Dear Dr. Togba,
Q. I weigh 155 pounds, but at 5′8" I’m very well proportioned. What bothers me is the flabby skin hanging from my belly. Would I need a tummy tuck or liposuction? When is it best to do liposuction?
A. Based upon the information provided, our recommendation would be an abdominoplasty, also known as a tummy tuck. The abdominolplasty will not only remove the excess skin of the lower abdomen giving you a flatter tummy; it can also repair the muscles of that area to prevent your tummy from sagging in the future. For patients with normal skin, liposuction is the desired procedure for sculpting such areas as the abdomen, waist, inner and outer thighs, hip rolls, back, knees, chin and enlarged breasts on males. Patients are usually near or at normal weight, but bothered by the presence of diet and exercise-resistant deposits of fat. For liposuction, small incisions are made in inconspicuous places at the site of fat deposits. Because fat cells are from specific body areas, the results are permanent if you maintain a healthy and active lifestyle. If you do gain weight, you will gain it proportionately over your entire body; you will not continue to fight this area.
Dr. T
Dear Dr. Togba,
Q. A friend recently had liposuction to reduce her saddlebags and she looks great! I would like to have liposuction on several areas of my body. Which body areas can be reduced?
A. Liposuction is popular because it’s the proven solution for removal of fat from nearly any body area. The basic "tumescent" procedure is used for all body sculpting. The ultrasonic technique is commonly used in conjunction with the tumescent procedure in areas where tissue is more fibrotic. Women generally want liposuction on their hips, thighs, abdomen, and "saddlebag "area. Men generally want their "spare tire" removed-an area that is ideally suited for ultrasonic liposuction. Men should also know that the ultrasonic liposuction technique has revolutionized the treatment of gynecomastia(enlarged male breasts). Ultrasonic techniques were invented for, and are very effective at removing fat from the upper- and mid-back. Other less common areas that can also be reduced include knees and ankles. Because of its visibility, the neck is a common small area for liposuction. Very little postoperative pain combined with a quick recovery time have made this a popular area for young people.
Dr. T
Dear Dr. Togba,
Q. Does ultrasonic liposuction really "melt" fat? I know you can do liposuction on different areas, but can you do arms? What is the long term effect?
A. Ultrasonic liposuction doesn’t exactly melt fat; rather it liquefies fat before it is removed with suction. Electrical energy is translated into high-frequency sound, which is then transduced through a hand piece into mechanical vibrations emitted at the tip of a hollow titanium rod. The fat cells implode and liquefy, then the fatty emulsion is aspirated. The advantages of ultrasonic liposuction are easier removal of fat in hard to treat areas (fibrotic areas with dense tissue) and more precise sculpting in difficult areas. Ultrasonic liposuction is not "better" than tumescent liposuction, but, rather, it is better suited to achieving optimum results in fibrotic areas including the male chest, upper abdomen, "love handles,"and dense tissue areas. In fact, ultrasonic liposuction is an adjunct to regular tumescent liposuction; I always employ the tumescent technique during liposuction and, in certain cases, I use the ultrasonic wand as an additional surgical tool. Tumescent liposuction alone can actually be preferable for areas with thin skin, such as chins and arms. The arms respond well to liposuction; I use a thin cannula best suited to the thin skin of that area. The long term effect is that those fat cells are gone forever.
Dr. T
Dear Dr. Togba,
Q. I am a woman in my mid-40s who used to be very obese. I underwent a laparoscopic gastric bypass procedure one year ago and have lost over 100 pounds. My health is much improved, but nobody told me that I would have loose, hanging rolls of skin everywhere. When I’m unclothed looking in the mirror, I really dislike the rolls of skin. Many of my friends in my bariatric support group complain of a similar problem. What can be done to help?
A. Developing loose, hanging skin throughout the body is very common after losing a large amount of weight, for example, after bariatric surgery such as gastric bypass or Lap Band. Body contouring procedures such as the body lift (also known as the belt lipectomy), breast lift, thigh thift, arm lift, facelift, and necklift can help remove the extra skin.
Dr. T
Dear Dr. Togba,
Q. A lot of my girlfriends have had their breasts enlarged. I like how some of them look and not others. One friend has breasts that sit up "too high" on her chest. Another friend’s breasts look fake; you can see the implants. Yet several of my friends have beautiful, natural-looking breasts that simply look several sizes larger than they had before. That’s what I want. Please tell me how you would ensure surgically that I get the look I want.
A. These less than satisfactory results can be avoided, in my most cases, by selecting the surgical approach appropriate for your situation. Let me first address the problem of implants sitting "too high"on the chest. Many women seeking breast enlargement surgery do not have distance between the areolar complex (nipple) and the bottom of their breast to increase their size as much as they might like. The patient has much more latitude with sizing if the surgeon she selects has experience with lowering the infra-mammary crease (crease created as the breast hangs against the chest wall). This increases the breast envelope size, which allows the space for the larger implant. The final result is a naturally-hanging breast where the breast implant does not sit high on the chest. By using this technique and also placing most implants under the muscle, it helps to produce a natural appearance as well as disguise the implant, thus avoiding the "fake" look which you mentioned. I have performed more than 1,000 breast surgeries and learned how these techniques can improve the result. A Board Certified Plastic Surgeon with a greatest deal of breast surgery experience can offer you these options. At my office you can view before-and-after books showing all types of breast surgery.
Dr. T
Dear Dr. Togba,
Q. This Christmas my husband gave me a breast augmentation. We’ve discussed my getting implants before but have been concerned about achieving a proportional balance for my body type. Beyond that, will they look and feel natural?
A. Giving plastic surgery as a Christmas gift becomes more popular every year; many spouses share the decision, the concerns, and the pleasing results. Natural looking results can be attributed to several things: proper implants, the surgeon’s experience, and understanding of placement for the patient’s particular body type. There are many variations of implants: anatomical round, teardrop, textured, and smooth. The choice depends upon the body type, the breast shape, and the patient’s preference. We have before-and-after photos at our office to help you visualize both the pre-operative condition and the realistic post-operative result before making a decision.
Dr. T
Q. Can you place a breast implant through the armpit?
A. Dr. Togba. There are generally four incision choices for a breast augmentation: under the breast at the inframammary crease (where the breast meets the chest wall), through the nipple complex, through the belly button, or through the armpit. I prefer the armpit incision because no scars of any sort appear on the breast.
Dear Dr.Togba
Q. I’ve been into your nice office and seen your patient counselor. Your pictures of breast augmentation results look very natural. Do you use different shaped implants?
A. Dr.Togba. There are many variations of implants: anatomical round, teardrop, textured, and smooth. The choice depends upon the body type, the breast shape, and the patient’s preference. How the implant is placed and positioned also impacts the final look. For most patients, especially those with minimal breast tissue, it’s best to position the implant underneath the chest muscles. This gives additional padding and a softer contour of the upper half of the breast. Your Plastic Surgeon should be experienced in many types of breast surgery and can help you achieve a natural looking result.
Q. What implant materials are available?
A. Dr.Togba. At this time, all breast implants are made out of a solid silicone outer covering and filled with either saline or silicone gel. Choosing between saline and silicone filled implants is a personal choice that depends on many factors. Your plastic surgeon should be able to help you make an informed decision.
Dr.T
Dear Dr. Togba
Q. Breast Augmentation seems to be a popular procedure. I’ve done my research and found that there are several ways to do the surgery. What technique do you use? How do I determine which method is best?
A. According to the American Society of Plastic Surgeons, over 340,000 Breast Augmentations were performed in 2007. As your research suggested, Breast Augmentation can be done through a variety of approaches such as around the areola, through the crease under the breast, the umbilical depression, or the underarm (axilla). The plastic surgeon you choose will usually have a preference to the technique that is used. Although I am comfortable using any of these approaches, I prefer the underarm incision. Through a very small incision in the axilla, I use an endoscope or camera, which allows me to establish a pocket under the breast for placement of the implant. For more natural results, I place the implant under the chest muscle. The advantages to the axillary approach are:
• Patients maintain full breast sensation
•There are no scars on the breasts nor incisions into the breasts
• There is no interference with milk production
•The incision in the underarm hid and fade for many to the point of invisibility
I’ve used the endoscope in my practice since 1992. I perform several Endoscopic Breast Augmentations weekly and have successfully performed two thousand since the beginning of my practice. My recommendation when looking for this particular approach is to make sure your plastic surgeon has experience with the endoscope. This my preferred method for Natural Looking Breasts.
Dr. T
Dear Dr. Togba,
Q. One of my girlfriends just had her breasts enlarged. The surgeon put the implant through the armpit underneath the muscle and she said it was all done on a TV screen. Is this possible?
A. Yes. A popular technique in cosmetic breast augmentation are implants inserted through a one inch incision in the armpit, then positioned partially under the muscle. This surgical approach has the advantage of giving a more natural shape to the breast, which is an improvement over the appearance when the implant is placed totally under the muscle. This procedure has become possible because we are now using an endoscope which is a wand with a bright light and camera attached to it so that the surgeon is able to view what he is doing on a TV monitor just like when an orthopedic surgeon does knee surgery. To perform the surgery, a separate surgical instrument called an electrocautery must be inserted through the same entry point. The tiny "eye "of the endoscope’s camera allows a surgeon to view the surgical site more clearly than if the skin were opened from a long incision. There are other advantages with this procedure: risk of sensory loss from nerve damage is decreased and the recovery time is frequently shortened.
Dr. T
