Author: Morgan Cosmetic Surgery

 

What is buccal fat?

Buccal fat is the cheek fat that sits directly under the buccinators muscle in the cheek. It gives the cheeks a plump, full look. With age, it gradually resorbs

What is buccal fat removal?

Buccal fat is removed by making a small incision inside the mouth over the fat. The muscle is separated to allow excess fat to be removed. It is done in the office with local anesthesia or in the operating room with general anesthesia. Surgery is faster and a bit safer when you are asleep.

What does buccal fat removal do?

It decreases the fullness of the cheeks. Your result may not show right away.  At first, swelling may hide the result. You usually see the result in 2-6 weeks and the final result in 6 months.

What is the recovery?

Cheeks are sore for about 5 days. There may be some bruising. Soft food is recommended.  Absorbing sutures are used. No sports or work outs for 2 weeks.

Can other operations be done at the same time?

Yes, if you are asleep for the procedure. Done with local anesthesia in the office, usually only one procedure is done at a time.

How hollow will it make my cheeks?

The result should look natural, not excessively hollowed. Your body naturally absorbs cheek fat as you grow older so if too much fat is removed, you can get a dramatic hollowing of the cheeks later on.  This is a problem that cannot be corrected.

What are the risks?

There are the usual surgical risks such as bleeding and infection but major problems are uncommon. Most complications are minor and resolve with little or no treatment.

Is buccal fat removal right for me?

Dr. Morgan can tell you after she examines you. It depends on whether the look you want is likely to be created by removing buccal fat. If not, other procedures may be recommended.

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

What is the J-Lift?

The J-lift is an upper body lift that hides the incision in the arm crease. It is especially useful if you have lost a lot of weight and the upper back tissue is loose at the sides, but not across the entire upper back.

The lift removes excess skin from the upper side of the back and the side of the chest. It can be continued across the chest to lift the upper abdomen and/or to tighten or lift the chest or breast tissue.

What about incisions?

The incision curves from the back of the arm around to the front of the arm. It continues into the natural breast crease and onto the breast or chest if these areas need lifting.

How long is the recovery?

Recovery takes about 2 weeks. There is some pain; the arms and chest will feel tight and stiff. You cannot work out for at least 4-6 weeks after a J-lift.

Can other operations be done at the same time?

It depends on the operation. The J-lift can be done with a lower body lift in a young, fit person but that is a lot of surgery! J-lifts are more easily combined with tummy tucks and arm lifts.

Is the J-lift right for me?

Dr. Morgan can tell you after she examines you if the J-lift would be better for you than the standard upper back lift. If you have excess skin in the middle of the upper back, the J-lift might not be the right choice.

Are there risks and complications?

All surgery has risks  but most complications are minor. The usual problem, if one arises, is an uneven or irregular scar or an area of poor healing. Dr. Morgan will discuss risks with you and 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, it’s easy. You can contact us through the contact form on this website or call our office at 404.941-3200. During office hours, we actually answer our phones

 

1. Most adults have about 5 million hairs on their body, which means just as many pores. Pores are simply the opening at the top of our hair follicles.  Gases, liquids, and microscopic particles pass through your pores.  Oil comes out of your pores – it is made by glands attached to your hair follicles. Because we have so many tiny fine hairs on our faces, we have lots of facial pores.
2. Several things affect the size of your pores. While certain factors are out of our control, like age and genetics, sun exposure, smoking, wind damage and pollution can cause damage to your skin and make your pores look larger. (delete ‘as well as smoking.’)
3. It is possible to slightly reduce the size of your large pores with products that contain tretinoin,a form of Vitamin A. Other things that can help are exfoliants or exfoliating treatments like microdermabrasion and microneedling. We recommend at least 3 treatments of microneedling to see a decrease in pore size.  We offer both microneedling as well as different strengths of tretinoin by Obagi.  We also offer TCA peels which can remove damaged skin and reduce pore size.
4. Pores tend to look larger when skin is oily. Daily face-washing may be enough for most to reduce oils on the skin, but for others there are products that contain salicylic or glycolic acid, both which can help dry out over-oily skin.
5. Whiteheads and blackheads occur when pores become clogged. This can happen from oil build-up or dead skin cells, bacteria, and makeup.  Washing your face daily, in the morning and the evening, can help to prevent such build-up.  Depending on whether you have oily, normal, or dry your skin is, you may prefer Obagi Gentle face wash or Obagi Foaming face wash.  The worst thing you can do to a blocked pore is squeeze it or touch it.  Leave it alone (we know, it’s hard).  Contact with your fingers only adds more dirt and oil, and the squeezing causes inflammation, redness and infection which make pores even larger.
6. Debris, such as dead skin cells, collects around the edges of pores, making them look bigger. Topical vitamin A treatments like tretinoin can prevent skin cells in the pore from sticking together, and help to reduce the ridges or rims that develop around pores that make them more visible.
7. The best thing you can do for your skin and your pores is to wear sunscreen and avoid too much sun exposure. Sun damage causes not only age spots and wrinkles, but it can thicken the top layer of the skin.  This thickening causes pores to look bigger, because of the rim that forms around them.  We recommend sunscreens that contain zinc oxide.  There are great options now that have less shine like Obagi Sunshield Matte or try a tinted one like Tizo Mineral Sunscreen. If your skin truly cannot tolerate sunscreen – we carry Vitamin C serum which also gives you sun protection, although less than a zinc oxide sun screen.

 

 

Cosmetic Question: What is a nonsurgical rhinoplasty? Would this be an option for me if I wanted a taller nose?

Cosmetic Answer: Yes, this would be an option for you.

Injectable filler is very helpful for people who feel their nose needs more height but they do not want to have surgery.  Very often, these people are of Asian or African descent. Whereas the Caucasian nose tends to be tall and is prone to humps.  Asian and African noses tend to be low with no hump.

Caucasian noses tend to be too big. Asian and African noses tend to be too small. So for Asian and African noses, the dorsum or top of the nose can be made taller by injecting filler to build up the nose.

The usual fillers that are used for this procedure are made of hyaluronic acid because they are molded easily and if you do not like the look, they can be dissolved.

What is involved with a filler rhinoplasty?

Rhinoplasty simply means changing the nose. Some doctors will inject filler along the top of the nose using a long needle, without anesthetic. This saves time for the doctor but it is not the safest technique nor the one likely to give you the best result.

In my opinion, the best approach takes a bit more time. First, I inject local anesthetic with epinephrine along the top of the nose. This makes the filler injection painless and even more important   it shrinks the blood vessels. This is extremely important because it is catastrophic to inject filler into the blood vessels in the nose. The filler can totally block the blood flow and this could cause damage to the inside of the nose or even harm your vision. So, this preliminary anesthetic injection shrinks down the blood vessels and makes the blood vessels so tiny that it is very difficult to inject anything into them. It also means you are less likely to bruise.

I then inject the filler using either a cannula (blunt tube) or a needle. Cannulas do not bend as easily as needles so depending on where my patient needs the filler and depending on the shape of my patient’s nose, I may use a cannula, a needle or both.

To achieve a higher nose, the filler must be injected along the top of the nose. If too much filler is injected it will just spread and give you a wider nose. I inject the filler very carefully, with pressure to prevent it from going sideways and checking the filler by how it feels and how it looks. I slowly do this until I get the best possible look for you.

Is this permanent?

No. Filler will last about a year in most people. It is quite safe and can be done conveniently in the office taking only about 45 minutes to an hour. It does alleviate the cost and recovery of nasal surgery. After having it done several times, it may help you decide if it would be worth having surgery. It really is a nice treatment.

Cosmetic Question:  I want arm liposuction but I am afraid it will make my skin sag. Suggestions?

Cosmetic Answer: You are exactly right to think this through in advance. Our inner thighs and inner arms have naturally thin skin. It does not shrink down easily and can sag if too much liposuction is done.

One way to minimize loose skin is to work out 3 times a week doing 5 pound biceps and triceps exercises. This will add volume to the arm to some extent, replacing the lost volume from the fat removal. Many people do not have the time or self-discipline to do this.

Will skin loosen so much that you regret having liposuction or that you need an arm lift?  You truly need an examination to determine this and you need to tell me what your goal is because that makes a difference. If you want toned, smooth arms to go sleeveless, loose skin can be disastrous. If you want thinner arms to fit in clothes better, you might find loose skin a reasonable trade-off.

I have done a lot of arm liposuction. Using a small cannula (2-3 mm) all the way around the arm. I can usually avoid loose skin, unless my patient has a lot of fat removed or stretch marks.

Why does this matter so much?  Removing a lot of fat deflates the skin well beyond its ability to shrink down. Having stretch marks means the skin has lost its elasticity and cannot shrink down.

Will massage help skin to shrink down?  I have had several women with stretch-marked skin have aggressive and quite painful  massage starting 10 days after arm liposuction. Their skin did not loosen very much. They were convinced it was because of the massage. I truly do not know why it did not work and you are welcome to try it but only if you are prepared for it NOT to work. I do not want you to be disappointed if it does not work for you.

What about treating skin with an office skin tightening laser after an arm lift?  These machines work by shrinking the collagen in the deep layer of the skin. Thin skin has less collagen and results may be disappointing.

What about microneedling?  It actually might work because it does thicken the skin and thick skin will shrink. If you want a lot of fat removed or have stretch marks, you should plan on 3-6 microneedling treatments either before surgery or starting 6 weeks afterwards.

You may actually be better off with an arm lift. This is an important decision and the best way to figure out what is best for you is to see me for a consultation. Everyone is different and every skin is different – what we want is the plan for you that is most likely to give you a result that makes you truly happy!

I love to help my patients get the look they want in the best way possible.

Give us a call so we can help you!

 

Cosmetic Question: What are the best treatments for hyperpigmentation?

Cosmetic Answer:  Much depends on your skin and what causes the darkening. This topic and treatment can become complex. Here are the 3 most common causes of hyperpigmentation and the 4 principles of treating hyperpigmentation.

The Three Common Causes of Hyperpigmentation and Their Treatment

• Sun damaged skin – facial skin color is blotchy all over.
  • First treatment, tretinoin (Retin A), glycolic and skin lightening creams.
  • Second treatment, SkinPen microneedling.
  • Third treatments, glycolic or TCA peels or color-removing lasers
  • Most aggressive treatment, skin resurfacing laser or deep phenol peels.
• Melasma – very dark color usually over the upper cheeks, caused by hormones
  • If from birth control pills, change or stop the pill.
  • Treat as you would for sun damaged skin.
  • Melasma color tends to quickly return if treatment stops.
• Post-inflammatory hyperpigmentation or PID – skin quickly darkens from even mild injury.
  • Prevention, prevention, prevention – this discoloration can last years.
  • 6 weeks before surgery, apply skin lightening creams to the surgical area twice a day.
  • Once skin turns dark, 100% shea or cocoa butter-DO NOT USE SOAP.
  • Hydroquinone tends not to work well with PID but can be tried.
  • If acne develops, immediately treat acne including antibiotics and a skin lightener.

The Four Principles for Treating Hyperpigmentation

1. Protect the skin from the sun
   • Sun block on all exposed areas face and neck.
   • Sun protective clothing, e.g. Solumbra, for the rest of the body.
   • Once skin darkens, even with treatment, it tends to darken again with sun exposure.
2. Initial treatment = tretinoin (Retin A) + glycolic + skin lighteners
3. After 3 – 6 months, replace 4% hydroquinone with Lytera from Skinmedica by Allergan
   • Why? Hydroquinone in time can give skin a permanent grey tone.
4. PID – post-inflammatory skin darkening – easy to prevent, hard to reverse.

Cosmetic Question:  Can you explain Kybella? I am not sure what it is, how does it compare to liposuction.

Cosmetic Answer: Great question. Let me explain Kybella.

• Kybella contains deoxycholic acid, a fat-dissolving, naturally occurring bile acid. It is injected in the office. Treatment takes a half hour. It is FDA approved to treat fat under the chin.
• Kybella can dissolve fat in other areas such as under the arms, saddle bags, inner thighs.
• The most that can be injected at one time is 5 vials (10 ccs.)
• Kybella treatment involves multiple tiny injections.
• Does it hurt? Yes, so topical anesthetic and speedy injections are used. Pain subsides in 3-5 minutes. You may need a pain pill the night of your treatment. The next day, the area is red and swollen. By the second day, redness should be gone, but tissues remain firm and tender.
• For fat under the chin, most people need 2 treatments. Some people need three and some only need one. It takes 6 weeks to see results. Treatments are scheduled 6 weeks apart.
• According to Realself.com, 90% of people who have had it done say it was worth it!

• Kybella is like liposuction in these ways:
  • Fat cells are destroyed and can only return if you gain weight.
  • Most fatty areas can be treated.
  • Results are better than fat reduction machines.
  • It can be used to touch-up irregular liposuction results.
• Kybella is unlike liposuction in these ways:
  • Large areas cannot be treated at one time because the safe limit is 5 vials at a time.
  • It requires no anesthesia (except for topical) and is done in a short office visit. Recovery is fast.
  • It is less expensive for small areas. It can be more expensive for larger ones.
  • Kybella cost $1200 for a treatment with 2 vials of Kybella. You get $40 of Brilliant Distinction points for each 2 vial treatment and often there are promotions that lower the cost further.
• Kybella is excellent for easy, fast, effective, minimal recovery treatment of localized areas of fat. Liposuction is a better choice for multiple, large areas of fat.

Question:

Can you explain how insurance works? I had a mole removed by an out-of-network doctor. Insurance said it would cover it. It never paid anything. I am confused.

Answer:

You probably had not met your deductible. Insurance today is something of a catastrophe, but here are some common questions. Before relying on insurance, it is important to read your policy and call your insurer to be sure you understand what is covered, as best you can.

• Deductibles – what you pay out-of-pocket for your insured medical care, before insurance pays anything. Say you have a deductible of $3000. Your out-of-network mole removal costs you $500. You submit an insurance claim. Insurance sends a notice that it approved $100 for the mole removal. But where’s the check? You don’t get one if you haven’t met your deductible. Instead, a $100 insurance-approved payment lowers your deductible from $3000 to $2900.
• Co-insurance – what you pay out-of-pocket for major procedures. Say you have an insurance-approved breast reduction. You have not paid any of your $3000 deductible and you have a 20% copay for surgery with a $2000 limit and your surgery costs $7500. You will pay out-of-pocket $3750 for your surgery: the $3000 deductible + the $1500 for co-insurance.
• Co-pay – this is what you pay for some insurance covered care. You see your doctor for a visit. You have a $20 co-pay. It also goes toward your deductible.
• Out-of-pocket maximum – insurance limit on what you pay out-of-pocket.
• Networks – each insurance policy has a doctor network. The doctors that are in your network accept your insurance and agree to not bill you for what insurance does not pay. Networks are getting smaller. Say you go to a hospital for a facial laceration. Only 1 of 5 ER doctors is in-network here and she is out sick. You get a bill for $2000. Your insurance pays for instance, 80% of its in-network fee to your out-of-network doctor. If insurance pays $800 to the in-network doctor, it pays $640 to the out-of-network ER doctor. You owe the balance of $1360.
• How to tell if a doctor is in-network? Often you can’t. Insurance policies’ network lists are often wrong and doctors are often not told if they are in network.
• Network-only insurance – Some policies pay nothing for out-of-network care. Let us say you need breast cancer reconstruction. Your in-network plastic surgeon may be hours away.  But you will pay out-of-pocket entirely for out-of-network surgery.
• Pre-determination – you want a breast reduction. Your out-of-network plastic surgeon submits a “Predetermination Letter” to your insurance. You are approved! Insurance should reimburse you after surgery for your surgeon’s fee to the limit of the policy – but it may not. Why not? Who knows? Pre-determination is not a guarantee of payment.
• How can you find out in advance how much your insurance will pay?  You can’t and neither can your doctor.

Government regulation and for-profit health insurance has made health care expensive by vastly increasing administrative costs. Doctors’ fees remain a very small part of health care costs. Most doctors have to see many more patients than they should because insurance payments go lower and lower, overhead higher and higher. Your frustrations are truly the result of government regulation and insurance management. Your doctor didn’t cause it and cannot fix it.

Cosmetic Question:  I know I cannot smoke tobacco before surgery but is smoking marijuana okay?

Cosmetic Answer:

The answer is NO! You cannot safely smoke marijuana before elective cosmetic surgery.

This is an important question because marijuana has been illegal for so long that until recently, we knew little about its effects on our health. Medical research into it was not funded.

Now we have medical research that suggests smoking marijuana may be as bad as or even worse than tobacco for our health. Here are a few findings:

• Marijuana has been shown to cause sudden, fatal heart attacks in the young, otherwise healthy people. So it may pose a much greater risk to the circulation than tobacco.
• Another study shows that, like tobacco, smoking marijuana lowers ENO– this means that it lowers the airflow in the lungs, reducing oxygen in our bodies.
• Another study shows that marijuana has auto-immune effects. These are not yet understood but it suggests it may damage our ability to fight infection.

No one should be surprised by these findings. We have always known that breathing smoke is very, very harmful to the human body. Why would marijuana smoke be safe, when all other kinds of smoke are so dangerous? Common sense tells us smoke, whatever the source, is bad for us.

When you have cosmetic surgery, you want the best possible result. It is horrible to see your skin struggle to heal and then turn black or to develop an infection that ruins your result. This is much more likely if your body is starved of oxygen and we know that is what smoking does to us.

NO SMOKING before surgery.

How long before?  A month is the standard rule.

If you cannot do this, please let me know. Do not keep it a secret. Sometimes smokers can stop if given medicines that temporarily remove the desire to smoke or together we may modify the surgical plan. Or take special precautions at surgery. Above all, we want to help you get your best possible result.

 

 

Cosmetic Question:  I have had a tummy tuck. Now, SURPRISE! I am pregnant again. What will happen? Will my previous tummy tuck damage my baby?

Cosmetic Answer:

Fortunately, your previous tummy tuck will not damage your baby.

Instead, the pregnancy will damage your tummy tuck. The hormones of pregnancy plus the baby’s steady grow will stretch your skin, the muscle repair and the incisions all over again. Unfortunately this is just how it is.

Will skin creams help? They will make no difference. Since the products in many creams are absorbed by the skin, it is wise to check with your obstetrician before using any skin cream during pregnancy.

Will a belly band (faja) help? They will provide support to your belly as the baby gets bigger. Some obstetricians do not recommend them because they can weaken back muscles. That is something to discuss with your obstetrician because every woman and every pregnancy is different.

Just enjoy your baby and your new pregnancy. Then, if this is really and truly your last baby, six months after delivery or 3 months after you stop breast feeding, you can go back to your plastic surgeon to discuss a redo tummy tuck.

Will everything have to be done over again? It is hard to predict because the skin and muscle almost always need to be repaired. You may not need further liposuction but there is no way to tell until after you have your baby.

We always recommend that a tummy tuck only be done after you finish having your family, because pregnancy does damage the tummy tuck result. However, life is unpredictable and women can get pregnant unexpectedly.

Do not worry you are not the first person this has happened to.

What if your first plastic surgeon has retired or moved? Just give us a call.