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Weight loss after tummy tuck

By | May 3rd, 2013

Many patients in my practice talk about how they keep losing weight after an abdominoplasty (tummy tuck) procedure. Many think that it is related to early satiety, possibly secondary to the abdominal wall tightening. There was an article just published, Plastic and Reconstructive Surgery 131:2 2013, showing that many patients had sustained weight loss at 1 year after abdominoplasty even after accounting for the weight of the tissue removed. These authors felt that part of the continued weight loss was related to neuroendocrine changes from the bulk of fat cells removed with the abdominoplasty procedure.
Even though I like patients to have already lost weight and be at a stable weight before having a tummy tuck, I know that many patients will use this procedure as a way to get through a barrier when they can’t seem to lose any more weight. It is nice that science is starting to show us why this works. Please visit my website at www.hallmd.com if you would like more information on abdominoplasty.
Gary Hall,MD

Allergan Gummy Bear Implant Approved and Available in Kansas City

By | February 23rd, 2013

Finally, after being available in Europe for about 15 years the highly cohesive form stable silicone gel breast implant was just approved for use in the United States. This will be the first highly cohesive gel implant on the market in the United States from a long term established implant company. Allergan is a well respected medical company that brings a lot of security with it. The term “gummy bear” of course is not it’s real name but has been popularized in the press.

This implant has the ability to give more control over the shape of the breast than the current silicone gel implant that is available. The more cohesive nature of the silicone gel should alleviate any fears a patient should have regarding silicone migration and it seems to have less risk of capsule formation and rippling in current studies.

Of course it seems that every good thing always has some negatives. With this implant the negatives are that it will take at least a 1/2 inch larger incision than the current gel implant and will feel just a little firmer with the more cohesive gel. Also, since it has shape to it, if the implant should rotate in the breast pocket after placement it could give some deformity to the breast. As it seems with all new things on the market the manufacturer is charging more for the implant also.

As I am now certified by Allergan in the use of this new implant I would be happy to discuss this new augmentation option that we now have available. Please visit my website at www.hallmd.com and call my office at 913-341-2188 for a free consultation.

Breast Implant Device Identification Card

By | November 16th, 2012

I frequently have breast augmentation patients ask me what they are supposed to do with the implant ID card that we give them and what if they lose it.

Every breast implant box comes with an ID card that the nurse in the operating room then puts a patient identification label as well as stickers with implant information on.  There is also a place to mark left and right so we will know what implant is on a particular side.  This implant sticker has the serial number of the implant so that information is readily available if needed.

Some patients worry that if they lose the card their warranty is not good anymore.   No problem there, the card is not necessary,  it just makes it easier if your medical record is not readily available.

I always recommend putting the card in your files at home where you can always find it.  Then many years down the road if there is a need for information on your implants it is readily available.  This information is also recorded at the place of your surgery but sometimes may not be readily available.

 

 

Tummy Tuck Pain Management in Kansas City

By | November 6th, 2012

Over six years ago I kept all of my tummy tuck (abdominoplasty) patients overnight so that the early pain could be kept in control.  Then a new device was released called a pain pump.  This devise slowly released numbing medicine through two little catheters that I placed during surgery and lasts about 3 days before it runs out.  This was very effective at controlling the pain and enabled me to start doing abdominoplasty surgery on an outpatient basis.  Patients really seemed to like this since it saves them quite a bit of money and they don’t have to go in to the hospital.  This pain control method has worked very well for the last 6 years.  A new product has now been released called Exparel.  This is the same numbing medicine that I used with the pain pump but it is in a delayed release format.  I just inject it during the surgery and the numbing medicine slowly releases for the next 3 days.  So far the pain control has been better than that achieved with the pain pump,  no catheters are needed and no device is hanging from you to carry around.  My patients and I have been very happy with this change and I plan to use this for all of my abdominoplasty patients from now on.  At least until the next great thing comes along!  If you have any interest in this procedure please visit my website at www.hallmd.com and call my office at 913-341-2188 for a free consultation.

Rhinoplasty in Kansas City

By | September 4th, 2012

Many people are unhappy with their nose.  They either think it is too big, too small, too crooked, too wide, has a hump or is droopy.  This is why rhinoplasty is a common plastic surgical procedure.  Due to the large variation in what needs to be corrected their is a large variation in what is done in a rhinoplasty.  Some people just need a little rasping or a small dorsal hump or a little lifting of the tip.  While others need a large dorsal hump excised, tip reduced, and nasal boned infractured to narrow the nose.  Frequently the nasal septum requires work also.

When you see a surgeon regarding your nose make sure that you bring out all of your concerns and expectations and make sure these are addressed in the consultation.  You can find other information on my website.

Below is a young man who was unhappy with his nose and is shown here about 8 months after a rhinoplasty

rhinoplasty

Inner thigh lift Kansas City

By | August 28th, 2012

Many patients have excess tissue in the inner thigh area.  Most commonly this can be treated with liposuction alone.  Some patients however have loose skin in this area that will not contract after liposuction and will just sag and hang there.   Many of these patients have had large amounts of weight loss.  In this group of patients an inner thigh lift can be helpful.

In most patients I will do this with only a groin incision.  This will allow me to excise an elipse of skin in the groin area pulling up and tightening the inner thigh.  This is usually combined with liposuction.  Some patients however have loose sagging skin all the way down to the knee.  These patients will benefit from extending the scar from the groin down to the knee allow more of the excess skin to be excised.  This does leave a more noticeable scar so I only do this for severe cases.  Using in patients with very large amounts of weight loss.

This surgery can be done as an outpatient but frequently I have patients spend the night in the hospital.  A general anesthetic is required and the surgery can take 2.5 to 3 hours depending on what all is done.

Tubular Breast Surgery in Kansas City

By | May 1st, 2012

Many women have tightness of the tissues in the breast that can cause the breast to assume a tubular shape.  Some of these cases have a very tight circumferential band that cause the nipple areola complex to actually herniate through this band exacerbating the deformity.  Most of these case will need an areola reduction procedure and small lift.  During this part of the surgery any constricting bands can also be released.  Best result are usually had if an implant is also placed to help reshape the breast to give it an attractive contour.

Below is a patient

Tubular deformity

Tubular deformity

Saline or Silicone Gel Implants in Kansas City

By | April 13th, 2012

When the old generation of silicone gel implants were taken off the market back in 1992 saline filled implants were the only option.  The implants in use back then had a silicone gel that was very runny, almost like a thick oil and had thin shells.  These two aspects helped give a very natural feel but also led to rupture of the implant with the silicone migrating through the breast tissues causing all kinds of problems.  Then in 2006 silicone gel implants got approval for use again.  The new generation of implant had a much more cohesive silicone and a more durable shell.  This implant had undergone many years of trial use prior to full approval and has a very safe track record.

I personally was slow to become a fan of the silicone gel implant but I am now using it in the majority of my patients with very good results.  The saline filled implant can still give a very nice result with a smaller incision.  The gel implant will give a softer result in most all patients with less of a risk of rippling.  These issues are especially noticeable in very thin patients or patients with very large implants.  Both types of implants can leak, with the saline the water is just absorbed by the body and you will notice the size discrepancy.  Some people feel that if the gel implant gets a crack in the shell that is will never even be a problem and that the cohesive gel will just sit there.  I agree with the manufacturer that it would still probably be best to have it replaced.  For your lifetime the manufacturers will give you a new implant if one develops a defect and leaks and during the first 10 years they will also give money towards the cost of getting it replaced.  The initial cost is higher with the silicone gel implant as the manufacturers charge about double for the gel implant so the surgery will cost about $900 more.

As with many things there are pros and cons to both types of implants. Which you use needs to be a decision reached taking the advice of your plastic surgeon in consideration along with your own wishes, desires and concerns.

Breast lift for Breast Asymmetry in Kansas City

By | March 8th, 2012

Breast asymmetry is a common problem that I see in my office.  Most patients have some slight asymmetry but for a few it is enough of a problem to be noticeable and bothersome to the patient.   Frequently patients not only have size asymmetry but also have asymmetry with the position of the nipples.  If the patient wishes to be larger then I will do a combined augmentation mastopexy procedure.   For the augmentation I will either use a bigger implant on the smaller breast or do a reduction on the larger breast.  I find in my practice that I am frequently just doing a small reduction on the larger breast at the same time as the lift and then using the same sized implant.  This tends to give a better result over the long term.  Below is an example.

22 y/o who had breast fed two children resulting in atrophy and sagging of her breasts.  She wished to be lifted and augmented to a small D cup in size.  She is shown here about 3 months after a round block augmentation mastopexy.  She has 330cc on the right and 420cc on the left (to correct asymmetry) using round smooth saline filled implants placed behind the muscle.

asymmetry

Sagging eyebrows in Kansas City

By | March 3rd, 2012

I have many patients come into see me with complaints about their upper eyelids and saying that they just look tired or angry.  Many of these patients have little wrong with their upper eyelids the problem is with the eyebrows.  As we get older our eyebrows will sag causing the skin on our upper eyelids to overlap.  Our bodies compensate for this by activating the muscles in our forehead to raise the brows.  These patients will then have deep creases in their foreheads, low brows and sagging skin on the upper lids.  This gives the old, tired and angry look people understandably don’t like.

The solution for this problem is usually not eyelid surgery as that can actually cause the eyebrows to look lower and flatter.  The solution is brow lift surgery.  This can be done in a couple of different ways but does require going to the operating room.  You can find more detailed procedure information on my website.

The cost for brow lift surgery can vary but is usually about $5100.  Most people can return to a desk job in one week or less.  Patient satisfaction from this surgery is quite high and can make very significant improvements.

Below are photos of one of my patients as an example.  You can find others on my website.

 

58 y/o female that did not like the appearance of her eyes and had a brow lift and lower lid blepharoplasty done.  She is shown here about 2 months postoperative.