Sometimes, our bodies just do not respond to diet and exercise the way we want them to. We all would like to feel and look the best we can. Aesthetic plastic surgery procedures can reshape many areas by removing excess fat and skin and tightening the underlying muscle. Below are some of the procedures we perform for body contouring. The most common of these procedures are the tummy tuck (or abdominoplasty) and liposuction. These procedures are not designed as a weight loss technique, but as an adjunct to correct targeted areas that are not responsive to a balanced diet and exercise. Fortunately, the effects of body contouring procedures include a body that feels slimmer with a noticeable improvement in the way that clothing fits. Procedures can be performed in isolation or in conjunction with one another to optimize the results. During your consultation, Dr. Zeidler will help you to determine which procedures will help you achieve your goals.
Abdominoplasty (tummy tuck)
Abdominoplasty, or tummy tuck, helps flatten and shape the abdomen and waist by removing excess fat and skin and tightening muscles. The best candidates have pockets of fat or loose skin that haven't responded well to diet and exercise. The procedure can also be useful for women with stretched skin and muscles from pregnancy.
Abdominoplasty is performed through a horizontal incision placed low in the abdomen, often similar in location to a C-section scar. The exact location varies from patient to patient, and Dr. Zeidler will customize the scar based on each patient's specific needs. Through the incision, the skin and fat on the abdominal wall above the muscle layer is lifted. The belly button is separated and left intact on the abdominal wall. Just beneath the skin and fat lies the muscle layer. The two vertical muscles in the abdomen (the rectus abdominus muscles) can become separated. This is known as rectus muscle diastatsis and is the cause of abdominal wall laxity that is noticeable in some women after pregnancy. The diastasis can be repaired to restore the integrity and firmness of the abdominal wall. Once the abdominal wall is tightened, the skin and fat is pulled down, the excess removed, and a new hole is made for the original belly button. Liposuction is usually also performed simultaneously on the back flank area or "love handle" to achieve the best circumferential result.
A small percentage of patients may be candidates for a shorter scar mini abdominoplasty. In this procedure, the skin and fat is only lifted to the level of the belly button which is not separated from the surrounding skin. The muscle separation can be performed through the belly button using an endoscope with a small camera and endoscopic instruments. The upper abdominal area is not significantly improved with this technique, and for that reason, only select patients will have a good result with this technique.
Dr. Zeidler performs abdominoplasties in a fully accredited surgery center with board certified anesthesiologists. The procedure is generally done under general anesthesia, but can be performed under epidural anesthesia in certain patients. The procedure lasts three to four hours, and patients can go home the same day with supervision. The initial recovery is two weeks, and patients are encouraged to take this time off work. Dr. Zeidler offers postoperative "pain pumps" that deliver local analgesic to the area for the first 72 hours to minimize discomfort. Patients wear an abdominal binder which supports the area and helps to decrease swelling. This is converted to a compressive garment that should be worn for six weeks after surgery. Strenuous activity and exercise should be avoided for six weeks after surgery.
Risks associated with abdominoplasty include fluid collections (seromas), persistent numbness of the surgical site, contour irregularities, and loss of circulation to the skin or belly button. Other risks include unfavorable scarring, bleeding, infection, blood clots, and anesthetic complications.
Suction Assisted Lipectomy (liposuction)
The most popular cosmetic surgery procedure in the United States, liposuction, sculpts the body by removing undesirable fat that has not responded to diet and exercise from areas such as the abdomen, waist, hips, buttocks, thighs, knees, chin, cheeks, neck and upper arms. Liposuction is done through extremely small incisions. The remaining skin shrinks to achieve a slimmer contour. Because liposuction is unable to remove excess skin, the best candidates are those with spot areas of fat, reasonable skin tone, and little extra skin. Liposuction can still be performed in patients without the optimal characteristic, and Dr. Zeidler will help you choose a surgical plan the meets your expectations.
The technique of liposuction uses a long thin cannula with holes in the end connected to a vacuum device. A few small puncture holes are made in order to insert the cannula to access the areas of fat to be removed. First, a salt solution is injected to expand the fatty tissue so that fat can be removed easily with less trauma. This solution contains medications to provide a local anesthetic and to constrict blood vessels to prevent bleeding. Small cannulas and multiple small incisions are used to allow for gentle crossing techniques to provide the smoothest possible result. Dr. Zeidler also uses the VASER ultrasound assisted technique for liposuction for especially stubborn areas such as the area over the rib cage under the breasts, and the back. This systems disrupts fat cells with a small ultrasound probe before they are removed by the suction cannula.
Dr. Zeidler performs liposuction in a fully accredited surgery center with board certified anesthesiologists. The procedure is generally performed under general anesthesia, but can be performed under epidural anesthesia in certain patients. The procedure can last anywhere from one to five hours depending on the amount of fat being removed, and patients can go home the same day with supervision.
After surgery, patients will be fitted with a compression garment which need to be worn continuously for three weeks. This garment will decrease swelling, promote absorption of the fluid, and allow for a more comfortable recovery. The initial period of recovery is generally one week, and patients can return to exercise by three weeks after surgery. Patients notice an improvement in shape immediately, but it takes three to six months for all of the swelling to go away, and for the tissue to soften. It is common to feel areas or firmness and even lumpiness initially. Dr. Zeidler usually recommends lymphatic drainage massage after two to three weeks to help provide to best results.
When liposuction is performed in a controlled, conservative fashion, the risks of the procedure are very small. These include persistent numbness of the skin, pigment changes, and minor contour irregularities. Other risks include visible scars, bleeding, infection, blood clots, and anesthetic complications.
Body Rejuvenation after Pregnancy (mommy makeover)
Post-pregnancy rejuvenation, or "mommy makeover," refers to a set of plastic surgery procedures designed to bring a mother's body closer to the condition it was prior to child birth. This generally includes body contouring procedures and breast procedures.
As a result of pregnancy and breast feeding, many mothers find that their breasts are droopy and have lost a significant amount of volume. This is a result of the engorgement of the breast during pregnancy and breast feeding, which later goes down leaving breasts looking deflated. This is accentuated by loss of breast tissue and loss of skin elasticity which can prevent breasts from returning to their former shape. A mastopexy, or breast lift can help correct some of these problems. Dr. Zeidler uses an "auto-implant" technique to redistribute breast tissue to create a maximum amount of fullness in the upper portion of the breast. Sometimes this technique is combined with placement of breast implants to restore or increase breast volume. Sometimes fat transfer from another part of the body such as the abdomen or thighs can be used to create a small increase in breast volume without the need for an implant.
A small number of women have breast enlargement that does not go away after pregnancy or the discontinuation of breast feeding, and their breasts are not only droopy but larger than they were before. These patients will benefit from a breast reduction which decreases size and lifts breasts at the same time.
The abdominal region is also significantly affected by pregnancy. The abdominal wall tissues are overstretched by pregnancy and are not able to snap back despite weight loss. The skin and fat of the abdomen can be saggy and redundant. The vertical abdominal muscles (rectus abdominis muscles) can remain separated which leads to a square shape of the abdomen. An abdominoplasty, or tummy tuck, can fully correct all of these issues by tightening the abdominal muscles and removing excess skin and fat. The result is a slimmer, tighter, and more stable abdomen. Some women are candidates for a mini-abdominoplasty with a short scar that is the length of a C-section scar.
Some women may develop a new or enlarged hernia in the abdomen, most commonly around the belly button. This leads to an abnormal bulge from abdominal contents pooching though the abdominal wall. Hernias should be repaired in conjunction with abdominoplasties when possible.
Many women will benefit from liposuction either at the time of abdominoplasty or alone. Liposuction will remove excess fat in the abdomen, hips, or thighs to provide a smoother and improved contour.
During your consultation, Dr. Zeidler will explain the limitation and benefits of each technique and come up with surgical plan to meet your goals.
Rejuvenation after Weight Loss
With the advent of bariatric surgery, or weight loss surgery, more and more people are able to achieve their goal weights and a healthier lifestyle. As a result of this major weight loss, the skin is not able to contract back, and many people are left with large amounts of hanging skin and fat. No amount of exercise will reduce this excess tissue, and therefore, surgery is often the only way to treat the problem.
For most patients, multiple plastic surgical procedures are necessary to achieve their goals. Often times, the procedures are separated into different operations or stages, to enhance the chances of success and to minimize the risk of complications. This includes procedures for the face, neck, arms, breast, abdomen, buttocks and thighs. The most common areas to treat in the first stage include the abdomen and the breasts or the arms. As a result of the large amount of weight that was lost, many patients have an enormous amount of redundant tissue and fat in the abdominal area, often associated with a large overhang, called a pannus. The abdominal pannus can make hygiene difficult, interfere with normal activities and exercise, and make fitting in clothing difficult. An abdominoplasty is the best option for addressing these problems. The operation is tailored for each patient's needs and can be done using a traditional technique with a low horizontal incision, but sometimes also requires a vertical incision to achieve a better waistline. This type of abdominoplasty is called a Fleur de Lys abdominoplasty. Some patients have excess skin in multiple dimensions and thus require removal of skin in both the lower abdomen and the lower back, and this is best treated with a circumferential body lift which removes excess skin circumferentially around the body. During your consultation, Dr. Zeidler will tailor a surgical plan to meet your goals.
With massive weight loss, many patients find that their breasts have become deflated. A mastopexy, or breast lift alone or with an implant can improve the appearance of the breasts.
Other areas of concern for massive weight loss patients include extra skin and fat in the arms (see brachioplasty below) and extra skin and fat in the lower extremities, most notably in the thighs. Medial and lateral thigh lifts can help rejuvenate the thighs. A lateral thigh lift involves making an incision at the top of the buttocks which extends to the groin crease in the front, and through this incision, the outer thigh tissues can be mobilized and tightened, often with the aid of liposuction. An inner thigh lift utilizes the groin crease incision or a verticle inciscion on the inner thighs.
Facial rejuvenation plays a vital role in the total rejuvenation. As a result of the wight loss, large amounts of excess skin under the chin and in the neck area collect due to loss of skin elasticity. The brow drops considerably, and there is redundant skin around the eyelids, which can cause a face to look tired and angry. Many patients don't recognize themselves after weight loss, because they are used to fuller and higher cheeks from the extra weight. Facial rejuvenation can return much of that look by brightening the face and increasing fullness in targeted areas. The procedure that best addresses the cheeks, chin, and neck is a lower face an neck lift. The procedures that best address the upper face and eyes are a browlift and blepharoplasty or eyelid lift. Fat transfer from another part of the body is a useful technique to add permanent and natural appearing fullness.
There are many options for the massive wight loss patient. Obviously all of these procedures cannot be performed at the same time. During your consultation with Dr. Zeidler, she will help you to prioritize your goals and develop a surgical plan that meets your needs and expectations. Rejuvenation after weight loss is the final step of your journey towards a healthier lifestyle, and for many patients becomes one of the most exciting and fulfilling steps in the entire process.
Brachioplasty (arm lift)
After substantial weight loss, weight gain or simply from the effects of aging, skin on the upper arms can become inelastic, loose and flabby. Arm lifts, also known as brachioplasty, remove that excess skin and fat. Rejuvenation of the arm area in massive weight loss patients is a unique area in plastic surgery. In most cases, the treatment option that best corrects the excess hanging skin and fat in this area is a brachioplasty. Liposuction is often performed in conjunction with skin excision in order to achieve the best aesthetic result. These results can be dramatic, as some patients have so much excess skin that it looks like they have bat wings. The dramatic rejuvenation fo the arm to a normal contour is well worth the scar for these individuals.
Buttock rejuvenation can help to enlarge or reshape the buttocks when diet and exercise is not enough. A buttock augmentation (butt augmentation) or buttock lift (butt lift) contours the buttocks and compensates for low amounts of fat in the area leading to a more voluptuous and perky profile.
Buttock augmentation can be achieved through injections of the patient's own body fat (autologous fat transfer) or with silicone implants. Autologous fat transfer is Dr. Zeidler's preferred choice, as it provides more natural results and a lower risk of infection, although implants may be recommended for patients with little body fat.
In both techniques, incisions are made in inconspicuous locations to minimize visible scarring. The procedure is performed under general anesthesia, and most patients are able to return to work after about two weeks. When performed by an experienced surgeon using the proper techniques, buttock augmentation is a highly satisfying and permanent procedure that enhances the profile of the buttocks and surrounding areas for a younger, firmer, curvier look.
Labiaplasty (Labia Surgery / Labia Reduction)
Many women suffer from enlarged labia minora (the inner genital lips). Some may not like the appearance of their large, uneven or thick labia, which can sometimes extend beyond the labia majora. Others may be bothered by labial irritation while conducting normal activities, or may find it difficult to keep the labial area clean. Still others may experience pain during sexual intercourse, sports or other vigorous activities.
Labiaplasty reduces large labia or reshapes uneven labia, improving their appearance and reducing associated discomfort. During the labiaplasty procedure, Dr. Zeidler trims excess labial tissue and recreates the edges of the labia with a natural-looking color and shape. The results of labiaplasty can include: improvement in the appearance of the vagina and vulva, a boost inself-confidence, a reduction of discomfort caused by clothes rubbing against the labia, elimination of pain caused by large labia during sexual intercourse, and improvement and restoration of sexual satisfaction.
Scar revision is performed to reduce the appearance of scars caused by injury or previous surgery. Scars are by definition permanent, but surgery can narrow, fade and otherwise reduce the appearance of severe or unattractive scarring, which is especially helpful in areas of cosmetic importance such as the face and hands.
There are many surgical methods of scar revision, only some of which may be appropriate for a particular type of scar or its location. These include surgical excision, skin grafts, flap surgery and Z-plasty (repositioning a scar so that it aligns with the face and is less noticeable). The effectiveness of scar reduction depends on a number of factors, including the nature of the injury, your body's healing mechanism, the size and depth of the wound, how much blood supplies the area and the thickness and color of your skin. Dr. Zeidler will help educate on your options, what the limitations of a revision would be, and what techniques will best meet your goals.
To learn more about our Aesthetic & Reconstructive Plastic Surgery Services, please contact us at 408-559-7177 today to schedule an appointment.