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Plastic Surgery Procedures |
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PANNICULECTOMY, ABDOMINOPLASTY
CIRCUMFERENTIAL BODY LIFT  Circumferential Body Lift (front view)
PANNICULECTOMY: By definition, this procedure is done to remove the abdominal “pannus”. The pannus is that skin and fat that hangs over the pubic hair area. A panniculectomy removes this pannus; however, a panniculectomy does not address the abdominal musculature or allow for correction of any existing hernias. This surgery lasts approximately 4-6 hours.
ABDOMINOPLASTY (TUMMY TUCK): This is a more invasive procedure and in general, allows for removal of more skin and fat than a panniculectomy. Typically, an abdominoplasty allows for the removal of skin and fat from the top of the belly button to the top of the pubic hair. The plastic surgeon will individually craft your incision to allow for most clothing to cover your scar. If you are planning on wearing “low riders” or “hip huggers”, the plastic surgeon will place the incision low. If instead you want to show off your legs, the incision can be placed high in what is sometimes called a “French-cut”. If you are in between, the plastic surgeon can customize your incision and resulting scar to lie between these two types of incisions. Either incision allows the plastic surgeon to remove skin and fat from your abdomen. During your abdominoplasty, the plastic surgeon can also tighten your “six-pack” or rectus abdominis muscles. This can bring in your waist line by as much as 6 inches. Also, if there are any abdominal hernias, the plastic surgeon can repair them at that time. As in most other body regions, the longer the scar the better the results. This surgery lasts approximately 4-6 hours. Typically, patients can go home the same day or may want to spend a night in the hospital. 
 Circumferential Body Lift (side view)
All of the above procedures will result in excess fluid accumulation. To prevent fluid collection, drains are placed. On average, 2-4 drains are placed. The drains are sutured into the pubic region. Depending on output, most drains are removed two weeks after surgery. All procedures usually require a Velcro girdle or binder. The binder should be worn for a minimum of 3-4 weeks.
If your surgery is needed for medical reasons, insurance may pay for a portion of the operation. Some plastic surgeons will send your medical information to your insurance company for their determination. His/her staff will spend a significant amount of time and effort to try to have your procedure covered by insurance. In the end, however, the final decision is up to your insurance carrier.
 Circumferential Body Lift (rear view)
| ARM LIFT Loose upper arm skin is most often related to weight loss. If you were overweight, you more than likely developed heavy upper arms. To accommodate the increased volume of the upper arms, your skin stretched. After weight loss, the skin often fails to tighten, and so it sags. The only way to improve this problem is through an arm lift or brachioplasty.
 Brachioplasty
Dr. Katzen will discuss all aspects of the procedure with patients who want to tighten this arm skin and look as good as they feel. In some cases, Dr. Katzen may suggest liposuction to remove excess fat in the upper arms. However, when there is loose skin, this skin must be removed and an arm lift is the best choice.
To remove this loose skin, an incision is necessary. There are three types of incisions: 1) crescent; 2) modified “T”; and 3) armpit to elbow. These incisions lift skin, remove excess fat and tighten arm ligaments. Upper arm lifts can also address folds in the skin on the side of the chest near the armpit. Following the upper arm lift procedure, the skin is sutured closed. As with all incisions, there is always a resulting scar. With time, your scars will fade. Typically scars are not readily noticeable. Sometimes a pressure garment or elastic bandage is applied to promote healthy healing. Dr. Katzen will discuss which procedure is right for you.
Typically the upper arm lift takes about two hours. If your surgery is needed for medical reasons, insurance may pay for a portion of the operation. Dr. Katzen will send your medical information to your insurance company for their determination. His staff will spend a significant amount of time and effort to try to have your procedure covered by insurance. In the end, however, the final decision is up to your insurance carrier.
Immediately following an upper arm lift, patients will have limited use of their arms. Dr. Katzen discourages heavy lifting or extending your arms for the first week or two after surgery. Upper arm lift patients will return seven days after the procedure, and then again within two weeks for the removal of the sutures. Bruising and swelling are to be expected. Medication will control the minimal pain and discomfort that patients usually experience. Driving and exercise may be started after two weeks.
Upper arm lifts can produce dramatic results in arm contour and create a smoother look to the upper arm. Dr. Katzen’s arm lifts increase skin tightness, reduce arm fat and create a more youthful appearance.
| FEMALE BREAST RECONSTRUCTION
With weight loss, there is considerable loss of fat from the female breast. The elastic properties of the female breast have been stretched with weight gain and fail to recoil after weight loss. The resulting female breast after weight loss is an extremely elongated breast without much substance.
 Surgical reconstruction of the female breast requires correction of two fundamental principles. The first principle requires lifting the breast to a more normal position. The second principle requires returning volume to the breast.
 Breast Lift and Augmentation
If there is a lack of breast volume, breast augmentation with breast implants is required. There are many different types of breast implants and the plastic surgeon will discuss the options with you. Most females require both breast augmentation with implants and breast lift to re-establish both volume and position of the breasts.
If your surgery is needed for medical reasons, insurance may pay for a portion of the operation. Insurance companies usually do not pay for breast implants, but the plastic surgeon will sometimes send your medical information to your insurance company for their determination. The plastic surgeon and his/her staff should make every effort to try to have your procedure covered by insurance. In the end, however, the final decision is up to your insurance carrier.
The surgery usually lasts approximately 3-4 hours. Before any breast surgery is performed, a mammogram will be obtained to confirm normal appearing breasts.
Breast reconstruction patients can usually return to work 5-7 days after the procedure. During that time, heavy lifting and lifting objects over your shoulders is discouraged. Patients usually experience minimal pain and discomfort that is controlled with medication. Driving and exercise can usually be initiated approximately two weeks after surgery. Breast reconstructions are usually extremely satisfying to women who have had large breasts all their life. A breast lift and augmentation can dramatically improve the appearance of the breasts and restore natural breast shape after weight loss. Ask the plastic surgeon what he/she can do for your breasts to help you obtain a more natural-looking female figure after your weight loss.
| FACE AND NECK RECONSTRUCTION
After significant weight loss, there is loss of fat throughout the face. In addition, facial fat stretches the supporting ligaments and these ligaments fail to recoil. This loss of fat and ligamentous recoil failure results in significant sag throughout the face. This is most evident in the forehead, temple region, eyebrows, eye sockets, cheeks, jaw line and neck.
 Face and Neck Lift
FOREHEAD: With weight loss, there is usually loss of fat in the temporal region. In addition, there is wrinkling of the forehead and sagging of the upper eyebrows. To surgically correct this area, the brow needs to be elevated and re-suspended. This is either done through several small incisions made in the hairline or an open incision which heals very well in the hairline. Thus the eyebrow is thus raised and forehead wrinkles are eliminated. To reestablish loss of volume and tissue in the temporal area, Dr. Katzen uses grafting techniques to fill in this area with your own live skin and/or fat from other areas.
MIDFACE: Usually with weight loss, there is loss of fat in the cheekbones and descent of the remaining excess skin. This makes the line from your nose to the lateral corner of your mouth seem deeper and gives the face a significantly older appearance. To rejuvenate the mid-face, usually a cheek lift is required. This is achieved through a small hidden facelift incision in front of the ear. Some patients may require cheek implants due to the significant loss of fat in their face. To further correct the deep groove between the nose and the lateral corner of the mouth, fat and/or skin may be required to be injected in this area.
LOWER FACE AND JOWLS: With aging and loss of facial fat, there is drooping of skin and fat along the bottom portion of the jaw directly below the corner of the mouth. This is called jowling. The jowls can be lifted through the same incision as the mid-face. Through these incisions, the plastic surgeon is able to get down to the bottom of the jaw and re-suspend the jowls and re-establish a more youthful jaw line.
NECK: Sagging of the neck skin and the underlying muscles may be more evident with weight loss. The muscles appear as vertical bands that are sometimes visible without even grimacing. Through the previously mentioned face lift incision, the plastic surgeon is able to lift the neck and eliminate the excess skin in the central portion of the neck. In addition, Dr. Katzen will reconstruct the neck by sewing the muscle together. This results in a much cleaner well-defined neck line. Typically, the mid-face, the lower face, and neck lift surgery lasts 5 hours. It is usually performed under general anesthesia. Typically, the patients are presentable 3-4 weeks after the surgery when most of the swelling has subsided.
A forehead, cheek implant, face lift, neck lift, and lip augmentation can dramatically improve your face. The scars resulting are considered minimal considering the benefit obtained. Different patients have different priorities and the facial reconstruction can be done anytime throughout your total body reconstruction. For some patients, the face needs to be done first before the body lift, medial thighs, breast and/or arms. Ask the plastic surgeon about any and all the things he/she can do for your face.
| THIGH LIFT
 Successful and sustained significant weight loss can lead to extensive inner thigh skin excess. Constant rubbing of this excess skin can predispose to skin irritation and infection. These can interfere with personal hygiene and sexual relations. Clothing may be difficult to fit and there may be psychosocial concerns of a disfigured appearance. Comfort and appearance may be improved by a plastic surgery procedure known as the thigh lift.
A thigh lift involves resection of redundant thigh skin and fat. Redundant thigh tissues may extend to involve the buttocks and back of the thigh. The amount of inner thigh skin and fat will determine which incisions are necessary. Incisions range from a crescent incision that parallels the groin crease to a vertical incision that goes from the groin to the knee. Outer thigh lifts are done with incisions extending from the groin around the back to the hip and is usually done with a body lift. In certain cases liposuction is an adjunct procedure, but cannot replace a thigh lift if there is redundant skin.
 Medial Thigh Lift This procedure can take about three to five hours and is done under general anesthesia.
If your surgery is needed for medical reasons, insurance may pay for a portion of the operation. The plastic surgeon will send your medical information to your insurance company for their determination. His/her staff will spend a significant amount of time and effort to try to have your procedure covered by insurance. In the end, however, the final decision is up to your insurance carrier.
Patients may spend their first night in a hospital or overnight care facility. Bruising and swelling are to be expected as well as a “tight” feeling in the thighs. Medication will control the pain and discomfort that patients usually experience. Usually drains are not used; however if drains are used, they are soft and comfortable. Dressings and a light compression garment are used for several days. You should plan on no driving or work for two weeks and no vigorous exercises for at least four weeks.
The end result is usually tightened, lifted and flattened thighs. Patients are more confident and comfortable in clothing, especially sports wear and jeans. The procedure will last the rest of your life and you will look better than if you didn't do it. So go ahead and ask the plastic surgeon about a medial thigh lift.
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