Author: Morgan Cosmetic Surgery

The unpleasant smell of under arm sweat can be a huge annoyance. The odor comes from specialized sweat glands called Apocrine glands that lie deep under the skin, they can cause the kind of sweat that damages our cloths. It can get worse during the summer or when you engage in physical activities. When you start to notice your own body odor or notice large wet circles under your arms it may be too late to take preventative actions. This may lead to lower self-esteem and deter you from participating in activities you know cause you to sweat.

Until recently the only answer to this problem was surgery to cut out all of the under- arm skin. An option that is unappealing even to the worst sufferers. Then along came Botox, an option that works effectively but has limited effects, that lasts only three months. At $1500-$2000 per treatment it’s not affordable for regular treatments.

Fortunately, there is as much better option available now and it’s known as Radio Frequency (RF)! This radio wave generates heat which can be precisely measured and safely applied by a special probe under the skin to zap the sweat glands that are especially vulnerable to heating. The heat is applied at 70 degrees exactly, lower than the heat level needed to damage a nearby nerve so it is safe.

This treatment takes place in the office and lasts for about an hour. A combination of light laughing gas and local anesthesia make the procedure pain free. After the procedure you may have a few uncomfortable nights but the recovery is manageable with Advil and Tylenol. Pain sensitivity varies and we can provide you with some stronger pain medication if needed.

Within a week sweat glands stop working and you are able to enjoy activities and events sweat and anxiety free! Like almost all office laser and RF procedures, it is long lasting, but that doesn’t guarantee permanence. Three years is the expected duration and is a far better investment than the three months you get from Botox.

MRSA infections are now a common infection found in hospitals and nursing homes where they cause widespread infection and in the community where they show up as skin boils and abscesses usually from minor injuries during sports.  In elective cosmetic surgery, infections of any kind are possible but MRSA remains very rare.

The emergence of MRSA is directly related to the use of antibiotics to which bacteria become resistant.  MRSA is a staph infection. The letters stand for Methicillin-Resistant Staphylococcus Aureus. Staph is the most common cause of surgical infections which is why keeping MRSA at bay is important if you have surgery.

A single MRSA infection from which you recovered six months or more ago should not increase your risk but a recent one may require a delay in the surgery and a recurrent infection will need special planning.

A recurrent MRSA infections in the face suggests you have a MRSA biofilm in your sinuses. A biofilm is a super-thin layer of bacteria that settles on the lining of body spaces such as the sinuses. Antibiotics don’t reach it effectively and it can cause repeated infections. These biofilms can spread infection to other areas when you have surgery. This can be prevented if you get the right preventive antibiotics.

You need to tell your plastic surgeon about the infection including when and how you got it and how it was treated. Some of the extra steps that you may need could be:

• A consultation with an Infectious disease specialist several weeks before surgery,
• MRSA skin or nose cultures several weeks in advance,
• Balloon dilation of a chronically infected sinus six weeks before surgery.
• An antibacterial shower the morning of surgery
• IV vancomycin an hour before surgery
• MRSA antibiotic such as Bactrim after surgery

With the right advance planning and protection, you should be fine.

Pectoral Implants

Pectoral implants are soft solid silicone implants. The pectoralis major muscles, the main chest muscles, do not always respond to exercise, even if a man is strong and exercises strenuously. Implants are a way to create the bulky muscle look that exercise will not.

Occasionally the issue is a complete lack of development of the pectoralis major muscle on one side of the chest. This is a different problem. See our blog on Poland’s syndrome to learn about this.

Pectoral muscle implants come in many different off-the-shelf shapes and sizes. One of the most common shapes is rectangular. This shape is more likely to stay in position than oval shaped implants which turn more readily.

The surgery is done with general anesthesia. An incision is made about an inch below the crease of the axilla (arm pit) but still in the hair-bearing under arm skin. Through this incision the outer edge of the pectoralis major muscle is lifted, the muscle attachments to the ribs and breast bone separated, the implant is put in through a sterile funnel and then secured.

Implants usually need to be carved a bit because every person has different anatomy. The goal is for the implant to sit high on the chest and close to the breast bone following the pectoral muscles natural shape.

Drains are not usually needed. There is often pain for several days but once the muscles adapt to the implant, pain subsides.

A compression vest is worn to reduce swelling and to support the implant. No upper body exercise including running, swimming or upper body weight lifting can be done for 6 to 8 weeks but walking is fine a few days after surgery.

The main risk of this or any implant surgery is that the final result needs to be revised or the implant shifts in its position.

To find out more about pectoral implants call us at 404-941-3200 or email us from this website.

 

Many of my patients want to take arnica to increase their healing and reduce their bruising. I don’t object to this but I don’t recommend it. Here’s why.

• In the past, surgeons didn’t have cautery, tumescent fluid and other ways to reduce bruising but techniques have improved a lot. Bruising is less common than in the past.
• Controlled studies show no improvement at all from topical arnica creams. Why waste your money on something that we know doesn’t make a difference?
• Studies show that arnica by mouth may reduce face lift bruising in some people.
• No studies show that arnica speeds up healing.
• Here’s the problem though with arnica’s effect on bruising, studies show that arnica increases blood clotting.
• We have no studies showing that arnica is safe. We do know that serious blood clots after surgery can be fatal.
• I don’t recommend arnica but I don’t object if someone decides to take it and their surgery is not one that is high risk for blood clots.

Much more important than arnica are the things that patients and surgeons should do to get you the best possible result.

• Patients should stop all aspirin, ibuprofen, herbals, omega pills or any other products for two weeks that increase bleeding and bruising.
• Surgeons should inject fluid at surgery that reduces bleeding of tiny blood vessels.
• Surgeons should take care to control all possible bleeding at surgery and use gentle surgical techniques.
• Patients should rest and limit their activity after surgery. It will be a few days for minor surgery and several weeks for major surgery.
• Above all, if patients have a question or concern they should not go online and treat it themselves or take advice from others. Ask your surgeon to help you before, during and after your surgery.

What is a flank lift?

A flank lift is a surgical procedure that involves surgery and liposuction. The liposuction sculpts and the surgery tightens the roll of fat and tissue that can form on the lower body, going around to the back. This roll can make visible bulges in clothes and make your waist look thick. The procedure is included in the “360 lower body lift” but is often done alone.

What causes the need for a flank lift?

Usually pregnancy or age.  Pregnancy can stretch flank skin and shorten the waist, causing flank rolls to appear. Age can do the same thing because the spine shortens, the skin loosens and fat is shifted from the thighs to the flanks. These flank rolls won’t go away, even if you are under-weight. So surgery is the best answer.

What about incisions?

The flank lift uses an incision from the hips to the mid-back. Clothes will conceal the incision but a skimpy bikini will not.  Before having a flank lift, be sure you know where your incision will be.

Recovery?

Pain last for 2-3 days, then you are stiff and sore. Recovery takes 7 – 14 days. You can walk as soon as you have energy. No stretching or gym work-outs for 4-6 weeks.

Can other operations be done at the same time?

Definitely. Flank lifts are often combined with tummy tucks, breast surgery and liposuction but can be combined with almost any procedure, provided surgery stays within the safe 6 hour limit.

Is the Flank lift right for me?

Dr. Morgan can tell you after she examines you if this is your best choice. Other procedures that might be recommended instead could be an extended tummy tuck, lower back lift or liposuction. Every patient’s needs are different.

Risks and Complications

All surgery has risks but most complications are minor. An irregular scar or small skin separation is the usual minor problems. Dr. Morgan will discuss risks with you. They are also explained in detail in writing.

We love to help our patients. If you have questions or want to contact us to schedule a consultation, you can contact us through the contact form on this website or call our office at 404.941-3200.

Labiaplasty is the removing and reshaping of enlarged tissue around the vagina. It is an increasingly common plastic surgery operation. A major consideration for labiaplasty is what kind of anesthesia do you need to make you comfortable during the surgery. The surgery requires injections into the labial tissues to help reduce bleeding and to numb the area, if you are awake, so that the surgery can be done precisely.

General anesthesia is effective and safe but adds a lot of expense. Having it done in the office alleviates this expense but when the local anesthetic is being administered it can be very uncomfortable. Intravenous sedation is risky and oral sedation may be inadequate.

Pronox to the rescue! This is a low-concentration nitrous oxide (often called laughing gas) that does not use a mask over your face. You are in charge of a tube through which you breathe in an oxygen-nitrous mixture as needed. A few big breaths and you are a bit goofy and very unaware of the pain when the injections are  being done. Once those are done, you should feel no more pain but just in case, you keep the Pronox breathing tube at your side for the rest of the procedure to use as needed.

The Pronox is out of your system after about 15 minutes. It allows you to have your labiaplasty done safely and effectively in the office without the risks or recovery of sedation or general anesthesia. You still need a ride home after labiaplasty because you should not drive for several days after the procedure due to swelling and discomfort. You are wide awake and back to your normal self when you go home.

I used to recommend general anesthesia for labiaplasty because it really is safer than intravenous sedation and more effective than sedation by mouth. Pronox has changed that and I now recommend you have your labiaplasty in the office which makes it a safer procedure and provides a faster recovery time while you stay in control.

Does Pronox really make you laugh? Some women do get giggly but best of all, in the words of one patient, “That was awesome. I felt no pain. “

The Bull Horn Lip Lift

The goal of the bull horn lip lift is to give you a shorter, more youthful upper lip with more red lip showing and more teeth showing when you smile. It is done if the distance between your nose and upper lip is too long. This is usually from aging because the skin stretches with time. Although, some people are naturally born with too long of an upper lip.

Surgery removes the excess skin directly under the base of the nose, wrapping around in the crease of the nostril. It leaves a small and usually unnoticeable scar at the base of the nose. Results do vary depending on the skin type and how you heal. It lifts all of the lip except the outer corners.

This is the most common lip lift. I do many of these every year them. The surgery is not painful. You will swell a lot for 5-7 days. Sutures are removed in a week.

The Corner or Valentine Lip Lift

This lift removes a heart-shaped wedge of skin just above the corners of the upper lip, right above the red area. Even with great care, there is nowhere to hide the scar so it can be permanently visible.  This is fine for women who routinely wear make-up. People who do not want the risk of a visible scar can have Botox in the outer, lower lip or in the Depressor Anguli Oris muscle, or DAO for short.  Botox effects are temporary, lasting about 3 months so they are a safe but not a permanent solution.

The French or Central Lip Lift

This lift only removes skin in the center of the upper lip. It may leave some people looking like a rabbit because only the middle of the lip is made shorter than the rest of the lip. I only recommend this lift if a person has lengthening of the middle of the lip. This type of lip lift is rarely needed.

Crows feet are a sign of aging that most people do not like. Crows feet are caused by repeated muscle movement when smiling and sun damage to the skin-making it more fragile and thin.

Botox is the most popular treatment for crows feet. It can take up to 20 units to treat the area and last from 6 weeks to 3 months. Botox lasts as long as it takes the nerve endings to regrow into the muscles that were treated.

You can add tretinoin (generic Retin A) to your treatment if Botox given on a regular schedule is not giving you all the correction you desire. Put a tiny amount around the sides of the eyes and lower lids every night. This corrects DNA damage of the skin. In the space of three months, you will see fine lines visibly fainter. It works well for fine lines but it may not work well for deep, etched lines.

If with Botox and tretinoin you want more improvement, add a series of microneedling treatments. Because a lot of the cost is in the high-tech needle, it makes sense to treat your entire face, not just the eyes. These are done a month apart. It will thicken your skin over-all and the improvement around the eyes is visible and at times, quite dramatic.

With this triple approach of Botox, tretinoin and microneedling , you should see your eyes look the way you want, not the way they used to look!

 

 

Almost all of us in the USA now carry the cold sore virus (herpes simplex) in our bodies. It never goes away but lives on in the infected nerve cells. Sun, stress and irritation of the area are ‘triggers’ that can wake up the virus. It then moves down the nerve endings to cause another infection at the tip of the nerve ending. These infections can occur anywhere in the body. We really don’t want them to spread if we can help it.

You may not even know you have a re-activation. You may see a slightly crusty red spot on your skin. Or your lips may feel unusually dry and a little swollen and don’t get better on their own. A lot of facial cosmetic treatments can trigger a re-activation. Prevention is much easier on your body than treating it.

These Cosmetic Treatments are the Culprits:

• Laser skin treatments.
• Radiofrequency skin treatments.
• Lip fillers.
• Microneedling

Procedures that do not require treatment

• Botox,
• Facial fillers other than lips
• Surgical procedures on the face, as long there is no active infection.

The infection is very important to treat because it can cause scarring. Prevention only takes three days. Treating a re-activation may need medication for a month or longer. So, it is best to prevent it.

This is our approach:

• Three days of preventive Valtrex (valcyclovir) pills, starting the day before treatment through the day after treatment.
• Lysine tablets sold in pharmacies. They may reduce re-activation.
• Topicals, e.g. Abreva around the skin of a previous re-activation.

These over-the-counter remedies are not enough on their own.

Preventing a reactivation with medication is definitely safest for you.

 

 

This is great question because liposuction withdraws water from the body.

How it works:

• Tumescent fluid (salt water with local anesthetic) is pumped in under the skin.
• The fluid pumped is equals to the fat that is being removed (example: 4 liters of tumescent = 4 liters of fat)
• The liposuction cannula suctions out the fat, slightly injuring tissues along its path.
• Body fluids begin to enter the injured area. This is a normal body injury response.
• Fluids continue to enter the liposuction tissues for 48-72 hours.
• These fluids come out of the fluid in your blood. Your blood volume may get low.
• This is made a bit worse because liposuction also removes some of the tumescent fluid.
• Quite a lot of tumescent fluid drains from the incisions.
• The result is blood volume gets low. You may feel dizzy, weak or tired. This low blood fluid leads to your body making less urine than normal. In severe cases, this damages the kidneys. So you are told to drink a lot of fluid after liposuction to restore blood volume.

IT IS NOT USUALLY A PROBLEM if you have liposuction with general anesthesia because you will have intravenous fluids and a catheter in your bladder. Your urine flow through the kidney is monitored and if there is not enough urine, you get more intravenous fluid. Blood volume is usually just fine.

If you have a small area of liposuction, e.g. just local anesthesia in the office, the fluid shifts are minimal, there is nothing to worry about.

It becomes a problem if you have a large amount of liposuction awake but sedated. You will not have a catheter, your urine cannot be monitored, your chief fluid will be the tumescent and your blood volume can get low.

The Right Amount of Water to Drink

The “magic” answer is listen to your kidneys.

• Water is just right: You are urinating (peeing) every 3-4 hours during the day and once or twice a night and your urine is light yellow or clear. You’ve got enough water on board. Drink normally.
• Too much water: you are urinating every hour or so, day and night and your urine is clear? You are drinking too much. Cut back to your usual amount.
• Not enough water: You don’t urinate for five or six hours and your urine is medium to very dark yellow. Drink more water until your urine is ‘just right’ (see above.)
• Urinary retention!! You are urinating a little bit very often but your bladder never feels empty and you keep having to go. CALL YOUR SURGEON! Narcotics given at surgery can stop your bladder from working. A catheter is a ‘must’ until your bladder muscle is back to normal.