CosmeticSurg blog: Expert insights from Dr. Ricardo L. Rodriguez

President Obama ordered federal agencies, such as the FDA, to search their books and strike any overburdensome regulations. In June, the FDA quietly posted a request for comments to any existing regulations that are burdensome or outdated by technology. We passed the link on to Professor Mary Chirba who then submitted comments to the FDA regarding autologous stem cell therapies. She has graciously given us permission to post her comments here on our blog.

Most patients are often surprised by the choices and considerations they’re faced with when considering a Breast augmentation.

Looking at your breasts the way a doctor does can be an emotional event full of new information which may be hard to process. However, it is essential that you and your doctor are ‘on the same page’ regarding the type of implant and surgical approach that will be used.  

After the initial consultation, I prefer to see all of my patients one more time to be sure that we have answered all of the questions.

I did my first case of micro fat grafting to the face over 20 years ago. It was a patient that had acne scarring in her face. During the decade of the 90’s I had tried laser for that problem, under the theory that you could level the skin.

Frankly the results were OK, not great, because the pits were not filled. Fat grafting was used to fill the pits under the skin. The great surprise was how good the skin looked after the fat injections ! The skin became rosier, softer, and just younger looking.

There are several factors which contribute to visible breast implant rippling. The most common factors are:

1. Type implant: saline, gel silicon, or gummy bear silicone
2. Amount of coverage of the implant by your own soft tissue cover (skin, breast gland, fatty tissues)
3. How much of the implant is placed under the muscle

In summary, Laser resurfacing technologies destroy tissue (which the body repairs), while fat grafting (Fat injections) builds up and regenerates tissues.

Most lasers shoot a high energy beam which vaporizes cells, whereas fat grafting techniques mobilize teams of repair cells to bring more blood supply and nutrients to your face.

I believe that stem cell enhanced fat grafting offers an advantage to lasers currently being used by plastic surgeons and dermatologists. Fat grafts are the most natural way to get a long lasting youthful rejuvenation of your face.

Let’s clarify what lip lift does first. The lip lift shortens the long space between the base of the nose and the upper lip. Some people are born with a longer space, while other people start to notice it more during the aging process.

Here are the considerations to make when planning the procedure, and the steps involved in the procedure.

Why does the butt look lifted in a BBL?

It’s all about how the eye perceives shapes. When you look at the back of a typical woman what you think is the butt is really a combination of two separate fat pockets:

1. the buttock itself
2. the flank, or “back muffin top” above the buttocks

The combination of the two fat volumes creates a visual unit. It is longer than it is wide so the butt appears to be droopy or sagging. From the side it appears there is no shelf but a long slope that makes the buttock look like it is hanging. If you eliminate the back muffin top above the buttock there are a lot of perception changes that result.

Plastic surgeons have been performing Fat grafting surgeries for over a hundred years. Patients interested in having a procedure involving fat grafting should be familiar enough with the process to ask questions during their consultation.

The success of fat grafting is highly dependent on the skill and technique of the surgeon as well as the patient’s attention to detail and instructions during post-op.

Here are 10 questions to arm yourself with prior to a consultation for any plastic surgery involving a fat transfer:

Five levels of anesthesia used in Cosmetic Surgery are:

• local anesthesia only
• local anesthesia with valium
• IV sedation moderate, also known as Twilight Anesthesia
• IV sedation with propofol- deep sedation
• General Anesthesia with a ventilator

If you’re considering Liposuction to the your love handles, saddlebags, or abdomen, familiarize yourself with the procedure and the options available to your surgeon. Know exactly how your liposuction procedure will be handled before you schedule it. Dr. Rodriguez explains what you need to know.

There are four main factors that can affect your liposuction result. Two of them have to do with the instrument used by your plastic surgeon, and the other two are related to the post op recovery period.

Recently, a patient came to me for a second opinion. She was an attractive, dark skin Hispanic female who had had Liposuction to the saddlebag area along with a tummy tuck and a breast lift. The result was great, but the patient was unhappy. She had a small waist, and a nicely defined hourglass figure. Her hips were curvy. Now why would a patient be unhappy with a ‘good’ result?

The use of IV Sedation with cosmetic surgery offers several advantages over General Anesthesia:

1. IV Sedation has less nausea than General Anesthesia
2. quicker recovery immediately following the surgery
3. dramatically reduces the risk of pulmonary embolism which is a major concern with General Anesthesia

In many plastic surgery forums I always see the question – ‘Can a tummy tuck can be performed with something other than General Anesthesia’? The good news is YES – you can have a tummy tuck with IV Sedation. Instead of general anesthesia, I use local tumescent anesthesia with IV sedation. This type of anesthesia is highly preferable compared to general anesthesia and I want to explain why. With General anesthesia , a machine is breathing for you and you have a tube down your throat or nose. With IV anesthesia you are breathing on your own and there is no tube in your throat or nose. Recovery from IV sedation is also much easier with IV sedation compared to General anesthesia. Most people experience much less nausea with IV sedation.

In my previous blog post about postoperative Tummy tuck swelling I talked about how the blood supply is disrupted to different degrees using the two different types of Tummy tuck techniques (standard vs. Lockwood). In summary, the more skin that is elevated and separated from the muscle layer, the more blood supply disruption you have. On this post we will address swelling of the tissues after Tummy tuck and why compression garments following surgery are important to reduce swelling. The body is made mostly of water, and there is a constant fluid leakage from the tissues balanced by reuptake of fluid into the lymphatic drainage system. When the lymphatic system is impaired, we get fluid accumulations. The fluid can accumulate between the tissues as interstitial fluid (like a soaked sponge), or outside of the tissues as a seroma (like a sac of fluid). It can also accumulate at some distance from the operative site, usually the upper thighs or legs. The drawing illustrates the various types of fluid accumulation following surgery. As you move from left to right on the illustration you have increasing swelling to result in these conditions:

I get many patients who come into my Baltimore office requesting a Tummy tuck. The Tummy tuck will give a much flatter tummy, and if they get liposuction around the love handle area, a drastic reshaping of the entire midsection. But the biggest drawback is the scar. It goes most of the time from hip bone to hip bone. Invariably, I get the question, can we do a Mini Tummy tuck? The patient is hoping to get most of what she needs with a smaller scar and a less involved surgery. What is the difference between the Tummy tuck and the Mini Tummy tuck?