liposuction

Your Body Contouring Questions Answered: Getting Ready for Swimsuit Season

swimsuit-chat-260x200-emailAs we kick-off the summer months and have officially reached bathing suit season, it is natural that many of us take a look in the mirror and think about how we might change our body. In addition to keeping a healthy diet and exercising regularly, there are now more choices than ever in how we might achieve our goals. But with so many choices, both surgical and non-surgical options, choosing what body contouring procedure is best for you can be difficult.

During our live chat on Tuesday, March 22nd, hosted by Emory Aesthetic Center’s plastic surgeon, Dr. Felmont Eaves, we answered your questions around body contouring options to help shape your body for summer and tighten excess or loose skin. Dr. Eaves discussed both surgical and non-surgical procedures – including liposuction, tummy tucks, and thigh lifts.

Below are just a few highlights from the chat. A full list of questions and answers can be found on our chat transcript. You can also visit emoryaesthetic.org for a full list of services and treatments offered by the Emory Aesthetic Center.

Question: How do you get rid of a stomach belly fat?

Dr. Eaves: If diet and exercise don’t get you what you want, then there are three main ways to address belly fat, non-surgical fat reduction, liposuction, or abdominoplasty. Which one is best for a patient depends on their individual circumstances.

For instance, non-surgical treatments like Coolsculping® work best in patients with smaller amounts of fat and youthful, elastic skin. Liposuction works best in similar patients, however is more aggressive in terms of fat removal. The tummy tuck is the “king” of tummy contouring – it can tighten muscles, reduce fat, and tighten skin. Tummy tucks are more common in patients that have had pregnancies or who are a bit older and have developed some skin laxity.

Question: I have 2 weeks until I have to be in a bathing suit. What are some quick fixes that can be done with belly and thigh bulges?

Dr. Eaves: That doesn’t give much time! I’m afraid that neither surgery nor non-surgical fat removal would work and get you ready in such a short period of time.
One thought, however. We often think about concentrating on getting our bodies (or faces) ready for a big event. However to get your body where you want, it really takes a sustained, consistent approach. Crash diets and hours in the gym for short periods of time doesn’t really get you anywhere . . . a good, healthy, balanced and sustainable diet coupled with a reasonable exercise routine that you can stick with is the key. Of course surgery can help a lot, but the patient gets the very best results when they get their weight and health to a good place.

Question: Is there such a thing as a “mini” tummy tuck which does not have to go all the way across the abdomen?

Dr. Eaves: Not only is there the mini-tummy tuck, but some patients are candidates for tummy tucks with even shorter scars – the endoscopic tummy tuck. However before you get excited about these options, be aware than only a very small percentage of patients are candidates for these procedures. In order to be a candidate, you need to have good, elastic skin and relatively small amounts (or not) excess fat.

These procedures are ideally suited for patients who have experienced some spreading of the muscles of the abdomen from pregnancy, which we call a diastasis recti. If you have any significant amount of loose skin, or more significant fatty deposits, you are unlikely to get a good result with a limited scar approach. That being said, we now use techniques to help the scar appear better, such as special sutures that take the tension off of the skin. There sutures also eliminate the need to have surgical drains with a tummy tuck, which is a big plus.

Question: I need help with both my tummy and my breasts. Can I have both surgeries at the same time?

Dr. Eaves: Not only can you treat both the tummy and the breasts at the same time, but this is a very common procedure. For the tummy, most often this involves a tummy tuck due to the effects of the pregnancy. What we might do in the breasts depends on how the breasts recovered after pregnancy and maybe breast feeding. For instance, if the breast lost volume but didn’t become saggy (we call that “ptosis”), then a breast augmentation is a great option.

If you like the size of the breasts but they have become too droopy, then you would likely want a mastopexy, or breast lift, but without implants. It is also quite common to do both breast augmentation with implants and a lift. If you have a consultation with a plastic surgeon, he/she can help you sort through these options and see which is best for you.

cta-learn-blue

or call us at 404-778-6880 to schedule a consultation

If you have additional questions for Dr. Eaves, please feel free to leave a comment in our comments area below.

Fat Grafting 101: What You Need To Know

lovely-ladyIf you are like me, you spend hours at the gym trying to get rid of it and you diet to prevent it. You know what I am referring to…“love handles”, “saddle bags”, basically the accumulation of fat on certain areas of our bodies. But without fat, our faces would appear drawn and old, our breasts and butt would droop and our hands would look like skeletons. In other words, fat is a necessity and it has its benefits. In the right location and quantity, it is a sign of youth. I am not recommending you hang up those running shoes, but at the Emory Aesthetic Center, we can reorganize this necessary fat to improve your appearance, address early aging, and make you feel better about yourself. I am referring to a technique called autologous fat transfer or fat grafting. Let me answer some common questions to help you make an informed decision when considering undergoing this procedure.

What is autologous fat grafting and how is it done?

Some refer to it as fat transfer or fat grafting, but the concept is not new and has been reported as early as 1893. Modern fat grafting did not develop however until the 1980’s with the popularity of liposuction. Today, in a fat grafting procedure, fat is harvested from the body by liposuction. The fat is gently prepared for injection back into the body, and then grafted into an area of deficit with small needles or cannulas. The fat is carefully placed in multiple tissue planes so that it receives plenty of oxygen and nutrients so it can develop a new blood supply. The fat that survives provides the soft tissue volume to address areas of need. The fat that does not survive is absorbed.

What are the common sites of fat grafting?

The most common areas for fat transfer are the face, breast, buttocks and hands. In the face, fat transfer can be done alone or combined with chemical peels or excisional techniques such as a facelift. Fat is typically placed in the cheeks, nasolabial folds (smile lines), and even hollowed temples. Very little volume is needed to improve these deficient areas.

Fat can also be used instead of implants to augment the breast or buttocks. These procedures require larger volumes of fat grafts and in some cases, require more than one surgical stage to get the desired result. Fat grafts can also be used to correct lumpectomy deformities after breast cancer treatment and contour irregularities after liposuction. Releasing the scar in these instances and filling the deficiencies with fat grafts is a powerful improvement tool.

What is the recovery?

Recovery after fat grafting alone is generally rapid and may only be prolonged if additional procedures are performed at the same time. As an example, fat grafting to the cheeks alone may result in bruising of the cheeks and minor discomfort at the fat donor site (where the fat was taken), but requires no time away from work. If this is combined with a full facelift, then the recovery may require 2-3 weeks away from work. Recovery is also longer if a larger volume of fat is transferred. For example, a buttock lift where 600cc of grafts are placed will require 2-3 weeks of recovery compared to the fat grafting of 10cc to the cheeks where you return to work in 2-3days. After an isolated fat grafting procedure, you might notice a week or two of swelling, possibly more if the volume of grafts is high. The injected areas will likely be bruised and feel firm. The sites where the fat was taken will follow a similar recovery. The incisions are small so once swelling and bruising improve, you can be back to regular activities in a relatively short time.

Are there any complications?

Complications like infection can occur but are rare with isolated fat grafting. Donor site complications such as bleeding or contour irregularities are also rare. An additional complication is “loss” of the graft. This refers to fat not picking up a blood supply and being absorbed over time. Typically we wait to judge the increase in volume for 3-6months after the procedure to ensure that the fat has survived.

If you look in the mirror, and see fat that you wish were somewhere else, fat grafting may be a great procedure for you. Come meet with one of the board-certified physicians of the Emory Aesthetic Center. We can discuss your goals and see if fat grafting alone or in combination with other procedures is right for you.

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or call us at 404-778-6880 to schedule a consultation.
emoryaesthetic.org

About Dr. Anderson

anderson-ericaErica Anderson, MD, is board certified by the American Board of Plastic Surgery and currently holds an appointment as Assistant Professor in the Division of Plastic Surgery at Emory University. Dr. Anderson completed her general surgery residency and plastic surgery residency at the University of Colorado Health Sciences Center and associated hospitals in Denver, CO. She completed a year of advanced training in Aesthetic Surgery at Grotting Plastic Surgery in Birmingham, Alabama.

Dr. Anderson returns to Emory University after being in private practice in Arlington, Virginia. While there, she maintained a busy aesthetic and reconstructive practice and also served as Medical Director for the Wound Healing and Hyperbaric Center at Virginia Hospital Center.

Dr. Anderson’s academic and research interests are largely focused on clinical outcomes with regards to cosmetic surgery. Her areas of clinical interest are diverse including cosmetic surgery of the breast and body as well chest wall reconstruction and wound care.

Dr. Anderson is married with 3 children, Trent, Connor and Fiona, and 2 vizslas, Max and Mimi.

Your Weight and Plastic Surgery: Why It Matters

exercising-2womenSometimes patients will go into a plastic surgeon’s office excited about a decision to finally move forward with breast or body contouring surgery, but then afterwards emerge having found out they are not currently a candidate because of excess body fat. This scenario is not only disappointing, but it can be an emotionally deflating and potentially embarrassing experience for patients. As plastic surgeons we sympathize over the emotional pain that such patients feel, and we want to help them realize their goals. However there are several specific reasons that your plastic surgeon might recommend weight loss prior to undergoing a procedure and our motivations are only to provide you with the safest care and the best results.

According to the Centers for Disease Control (CDC), currently 69% of the U.S. population over 20 years of age is overweight. Of this percentage, 35% is obese. So how does the CDC calculate this statistic? First, the CDC defines “normal” weight, “overweight” and “obese” using a formula that calculates Body Mass Index (BMI). This is based on your height and weight. A “normal” BMI is 20-25, “overweight” is defined as a BMI of 25-30, and a BMI over 30 is technically considered “obese”. The BMI calculation is not perfect – for instance it does not take into account muscle mass versus fat mass – yet it is a pretty good basic measurement nonetheless. And it is important to us as plastic surgeons because BMI is a good predictor of the risks of surgery and the likelihood of a good result.

Many medical studies have shown that increased BMI is a predictor of potential complications that can occur from plastic surgery. A higher BMI is associated with an increased risk for wound complications, such as dehiscense (the wound opens up), infection, or tissue necrosis (tissues do not survive due to poor blood supply). The increases are typically small for patients who are overweight – a BMI 25-30, but they start increasing quickly as the BMI enters into the obese range. In general, it is a fair statement that the higher the BMI, the higher the risks of surgery. These complications can be significant, so as plastic surgeons we consider these risks with great thought.

In addition, the results that you can get are likely to be much better if your weight is in a better range. Let’s consider a couple of examples. Say, for instance, that a patient wants breast reduction surgery, but they are very heavy. Even when the breasts become smaller and more uplifted, it is extremely difficult for us to deal with the fullness lateral to the breasts (the “bra roll”), which significantly compromises the aesthetic result. In addition, it is much harder to get a beautiful transition between the breast and the abdomen due to the excess weight. On the other hand, let’s consider the patient that is overweight and wants a tummy tuck or liposuction. In this instance, the surgeon will not be able to remove all the excess fat in these areas, as it is technically challenging and can look odd as it is out of proportion to the surrounding fatty deposits. Even a lot of liposuction cannot fully solve this problem. Body contouring surgery is great for shaping your body, but it is not a method or substitute for weight loss or weight control.

What is the “cutoff” BMI number for plastic surgery? That is a difficult question, and there are some exceptions based on individual surgical procedures, body fat distribution, muscle mass and other factors. Many plastic surgeons consider a BMI above 30 or 32 to be in the range where surgery should be delayed until weight loss is achieved. If you are interested in calculating your own BMI, there are several free online tools, including the one from the Emory Bariatric Center.

As plastic surgeons I believe that we have an ethical responsibility to guide our patients related to their weight and desire for surgery. When surgery is unfavorable due to weight, there is the opportunity to partner toward a weight loss goal. Struggling with excess weight is a problem that so many of us deal with, and it is good to know that someone is on your side and understands. We can provide some advice, but even more importantly we can help guide you toward weight loss experts that help with diet modification and even newer procedures – such as the recently approved intragastric balloon – to assist with weight loss. Let the board certified plastic surgeons of the Emory Aesthetic Center, along with the Emory Bariatric Center, help you achieve the weight and body that you want. Imagine the joy of finally getting your weight under control, and then having the surgery you want to get the most effective results.

404-778-6880
emoryaesthetic.org
Click here to schedule your personal consultation.

About Dr. Eaves

eaves-iii-felmontDr. Eaves recently returned to Atlanta, Georgia, to head the Emory Aesthetic Center as Medical Director, having previously completed his plastic surgery residency as well as a fellowship in endoscopic and minimally invasive plastic surgery at Emory University, The Emory Clinic, and associated hospitals. Before joining the Emory Aesthetic Center, Dr. Eaves was a partner in Charlotte Plastic Surgery for more than fifteen years and served as group president from 2010-2012.

His professional and institutional committee memberships and offices include an impressive list of national, international and local plastic surgery organizations, societies, boards, task forces, advisory councils, coalitions and foundations, including having served as President of the American Society for Aesthetic Plastic Surgery (ASAPS) from 2010-2011 and Trustee (2011-Present).

Dr. Eaves’ primary areas of academic inquiry have been in minimally-invasive and endoscopic aesthetic surgery, patient safety, system and process improvement in plastic surgery, evidence-based medicine applied to plastic surgery and recontouring surgery after massive weight loss. He has received several patents for new medical devices he developed, and has made major clinical service contributions to his field. Dr. Eaves has published more than 100 articles, book chapters and book reviews on plastic surgery in peer reviewed publications, as well as manuals, videos, computer programs and other teaching aids and has coauthored the first textbook on the topic of endoscopic plastic surgery.

Enhancing Your Shape with Liposuction

Screen Shot 2015-09-04 at 1.29.17 PMYear after year, liposuction remains the most common cosmetic surgical procedure in the United States and around the world (although breast augmentation often competes for the top spot). Cosmetic surgeons who perform liposuction are not surprised, as liposuction is one of the most powerful tools in their toolbox to help patients. Many patients, however, may not always be aware that liposuction can work to shape your body in several ways . . . not just as an isolated technique to remove fat.

Liposuction really came into its own during the 1980s. The principal of liposuction is simple – fluid is injected into the fatty layers to help remove the tissue and reduce bleeding, then a blunt hollow tube (a ‘cannula’) is inserted through tiny incisions to suck out the fat. Surgeons move the cannula into different layers and patterns to reduce the thickness of the fat layer and create a smooth surface.

Over the years, several adjunctive technologies have been developed to help with liposuction. These include ultrasonic assisted liposuction (UAL, sound waves help break up the fat), laser assisted liposuction (LAL, the laser energy helps disrupt the fat), power assisted liposuction (PAL, a vibrating tip helps break up firm tissues), and water assisted liposuction (pulses of water help break up the fat). Although the companies that produce these machines will always claim theirs is the best, all of these technologies – including standard traditional liposuction (SAL) without an energy source – work very well. The surgeon’s familiarity with the technology is far more important than which machine they use. As a patient, you should pick the surgeon, and let them use the technology that they feel will work best, rather than be pulled in by fancy company advertising or an interest in a particular technology.

So how can liposuction enhance your shape? Liposuction can remove fatty deposits of the stomach, the flanks (‘love handles’), the thighs, the back, the arms, and under the chin. Patients often treat many areas at one time, and that is a safe and logical strategy, as long as the amount of aspirate (the liquefied fat and liquid that is sucked out) does not exceed recommended amounts. Your surgeon will use the fat removal to, in essence, sculpt your new look. By removing fat in certain areas and leaving the normal fat in others, your contours and curves are optimized.

However in addition to just removing fat, liposuction is important in two other ways. When patients have loose skin, liposuction can be combined with skin removal to create dramatic improvements. A tummy tuck is a great example of how liposuction and excision can be combined . . . by removing the loose skin the tummy skin become tight and smooth, but by adding liposuction the fatty layers can be reduced and shaped as well. It is a great combination.

As a final mechanism, liposuction can function in reshaping your body by providing fat that can be put into other areas where you would like more volume. Over the past 5-10 years, this has been an exciting development in body contouring surgery, as cosmetic surgeons have gotten better and better at using fat to enhance shape. Harvesting fat in one area through liposuction, and then injecting it into another area (‘fat grafting’) can be very powerful. The transplanted fat can enhance volume in areas like the buttocks, the breasts, or the face (think fuller cheeks or softening the deeper grooves around the mouth).

It is important to remember that liposuction is not a weight loss solution – if you need to loose weight, you will get your best results if you do so prior to having liposuction. It is also important to realize that liposuction cannot tighten loose skin. If someone has loose skin in an area where fatty deposits are to be removed, then a combination of liposuction with resection of the loose skin (think tummy tuck with liposuction) is much more likely to give a good result. Liposuction works best in patients who are at a good body weight, have smooth, elastic skin, and where the fatty deposits they want to treat aren’t too big and are well defined.

If you are thinking about how to reshape your body, come in and see one of our board certified cosmetic surgeons at the Emory Aesthetic Center. We can look at your body, help you think through and refine your goals, and figure out how liposuction – or other minimally invasive or surgical procedure – can help you achieve the body shape that you want.

404-778-6880
emoryaesthetic.org
Click here to schedule your personal consultation.

How To Get Cosmetic Surgical Results Without Surgery

natural-beautyNo one really wants to have surgery if they don’t need it; therefore, it isn’t surprising that cosmetic surgeons are asked quite often how someone can get surgical results without actually having surgery. Well, it certainly sounds good . . surgical results without surgery, right? The problem is that it really doesn’t work that way. The long and the short of it is in order to get the dramatic results of surgery, you have to have surgery. But with all of the new non- and minimally-invasive treatment options that have become available in recent years, the answer isn’t always so cut and dry, and there are options. It is not a matter of good versus bad, but really understanding the differences between the surgical and the non-surgical options, and figuring out which one is going to best help you achieve your goals.

The facial region is the area with the greatest number of non-surgical options, from Botox® to dermal fillers and chemical peels to lasers and micro-needling. Non-surgical treatments can be quite effective in the face when you are treating the right problem. Botox® does a wonderful job of temporarily softening wrinkles in the forehead, between the brows, and the sides of the eyes. Dermal fillers can plump up the cheeks and minimize creases around the mouth. Skin products, in-office chemical peels, Intense Pulsed Light (IPL), micro-needling, and lasers can do a superb job of improving the fine wrinkles, texture, and pigment in the skin. However, if you are looking to reduce the jowls, tighten the neck or lift droopy brows or eyelids, then non-surgical treatments won’t provide the results that you seek. It is extremely common patients will undergo a blend of surgical and non-surgical procedures to take advantage of the strengths of both. In younger patients who are not yet ready for surgery, non-surgical options may provide them exactly what they want.

For breast augmentation, the surgical versus non-surgical comparison doesn’t work, because there really aren’t non-surgical options to do the things that patients want. At the present time you can’t increase the breast size, reduce the breast size, or lift up drooping breasts without surgery. In the breast, though, the discussion is often around full length or reduced incision approaches. Like non-surgical treatments, reduced scar approaches sound really positive – and of course who wouldn’t want that? However, in some cases a full scar approach is required to get the degree of results that a patient wants or needs.

Only recently have significant non-surgical options emerged for treatment of the abdomen, flanks, and thighs. These treatments are directed at two primary goals – reducing the fatty layers and tightening the skin. Infrared therapy, external ultrasound, and cryolipolysis (fat freezing) are all energy devices approved to reduce the thickness of the fatty layer. CoolSculpting® is a fat freezing treatment currently available, and it is the treatment that we have chosen to offer at the Emory Aesthetic Center due to the level of comfort experienced by patients and the medical studies that support its use. But not all patients get the results that they seek. And while a few patients don’t seem to achieve much of a result, a small number of patients are “super-responders” who can get a dramatic result, sometimes with just one treatment. But overall, most patients will see a 10-20 percent improvement in an area with a single treatment, but for additional improvement they will need repeat treatments. Liposuction is the surgical counterpart to fat freezing. Not surprisingly, liposuction allows us to treat more areas at a time, be more aggressive in fat removal, and depending on the number of areas to treat and the number of CoolSculpting® sessions, sometimes liposuction can be less expensive as well.

At this point, non-surgical treatments seem to do a better job at fat removal than skin tightening. For this reason, there isn’t much in the way of non-surgical options for patients that may have significant skin laxity, for example when they need a tummy tuck or thigh lift. In these instances, surgical resection can be combined with liposuction to not only tighten the skin, but to sculpt the tissues as well. It is because of this combined strategy that tummy tucks, for instance, can produce some of the most dramatic improvements of any of the surgeries that plastic surgeons perform. However, if a patient is young and has generally good skin quality, with limited fatty deposits, fat freezing without the need for surgery can be a great option.

To pull it all together, there are some things that surgery can do that non-surgical treatments simply can’t do. In other cases non-surgical treatments can be highly effective and can provide for you the results you want – without the need for a surgical procedure or significant recovery period. What is best for you depends on your specific appearance, your tissues, and your goals. At the Emory Aesthetic Center, we are happy to be able to offer the entire spectrum of surgical and non-surgical options. Our board-certified physicians can work with you to determine the best solution for you and your desired result.

404-778-6880


emoryaesthetic.org


Click here to schedule your personal consultation.

About Dr. Eaves

eaves-iii-felmontDr. Eaves recently returned to Atlanta, Georgia, to head the Emory Aesthetic Center as Medical Director, having previously completed his plastic surgery residency as well as a fellowship in endoscopic and minimally invasive plastic surgery at Emory University, The Emory Clinic, and associated hospitals. Before joining the Emory Aesthetic Center, Dr. Eaves was a partner in Charlotte Plastic Surgery for more than fifteen years and served as group president from 2010-2012.

His professional and institutional committee memberships and offices include an impressive list of national, international and local plastic surgery organizations, societies, boards, task forces, advisory councils, coalitions and foundations, including having served as President of the American Society for Aesthetic Plastic Surgery (ASAPS) from 2010-2011 and Trustee (2011-Present).

Dr. Eaves’ primary areas of academic inquiry have been in minimally-invasive and endoscopic aesthetic surgery, patient safety, system and process improvement in plastic surgery, evidence-based medicine applied to plastic surgery and recontouring surgery after massive weight loss. He has received several patents for new medical devices he developed, and has made major clinical service contributions to his field. Dr. Eaves has published more than 100 articles, book chapters and book reviews on plastic surgery in peer reviewed publications, as well as manuals, videos, computer programs and other teaching aids and has coauthored the first textbook on the topic of endoscopic plastic surgery.

Can Men Get Plastic Surgery?

guysAt the Emory Aesthetic Center, we have traded in our Cosmopolitan subscription and replaced it with Sports Illustrated. Why? It’s simple. Plastic surgery is no longer just for women.

Today, we are seeing more and more men of all ages requesting plastic surgery for cosmetic reasons. We’ve discovered that men are just as worried about their appearance as women. But it is important to know that men’s needs may be different, as most cosmetic procedures have been designed with women in mind. Factors to consider include skin thickness, beard growth, and body type.

Let’s review the top plastic surgery procedures men are requesting by the numbers.

Face-Lift/Neck-Lift
Results last: 10 to 15 years
Recovery: 7-10 days
Cost: $12-14,000

Eyelid Lift
Results last: 15 to 20 years
Recovery: 7-10 days
Cost: $6-8000 for upper and lower (half of that for just upper)

Body Liposuction
Results last: Depends on maintaining a healthy lifestyle and weight
Recovery: 1-2 days
Cost: minimum $4500-unmlimited based on areas treated

Breast Reduction
Results last: Permanent
Recovery: 2-3 days
Cost: $8-10,000

Rhinoplasty
Results last: Permanent
Recovery: 5-7 days
Cost: $7-9,000

Botox®
Results last: 6 to 9 months
Recovery: 0 days
Cost: $300-600 per treatment

Dermal Fillers
Results last: 1 to 2 years
Recovery: 1-2 days
Cost: $450-800 per syringe

At the Emory Aesthetic Center, our board-certified physicians understand that the delivery of plastic surgery is different for men than women. We will approach your individual goals with personal attention and help you choose the procedure that is right for you.

404-778-6880
emoryaesthetic.org

About Dr. Anderson

Erica Anderson, MDErica Anderson, MD, is board certified by the American Board of Plastic Surgery and currently holds an appointment as Assistant Professor in the Division of Plastic Surgery at Emory University. Dr. Anderson completed her general surgery residency and plastic surgery residency at the University of Colorado Health Sciences Center and associated hospitals in Denver, CO. She completed a year of advanced training in Aesthetic Surgery at Grotting Plastic Surgery in Birmingham, Alabama.

Dr. Anderson returns to Emory University after being in private practice in Arlington, Virginia. While there, she maintained a busy aesthetic and reconstructive practice and also served as Medical Director for the Wound Healing and Hyperbaric Center at Virginia Hospital Center.

Dr. Anderson’s academic and research interests are largely focused on clinical outcomes with regards to cosmetic surgery. Her areas of clinical interest are diverse including cosmetic surgery of the breast and body as well chest wall reconstruction and wound care.

Dr. Anderson is married with 3 children, Trent, Connor and Fiona, and 2 vizslas, Max and Mimi.

Non-Surgical and Surgical Body Contouring: Setting Realistic Expectations

Body Contouring Expectations

As we kick-off the summer months and have officially reached bathing suit season, it is natural that many of us take a look in the mirror and think about how we might change our body.  In addition to keeping a healthy diet and exercising regularly, there are now more choices than ever in how we might achieve our goals. But with so many choices, both surgical and non-surgical options, choosing what body contouring procedure is best for you can be difficult.  How can you know which is best, and how can you make sure that your expectations are realistic?

 At the Annual Meeting of the American Society for Aesthetic Plastic Surgery (ASAPS), held this year in Montreal, Canada, plastic surgeons from around the world discussed exactly these kinds of questions. This year, I participated in back-to-back panels on body contouring, and thought that the folks here in Atlanta would be very interested in hearing what the experts are saying about the various body contouring procedures and the kind of results that can be expected.

The first panel, which I chaired, was on non-surgical body contouring, and how it compares with liposuction. Anesthesia is not required for these non-surgical procedures and usually one can return to full activities virtually the same day. Such procedures include cryolipolysis, radiofrequency, and different types of external ultrasound. These technologies all work differently but are designed to accomplish the same thing – remove unwanted fat without surgery. Cryolipolysis, better known as CoolSculpting®, does this by freezing the fatty tissues; radiofrequency treatments heat the tissue under the skin; and ultrasound uses sound waves to break up fat cells.

After the panel discussed issues for an hour, several “take home” messages were clear to the doctors. First, non-invasive body contouring procedures do work and are well tolerated by patients, but the results can be significantly less dramatic than those from liposuction. Second, to get the desired results, most patients need repeat treatments of the same area. And third, not everybody is a good candidate for non-surgical fat reduction. The best patients for non-surgical body contouring are at an overall good body weight, have firmer, elastic skin and have a limited number of areas to treat. Patients who will do better with liposuction or a tummy tuck include those who are older or have less skin elasticity, women post pregnancy who may need a tummy tuck, or those with larger, more diffuse fat collections.

The second panel was on abdominoplasty, otherwise known as tummy tucks.  Despite the new non-surgical technologies that are emerging, the number of tummy tucks done each year in the United States continues to grow. There are several reasons for this continued growth in the number. First of all, tummy tucks really work, and the results can be among the most dramatic of the body contouring procedures. Second, there have been significant improvements in the way abdominoplasties are performed. These include better ways to control pain after surgery (for example with pain pumps and long lasting local anesthetics), the eliminated need for drains in many patients, and better control of scarring. Third, as many are working hard to control their weight and keep their body in shape, they realize that neither non-surgical treatments nor liposuction will tighten their loose skin, something that is at the core of abdominoplasties.

So as you look in the mirror, how do YOU make sure that you choose a body contouring method that is best for you, and what should you expect? The most important thing is to have a consult with a physician who can offer you the entire spectrum of options – non-surgical, liposuction, or tummy tuck. Listen to what they say. In some cases, patients will have loose skin of the abdomen and weak muscles after pregnancy, and in these cases, nothing short of a tummy tuck will give significant results. In other cases with isolated, small fat pockets, non-invasive CoolSculpting® may be an excellent option. And still in other cases where there are many body areas a patient may want to treat, liposuction may be more effective and cost less in the long run than non-surgical treatments. Ask the doctor about how your skin will change after the procedure, what your recovery will be like, how many treatments will be necessary, and how the treatment options compare. Working with a cosmetic surgeon who has experience with all the options is the very best way to set expectations that are realistic for you.

There is a great old saying that “if the only tool you have is a hammer, the whole world looks like a nail”. In the world of body contouring, nothing could be more true. Many centers that offer non-surgical treatments can’t offer you liposuction or a tummy tuck, so guess what? They’ll offer you what they have. Even worse, in many cases you might not even be evaluated by a physician who is trained in all the different techniques, so they can’t help guide you to compare realistic expectations between the options. And for those who are not good candidates for non-surgical technologies, this can be a prescription for disappointment.

At the Emory Aesthetic Center, we not only offer the full spectrum of body contouring options – from CoolSculpting® to liposuction to abdominoplasty (tummy tuck) – but we also require that all patients interested in body contouring have a consultation with one of our board certified physicians to discuss exactly these issues. We want you to love the results of your treatment, and we will work with you to help you find the best body contouring option for you and to set realistic expectations.

404-778-6880
emoryaesthetic.org

About Dr. Eaves

Felmont Eaves, MDDr. Eaves recently returned to Atlanta, Georgia, to head the Emory Aesthetic Center as Medical Director, having previously completed his plastic surgery residency as well as a fellowship in endoscopic and minimally invasive plastic surgery at Emory University, The Emory Clinic, and associated hospitals. Before joining the Emory Aesthetic Center, Dr. Eaves was a partner in Charlotte Plastic Surgery for more than fifteen years and served as group president from 2010-2012.

Liposuction versus CoolSculpting®: Which is Right for You?

Lipo vs CoolSculptingLiposuction and CoolSculpting® are two very different procedures that are designed to reduce unwanted fatty deposits. So with both procedures producing the same outcome in the end, how are you to decide which is best for you? Like so many things in cosmetic medicine, it depends . . .Let me break down the differences between the two so that you can make the best decision for you.

Liposuction was developed in the 1980’s and has been around a lot longer than CoolSculping. There are now many types of liposuction including Suction Assisted Lipectomy (SAL) – the original technique but still a great one; Ultrasound Assisted Liposuction (UAL) that uses sound waves to break up the fat, Power Assisted Liposuction (PAL) that uses vibration, Laser Assisted Liposuction (LAL) that uses laser energy, and Fluid Assisted Liposuction (FAL) that works like a water jet. Despite the different approaches, all of these techniques can work well, and none is clearly superior over the other, despite marketing claims to the contrary.

Liposuction is a surgical procedure and can be performed under local anesthesia, under sedation, or with full general anesthesia. The type of anesthesia you will need depends on the area(s) to be treated and the amount of fat that needs to be removed. In general, the more areas that you treat, the more sedation or full general anesthesia you will need. The incisions for liposuction are small, typically less than 1/4 inch, so there isn’t much scarring. There is, however, a recovery period that lasts for a few weeks – bruising and swelling are most common. Patients can usually resume light exercise after a few days.

As opposed to liposuction, CoolSculpting® is a non-invasive procedure that doesn’t require anesthesia at all. The CoolSculpting system includes a disposable gel pad that is placed over the treatment area. A cooling head is then placed over the gel pad and suction is activated. The machine has a base that cools the liquid flowing through the headpiece and pulls the fatty area into the head, therefore, freezing the fat. After an hour or so (or two hours for a non-suction treatment type) the cooling head is removed and the frozen area is massaged briefly. Although there can be some discomfort when the tissue is first pulled into the cooling head, this becomes numb once the cooling starts and the massage doesn’t hurt. Like liposuction, it takes a few weeks to see the final result, and although there really isn’t much pain, like liposuction, the treated area can feel a little tender for a while.

Liposuction is the more aggressive treatment of the two, allowing more fat to be removed in a single session. Because CoolSculpting removes less fat per treatment, patients may need several sessions of CoolSculpting to get their optimal result.

Patients who are thinking about other cosmetic surgical procedures may be better candidates for liposuction than CoolSculpting since they would already be under aesthesia. In addition, the combination of liposuction with an excisional procedure (think tummy tuck with liposuction) is very powerful and can deliver dramatic results. Another example of when liposuction is preferable is when a patient might want to add volume to an area and they want to do so with their own fat. Liposuction can be used to harvest fat for fat transfer to another site. Liposuction is often preferred when there are many body areas that the patient wants treated, as these can be done all at one time, rather than over many different sessions with CoolSculpting.

CoolSculpting can be a great option for smaller fatty deposits. It is also a great choice for patients that are keen to avoid surgery, either for personal preference or because of health issues that may increase the risk of surgery.

Patients always wonder which is more cost effective – liposuction or CoolSculpting. This is another it depends situation. If a patient is treating a single small area that will probably be effectively treated with two sessions, then CoolSculping makes a lot of sense and may be cheaper. However if there are multiple sites to treat, and some of these will need three or more CoolSculpting sessions to get full resolution, then liposuction may be the less expensive of the two.

In the long run the choice of which is best for you depends on you – how you feel about it, what issues are the most important, and how aggressive you want to be in removing the fat. If avoiding surgery is super important to you, and you’ll accept less dramatic results in order to do so, then CoolSculping might be your best option. On the other hand, if you’d rather get as much fat off as possible, and would rather do this in one session instead of several, then liposuction may be your best bet. Let the board certified cosmetic surgeons at the Emory Aesthetic Center help you figure out what approach is best for you.

404-778-6880
emoryaesthetic.org

About Dr. Eaves

Felmont Eaves, MDDr. Eaves recently returned to Atlanta, Georgia, to head the Emory Aesthetic Center as Medical Director, having previously completed his plastic surgery residency as well as a fellowship in endoscopic and minimally invasive plastic surgery at Emory University, The Emory Clinic, and associated hospitals. Before joining the Emory Aesthetic Center, Dr. Eaves was a partner in Charlotte Plastic Surgery for more than fifteen years and served as group president from 2010-2012.

His professional and institutional committee memberships and offices include an impressive list of national, international and local plastic surgery organizations, societies, boards, task forces, advisory councils, coalitions and foundations, including having served as President of the American Society for Aesthetic Plastic Surgery (ASAPS) from 2010-2011 and Trustee (2011-Present).

Dr. Eaves’ primary areas of academic inquiry have been in minimally-invasive and endoscopic aesthetic surgery, patient safety, system and process improvement in plastic surgery, evidence-based medicine applied to plastic surgery and recontouring surgery after massive weight loss. He has received several patents for new medical devices he developed, and has made major clinical service contributions to his field. Dr. Eaves has published more than 100 articles, book chapters and book reviews on plastic surgery in peer reviewed publications, as well as manuals, videos, computer programs and other teaching aids and has coauthored the first textbook on the topic of endoscopic plastic surgery.

Realistic Liposuction Results: What Can I Expect?

Liposuction ResultsUnderstanding what any treatment can do . . . and even more importantly, what it can’t do . . . is critical for you to know when considering the best cosmetic procedure to address your individual needs. This is particularly true for liposuction, as the tremendous popularity of the procedure has spawned some misconceptions and unrealistic expectations. In the right patient liposuction is a wonderful procedure with small scars, quick recovery, and dramatic results. However, in the wrong patient liposuction can lead to disappointment, and if pushed beyond appropriate limits, can even lead to deformity requiring surgical repair.

One of the most common misconceptions about liposuction is that it can help you loose weight. Liposuction, in general, is not an effective weight loss tool. In order to keep the procedure safe, there are long-standing recommendations to limit the amount of liposuction done on an outpatient basis. Very large amounts of liposuction can be associated with the development of loose skin in the treated areas.

Another misconception about liposuction is that it can tighten loose skin, especially if it is “laser liposuction” or “ultrasonic liposuction”. For sure the skin will retract some after any liposuction technique due to the skin’s inherent elasticity, however meaningful tightening typically doesn’t occur, despite marketing claims. Although rare, I’ve had to help a couple of patients in which their surgeon pushed an energy-based liposuction (laser or ultrasound) too far in hopes of tightening the skin. Doing this can lead to an irregular appearance to the skin, lumps, and even burns and visible scarring. The long and the short of it is, if you have significantly loose skin and want it to be smoother and tighter, liposuction by itself is probably not the procedure for you.

Cellulite – that frustrating, pitting appearance of the thighs or buttocks – is another area that patients sometimes expect liposuction to help but it really doesn’t. Currently there aren’t great treatments for cellulite that give consistent and dramatic results (again, despite the marketing!). Sometimes patients have pits that are associated with loose skin but don’t have real cellulite, and in these cases a body lift – not liposuction alone – can help these areas. Here’s a test you can do at home — lift up on the skin above the pitting area. If the pits smooth out dramatically, then the pits are probably related to loose skin in the area and you might be a candidate for a lifting procedure. If you lift and the pits just stare back at you, then a lift is probably not for you.

We’ve just reviewed the things that liposuction doesn’t do, but the great news is that liposuction of the right amount and in the right patient is safe, effective, and gives predictable results. The patients that do the very best with liposuction are at a good weight but have certain stubborn areas that just won’t go away with diet or exercise. The best candidates also have tighter, more elastic skin. Often, but not always, that means that younger patients are better candidates for liposuction.

However if you have some loose skin, don’t despair. Liposuction can still be a powerful tool to contour your body when combined with an excisional procedure. For example, let’s say you have some fatty collections in the love handle area and in the front of the tummy but you have loose skin in the lower part of the tummy. In this case you may be a great candidate for liposuction combined with an abdominoplasty (tummy tuck). Liposuction can smooth and contour the flanks and can thin the upper abdomen while excision of the fat and loose skin of the lower tummy will tighten everything up.

Another area where it is good to set expectations relates to recovery. Patients always want to know how they’ll feel after liposuction, how long it takes for the pain to fade, and how long until the swelling is gone and they see their final result. In general, liposuction is less painful and with a quicker recovery than excisional procedures, like a tummy tuck. Patients are often able to return to work after only a few days, and although they have some soreness for a couple of weeks, they are able to function well. Usually patients can resume light exercise within 2 weeks. There will be swelling, although often even swollen areas look better than before surgery. The majority of the swelling is gone by 3-4 weeks, although subtle amounts of swelling can take 3-6 months to resolve. You may also develop some bruising, and if so, this typically fades away within a couple of weeks.

Liposuction is the most common aesthetic surgical procedure performed in the United States, and with good reason: liposuction works and it works well. It works best in patients who are good candidates and who are not trying to have liposuction do more than it is capable of delivering. The board certified physicians of the Emory Aesthetic Center are happy to consult with you about what are reasonable expectations of liposuction in your individual circumstance, and help develop a treatment plan specific to you.

404-778-6880
emoryaesthetic.org

About Dr. Eaves

Felmont Eaves, MDDr. Eaves recently returned to Atlanta, Georgia, to head the Emory Aesthetic Center as Medical Director, having previously completed his plastic surgery residency as well as a fellowship in endoscopic and minimally invasive plastic surgery at Emory University, The Emory Clinic, and associated hospitals. Before joining the Emory Aesthetic Center, Dr. Eaves was a partner in Charlotte Plastic Surgery for more than fifteen years and served as group president from 2010-2012.

His professional and institutional committee memberships and offices include an impressive list of national, international and local plastic surgery organizations, societies, boards, task forces, advisory councils, coalitions and foundations, including having served as President of the American Society for Aesthetic Plastic Surgery (ASAPS) from 2010-2011 and Trustee (2011-Present).

Dr. Eaves’ primary areas of academic inquiry have been in minimally-invasive and endoscopic aesthetic surgery, patient safety, system and process improvement in plastic surgery, evidence-based medicine applied to plastic surgery and recontouring surgery after massive weight loss. He has received several patents for new medical devices he developed, and has made major clinical service contributions to his field. Dr. Eaves has published more than 100 articles, book chapters and book reviews on plastic surgery in peer reviewed publications, as well as manuals, videos, computer programs and other teaching aids and has coauthored the first textbook on the topic of endoscopic plastic surgery.

Tummy Tucks 101: Answers to Frequently Asked Questions

tummy tuck 101Tummy tucks – also known as abdominoplasties – have grown significantly in popularity over the past 15 years, and they are now one of the most common procedures performed by plastic surgeons. Part of the reason why tummy tucks have grown in popularity over the years is our increased focus on health and fitness, but another big reason is that tummy tucks can provide dramatic results. There have been recent advances in the procedure that offer better pain control and a better recovery. Now may be a good time to take a fresh look at some of the most common questions that patients ask us about abdominoplasties.

“Do I need a full tummy tuck, or can I have a smaller scar – say with a “mini” tummy tuck or just liposuction?”

There is not just one type of tummy tuck – abdominal contouring can include a variety of approaches depending on one’s individual situation. It is often helpful to think of a tummy tuck in terms of where the problem is. Is there too much loose skin, is there too much fat, or have the muscles been stretched or separated by pregnancy? If your skin is relatively tight then you may be a good candidate for a reduced scar approach, such as liposuction (tiny scars), an endoscopic abdominoplasty (1-2 inch scar), or a mini-abdominoplasty (a scar about the length of a C-section). On the other hand, if there is a lot of loose skin that you will need tightened, that will require a longer scar. If there is too much fat, then liposuction can be combined with the removal of skin – a very common situation. If the muscles are separated, then some sort of tummy tuck with muscle repair is needed, however the incision can be short or long depending on the skin.

“Do I have to have a drain after a tummy tuck?”

Historically the answer to that question was “yes”; however, new techniques have eliminated the need for drains in many cases. We now can use special stitches – known as progressive tension sutures – to seal the tissue together so that there is no need for a drain. The progressive tension technique has another advantage as well; it often allows us to remove a bit more skin than we could otherwise. Although I currently can’t prove it, I also suspect that the sutures help make the scar from the tummy tuck better because they reduce the tension on the skin during healing. Patients love it when they don’t have to have drains.

“How much pain will I have after a tummy tuck?”

Historically tummy tucks were one of the more painful operations that plastic surgeons performed, especially when repair of the muscles was required. Over the past several years, the development of some new ways of controlling pain has helped this situation a lot. First came the development of pain pumps – these are devices that push a local anesthetic through a small tube and into the area of surgery. These were very helpful and many surgeons still use them, but it requires a tube coming out of the skin. More recently there has been the development of a long lasting local anesthetic which can give significant pain control for up to 3 days, and it doesn’t require a tube. Good pain control clearly makes the recovery more pleasant. It also means that less narcotic pain medicine is required; therefore, there is less chance of a reaction to the medication. In addition, it may make the surgery even safer by allowing patients to move around more easily and to be more active.

“How long is the recovery after a tummy tuck?”

Well, the answer depends on several factors and to what level of recovery you are thinking about. If you don’t need the muscles repaired, it is likely that your recovery is going to be easier and quicker. Most patients having a full tummy tuck (with muscle repair) find that they are generally able to drive a car within a week, depending on their pain level (remember you don’t want to drive when on narcotic pain medicine). Many patients can work remotely from home, and find that they are able to log on to their computers, answer emails, or even have a conference call after only a few days, although they won’t feel like going in to work for maybe 2-3 weeks post surgery. Light exercise (e.g. walking or gently peddling on a stationary bike) can start by this time as well. By 6-8 weeks, most patients would consider themselves fully or nearly fully recovered, although it is worth remembering that the nerves will continue to heal, the scar will continue to fade, and the swelling will continue to go down for several months.

“Will the results last?”

Yes! As long as your weight remains stable over time, abdominoplasties are typically a ‘once and done’ procedure, never needing to be repeated. Of course your skin will age a bit over the decades, but it usually never gets back to the looseness that you may have experienced before surgery.

“After pregnancy, my tummy needs help, but my breasts do, too. Can you work on both at the same time?”

Not only is the answer “yes”, but combining a tummy tuck with a breast lift or breast augmentation – popularly called a “mommy makeover” – is very common. Moms love their little ones, but it is great to get their bodies back, too!

Will a tummy tuck help my stretch marks?”

That depends on where the stretch marks are located, but the answer is usually “yes”. A full tummy tuck removes most of the skin in the lower abdomen, and any stretch marks in this zone will be removed along with the loose skin. Stretch marks outside of that zone are not really going to be helped.

The board certified physicians at the Emory Aesthetic Center keep up with the latest developments in abdominoplasty. We are happy to work with you to help create a plan that is best for you.

404-778-6880
emoryaesthetic.org

About Dr. Eaves

Felmont Eaves, MDDr. Eaves recently returned to Atlanta, Georgia, to head the Emory Aesthetic Center as Medical Director, having previously completed his plastic surgery residency as well as a fellowship in endoscopic and minimally invasive plastic surgery at Emory University, The Emory Clinic, and associated hospitals. Before joining the Emory Aesthetic Center, Dr. Eaves was a partner in Charlotte Plastic Surgery for more than fifteen years and served as group president from 2010-2012.

His professional and institutional committee memberships and offices include an impressive list of national, international and local plastic surgery organizations, societies, boards, task forces, advisory councils, coalitions and foundations, including having served as President of the American Society for Aesthetic Plastic Surgery (ASAPS) from 2010-2011 and Trustee (2011-Present).

Dr. Eaves’ primary areas of academic inquiry have been in minimally-invasive and endoscopic aesthetic surgery, patient safety, system and process improvement in plastic surgery, evidence-based medicine applied to plastic surgery and recontouring surgery after massive weight loss. He has received several patents for new medical devices he developed, and has made major clinical service contributions to his field. Dr. Eaves has published more than 100 articles, book chapters and book reviews on plastic surgery in peer reviewed publications, as well as manuals, videos, computer programs and other teaching aids and has coauthored the first textbook on the topic of endoscopic plastic surgery.