas on the patient’s body.
• Might be an ideal option for a patient with body fat concentrated in other regions of the body besides the chest, and/or has a “pear” shaped body (a bit larger in the lower body than in the upper body).
• Best for women looking to increase their breast size by half a cup to one cup size.
• Some complications of breast implants, like rippling and implant rupture, are avoided by using fat grafting instead of implants.

Disadvantages:

• Is not effective for women who want to increase breast size by more than one cup size.
• Multiple treatments are often necessary for the full effect.
• The actual procedure takes more time than breast surgery with breast implants.
• Since the procedure takes more time and can require multiple treatments, it is more expensive than using breast implants. Conventional breast augmentation with implants only requires one surgery.
• Women who are petite/thin might not have enough body fat for the fat transfer to the breasts. A decent amount (approximately one liter to one and a half liters) of body fat needs to be removed from another area of the body. Often, women who have small breasts that are looking into breast enhancement procedures are thin and might not have enough fat on other areas of their body for the fat transfer.

Choosing the Right Size Breast Implants

Choosing the appropriate breast implant type, shape, and size is the essential first step when considering breast augmentation surgery. “Today, there are various types of breast implants on the market. Implants come in a variety of shapes, sizes, and textures,” says Dr. Usha Rajagopal, a board certified plastic surgeon in San Francisco. As a female plastic surgeon, Dr. Rajagopal sees a lot of patients who are interested in breast augmentation and breast lift surgery. “Many patients feel more comfortable seeing a female plastic surgeon for breast augmentation surgeries,” explains Dr. Rajagopal.

Dr. Rajagopal suggests that women who are considering breast augmentation surgery research the following topics regarding breast implants on their own in addition to asking in depth questions during their consultation with a board certified plastic surgeon.

Types of implants: Saline and silicone breast implants are the most common types of implants used for breast augmentation. Saline implants are filled with a saline solution, which is simply sterile water. These implants cost a little less than silicone implants. Silicone implants have a cohesive silicone gel inside. Their texture is more firm than saline implants.

Insertion Methods: Implants can be inserted three ways: Through the armpit, via an incision made underneath the breast, and through an incision made around the areola (the dark skin around the nipple). Silicone implants come pre-filled, so only saline implants can be inserted from a tiny incision in the armpit or from around the areola. For saline implants, the saline solution is pumped into the implant shell after it has been placed in the desired spot inside the breast. Dr. Rajagopal prefers to insert implants, including saline breast implants, from an incision underneath the breast fold. This insertion method allows the surgeon to have more control over placement of the implant.

Placement: Breast implants can be placed either underneath the chest muscle (pectoral muscle) or on top of it. Dr. Rajagopal prefers to place the implant underneath the muscle and does so for most of her patients. Placing the implants underneath the muscle produces a more natural look. This type of placement is believed to reduce the chances of developing capsular contracture (hardening of the breast due to scar tissue).

Textures and Shapes: Breast implants can have a textured surface or a smooth surface and come in either round or tear dropped shapes. Typically, tear dropped shape implants are textured to help them remain in place. If round implants happen to rotate later on inside the breast, the round shape of the implant does not distort the appearance of the breast. Manufacturers of textured implants also claim that a textured surface reduces the chances of developing hardening of the breast (capsular contracture), although there is no medical proof to back-up that claim. Dr. Rajagopal prefers to use smooth round implants for her breast augmentation patients.

Natrelle Pre-Consultation Kits – Try different breast implant sizes before you see the plastic surgeon: Allergan, the manufacturer of silicone and saline breast implants, offers a pre-consultation kit for breast augmentation. The Natrelle Pre-Consultation Kit comes with different sized inserts and a profile bra for women to try on to see what breast size best suits their body. Women can experiment with different breast sizes under various outfits privately at home. The kit also comes with an educational DVD and booklet.

Natrelle Kits can be purchased from your plastic surgeon’s office or online at http://www.natrelle.com/ for $39.99. Allergan is also the manufactured of BOTOX® Cosmetic, Juvederm, and Latisse.

Treating “Cankles”: Ankle Liposuction is Increasing in Popularity

The term “cankle” is commonly used to describe an ankle that is not much slimmer than its adjoining calf. As this relatively new term becomes more ingrained in popular culture, more women are seeking ways to slim down their ankles. Dr. Usha Rajagopal at the San Francisco Plastic Surgery and Laser Center has seen an increase in patients who are interested in cankle reduction surgery. The procedure involves liposuction of the ankles and sometimes also of the lower calves to create a thinner and more feminine shape to the lower legs.

Thick ankles, or “cankles,” can be caused by excess fat deposits that happen to settle in the lower legs. “Ankles do not normally respond well to diet and exercise like other areas of the body. It’s very difficult, if not impossible, for most people to alter their ankle size by changing their habits,” says Dr. Rajagopal. Many uncontrollable factors, such as genetics, pre-determine ankle and calf size.

For cankle reduction surgery, Dr. Rajagopal first determines whether excess fat or muscle tissue is the cause of the patient’s undesirable ankle circumference during the consultation appointment. During the surgery, Dr. Rajagopal uses traditional liposuction to remove excess fat deposits from the ankle area. Fat removal via liposuction can be performed on the lower calf area as well, if needed, to achieve the desired look.

Some women, in particular women of Asian descent, naturally have wider calves and ankles due to muscle hypertrophy (an increase in the size of muscle cells) rather than from excess fat deposits. Individuals with excess muscle tissue around the ankles are not candidates for the liposuction based cankle reduction surgery detailed above.

To find out more about cankle reduction surgery or to schedule a free consultation with Dr. Rajagopal, please call the San Francisco Plastic Surgery and Laser Center at 415-392-3333. We are located at 490 Post Street, Suite 430 in downtown San Francisco near Union Square and Powell BART station.

About Labiaplasty

Labiaplasty, also popularly referred to as “designer vagina” surgery and known medically as labia reduction, is the surgical reduction of the labia majora (outer lips of the vulva) or labia minora (inner lips of the vulva) to fix elongated labia and/or to modify asymmetrical labia.

Dr. Usha Rajagopal, a female cosmetic surgeon in San Francisco, has performed hundreds of labiaplasty procedures at her practice, the San Francisco Plastic Surgery and Laser Center, over the last ten years. Labiaplasty has grown in popularity as more women seek out this very private surgery for numerous personal reasons. Dr. Rajagopal notes that many of her patients decide to have the procedure done to reduce pain or discomfort while wearing tight clothing like jeans or yoga pants, or while playing sports. Another common reason for labiaplasty is an individual’s shame or embarrassment regarding the appearance of their genitals. Childbirth can also drastically alter the size, shape, and overall appearance of a woman’s genitalia, and some women seek restorative surgery to fix this uncomfortable and embarrassing issue. As a female plastic surgeon, Dr. Rajagopal understands the personal sensitivity attached to this topic, and many women prefer a female surgeon when dealing with such a private matter.

Labiaplasty is an out-patient procedure that generally takes about one hour to complete.. Small incisions are made to remove any excess tissue or to even out the edges of the labia minor. The sutures are self dissolving and will dissolve on their own within a few weeks. There is very little discomfort, pain, or bruising for the patient during and after the procedure. Patients are able to return to work within a few days (usually 3-4 days).

Dr. Rajagopal is the San Francisco Bay Area’s foremost female plastic surgeon expert on labiaplasty. To schedule a free consultation at her office, please call 415-392-3333 or e-mail info@sfcosmeticsurgery.com. San Francisco Plastic Surgery and Laser Center is located at 490 Post Street, Suite 430 in San Francisco, California. Check out www.sfcosmeticsurgery.com for more information on labiaplasty and other cosmetic procedures.

About Male Breast Reduction: Gynecomastia

In today’s blog, I’ll attempt to answer some common questions about gynecomastia (also known as male breast enlargement) and your treatment options if you have this condition.

Gynecomastia can cause low self confidence and emotional pain. Some men may even avoid exercise or sexual intimacy to hide their condition.

What is gynecomastia?

Gynecomastia is condition of over-developed or enlarged breasts in men. It is common in men of all ages. Male breast development can happen in one breast or both.

What causes male breast development?

Gynecomastia can be the result of weight gain, hormonal changes, heredity conditions, disease, or the use of certain drugs.

What are my options for treatment?

Male breast reduction is much more common then you might think. There are a few different types of male breast reduction.

If your gynecomastia consists primarily of excessive fatty tissue, (this is the most common), I’ll use liposuction to remove the excess fat. The procedure may involve some slight discomfort, but is usually not painful.

If excess glandular tissue is the primary cause of the breast enlargement, it will be excised, or cut out, with a scalpel. It is usually performed in conjunction with Ultrasound Assisted Liposuction (UAL). Usually, incisions are made in an inconspicuous location, either on the edge of the nipple (areola) and along the breast crease.
Unless the reduction is quite major, scarring should be minimal.

On occasion, in extreme cases where large amounts of fat or glandular tissue are removed, some amount of remaining skin should be removed as well to adjust to the new breast contour.

What’s recovery like?

You will feel some discomfort for a few days after surgery–it usually feels like a heave workout. Any pain can be controlled with medications. You will have some swelling that can take a few weeks to go away. You will wear an elastic pressure garment for several weeks to help with the swelling. In general, recovery from this procedure is not too bad—many patients return to work in 3-4 days.

How can male breast reduction enhance my life?

Many patients report a huge boost in self confidence, sexual satisfaction, and physical activity.