Dr. Bae:
That’s right. That was a lot of tests, oral and written tests, and a lot of exams in school to become board certified, so thanks for not forgetting it.

Greg:
And I see you want to fight with me today. You got your college hat on, LSU. It’s close to mine, but I know you went to the University of Texas for a short time, didn’t you?

Dr. Bae:
No, no. I went to UT Austin, correct, but not for a short time. I went for all four years.

Greg:
Okay.

Dr. Bae:
I think I’ve told you this before. I didn’t technically graduate. I didn’t get enough credits to graduate, but I did all the stuff you have to do to be able to get into medical school, like MCAT and everything. But then I went to LSU for medical school and general surgery residency. I grew up in Louisiana, so that’s the LSU hat. I might just got out of an arm liposuction case.

Greg:
Can you at least get a UT hat the next time I see you? I mean, you went there. You could wear a UT hat for me.

Dr. Bae:
That would be totally legitimate. You are right. Out of respect to you, you’re right. I should wear a UT scrub cap next time I see you. Okay. Fair enough.

Liposuction vs Tummy Tuck

Greg:
Thank you. Now, I have a real question for you, Dr. Bae. A lot of people want to lose weight, whether it’s after having a couple of kids or maybe they feel like they can’t lose it on their own, and they’ve just gained so much weight in COVID. Is there one thing that fits everybody? Is it liposuction or how do we do this?

Dr. Bae:
Well, you just basically look at your body and if you can just pinch the skin and you pinch it and you feel like there’s fat in there, maybe you would think, oh, maybe I’m a candidate for liposuction, but then you also have to look at how much excess skin do you have? Do you have a lot of hanging skin or excess skin or wrinkly skin or stretch marks?

Dr. Bae:
The other thing you have to look at is how much of an abdominal bulge you have, like the upper part of your abdomen, and that could be a sign of a rectus diastasis, which is something when your abdominal wall stretches out because of having kids. You take those things into account, a stretched out abdominal wall, excess skin, excess fat. If it’s just excess fat, no hanging skin, no abdominal bulge, you could just do liposuction. That’d be fine.

Dr. Bae:
Then, the other option is if there is excess skin, then you would consider doing a tummy tuck. If you have an abdominal bulge, maybe that’s the only thing you have is the abdominal bulge after having kids, then you would still probably need a tummy tuck because the only way to fix the abdominal bulge is to go through a big, lower abdominal incision, like you would with a tummy tuck.

Different types of tummy tucks

Greg:
Well, what’s involved in a tummy tuck?

Dr. Bae:
A tummy tuck is, typically there’s a few different kinds. There’s a mini tummy tuck, traditional tummy tuck, extended tummy tuck. I guess some doctors will have different definitions, but in general, a mini tummy tuck is just when you’re removing the excess skin at the lower part of the abdomen. And so that means you have a nice flat tummy, otherwise just a little excess skin at the bottom. Maybe you don’t have a whole lot of excess fat. The only people I’ve found that really fit within that category of a mini tummy tuck with just that excess skin are marathon runners, who’ve had a kid. So they’ve had the kid, they still have a nice flat abdomen for whatever reason, genetically, they didn’t get stretched out abdomen.

Greg:
That’s very specific, by the way.

Dr. Bae:
That’s very specific and that’s really the truth. So they’ve worked off all the fat because they’re a marathon runner and they just have this excess skin. What we do is we make a lower abdominal incision, well below the panty line, so at least it’s hidden and they can still wear bikini bottoms and things like that. And so we just remove a strip of skin. That’s a mini tummy tuck.

Skin removal and diastasis repair

Dr. Bae:
If they’ve got more skin that’s hanging, if they’ve got stretch marks they want to get rid of, if they’ve got that abdominal bulge, then we have to make an incision along the lower part of the abdomen, still low enough that it can be hidden, just a little bit longer than a mini tummy tuck, that gives us the ability to remove excess skin, gives us access to go up underneath the upper abdominal wall to tighten that up and to do liposuction at the same time.

Extended tummy tuck

Dr. Bae:
And then if you have excess skin that wraps around the sides of your body towards the back, then that would be more like an extended tummy tuck. That’s kind of the upshot of it all is just notice whether you have excess fat, excess skin and abdominal bulge. That’ll give you an idea whether you need to do liposuction or a tummy tuck. Then depending on how much excess skin you have, how much stretch marks, how much that skin wraps around, that will help you determine what type of tummy tuck you get. I think that pretty much puts it all in a nutshell.

How to find Dr. Bae

Greg:
Yeah, that covers it. They’re truly answers for everybody. You just need a good consultation with a board certified plastic surgeon. Dr. Bae, how do they find you?

Dr. Bae:
They can find me on Snapchat, Instagram, Tik Tok at RealDrBae, R-E-A-L D-R B-A-E, not B-A-Y, and then you can check out our website, RealDrBae.com and they can check pricing on there for all those procedures, mini tummy tuck, full tummy tuck, extended tummy tuck. We got all that information on there, so that by the time you come in, you have a pretty good idea what you need and you have a good idea of how much it costs.

Greg:
Awesome. We’ll see you next time.

Dr. Bae:
Thanks so much, Greg.

Greg:
Hook ’em horns.

Dr. Bae:
Go Tigers.

The post Which type of tummy tuck is right for you? first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

Types of Mommy Makeover

In our practice, a Mommy Makeover can include a breast procedure (a lift, an augmentation or both), a tummy tuck, but also some other procedures. With pregnancy, the labia minora can stretch and cause discomfort during sex. Or possibly the labia can appear too bulky in underwear or bikini bottoms. For this reason, there are Mommy Makeover procedures that also include a labiaplasty.

With weight gain and loss during pregnancy and afterwards, the buttocks can become deflated like the breasts. That’s why we offer a Brazilian Butt Lift with some Mommy Makeover procedures. The benefit of performing these procedures in combination is that it leads to one recovery instead of multiple recoveries.

Mommy Makeover

As stated above, this procedure includes a breast lift, aug or both along with a tummy tuck. To help the patient understand all of their options when it comes to the breast procedure, we’ve divided every Mommy Makeover into type 1, 2 and 3.

Type 1 refers to a breast lift only. This is necessary when the patient has pendulous, droopy breasts after breast feeding. But they have enough breast tissue so that an implant isn’t necessary. Type 2 refers to a breast augmentation alone. This is necessary when a patient has deflated breasts and needs more volume, as with an implant. And type 3 is a combination of the two – when a patient has droopy and deflated breasts. A lift will improve the shape of the breast and an implant will restore volume.

As you’ll see below, type 1, 2 and 3 can be applied to all three kinds of Mommy Makeover that we offer in our practice.

Mommy Makeover Plus

This is a breast procedure (type 1, 2 or 3), a tummy tuck and a labiaplasty.

Mommy Makeover Deluxe

This includes type 1, 2 or 3 breast procedure as above, a tummy tuck and then a Brazilian Butt Lift to restore volume and lift to the buttocks. A Brazilian Butt Lift is the liposuction of all available fat from the torso with subsequent injection into the buttocks. Check out the video below for more details!

Video describing the 3 types of a Mommy Makeover

Check pricing for a Mommy Makeover from Dr. Kaplan by clicking here.

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

The post 3 types of a Mommy Makeover [video] first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

Why BMI isn’t enough

Sure BMI is better than looking at weight alone. Because even if a person weighs a lot, they may be very tall. And in that case, they would not be considered overweight.

However, BMI doesn’t take all nuances of body shape into account. For example, in the video below, the patient had a BMI of greater than 30. She would be considered obese. But there were several reasons she was a great candidate for a tummy tuck. First, she was healthy. No high blood pressure or diabetes. Second, her weight was concentrated in her thighs, not her abdomen.

So while her BMI was high, it didn’t accurately reflect the operation she wanted – skin removal from her abdomen. If most of her weight was in her abdomen, then it would be more appropriate for her to lose weight first since skin removal would not address the excess fat around her intestines (visceral fat). In her case, she her torso and abdomen were amenable to a tummy tuck and she had a great result.

If a patient is considered obese, they can still be offered a procedure. As long as no more than 5 liters of fat is removed in an operation, the patient can go home. With that limitation, they may have to come back in stages for surgery. But when patients undergo a cosmetic procedure that’s not medically necessary, there’s no reason to take unnecessary risks.

Video on Body Mass Index

Click here to check pricing on a procedure from Dr. Kaplan.

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

The post There’s more to it than BMI! [video] first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

Achieving the best cosmetic surgery results

The most common impediment to patients achieving their best surgical result is when they depend solely on the operation to fix everything. But as in the case study below, this patient ultimately achieves her best result by accomplishing something surgery can’t. Why can’t surgery fix everything?! Keep reading to understand why.

In this scenario, the patient had a tummy tuck. We made her abdominal wall tighter along with removal of fat and excess skin. These are typical elements of a tummy tuck procedure. But when it comes to fat removal, there are two types of fat. There is the subcutaneous fat – the fat under the skin that we remove with liposuction. And there’s the fat inside the abdomen, around the intestines referred to as visceral fat. Visceral fat can only be removed with weight loss and it’s particularly hard fat to lose.

At the time, the patient was fine with a tummy tuck that couldn’t address the visceral fat. If she did lose visceral fat in the future, her skin could tighten up on its own after a tummy tuck. What we weren’t expecting was the development of abdominal wall laxity after losing visceral fat with a keto diet. Again, the abdominal wall was tightened in the original operation. But once she lost more visceral fat, her abdominal wall had room for more tightening.

So the patient came back for more abdominal wall tightening and now has the result she was looking for. All thanks to surgery and an effective keto diet. You can see the journey in her own words in the video below.

Video: How to achieve the best cosmetic surgery results…lifestyle changes along with surgery

 
To check pricing on these procedures from Dr. Kaplan, click here.

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

The post How to achieve the best cosmetic surgery results [video] first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

While common sense would suggest shaving before surgery would get rid of bacteria, it might make it worse. Consider these scenarios. For an operation on the face or neck, do you shave your beard? An operation on the lower abdomen, do you shave the pubic hair? This is an ongoing debate in operating rooms across the country. So what’s the best way to go?

Why you shouldn’t shave before surgery

In preparation for surgery, a patient or their surgeon, may suggest shaving the operative site. This could be to clear the area for the future incision. But in many cases, the reasoning has to do with infection risk. Aside from the skin having bacteria, there is also the risk of bacteria clinging to facial or body hair.

So shave the area in question ahead of time, right? Actually, no. According to this NY Times article and the Centers for Disease Control and Prevention,

“…surgical site infections are a leading cause of complications among hospital patients, accounting for nearly one out of five health care-associated infections and thousands of deaths annually.

A study published in the journal Spine looked at a group of patients having spinal surgery and found that while postoperative infections were low over all, they were more common among patients who were shaved for surgery than among those who were not. The reason, experts say, is that shaving with a razor blade causes microscopic nicks in the skin that can become bacterial breeding grounds.

In its guidelines for preventing surgical site infections, the C.D.C. recommends that hair not be removed unless it will interfere with the operation. When shaving is necessary, electrical clippers should be used.

One study showed that patients with shaved incision sites had a 5.6 percent rate of infection, compared with a rate of less than 1 percent among patients whose hair was removed with clippers.”

You could read this two ways. Don’t shave before surgery or if you do, shave with an electric razor to avoid nicks in the skin.

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

The post To shave or not to shave…before surgery?! first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

The details in a mommy makeover

The breast augmentation portion of the procedure typically consists of a small incision either in the inframammary fold, around the areola or in the armpit. There are pros and cons for each choice, but the choice is yours depending on your case and what type of incision that you want to live with after surgery.

A gummy bear silicone implant is then inserted to give the perkiness patients desire. They can also choose between shaped or round implants depending on the look they’re going for. In some cases when there is excess droop in the breasts, a lift may be necessary. Depending on how much lift is required, it is performed with an anchor, lollipop areolar (donut) or crescent incisions.

The tummy tuck part of the procedure begins with liposuction of the abdomen and flanks. This extra step can really maximize the results of the tummy tuck. Then, a long incision across the abdomen is made, just below the panty line. The skin is elevated towards the breastbone and then the excess skin is removed. If the patient has any rectus diastasis or abdominal separation that typically results from multiple pregnancies, this is corrected by rectus plication wherein sutures are used to pull the muscles back together. Lastly, in an ideal case, progressive retention sutures are used so that drains are not required.

And wham bam, thank you ma’am, you’re all done! Checkout this video below and to check pricing on a mommy makeover from Dr. Kaplan, click here.

Mommy Makeover: The video

Oh, and for the ladies out there who haven’t had kids – if this combination surgery sounds like what you are looking for, don’t be shy in asking for the Mommy Makeover! Andon’t let the name scare you away; it’s just a name. Getting the combined procedure not only gives you one recovery period, but doing so will also save you money compared to going under for two separate procedures.

Click here for the original blog post written by @japsiecam for BuildMyBod.

The post What exactly IS a Mommy Makeover? first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

Full vs Mini Tummy Tuck

As the photos above shows, a mini tummy tuck is truly a very small removal of excess skin. A full tummy tuck includes liposuction, skin removal, repositioning of the belly button and tightening of the abdominal wall. A mini tummy tuck only removes a little bit of skin in a patient with a pretty firm abdomen. This extra roll of skin may develop in a healthy individual after pregnancy. But a mini tummy tuck is not the procedure needed by a majority of patients.

Full vs Mini Necklift

In my practice, a full neck lift includes incisions behind the ears and chin. The determining factor on whether to do a full necklift or mini is how much excess skin there is. If there’s a lot of excess neck skin, then incisions are made behind the ears to remove the excess skin. If there’s not a lot of neck skin, then that skin can be redraped with a mini neck lift that includes only the incision behind the chin. Through this one incision, the neck muscles can be tightened also. Check out these photos to see how the patients differ preop.

Full vs Mini Facelift

A full facelift includes incisions in front and behind the ears to remove and lift very saggy facial cheeks. If the patient only has slight “jowls” (the hanging skin along the jawline), a mini facelift with only the incisions in front of the ears will work.

To check pricing on any of these procedures from Dr. Kaplan, click here.

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

The post Full vs Mini tummy tuck, necklift and facelift first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

Do you need to tighten your abdominal wall during a tummy tuck?

During pregnancy, the abdomen stretches. Luckily, the skin recoils and tightens after delivery. The question is will it recoil and tighten enough. Additionally, will the deeper abdominal wall tighten or will you be left with a “pooch” or diastasis.

If the abdominal wall stretches out, exercise won’t necessarily fix it. You can work out your six-pack muscles but the “pooch” or diastasis isn’t a muscle problem. The tough tissue that makes up the abdominal wall, the fascia, encases the muscles. So while the muscles will get stronger with exercise, the surrounding fascia won’t tighten with exercise.

That’s where a tummy tuck comes in. Aside from removing excess skin and performing liposuction, a tummy tuck is also a great opportunity to tighten the abdominal wall via a rectus plication. This is done by inserting stitches into the fascia and tightening the abdominal wall like a corset as described here.

It’s not always clear looking at the patient’s abdominal wall during the operation whether they need tightening or not. The easiest way to tell is to determine if the 6-pack muscles are in the middle of the abdomen. If they are, that means the muscles are in the right place because the abdominal wall isn’t stretched out. If the 6-pack muscles are widely separated, then the muscles need to be brought back into the middle with tigtening described above.

So how do you tell if the muscles are in the middle? Stimulate them with electricity and see if they jump! Electrocautery, the instrument that helps stops bleeding during a procedure, can stimulate the muscles to jump so you know if they’re in the middle or spread out. Not sure what I mean? Watch the video below!

Video of rectus plication

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 Need to tighten the abdominal wall during a tummy tuck? [video] first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

When you’re a plastic surgeon, “cocktail conversation” at a party can involve any and all topics. How much recovery do I need after a neck lift? Can you get rid of my cankles? Breast pumping, not breastfeeding, resulted in my saggy breasts! This particular party patron made the last comment as a matter of fact. I was a little embarrassed that I didn’t “know” that pumping led to saggy breasts moreso than breastfeeding. Seems like if that was true, I would know that by now.

Is pumping a greater culprit of saggy breasts than breastfeeding?

This was not a topic in medical school. So between Google and other colleagues, this is what I found: the information online is really spotty. Most search results aren’t definitive and don’t reflect a series of studies. Rather, you find opinions on various online forums like reddit.

“Expert” opinion often takes the form of someone with an ulterior motive. The pro pumping stance comes from someone selling a breast pump. The pro breastfeeding stance from an organization selling yoga or transcendental meditation classes. Of course there are also genuine opinions from mothers but even amongst these real experts, there’s no consensus.

Taken altogether, saggy breasts are a result of pregnancy, not necessarily the technique of providing milk to the baby. There is no direct correlation of sagging being worse with breastfeeding or pumping. They certainly have their own advantages: emotional connection with a child during breastfeeding; ability to return to work with pumping.

At the end of the day, it depends on the quality of skin and ligaments in the breast. And this depends mostly on your genetic makeup and ability for your skin to recoil and tighten after pregnancy. So if you’re unhappy with saggy breasts, there are surgical and non-surgical options. The non-surgical options to tighten the skin seem to work but very temporarily. The only way to retain long-term results is with surgery but, as a surgeon, I don’t want to sound like I have an ulterior motive!

That disclosure being said, you can check pricing on cosmetic surgical and non-surgical items, in particular a mommy makeover, from Dr. Kaplan, here!

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

The post Saggy breasts worse after breastfeeding or pumping? 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.