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Buttock augmentation is becoming an increasingly popular procedure in the Metroplex. If you want to enlarge or re-shape your buttocks and have discovered that they do not respond to diet or exercise, buttock augmentation may be the solution you’ve been looking for. A buttock augmentation (butt augmentation) or buttock lift (butt lift) contours the buttocks and compensates for low amounts of fat in the area. Women and men who enlarge their bottoms can enjoy a more voluptuous and perky profile. Augmentation most commonly is achieved through injections of the patient’s own body fat (“Brazilian Butt Lift”).

Who is a candidate for buttock augmentation?

Buttock augmentation can enhance the natural curves for patients who are unhappy with the shape of their rear ends. It can also add volume and roundness to a flat or small butt for patients seeking a more balanced body profile. Body-builders may seek buttock augmentation if they are unable to develop gluteal muscles in proportion with the rest of their bodies. Generally, if you are looking for a fuller, curvier butt, buttock augmentation may be for you.

Implants vs. Fat Transfer

The preferred method for performing buttock augmentation is fat transfer, the use of the patient’s own body fat to reshape the butt. Fat injection achieves a more natural result, has a lower risk of infection, and also contours the areas around the buttocks to enhance the overall effect. However, implants may be recommended for patients who have very little body fat to harvest, such as body-builders and naturally thin patients.

Buttock Augmentation with Fat Transfer (”Brazilian Butt Lift”)

Buttock augmentation with fat transfer, also known as the Brazilian Butt Lift in honor of the country in which it was developed, involves two steps. First, the patient’s own fat is collected through liposuction. The most popular areas for liposuction before buttock augmentation are the lower back, waist, flanks (love handles), thighs and stomach. This not only provides the raw material for buttock enhancement, it also contours the areas around the butt for a more dramatic result. The liposuctioned fat is then purified in a special process so that the best fat is ready to be reintroduced to the body.

In the second step, the donor fat is added to the buttocks with hundreds of tiny injections at different depths to ensure an even, attractive augmentation. This method of fat injection lends a shapely contour to the buttocks that lasts a long time. Special attention is given to the upper buttocks so the entire rear looks youthfully and naturally lifted.

Recovery

After buttock augmentation with fat transfer or silicone implants, patients should avoid sitting directly on the buttocks or lying on their backs for two weeks to maximize results. During this time, compression garments are worn to reduce swelling. Patients may experience some pain or discomfort, bruising and swelling after the procedure. Most patients return to work two weeks after their buttock augmentation and are able to resume all normal activities within four weeks. Swelling typically dissipates by the sixth week. Patients are asked to use padding under the buttocks while sitting through the sixth week after surgery.

Side Effects

As with any surgery, there are risks to buttock augmentation with fat transfer. These include infection, bleeding, fat necrosis (hard lumps), reaction to the anesthesia, and damage to nerves or muscles. Occasionally, a repeat operation is necessary to achieve the desired results.

Results

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.

Patient Profile

The patient is a 25-year-old woman who was unhappy with her flat buttocks. She underwent gluteal augmentation with her own fat, otherwise known as a Brazilian Butt Lift. This consisted of liposuction from her trunk and thighs, followed by a fat purification process, and then enhancement of the buttocks with her own fat. She is seen 2 months after surgery with fuller buttocks.

Who is a candidate for breast reduction?

Women with large, disproportionate breasts with pain, discomfort or embarrassment due to their breast size may be good candidates for breast reduction  (reduction mammaplasty). Ideal candidates for a breast reduction are women who are not pregnant or breastfeeding, are done having children, and are at a stable weight. Although breast reduction is generally recommended for mature women with fully developed breasts, surgery may be performed on younger women if their breasts are causing serious pain and physical discomfort.

When can patients return to work and resume normal daily activities?

After breast reduction surgery, it is often possible to return to work within one to two weeks, depending on the patient’s job.  Many patients resume most of their normal activities, including some form of mild exercise, within a few weeks. You may continue to experience some mild, periodic discomfort during this time, but these feelings are normal.

Because sexual arousal could cause incisions to swell and create the possibility of delayed healing, sexual activity should be avoided for at least two weeks after breast reduction surgery.

When can patients shower after breast reduction surgery?

Patients are often concerned that limited mobility after surgery will prevent them from showering for several days.  Dr. Jejurikar recommends that patients shower as soon as their drains are removed after surgery, generally about 48-72 hours postoperatively, to help them feel refreshed and to keep their breast skin clean.

Will health insurance cover the breast reduction procedure?

Breast reductions may be covered by medical insurance if the purpose of the breast reduction surgery is to alleviate physical discomfort and pain caused by oversized breasts. Many factors determine your eligibility, including the specific terms of your insurance policy and the amount of breast tissue to be removed.

Insurance companies require specific documentation from plastic surgeons prior to approving reduction mammaplasty.  This usually includes photographs demonstrating large breasts and shoulder grooving from bra straps, as well as a letter describing patient’s symptoms, other treatment modalities attempted, and the estimated amount of tissue that will be removed.

Supporting documentation from other physicians and health care professionals can be very helpful in facilitating the approval process.  Letters from physical therapists and chiropractors documenting failed therapy for back pain and neck pain, as well as from primary care doctors demonstrating neck pain, shoulder pain and heat rashes despite appropriate use of a support bra, all help immensely.

How long will the results of breast reduction surgery last?

After breast reduction surgery, provided patients do not gain or lose a significant amount of weight or become pregnant, breast size should remain relatively constant in size. However, the effects of aging and gravity cause all tissues to sag over time; the breasts are no exception. If, after a period of years, the breasts become saggy or droopy, patients may choose to undergo a breast lift procedure to restore a more youthful contour.

Will there be scarring?

The various techniques for breast reductions require different incisions. Traditional breast reduction surgery uses anchor-like incisions that extend around the nipple, down the middle of the breast, and at the crease at the base of the breast. Vertical incision (lollipop) breast reduction surgery creates shorter scars that also circle the nipple and extend vertically down the breast, but avoid making an incision at the crease below the breast.   Dr. Jejurikar designs his incisions with the goal of minimizing scars while still creating an aesthetically pleasing breast. Scars from breast reductions tend to fade over time and can be hidden under bras, bathing suits, or a low cut top.

Can I breastfeed after a breast reduction?

There is a significant chance that breastfeeding is not be possible after breast reduction.   It is not possible to predict with certainty who will be able to breast feed after breast reduction surgery. Thus, if this is of paramount importance to a patient, she should delay surgery until a later time.

What are the risks and complications of breast reduction surgery?

Breast reduction surgery may have potential complications that are possible for all surgeries, including bleeding, infection, hematoma, adverse reactions to anesthesia, and poor scarring.  Potential risks that are specific to breast reduction surgery include asymmetrical breasts, altered or loss of nipple and areola sensitivity, and the inability to breastfeed.

This is a story profiling the benefits of Zeltiq, a noninvasive system for removal of fat.  It has significant benefits for both male and female patients and is available at our Dallas and Plano offices.  If you’re interested, call 214.827.2814 to learn more.

This is a press release from the American Society for Aesthetic Plastic Surgery

New York, NY (December 14, 2009) –  Findings from a new study published in the November/December issue of Aesthetic Surgery Journal (ASJ) suggest  that gender-specific differences in the perioral skin (skin surrounding the mouth) account for more and deeper skin wrinkling in women than in men.  The study, conducted by a team of plastic surgeons from the Netherlands, was presented at the annual meeting of the European Association of Plastic Surgeons last May in Barcelona, Spain.

“The aim of this study is to obtain new insight into the perception that women wrinkle earlier and more severely than men,” said the study’s lead author, Emma C. Paes, M.D., from the Department of Plastic, Reconstructive and Hand Surgery at the University Medical Center in Utrecht, Netherlands.  “If we understood the reasons for differences in wrinkling between women and men, then we might be able to develop better strategies for the treatment of perioral wrinkles.”

Skin surface replicas of the upper lip region in 10 male and 10 female cadavers (age range 75-93) were used to define the amount and depth of perioral wrinkling.  To provide additional data, 3 full-thickness lip resections were taken from each of 15 male and 15 female fresh cadavers and were investigated in a blinded fashion.

The study found that all of the following could be contributing factors to the presence of more and deeper perioral wrinkles in women:

• Women’s perioral skin contains fewer sweat glands and sebaceous glands (microscopic glands in the skin that secrete an oily/waxy matter, called sebum, to lubricate skin and hair), which could influence the natural filling of the dermis (skin).
• Women’s perioral skin contains fewer blood vessels and, therefore, is less vascularized compared to men, which could accelerate the development of wrinkles.
• In women, the closer attachment of the muscular fibers surrounding the orifice of the mouth to the dermis may cause an inward traction, thereby creating deeper wrinkles.

Current treatments for perioral wrinkles include the use of lasers, botulinum toxin injections, and injectable or implantable wrinkle fillers as well as older methods such as dermabrasion and chemical peels.  Despite these many options, the effective treatment of wrinkles in the perioral region still remains a challenging problem.

“We think it’s important to consider the reasons why a particular treatment may or may not be effective,“ said Dr. Paes.  “Sometimes one has to go back to the basics instead of just moving forward.  In the end, having more basic knowledge about a problem can speed up the process of finding the right solution.”

This is an article taken from Cosmetic Surgery Times.

Lifestyle Lift’s dirty little secret

September 10, 2009

• Ask if the doctor is a member of the American Society of Plastic Surgeons (ASPS).  Membership in the ASPS ensures that the doctor is certified by the American Board of Plastic Surgery and meets requirements for ongoing continuing medical education.
• Confirm that the doctor is certified by the American Board of Plastic Surgery.  Merely hearing that a doctor is board certified does not indicate which board has certified that doctor.  There is only one board, the American Board of Plastic Surgery, that is recognized by the American Board of Medical Specialties to certify surgeons in the field of plastic surgery.
• Find out more about the surgeon’s specific hospital privileges.  Although some procedures are commonly performed in an office or ambulatory surgical center, it is important to learn whether the surgeon has the same privileges in an accredited hospital.  Hospital credentialing committees carefully evaluate a surgeon’s training and competency for specific procedures.  If a surgeon performs a procedure in an office or surgical center, but does not have privileges to perform the same procedure in a hospital, it may be because he was deemed unqualified to perform that procedure.

Taking these steps before scheduling a consultation with a cosmetic surgeon will ensure that you find a plastic surgeon with the highest qualifications.

Many patients have asked me if they can smoke cigarettes up to the time of their cosmetic surgery.  The procedures most often in question are breast lifts with or without implants, breast reductions, tummy tucks and facelifts.  Simply put, smoking and these procedures can be recipes for disaster.  I strongly encourage smokers to quit smoking before these surgeries, as tobacco, nicotine, and carbon monoxide, all of which are within cigarettes, can impede wound healing.  In operations which involve lifting and tightening large amounts of skin, this can result in skin separation, or worse yet, skin loss.

Most board-certified plastic surgeons are selective in the procedures that they will offer to tobacco users.  Some procedures that do not require a significant amount of skin lifting, such as rhinoplasty, liposuction and breast augmentation, are thought to be somewhat safer to perform in smokers than procedures that require more skin manipulation.  For that reason, most plastic surgeons will perform these surgeries in smokers, but will still extend significant disclaimers and warnings.

Virtually everyone knows that smoking can cause pulmonary problems, heart disease and lung cancer.  For those reasons alone, I encourage all patients to quit using tobacco products.  In regards to cosmetic surgery, tobacco usage can cause significant problems with healing.  Because cosmetic surgery is elective, it only makes sense to quit tobacco usage prior to surgery to minimize this potential risk.

Many patients who have had multiple pregnancies come into the office asking about mini tummy tucks.  If you think about, no one wants a long scar on the abdominal wall, making the concept of a mini tummy tuck very appealing.  These same patients say that they are bothered about sagging of their skin, stretch marks, the appearance of their belly button and bulging of their abdominal wall, none of which they can fix with diet or exercise.  Some of their problems are the result of irreversible skin injury that occurs with fluctuations in weight.  Other problems, particularly the bulging of their tummy, are the result of laxity (looseness) of the abdominal wall muscles.
The differences between a mini tummy tuck and a full tummy tuck extend beyond the differences in incision length.  A mini tummy tuck removes saggy skin between the belly button and pubic region; that’s pretty much it. Most of the bulging of the abdominal wall remains, as the problems with the abdominal wall muscles haven’t been addressed.  A full tummy tuck can remove more skin and more stretch marks, tighten loose muscles, thereby eliminating bulges of the upper and lower abdominal wall, and re-shape the belly button.  While it’s true that the incision is longer, in some cases, it doesn’t have to extend from hip to hip.  The length of the incision is primarily determined by extent of loose skin.
If a fully tummy tuck is needed, I am very sensitive to placing the incision in an area that can be camouflaged easily.  I ask my patients to wear a bathing suit bottom so that I can design the incision to fall within this area.  This way, even if the incision needs to be longer than a mini tummy tuck incision, it can still be hidden relatively easily.
The bottom line: body contouring surgery can do wonders for re-shaping and re-contouring the abdominal wall, and improving a patient’s self-confidence and physical appearance.   Both mini tummy tucks and full tummy tucks have their merits; it’s important that the educated plastic surgery patient understand the differences.

Many of my patients ask how I choose the optimal size for a breast implant. Some women are very concerned about choosing too large of an implant, as they know this can make their breasts look unnatural. Other women are afraid that they won’t choose a large enough implant to see a discernible difference. There are a variety of tools that I use to help my patients select the best breast implant size:

• Photos. Having patients bring photos of breasts they like and breasts they detest help me determine their goals. Some women desire subtle enhancement and others desire much more dramatic enlargement.
• Measurements. The chest wall diameter, breast width and height are all important factors in selecting an appropriate implant. The breast skin envelope is only so large; selecting an implant that is too large invariably means that implant will sit too high, too low, or too lateral.
• Trial sizing. Although it is inexact, having patients try different implants in a bra in the office is a useful exercise. It gives them a crude idea of breast size and shape in clothing and often helps them verbalize their goals.
• Conversation. Different implants have vastly different shapes and profiles. It’s important that patients understand how this differs in appearance from other types of implants, and that can only conveyed adequately in the preoperative consultation.
• Intraoperative sizing. I will often utilize intraoperative trial implants and always sit the patient up during surgery to ensure that the breasts have a pleasing appearance.  This is particularly the case for patients with breast asymmetry, to ensure that the final implants utilized provide the greatest possible symmetry.

In the past couple of weeks, I’ve had some patients engage me in conversations about breast implant profiles.  They had seen pictures on the Internet of patients with breast augmentation results they liked and wanted the same style implants as in the pictures.  These patients had a limited understanding as to what breast implant profile refers, prompting this blog entry.

The naming for implant profiles predominantly refers to smooth, round implants, which are the most common type of implants used for cosmetic breast augmentation.  The two major breast implant manufactures have different names for their implants.  Allergan refers to its saline implants as low, moderate, and high profile and its silicone implants as moderate, midrange and high profile.  Mentor has similar names, but also has a moderate profile plus implant, which is between its moderate and high profile implants.

The profile of an implant equates to the projection of that implant.  For a given volume, the higher the profile, the fatter and narrower an implant is.  As a result, higher profile implants tend to provide more fullness and a rounder appearance to the upper portions of the breast.  Higher profile implants tend to be really useful in women with relatively narrow breasts who want significant enlargement of the breasts; in these women, if a low or moderate profile implant were selected, to achieve the desired volume may entail the implant riding into the underarm region.  In contrast, a patient with a wider build or wider breasts may find that high profile implants may fail to adequately fill their entire breast; they often times benefit from implants with lesser projection.  Higher profile implants also tend to be useful in women who desire a small breast lift without the incisions associated with a formal lift.

Almost no patients choose low profile implants for aesthetic breast augmentation; the limited amount of projection provided with these implants does not coincide with their aesthetic goals.  Generally speaking, women looking to maximize their cleavage and perkiness often times opt for high profile implants.  Ultimately, though, the best implant profile for a patient can only be determined after a careful examination by a board certified plastic surgeon, taking into account the specifics of a patient’s breast anatomy, as well as their desired appearance.