Author: Morgan Cosmetic Surgery

Question:  I need a breast lift and breast implants.  I have lost weight and breast fed 2 children.  Can I combine these two operations?  I’d like not just have one procedure.

Answer:
Yes, it is fine to combine breast implants with a breast lift.  However, there are a few things to know first.
First, infections are more common when implants are put in at the time of a lift.  We think this is because nipple bacteria can get into the implant pocket.  How high is the risk?  It is at least 5% – compared to a less than 1% risk of infection when breast implants are done without a lift.
Infection can be discouraging – infected implants must be removed.  It then takes 2 – 6 weeks to heal and then another 3 months before new implants can be placed.
Certain things raise the risk:
• Having a large implant (more than 350 cc).
• Working in a hospital or being cared for by someone working in a hospital.  This is because most hospital workers carry MRSA infections on their bodies.
• Having pets sleep in your bedroom and/or caring for them right after surgery.  Pets carry germs, because they don’t wash their paws!
• Smoking, being obese or diabetic.

Dr. Morgan advises women in these groups to not combine lifts with implants.

Even if you don’t get an infection, plan on a second operation after 6 months or so to improve your result.  You may not need this, but be mentally prepared because a breast lift tightens the breast, and implants stretch the breast.  Combined surgery means compromises.  Larger implants, more breast tightening and revising the implant pocket may be needed.

To learn more – just call us for a personal consultation with Dr. Morgan.  She will examine you and discuss everything to help you decide what is best for you.

Question:  I hear the FDA recently issued a bulletin warning that fillers can be dangerous.  What are the risks and what should I do?
Answer:

This is what the FDA has said and what Dr. Morgan suggests as well.
The FDA alert dealt with the risk of fillers being injected unintentionally into blood vessels in the face.  The forehead and eyes are especially risky.  The alert is based on research by plastic surgeons showing that fillers injected into facial arteries and veins can damage skin and other tissues, including the eye and brain.  This is very rare, but obviously very serious.

The FDA suggestions are that you, the patient, should:
1. Talk to the health care provider before you are treated
2. Ask about the provider’s filler training and experience
3. Read the filler labelling
4. Visit fda.gov for information on approved fillers
5. Seek immediate attention if you have a complication.

Physicians should:
1. Be trained and have experience giving fillers
2. Know the anatomy, including blood vessels, of the face
3. Inform you of the risks of having fillers
4. Inject with care
5. Know the signs of filler injection into a blood vessel
6. Stop injecting if this is happening
7. Get you medical care if this happens
8. Train the staff to help patients with such complications
These guidelines, in Dr. Morgan’s opinion, have two problems.
First it does not mention specific steps that make filler injections safer:  injecting local anesthetic to shrink blood vessels, using cannulas instead of needles when possible, testing before injecting, having Vitrase (filler dissolving enzyme) available to dissolve a dissolvable fillers.

Second, the FDA guidelines are only for physicians.  What about the many non-physicians, including nurses, NPs, Pas, dentists and chiropractors in offices, spas and clinics who routinely inject fillers, often with little training.  Although many are in clinics with a medical director, that physician may have no filler experience and may not be on-site.

Dr. Morgan personally feels that fillers are best injected by physicians specializing in cosmetic treatments, however if you have someone else inject your filler, always be sure that there is a physician experienced in cosmetic treatments immediately available in case a problem arises.

Question:  I think I need buttock implants.  I don’t have a lot of fat.  Are buttock implants safe?

Answer:

Yes – recent advances in buttock implants have made this is better operation.

 

That said, for women with enough fat, liposuction and transferring the fat to the buttocks is better because the fat is soft like our natural buttocks.  This procedure is called a BBL (Brazilian Butt Lift).

 

However, a BBL requires at least 2000 cc of harvested fat, or about 2 quarts.  Slim women don’t have this much fat.  For them, buttock implants are better.

 

Buttock implants used to have a poor reputation because of poor cosmetic results and high rates of infection.  The good news is that has changed.

 

Better cosmetic results – Lower Infection

• Putting buttock implants in the muscle
  • Buttock implants used to go under the fascia (lining of the buttock muscle), on top of the muscle.  Implants here are prone to infection and tend to droop with time.  Today, buttock implants are usually placed in the buttock muscle – with muscle over and under the implant to hide, support and protect it.
• Avoiding implants that are too big
  • Although everyone wants the biggest implant possible, these can stretch tissues so they can’t heal.  The implant should not be wider than your own buttock.
• Having better implant materials
  • Buttock implants started by using round gel breast implants.  These could rupture. Solid silicone implants were hard and unnatural.  Today we have a new material – a soft solid silicone in a natural contour shape.
• Using two incisions, one for each implant
  • Buttock implant incisions go in the crease, but the tissue in the crease may not be soft enough to sew easily. Today we often use an incision on each side of the crease – where tissues close easily over the implant, but remain hidden from view.
• Knowing that recovery takes time!
  • No sitting for 3 weeks
  • Back to normal daily activity in 6 – 8 weeks
  • Back to exercise in 8 – 10 weeks
  • Pain control with Exparel, an injection done in hospital – this reduces the muscle pain, making your early recovery easier.

 

So if you are slim, want more shapely buttocks, but don’t have much fat – buttock implants are recommended instead.

 

 

 

 

Question:  A friend of mine had liposuction and ended up looking fatter two weeks after surgery.  I found it bazaar.  How can this happen?

Answer:
It happens because of the biologic nature of surgical recovery.  It goes like this –

1. Our bodies experience surgery including liposuction as an injury – so it starts to swell.
2. The swelling builds up for 3-5 days, then stops.  At two weeks, it starts to subside.
3. The swelling has two components –
a. water, which we retain in the surgical area
b. healing protein which is very thick and lumpy and first.

If you had seen your friend the day of surgery, she probably would have liked the result.
• At two weeks, she was swollen and thought she was ‘fatter.’
• By 6 weeks, she will see most, but not all the swelling gone.
• Between 6 weeks and 12 months, her body will replace the lumpy, thick healing collagen with thin, soft delicate permanent collagen – revealing her final result.

Watch in this video as Dr. Morgan talks about swelling after liposuction, why it occurs, and what to expect.

https://vimeo.com/144036950

Question:

I have very thin legs and I want shape down to my ankles.  Can I have a calf implant that will give me that?

Answer:

You will probably need a combination of calf implants with fat transfers to the lower leg.  A calf implant alone won’t give you the look you want.  Here’s why:

Calf implants are specifically designed to enlarge the look of the muscle of the calf.  This comes from the gastrocnemius muscle, which gives shape to the upper leg.  This muscle divides, attaching to both the inside and outside of the upper leg.  This is what gives the upper leg its shape.  Depending on the look you want, you may need one implant in each leg over the inner muscle.  Or you may want more shape with two implants per leg, one on either side.  Whichever you choose, your upper leg will now be nicely shaped.

Implants cannot go lower than the muscle – they will irritate the tendons.  However, you can shape your lower legs with fat transplants.  Fat is taken from another part of your body, such as your hips, and injected under the skin from just below the implant down towards the ankle. (Fat transplants are not often done around the ankle itself because the skin is thin and can be damaged by injections.)

There is a big difference between calf implants and fat transplants – implants don’t absorb.  They are made of a very soft solid silicone – and are permanent.  The implant doesn’t get smaller.

Fat transfers on the other hand are living tissue.  Not all the injected fat will survive.  As much as 60% of the injected fat on average absorbs – and at times, it all absorbs.  Even if this doesn’t happen, you are likely to need at least two sessions of fat injection to get the look you want.

Calf implants are done with you asleep so if you want fat injections as well, it makes sense to do the first fat injections with the calf implants – that way, you have one recovery.  The second set of fat injections might be done in the office, depending on what is needed, your health and how you tolerate local anesthesia.

For more information, just give us a call.  We would love to help you.

 

Cosmetic Question:  How long does it take to fully recover after you have permanent lip implants are put in?

Cosmetic Answer:
We recently had a lip implant patient and she came back every week.  She was prone to cold sores, so we had her take Valtrex during her healing period.

• At surgery, we also gave her antibiotic (Keflex) to reduce bacterial infection.  She took arnica on her own, but she didn’t think it made any difference.

• There was a tiny bit of bruising, that was gone in a week.  After a week, however, she couldn’t purse her lips, she had to eat with a spoon and she couldn’t drink from a bottle.  Her lips were swollen and felt tight.  Smiling was very difficult.  This procedure in particular was done in winter.  As a result, her lips chapped a lot and needed constant use of lip balm.

• By 3 weeks, she could smile normally, eat normally, and open her mouth wide, but drinking from a bottle was still difficult.  At this point her lips could purse, but not as tightly as normal.

• At 4 weeks, everything was back to normal except she still had a little sense of tightness in the lip and a few small areas of numbness along the outer part of the upper lip.

• At 6 weeks, apart from tiny numb spots and some persistent chapping – which cleared by temporarily increasing her Valtrex – everything was normal.

She was sociable with a lot of friends. “It’s funny,” she said, “They have known me for years. They see I look different but they can’t tell how. They keep saying, “Golly, you look great. What have you done! We love your hair.” She kept her secret to herself, telling us, “I finally have lips! I love it.”

She had small lips and a medium implant.  She felt it was perfect for her.

 

Question:  What is a flank lift?  I am 55, my skin has loosened and no matter what happens, I have sag on the sides.  Would it help?  What is involved?

Answer:
It sounds as though you are a perfect flank lift candidate.  A flank lift is a kind of lower body lift, but a limited one.  It restores the natural contour of the waist by removing excess skin and fat going from the side of the lower body to the lower ribs at the back.

You may be a candidate if:
• You lost weight and this area is loose but the rest of the lower torso is ok.
• You are over 50 and have lost a little height – resulting in excess skin and fat that never flattens on its own.
• You are under or over 50, and the flank skin is loose – perhaps from a previous liposuction or sun damage, or both.

Still not sure if you could benefit from a flank lift? Grab your sides and pinch – if there is extra skin and tissue, a flank lift may be the perfect procedure for you.

A flank lift requires general anesthesia, but you can fortunately go home the same day.  You will have some pain the first 3 – 5 days, and you will be sore for another 5 days or so.  For 2 weeks it is important to refrain from housework – vacuuming, lifting, repetitive motion like hanging up laundry.  (you can thank us later for the excuse!)
Additionally, no bending to the sides for 4 -6 weeks and no contact or impact exercise (kickboxing, running) for 6-8 weeks.  A compression a garment will be required for about 2 weeks – and longer if you need it to keep comfortable.

In 10-14 days you can go back to work, depending on the work you do and the length of your commute.  If you work from home, you will be fit to work part time by 5 – 7 days after surgery.

In general, a flank lift is a great option that will give you an excellent lift with a much easier recovery than a 360 body lift or a tummy tuck.

Just call us for an appointment today – 404.941-3200

Question:  My temple area is sunken in.  I have had filler but it doesn’t last.  Is there anything permanent to fix this area?

Answer:
Yes!  There is a lovely new implant specifically designed for this problem.  In fact, hollow temples can now be better treated with this implant than with filler.
In the past, you could see and feel temple implants.  With the new placement technique, they truly look natural.
This implant has 3 other advantages over filler –
• The implant is permanent.
• It avoids the risk that fillers have of being injected into blood vessels which can cause problems.
• Since this area typically needs 2 syringes of filler, one for each side, the permanent implant is likely to cost little more than 2-3 filler treatments.

This new implant is specifically designed to fill the temple area.

How is it done? A small incision is made behind the hair line, above the ear.
The implant is placed just over the deep layer of muscle which keeps it in place.

It can be done with general anesthesia or in the office, with local anesthesia.
We do recommend sedation by mouth and a ride home.

Recovery?
-YA tape dressing for a few days to support the implant.
-Swelling and sometimes bruising which can last 1 – 2 weeks. .
-Soft food for about five days – and side sleeping may not be comfortable t first.
-No vigorous exercise for 2 weeks
-No impact sports – running, kick boxing – for 6 weeks.

This implant is one of the new wave of excellent cosmetic implants that provide excellent options to repeated filler treatments.  Call us if we can help you!

Question:  What is new with chin implants?  Can they be done in the office?

Answer:
Chin implants have improved tremendously over the years – both the implants themselves and our understanding of how to get the most natural look for you.

For many years the standard implants have been on-lay implants, but todays implants are much better.  On-lay implants tend to sit too high and to look unatural.  They were too short, and the true chin is longer, going from just in front of the jowls from one side of the jaw to the other.  The new “extended” chin implant, provides a much more natural look.

There are many sizes and shapes to choose from.  All of them are designed to sit low on the jaw to give your chin 3-dimensional enlargement.  Width, projection and height vary from implant to implant.  Some will create a square chin, and some are designed to give more wideness to the front of the jaw.  Others are designed for maximum projection.

Choosing the right implant for you is important, and so we spend a lot of time making sure we help you select the right one.  Also, at surgery, various sizers are available.  These are used to be sure the implant put in is the best for you.

Here’s what to expect –
You can have surgery in the office or in an operating room, either asleep or heavily sedated.  If your surgery is done in the office, you will have oral sedation and local anesthesia.  This works well for some people, but you will be aware of the pulling, scraping and sometimes, pain.
Because of this, it doesn’t suit everyone.

The procedure is fairly simply.  A small incision is made in the natural chin crease.  With a special instrument, the tissues are lifted off the lower jaw on either side of the chin.  Once these tunnels are made, the implant in slipped in place.  The implant is then sutured in position and the incision is closed.  Chin implant surgery takes about an hour.

What is the recovery like?
After surgery you will notice swelling, but it will begin to subside after a week or so.  Your jaw will be sore and your mouth won’t open fully for about a week.  You will need to eat soft food and it will be hard to brush your teeth (a child’s toothbrush will be easier at first).

In about 6 weeks you will see the final result, but tissues continue to soften and improve for months after that and up until the 6 month after surgery.

Question:  I had liposuction six months ago.  I do not have a symmetric result and I can see some irregularities.  Did my surgeon mess up?

Answer:  It is very unlikely that your surgeon “messed up.”  Here’s why –

1. Surgery results are never symmetric because our bodies are not symmetric.  Most people do not even notice until looking in the mirror after having surgery.  The differences can be startling.
2. Liposuction often produces small irregularities, especially in slim, trim people, because liposuction is done by feel and after injecting tumescent fluid.  This fluid makes liposuction safer, but also hides the fat.  Your surgeon relies on the markings and feeling the fat – liposuction is by its nature an imprecise technique.
3. Some areas tend to have slight visible irregularities – where the skin is thin or tissues are fibrous.  These areas include the neck, arms, inner thighs, lower abdomen and near the navel.
4. In addition, liposuction removes fat through small, blunt tubes called cannulas.  A cannula goes through the fat like a train along a train track, leaving spaces between the tracks.  This leaves a hill-and-valley effect under the skin.  Thick skin hides this, but thin skin may not.  Despite all this, one patient – a slim, trim perfectionist who noticed every irregularity – commented, “I am so happy with how I look that I have been at the pool all summer for the first time ever!  My boyfriend absolutely cannot believe it!”.  So even with natural asymmetry and slight irregularities, you still can be thrilled with your liposuction.