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Archive for August 2016

What is a Mommy Makeover? (Am I a Candidate for One?)

“Mommy makeover” is a term used generically for a number of different combined surgical procedures. There is no single mommy makeover surgery, but a general concept of helping regain some of the shape you had before pregnancy. The surgeries may be done in combination, or over more than one setting.

Typically, I am addressing concerns women have with changes they have from pregnancy and breast feeding. However, it can extend to facial changes that women go through due to the stresses of raising kids!

For the breasts, one changes that many women see is deflation, or drooping and flattening of the breasts after pregnancy or when breast feeding stops. This occurs because the enlarged breast ducts start to shrink back down, causing the breasts to get smaller. The constant stretching of the breast skin and breast tissue over the many months of pregnancy and breast feeding eventually leave the tissue very lax (stretch marks are one sign of this).

Most of the time the skin and breast tissue won’t have the same elasticity or “snap back” it used to have. For some women, a breast augmentation (implant enlargement of the breast) is enough to restore the lost volume, shape, and contour of the breast. Sometimes a mastopexy, or breast lift, is needed in addition to the implants. A breast lift can mean any one of a number of different specific surgeries and can involve any one of a number of different incisions and approaches, tailored to you. At a minimum, a breast lift will help relocate the nipple-areola to a more aesthetically pleasing location on the breast mound. Typically, a breast lift will also help round out the entire breast and more the breast tissue back up on the chest.

The belly is another area that goes through a lot of changes too. Stretched, lax skin and additional fat deposits can be a long term issue after pregnancy. Also, many women have diastasis recti – a term for stretched muscle and fascia in the lower abdomen. This is the “bulge” or “pot belly” or “beer belly” of the lower abdomen you may see, even if you are very thin and back to your pre-pregnancy weight. These areas can be helped with a mini-abdominoplasty (mini-tummy tuck) or a regular tummy tuck. These surgeries will address the lax muscle and remove the lower abdominal skin and fat (and stretch marks if they are low on your belly). Liposuction of the flanks / love handles can help contour the waist in addition.

Some women only need liposuction to remove the excess fat of lower abdomen, without removing skin, because their skin has enough elasticity to snap back after removing the extra fat.

Facial lines and wrinkles become more prominent and noticeable after pregnancy, long sleepless nights, and many stressed-out days! Botox and Juvederm filler can help restore some of the look of the face, and reduce those lines and wrinkles.

So! What can I do to help “mommy”? Breast implants and/or lift? Tummy tuck or liposuction? Botox? There are many options depending on which areas concern you the most. Come in to discuss what I can help you with!

For additional information, you may also visit birchenoughmd.com/mommy-makeover/.

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“What’s the Difference Between BOTOX and Filler?”

As well-known and ubiquitous as these products are in the popular press and in my office, there is still a lot of confusion from patients over which injectable to use, when, and where. So here’s a primer!

Botox (and other botulinum toxins like Dysport and Xeomin) works by INHIBITING MUSCLE action.

So, if the wrinkles in between your eye brows (the glabella) or in your forehead or the “crows feet” area are caused by the action of a muscle, then you can decrease the repeated skin creasing by injecting Botox into the muscle. Over about 5-7 days the muscle loses ability to contract, allowing the skin to flatten out and not be so creased. It usually lasts only about 3-5 months before the muscle gets back to full strength and you have to inject it all over again.

However, (and here’s the kicker) the muscle can’t be one that is used for critical facial expressions like smiling or closing your eyes. That’s the reason I avoid injecting Botox around the mouth, cheeks, or into the eyelids – you really need those muscles to work properly to maintain normal facial expressions and functions.

FILLERS (including the hyaluronic acids – Juvederm, Voluma, Restylane, Belotero – and other products like Sculptra and Radiesse) do just that – they FILL! Unlike Botox, the effect is immediately noticeable. They are gels that are injected under the the skin (not into the muscle) to fill in creases, increase volume, and make deeper grooves more shallow. Common places for fillers are in the hollows under the inside part of the lower eyelids (nasojugal grooves), the folds next the nose between the cheeks and lips (nasolabial folds), and the deeper grooves that can form from the corners of the mouth down to the chin (marionette lines).

Fillers can also add volume to the lips and cheeks when used in the right amounts and in the anatomic locations. Just puffing up the lip is easy but looks unnatural. I tend to restore lip symmetry and refine the borders of the lip through very small, precise injections of filler. Very fine lines on the upper lip are difficult to smooth out because of the gel quality of fillers.

So, now that you know the basics, you can come on in to get your injectables! For more information on BOTOX, please visit the skin services section of our website.

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Can You Liposuction “This”?

Patients frequently ask about liposuction and whether it is appropriate for “THIS” – as they grab a certain part of their body they aren’t so happy with – jowls, under chin or neck, bra line on the side of their chest, their love handles, their lower abdomen, their inner thighs, etc.

My answer is always a little tongue-in-cheek “I can liposuction just about anything with fat in it, but should I?”

The appeal of liposuction over other methods such as excision of skin and fat is known: less invasive surgery, less downtime, smaller scars, less costly, etc.

The factors that go into being able to do liposuction successfully are many, but one of the most important factors is the overlying skin tone and elasticity. Because liposuction by definition removes fat (and affects tightening of the skin in varying amounts), it is the skin that then has to contract to provide a good contour and look after the appropriate amount of fat is removed.

 

Take the patients shown as examples:

Patient 1            Picture2

 

Patient 1 (on left) has a moderate amount of fat in her lower abdomen and flanks, with very good skin tone, texture and elasticity. There are no stretch marks or loose skin. If I remove fat from her, I can trust that her skin will tighten up afterwards (usually reaching it’s final tightness after about 3 months.) She’s a very good candidate for liposuction!

 

Patient 2 (on right) also with a moderate amount of fat, on the other hand, has much looser, inelastic skin in the lower abdomen. She has significant stretch marks, and some of the loose, thin skin is already starting to overhang. While I could do liposuction on her, she would be very disappointed because her skin will be even more loose and floppy! A much better procedure for her would be an abdominoplasty (tummy-tuck) to remove that extra, loose skin along with the underlying fat. However, a long scar and recovery time would be needed.

 

Read more about liposuction and abdominoplasty by visiting http://birchenoughmd.com/liposuctionsmartlipo/ and http://birchenoughmd.com/abdominoplasty/ and then come in for a consultation to discuss it further! SB

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“Can I Get an Upper Eyelid Lift in the Office?”

Many patients would prefer to have and upper eyelid lift (or blepharoplasty) in the office – for convenience, comfort, and cost reasons. This is a great procedure to do if you are looking to improve the “tired” look or wish to remove excessive skin and fat above the eyes. Women tell me that it is time for this surgery when they have to pull up the extra skin with their other hand just to put on eye shadow! That’s where a “upper bleph” can help.

In the office, we make the patient comfortable with pain medication and something to keep them calm, though the patient is awake during the entire procedure. Lidocaine injection is used to completely numb the skin prior to the surgery. The skin and fat is removed and sutures are placed. Typically, patients will have about 3-5 days of swelling and some minimal bruising. Makeup can be applied after that point. The stitches come out at about 5-7 days, and then scar management continues after that.

This is a terrific surgery for improving the overall aesthetics of the eyes. Please see some of my images below.

Before - Front View

Before

After - Front View

After

For more information about upper eyelid lift procedures, please visit http://birchenoughmd.com/eyelid-surgery-blepharoplasty/

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