Your typical tummy tuck includes liposuction to the abdomen, removal of excess skin and often-times, abdominal wall tightening. It’s not always necessary but it’s important for the patient to be aware of this aspect of the procedure. The tummy tuck tightens the abdominal skin but the abdominal wall is a whole different animal.

When is abdominal wall tightening necessary

Here are some new words to learn! The abdominal wall is beneath the skin and is made up of fascia. The fascia is the abdominal wall covering that contains all of your organs. Sometimes after having kids, the abdominal wall fascia in the front stretches out around the six-pack muscles. These are the rectus abdominus muscles. When this area stretches during pregnancy and stays stretched, it’s called a rectus diastasis.

While the area contains muscles, the rectus muscles themselves don’t stretch or become weak. However, the left rectus muscle is moves further towards the left and the right rectus muscle is pushed more towards the right. The area in between the muscles is the rectus diastasis. Since the fascia stretches and not the muscles, doing crunches won’t “un-stretch” the fascia. Only a tummy tuck will fix this.

During the tummy tuck procedure, stitches tighten up the fascia to help flatten the tummy. So if you haven’t had kids or your abdominal wall recovered and you don’t have a rectus diastasis after pregnancy, you won’t need the abdominal wall tightening. It’s great if you don’t need it since this can be the most painful portion of the operation. Unfortunately, there’s no way to make your abdominal wall tighten after pregnancy with specific exercises. It either happens or it doesn’t. Cross your fingers you don’t need it!

To check pricing on a tummy tuck from Dr. Kaplan, click here.

Click here for the original blog post written by Dr. Jonathan Kaplan for BuildMyBod.

The post Tummy Tuck with Abdominal Wall Tightening first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

What’s the purpose of postop garments

It’s not clear why postop garments became such an integral part of cosmetic procedures. There’s not a peer-reviewed, multi-center, high quality study showing the effectiveness of using postop garments. Nothing similar to a drug trial with and without postop garments.

However, many surgeons use them. Here are some possible reasons.

After a breast augmentation, with fresh incisions under the breast, your surgeon may worry you’ll wear a bra with underwire. This could cause irritation to the incision, possibly risking it to open. To avoid this problem, your surgeon may recommend a special postop bra because they are usually soft, without much structure. And certainly don’t have underwire. Therefore, your surgeon knows exactly what you’re wearing after surgery and can rest easy it’s not a bra that will place undue stress on “their work.”

In the case of a tummy tuck or liposuction, the patient is often sore and the potential for fluid to collect under the skin is high. With swelling, the skin stretches, causing pain fibers to fire, putting the patient in more pain. To alleviate some of this pain, the garment can reduce the amount of swelling, theoretically reducing skin stretch and therefore pain.

While there’s no proof of these benefits in a large study, many patients like the garment and the “sense of security” it provides after surgery. It’s also interesting to see how many patients are reluctant to embrace the idea of a postop garment before the operation but come to appreciate its benefits after surgery.

Click on the links to check pricing on the procedures that often require a postop garment. Breast augmentation, tummy tuck, liposuction.

Click here for the original blog post written by Dr. Jonathan Kaplan for BuildMyBod.

The post Postop garments first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

What does a breast augmentation revision entail?

A breast augmentation revision can mean many things. First it depends on what the problem is. Did the implants bust or leak? Then a revision would mean an exchange of the old implants for the new implants. But then you have to decide, do you go up in size, switch from saline to silicone or silicone to saline? If you’re going down in size then you’ll need a lift to remove excess skin so the breasts don’t look deflated with the smaller implants.

In the video below, the patient was actually happy with the existing size of her implants (300cc). But she was unhappy about other things. As you’ll see in the video, she had a great deal of ptosis (droop) in the right breast. The other thing, which you can also see in the video, was rippling, a common undulation of the skin caused by saline implants.

Breast lift, capsulectomy, implant exchange

So when you review her concerns – droop of both breasts (right greater than left) and rippling – it’s clear what a revision means in her situation. She needs to remove excess breast skin to perform a breast lift to correct the droop. The rippling can be corrected by exchanging the saline implant with a silicone implant (but the same size implant).

She could also feel the implant on the undersurface of the left breast really easily. This was due to very little tissue between the skin and the implant. This was corrected during surgery by closing off the implant pocket with breast tissue so there’s more breast between the skin and the implant.

One additional issue that was apparent during the operation was the formation of thick scar tissue around the implant. This scar tissue is referred to as a capsule. When the scar is thick and can deform the breasts, that’s capsular contracture. The capsulectomy was included with her procedure as you’ll see below.

Video review of breast augmentation revision

To check pricing on breast augmentation revision from Dr. Kaplan, click here.

Click here for the original blog post written by Dr. Jonathan Kaplan for BuildMyBod.

The post Breast Augmentation Revision [video] first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

It’s a totally reasonable thing to do. Patients, when going in to see their plastic surgeon, bring “wish pics.” That is, a photo of someone (doesn’t have to be famous), that’s had the operation and the results they’re looking for. But reasonable intent can translate into unreasonable expectations.

What’s wrong with wish pics?

Patients bring in their wish pics all the time. It’s definitely helpful to see where they are and where they’re trying to go. This exercise also provides insight as to their expectations and self-image. Some patients have reasonable expectations. Whereas others have an inaccurate self-image preop and an inaccurate appreciation of what’s possible.

Wish pics therefore give an opportunity to have a frank and honest discussion. Sometimes they’ll bring in photos of celebrities that are of a different ethnicity and body shape that is physically impossible to emulate. However, I recently noticed an unexpected pitfall, especially in the case of breast augmentation –  they bring photos of clothed patients.

In some cases, when patients see themselves in the mirror, they view themselves naked. Then they look at a photo of someone else with a breast augmentation and say, “I want to look like that!” But the person in the photo is clothed, which covers up issues of asymmetry, stretch marks, lack of cleavage and other natural imperfections.

So you have to prepare the patient that they can’t conflate how good the breasts look in the photos and how they will look naked. In other words, don’t focus on how “perfect” the breasts look clothed. They may not look that perfect postop when looking in the mirror without clothes on.

One classic example is a patient wanting the cleavage present in a photo of a clothed person. It’s unclear if that cleavage is due to a push-up bra (which wouldn’t be utilized when naked) or if it’s au natural.

Don’t put the breasts on a pedestal

It’s also important that the patient doesn’t “put the breast on a pedestal!” Patients need to be reassured that everyone, even those in the photos, have imperfections when naked.

To discuss further with Dr. Kaplan and to check his pricing, click here.

Click here for the original blog post written by Dr. Jonathan Kaplan for BuildMyBod.

The post Pitfalls of breast aug wish pics! first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

Paying it forward

Video is critical to a patient’s preop education. They book their surgery and they want to be prepared. Reasonable enough. In the distant past, that meant talking to someone who had a similar experience. Then in the not too distant past, they started reading about it online. And now more recently, with the rise of video clips on Snapchat and YouTube, they’re watching the entire procedure ahead of time and checking the cost.

Patients benefit and appreciate that video preparation. So when the patient undergoes the procedure themselves, they want to educate those that come after them, i.e. paying it forward. In the case of a procedure under local anesthesia, patients are filming their own surgery. You can see an example below of a patient getting their upper eyelids “done.”

Video: Patients are filming their own surgery

Considering surgery? Click here and check pricing from Dr. Kaplan but also watch some video of the procedure!

Click here for the original blog post written by Dr. Jonathan Kaplan for BuildMyBod.

The post Patients are filming their own surgery! Yeah, that happens! [video] first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

Why women get labiaplasty

The excess skin of the labia minora exit from the area within the vagina. This is not the outer labia or “lips” but the thinner skin that can extend down from the vagina, often after pregnancy. But it doesn’t always occur only after stretching associated with pregnancy. It can also occur during puberty. There is nothing “wrong” with the labia minora and they do not require any alteration in general. However, in some situations, they can cause social discomfort for the woman.

For example, the tissue extending from within the vagina can hang down and be visible through a bikini bottom or any type of bathing suit. The tissue can make a woman feel unattractive during intimate situations. And if we’re not that person and we don’t know what they feel like in that scenario, we also can’t tell them how they should or should not feel.

Notice that the feeling of discomfort is not associated with age. So if someone is young, as in younger than 18 years of age, and they feel social anxiety in a bathing suit due to large labia minora, they may want a labiaplasty. It’s reasonable to argue that the patient should wait until they complete puberty and their secondary growth phase. If a patient gets a labiaplasty too soon, they could continue to grow and the excessive labia minora could recur prior to the completion of puberty. But again, this is a personal decision and will need to be decided on a case by case basis.

If you are looking for pricing regarding a labiaplasty from Dr. Kaplan, click here.

Click here for the original blog post written by Dr. Jonathan Kaplan for BuildMyBod.

The post How young is too young for a labiaplasty? first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.