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    Default Ask the surgeon a question

    Hello,

    I'm a newbie here, but wanted to offer to answer any questions about cosmetic surgical procedures. I am a surgeon (not a plastic surgeon), and I do cosmetic surgeries of of the body, including many breast augmentations of all types, breast lifts, breast reductions, tummy tucks, and lipo pretty much everywhere. I don't have much experience with facelifts, but do have some experience with Botox and other injectables. If you have any questions about of any of these I would be more than happy to answer. Feel free to post questions here or PM me!

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    Default Re: Ask the surgeon a question

    Is anyone doing scar revision yet on the breasts? I had a lift with implant done about two years ago. The "anchor scar" is not that bad and doesn't really bother me but I have a thicker scar on the edge of my areola from where a stitch was too close to the surface and didn't dissolve properly.
    XoXo Gia
    Danielle Fishell (the Dish): "If the Super-Star thing doesn't work out, Gia makes a great stripper name"

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    Default Re: Ask the surgeon a question

    Quote Originally Posted by Gia2608 View Post
    Is anyone doing scar revision yet on the breasts? I had a lift with implant done about two years ago. The "anchor scar" is not that bad and doesn't really bother me but I have a thicker scar on the edge of my areola from where a stitch was too close to the surface and didn't dissolve properly.
    It sounds like you have what's called a "suture granuloma," which is a common problem. This is where a knot in the deep sutures doesn't absorb completely, and the body forms a cyst or "wall" around the knot. If it were me, I would excise the scar and the granuloma in the office under local anesthesia. Shouldn't take more than 15-20 minutes, and shouldn't be expensive. If you go back to your original surgeon they might do it for free. Hope this helps!

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    Default Re: Ask the surgeon a question

    TY, Kind of but now it is just a scar. Ill call them when I get back to MIA next week.
    XoXo Gia
    Danielle Fishell (the Dish): "If the Super-Star thing doesn't work out, Gia makes a great stripper name"

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    Default Re: Ask the surgeon a question

    I can't think of anything right now, but Welcome to the forum!


    MANY MEN WANTED TO LAY ME DOWN, BUT FEW WANTED TO LIFT ME UP

    -Eartha Kitt

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    Default Re: Ask the surgeon a question

    I want a tiny waist. Is liposuction the answer? I have an appointment with my doctor Saturday about this. But I want your opinion too


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    Default Re: Ask the surgeon a question

    Quote Originally Posted by CamBabe View Post
    I want a tiny waist. Is liposuction the answer? I have an appointment with my doctor Saturday about this. But I want your opinion too
    I hate to use the cop-out that I would have to see and examine you, but I would in order to advise you specifically. Generally speaking, lipo is really good for women with excess subcutaneous fat (ie, fat under the skin, but above the abdominal muscles). If you can pinch a large amount of skin/fat, or if you have "rolls," you probably have excess subcutaneous fat and could benefit from lipo. If done well, and if you stick to the post-op instructions (especially wearing the compression garments), you can have excellent results.

    There are two body types that DO NOT benefit from lipo usually:

    1. Women with a large amount of fat inside their abdomen, which means the fat is underneath the muscles. In this case lipo would not be significantly helpful, because lipo only removes fat under the skin, not under the muscle/inside the abdomen. Some people have a mixture of fat both under the skin and under the muscle, and for those women I advise them that in order to maximize the effectiveness and get the most bang for their buck they should try to lose weight first and then do lipo for contouring.

    2. Women with very little fat who have excess skin or laxity in the abdominal muscles. This applies mostly to women who have had babies. It is VERY difficult for a woman, even if she is in terrific shape, to have a perfectly flat belly after having kids. It's not impossible, but is difficult. The skin and muscles are so stretched during pregnancy that they almost never return to a "tight" pre-pregnancy shape. Again, this has nothing to do with not being physically fit: my wife is in great shape, has very little body fat, is actually technically underweight, but after having kids her lower belly is not perfectly flat, and it drives her crazy (not me - I think she looks incredible). So for women with laxity in their abdominal muscles or abdominal skin, lipo is very unlikely to help. And these women come in all the time - they think a little lipo will help flatten out their belly, but unfortunately the only way to flatten out the muscle and skin is through a tummy tuck with muscle plication (tightening).

    One more thing about lipo. While it usually yields very good results for the right people (and the right surgeon!), it is important to remember that it will take a minimum of 2 weeks away from dancing or any other physical activity. I usually tell my patients to wear their compression garments 23/7 for 2 weeks minimum, with the one hour off for showering, and then as much as possible for the next 6 weeks. The compression garment helps contour the body, and helps ensure the skin lays flat and tight against the muscle, which gives you the shape you want. So for best results I would strongly recommend planning two weeks off from any physical activity, including dancing, and wear the compression garment all the time.

    I hope this helps - please feel free to PM me or write here with any other questions - good luck!

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    Default Re: Ask the surgeon a question

    Hi Tom. I have c-section scar that looks bad because the tissue isn't distributed evenly so it looks like there is a depression. I would like to get a scar revision done on that. I also have diastisis recti, apparently because of my petite frame. I look ok when I don't eat any food, but if I do there is a protrusion and my belly button is now an outie. It's ruined. I have lost all my baby weight and weigh 110 now, but I obviously can benefit from a tummy tuck.
    Problem is I don't want a scar spanning across my whole belly. Also I heard that a scar revision is a simple procedure done under local anesthetic and costs less. Can I just get a scar revision and forget the rest? If I keep working on my diastisis with exercise could it improve without surgery? I'm almost 6 months postpartum.

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    Default Re: Ask the surgeon a question

    Quote Originally Posted by jekka View Post
    Hi Tom. I have c-section scar that looks bad because the tissue isn't distributed evenly so it looks like there is a depression. I would like to get a scar revision done on that. I also have diastisis recti, apparently because of my petite frame. I look ok when I don't eat any food, but if I do there is a protrusion and my belly button is now an outie. It's ruined. I have lost all my baby weight and weigh 110 now, but I obviously can benefit from a tummy tuck.
    Problem is I don't want a scar spanning across my whole belly. Also I heard that a scar revision is a simple procedure done under local anesthetic and costs less. Can I just get a scar revision and forget the rest? If I keep working on my diastisis with exercise could it improve without surgery? I'm almost 6 months postpartum.
    First of all, congrats on only being 6 months post-partum and doing so well with your weight - very impressive! I'll tackle each of your questions one by one:

    1. Diastasis recti - if the bulge is primarily around your belly button, you could have an umbilical hernia, which may or may not be in combination with the diastasis. A hernia is a hole that goes all the way through the muscle and the layer of thick tissue over the muscle, called fascia. A diastasis is a separation of the muscle in the middle of the abdomen, but with the fascia in tact. With a hernia the bulge that you see is actually tissue inside the abdomen (usually fatty tissue that everyone has inside their abdomen) pushing out through the hole under the skin. With a diastatis, the bulge is due to increased pressure in the abdomen causing the fascia to bulge out, but the contents of the abdomen do not bulge out like they do with a hernia. A diastasis might, if you are lucky, improve with exercise (usually not), but a hernia will not. All that to say, a hernia is considered a true medical problem that requires surgery to repair, while a diastasis is considered a purely cosmetic concern. If your doctor diagnoses you with a hernia, insurance will pay for the surgery to repair it. Insurance almost never pays for repair of a diastasis alone. Sometimes you can have a true umbilical hernia AND a diastasis above it. In that case your surgeon might work out a payment arrangement where you only have to pay for what the insurance doesn't cover - probably a major discount for you. So the bottom line is be sure of the diagnosis, and find a surgeon who will work with you financially if you have a true hernia, because insurance will probably pay for a bulk of the cost.

    2. C-section scar - yes, this can be done under local in the office, which is probably how I would do it. You will still have a scar, but it can be revised to a much small scar.

    3. Tummy tuck - this is not a bad option for you, but I would wait until at least a year post-partum, and be SURE you don't want any more kids. A pregnancy will essentially undo the tummy tuck in most cases, so just be sure you are finished having kids before you go that route. With a petite frame, you might benefit from a "mini-tuck," or a small, low incision that won't be much larger than the C-section scar. In fact, usually we can place the scar at or below the C-section scar, so really your scars wouldn't be that different in terms of length and location.

    Just from what you've told me and not having examined you, here's what I would recommend if you were my patient: umbilical hernia repair, repair of the diastasis, and tummy tuck at the same time, which would include revision of the scar. I would charge you my standard tummy tuck rate, minus whatever insurance pays for the umbilical hernia repair, so you could get a discount of up to 50%. That sounds like a big surgery, but really it's essentially just a tummy tuck. To repair a true diastasis, you basically have to have the same exposure you do for a tummy tuck, and repairing a diastasis is the EXACT same as tightening the abdominal muscles, which you might need anyway, and the hernia can be repaired at the same time very easily. You already have a scar you need revised/removed, and the new scar would probably not need to be much longer if you have a truly petite frame. So you would get everything you want in one surgery, and the surgery would be essentially the same time and same recovery as a standard tummy tuck, plus 10 minutes or so extra for the hernia repair. So I would advise just getting a tummy tuck and making sure your surgeon repairs the diastasis and hernia - that gives you everything you want.

    If it were me, I would just charge you for the tummy tuck, since that's really all that's being done, and I would discount whatever insurance pays for the hernia. Not all surgeons will do this, so you might have to shop around for a good surgeon who is willing to work with you. But that's the route I would go based on what you've told me. I always advise patients to do as much as they can at one time, and in your case you can get everything you want in a single surgery and potentially get a good discount if insurance pays part of it. I know that's a lot of info - let me know if you have any other questions! Good luck!

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    Default Re: Ask the surgeon a question

    What do you think of Coolsculpting? It's hard for me to buy the concept of fat cells just being "processed out of your body."
    "Do you do tech support in exclusive?"

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    Default Re: Ask the surgeon a question

    Do you play music when doing surgery on your patients who are under anesthesia like they do on that show Nip/Tuck?

    And what type of procedures do you think Kim Kardashian has had?
    “Cook for him like a housewife, fuck him good like a nympho….pay the rent and the car note, he invests in me like crypto”

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    Default Re: Ask the surgeon a question

    Hi Tom-

    I just turned 50 this year and I guess you can say I'm pretty fit, been working out consistently most of my life but what I'm now starting to notice is that when I hold my arms out straight I'm getting a slight underarm sag. It's not super noticeable but it bothers me a lot and I don't want it to get worse.
    If I wear compression garnments on my upper arms will that help?
    Thank you

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    Default Re: Ask the surgeon a question

    Quote Originally Posted by miss.a.p1600 View Post
    Do you play music when doing surgery on your patients who are under anesthesia like they do on that show Nip/Tuck?
    Follow-up question: Do you fuck your patients? Lol that show was so fucking unrealistic.
    "Do you do tech support in exclusive?"

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    Default Re: Ask the surgeon a question

    Quote Originally Posted by luvnrockets View Post
    What do you think of Coolsculpting? It's hard for me to buy the concept of fat cells just being "processed out of your body."
    I'm sure Coolsculpting works for some people, but I can't recommend it since there is no evidence that is generally effective. Like with any non-surgical technique, the main concern is long term benefit. Even if you had a temporary good result from Coolsculpt, I don't think you could be certain of any long term results. So my advice would be to save your money and do something known to be effective long term, such as lipo.

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    Default Re: Ask the surgeon a question

    Quote Originally Posted by SamanthaSugar View Post
    Hi Tom-

    I just turned 50 this year and I guess you can say I'm pretty fit, been working out consistently most of my life but what I'm now starting to notice is that when I hold my arms out straight I'm getting a slight underarm sag. It's not super noticeable but it bothers me a lot and I don't want it to get worse.
    If I wear compression garnments on my upper arms will that help?
    Thank you
    A compression *might* help, but probably not. Compression works well with post-lipo patients because lipo creates a space between the skin and muscle. The skin is just a few millimeters thick, then there is a layer of fat, and then muscle/fascia. Lipo removes the fat, so there is a mostly empty space between skin and muscle. Compression garments force the skin to stick the muscle, which obliterates that space and contours the skin on the muscle, which results in a much more desirable figure. It doesn't sound like you need lipo, so I doubt compression would help significantly.

    It sounds like your loose skin is due more to aging (loss of skin elasticity) than excess fat. Unfortunately there's not a lot that can be done surgically without creating long scars on your arms, which I wouldn't advise. Honestly, your best bet is to work on toning your arm muscles. By increasing your muscle size you might be able to tighten the skin and get rid of some of the looseness. You can certainly try wearing compression garments, but I doubt you will see a significant difference.

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    Default Re: Ask the surgeon a question

    Quote Originally Posted by miss.a.p1600 View Post
    Do you play music when doing surgery on your patients who are under anesthesia like they do on that show Nip/Tuck?

    And what type of procedures do you think Kim Kardashian has had?
    Quote Originally Posted by luvnrockets View Post
    Follow-up question: Do you fuck your patients? Lol that show was so fucking unrealistic.
    I've heard Nip/Tuck is a good show, but I've never seen it, so I don't know what went on inside or outside the OR. I will say I don't know of a surgeon who doesn't play music of some kind in the OR - pretty much standard these days. I usually let the anesthetist play their own music. In our office procedure room we have a TV for patients to watch during their procedure.

    In terms of having sex with patients - no way! People don't believe it, but sex is just not on my mind in the context of patient care. That doesn't mean I don't have really hot patients, or even patients I'm really attracted to - that's just natural. But at the office or in a hospital I just switch off the "try to have sex" part of the brain and focus on taking good care of my patients. The vast majority of doctors are the same way. It's a big ethical no-no for doctors to have sex with patients.

    As for Kim K - hard to tell, because so many of her pictures are airbrushed. If I had to guess I would say she has natural breasts, and probably natural butt. It looks to me like she has had some filler in her lips and cheeks. And maybe some lipo on her abdomen or flanks. Possibly some Botox on her face as well.

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    Default Re: Ask the surgeon a question

    Yeah, I hope my sarcasm was translated properly there. Of course you don't have sex with your patients; you don't seem like an idiot.
    "Do you do tech support in exclusive?"

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    Default Re: Ask the surgeon a question

    Are there any harmful additives in fillers like juvaderm? And what would be the most permanent solution to getting full upper cheeks? I want to lose weight but my body type gains and loses evenly so I'm left with a hollow face when I get thin and I love the full face I have now..but I'm technically a bit overweight. It's something I've been struggling with for quite some time , as I feel I have to choose between my face and my body.

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    Default Re: Ask the surgeon a question

    Quote Originally Posted by Tom Kazansky View Post
    As for Kim K - hard to tell, because so many of her pictures are airbrushed. If I had to guess I would say she has natural breasts, and probably natural butt. It looks to me like she has had some filler in her lips and cheeks. And maybe some lipo on her abdomen or flanks. Possibly some Botox on her face as well.
    And the rest. LOL

    Tom, how complicated is a breast augmentation involving replacing overs with unders? What happens with the original pocket?

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    Default Re: Ask the surgeon a question

    Kim K - That ass is not natural. Lol. Her thighs don't match her hips/butt. They're kinda skinny. Plus her butt kept growing through the years....just odd looking.

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    Default Re: Ask the surgeon a question

    I have 32DDD breasts, 29, no kids- They hang pretty low. I would love a breast lift, but in a business where people are looking at my tits all day will the scars be super noticeable? It the only option a lollipop or anchor lift?

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    Default Re: Ask the surgeon a question

    Quote Originally Posted by Vyanka View Post
    Kim K - That ass is not natural. Lol. Her thighs don't match her hips/butt. They're kinda skinny. Plus her butt kept growing through the years....just odd looking.
    Totally agree. look at her pics from when she was younger, even when she first came on the scene, her ass is shapely but way smaller. and now that thang is a massive donk that looks completely unreal and manmade.

    kim-kardashian-bum-before-and-after-photo.jpg

    But there is only one way to know for sure. First Tom we will have to get you that eye surgery to improve your vision lol (I'm kidding) then we will need to to a squeeze test.

    I think She's also had a rhinoplasty.

    Thanks for replying.
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    Default Re: Ask the surgeon a question

    Hi there, I wanted to start by thanking you for starting this thread. That's nice that you take the time to answer these questions.

    I wanted to ask you about breast implants. I currently am a natural C cup, I'm 5'9 and 155lbs. I work with alot of girls who have implants and hardly see any that I personally find attractive. I don't like a super perky look, I don't like a super round look. I think it's really unattractive when a girl has a thin chest and then gets implants that look like half a grape fruit with skin stretched over it. Most implants I see don't have much character to them. They all look so basic cookie cutter generic balloon shape.

    I like the top part of the breast to have a natural slope. From the profile I don't like it when the breast implant looks like a dome and there's no smooth transition from chest wall to bottom of breast. I don't want implants that are too wide and makes me look too bulky on top.

    My breast idol is Salma Hayek.
    What I like about her breasts are that they are big and full but they have a natural slope and hang to them. The top of her cleavage meets together and the bottom of her breasts sort of flare apart creating a little triangle between the bottom of the breasts. I find this boobie triangle so so cute and I think it makes breasts look so much sexier than having breasts that are separated all the way up.

    I know I'm being super particular. I'm just wondering if I would need anatomical shaped implants to achieve her look? Is there a certain technique/implant combination that could guarantee the underboob triangle look?
    Thank you.

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    Quote Originally Posted by simone87 View Post
    Are there any harmful additives in fillers like juvaderm? And what would be the most permanent solution to getting full upper cheeks? I want to lose weight but my body type gains and loses evenly so I'm left with a hollow face when I get thin and I love the full face I have now..but I'm technically a bit overweight. It's something I've been struggling with for quite some time , as I feel I have to choose between my face and my body.
    There are no harmful fillers in Juvederm. the substance in Juvederm, hyaluronic acid, is naturally produced by the body, so no problem with that. It is a good choice (or similar filler) for full upper cheeks. Your problem is very common and is the ultimate catch-22 of weight loss. I can't tell you how many women are frustrated with weight loss when the first area to show a noticeable change are the breasts, butt, face, etc. One of those cruel twists of nature. I recommend losing the weight to where you are happy with your body, and then get filler for your cheeks. I think that's going to give you the best overall look. Good luck!

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    Default Re: Ask the surgeon a question

    Quote Originally Posted by JessaJade View Post
    And the rest. LOL

    Tom, how complicated is a breast augmentation involving replacing overs with unders? What happens with the original pocket?
    Replacing subglandular (overs) with subpectoral (unders) is not terribly complicated, but is definitely more complicated than a standard augmentation or replacing implants in the same pocket. In my opinion, to do this right the entire capsule around the original implant needs to be removed. The capsule is a layer of scar tissue that naturally forms around the implant. My practice is to remove the entire capsule around the original implants, and then I suture the breast tissue to the pectoral muscle/fascia to completely obliterate the original pocket. Now, not all surgeons believe this is necessary. Some will just suture the capsule closed, others will just partially remove the capsule. The pocket will mostly like not cause a noticeable difference, but in my view it is best to recreate the original anatomy as much as possible. Either way, the original pocket will close and not be noticeable after you have healed.

    In terms of complexity, the same incision can be used as your original surgery. The length of surgery is usually 2-2.5 hours total, or about an hour longer than the original augmentation. The worst part for you is having to experience as bad or worse pain the second time around. If you replace implants in the same pocket, the pain is usually far less than the original augmentation. But because you are creating a new pocket and stretching the pectoralis muscles, you are going to have a lot of pain post-op - as bad or worse than the original.

    So replacing implants from the subglandular to subpectoral plane can be done, but it will take longer and your surgeon will probably charge more than a standard augmentation. The results should still be excellent. Let me know if you have any other questions!

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