Aging, child bearing, and weight gain all contribute to undesirable changes in the abdomen, trunk, buttocks, thighs, and lower legs. Common deformities of the abdomen include localized fat deposits (lipodystrophy), loose skin, stretch marks, laxity of the mons pubis, and stretching of the abdominal wall fascia. Deformities of the buttocks and thighs include lipodystrophy, cellulite, laxity of tissues, and stretch marks. Rejuvenation of the lower body can only be accomplished surgically as no amount of exercise or changes in diet can correct these deformities. Below is a discussion of the most useful procedures in body contour surgery.
Body Lift
Tummy Tuck
Fat Grafting
Liposuction
Brachioplasty
Scar Revision
Sclerotherapy
One of the largest and most rewarding procedures in body contouring is known as a body lift. The term "body lift" is somewhat confusing due to multiple names such as total body lift, lower body lift, complete body lift, and others. A body lift consists of a thigh lift, a buttock lift, and possibly an abdominoplasty. Which factors cause buttocks and thighs to become lax necessitating a body lift? Much has to do with genetics but another common cause is massive weight gain that can lead to overstretching of the skin. To assess whether you will benefit from a body lift, stand in front of a mirror and pull your lateral thigh and buttock up with both hands. If you are able to pull up a large amount of skin and you see significant improvement in the thigh/buttock area then you will benefit from a body lift. For excess skin in the medial thigh area a medial thigh lift may be indicated. This procedure can be performed in combination with the lower body lift. The lower body lift starts with a detailed measuring and marking of the skin to be removed. If auto-augmentation of the buttocks is to be performed it will be designed at this time. After the patient is anesthetized they are placed in the prone position (facedown) and the body lift is begun. Basically all the tissue and skin inside the markings is excised and the incisions are sutured with both permanent and absorbable sutures. It is important to reconstruct the superficial fascial system as this prevents spreading of the scar. The wounds are then glued together with dermabond and the patient placed in the supine position (lying on back). Next the abdominoplasty and medial thigh lift are performed if indicated. Four drains are usually used to drain excess fluid from the wounds. Sometimes more then 12 vertical inches of skin can be removed achieving remarkable tightening in the thighs and buttocks. This operation requires a 1-2 night stay in the surgery center and a 2-3 week recovery. Complications consist mostly of wound healing, seromas, scarring, blood loss, and 3-6 months of swelling of the legs. Dr. Martin has over 12 years of experience performing body lifts and is considered an expert in this procedure.
Auto augmentation of the buttocks – With long term massive weight gain comes many physical changes including loss of buttock volume and shape, saggy buttocks, and loss of tissue over the sacral/ischial bones. These conditions are not only unattractive but can lead to problems with sitting comfortably. In this procedure the tissue above the buttocks that is normally discarded is turned into a flap and rotated into the buttocks. This restores shape, volume, and functionality to the buttocks. Fat grafting or buttock implants can also be used to enhance volume of the buttocks. We have found that when given the option, most patients having a body lift will choose to add a buttock enhancement using their own tissue. Dr. Martin is currently one of the few surgeons in the Tristate who is performing this procedure.
Medial thigh lift – One of the most difficult and least rewarding procedures in thigh lifting is the thigh crease medial thigh lift. Developed in the 1990’s, this procedure lifts the medial thigh and also reduces the amount of skin present. The scar is placed in the groin crease and continues back toward the buttock crease. This procedure remains effective for deformities of the upper one third of the medial thigh. The main complications with this technique are limited lifting of the middle and lower thigh and long term healing complications such as spreading of the lateral vaginal wall. Fortunately for weight loss patients, marked advances have been made in medial thigh lifting techniques. Most medial thigh lifts are now performed using longitudinal incisions placed toward the inner back of the thigh from the lower groin to the knee area. This is termed a longitudinal thigh lift and has remarkable results with minimal complications. The resulting scars are well tolerated and the main problems have been with persistent seromas and swelling of the legs. Also, there is less pull on the vaginal area due to the design of the flaps. To simulate a medial thigh lift, grab the medial thigh skin between both hands and pull towards the inside of the leg. If you see significant improvement in your medial thighs, you are probably a candidate for a medial thigh lift. With a 12 year experience in medial thigh lift techniques, Dr. Kurtis Martin has the knowledge and skill to achieve outstanding results.
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Ever dream of having the perfect stomach? Everyone desires a flat, tight abdomen with great muscle tone and no excess skin or stretch marks. Working out and getting in shape is great for your muscle tone but can not restore your abdomen to a youthful contour. Plastic surgery of the abdomen (tummy tuck) is designed to remove excess skin, stretch marks, and fat along with tightening of the abdominal wall.. There are numerous types of abdominoplasty and your surgeon will choose the best technique for you. All abdominoplasties are performed in a surgery center or hospital and most require an overnight stay. Typically 1 or 2 drains are placed to remove excess fluid and these are removed in 1-2 weeks. All sutures are placed under the skin and do not need to be removed. This results in less pain for the patient and less chance of “railroad track” type scarring. In order to diminish the pain associated with tummy tucks a pain pump may be used. Post operatively you may shower, walk, and be active. No heavy lifting is permitted for 4-6 weeks. Complications of an abdominoplasty include tissue necrosis, scarring, hematoma, infection, and seroma. If you are a smoker you will have a higher complication rate and must quit smoking 2-4 weeks prior to surgery. Below are the most common types of abdominoplasty.
Standard abdominoplasty – An incision is made just above the mons pubis from hip to hip, the excess skin is removed, and the fascia and muscles are tightened. Usually the entire area from the belly button to the mons pubis is removed. If a c-section scar is present it will be removed. Stretch marks located above your belly button will not be removed but the excess skin will be tightened when it is pulled down towards the mons pubis. The belly button remains on the abdominal wall and is recreated by making a new opening in the overlying skin. The umbilicus is then pulled through and sutured in place creating a beautiful, “new” belly button. Generally the longer the incisions in an abdominoplasty the more skin removed and the more tightening that can take place. Dr. Martin is able to hide the incisions by placing them low on the abdomen so that the resulting scar is easily hidden in the bikini line.
Abdominoplasty with liposuction – Combining liposuction of the abdomen with concomitant abdominoplasty is a relatively newer concept developed over the last 10 years. Prior techniques would not allow a combination abdominoplasty/liposuction due to high incidences of tissue breakdown. With advances in techniques a combination procedure can now be routinely performed. This was accomplished by modifying the dissection of the abdominal flap and by performing less aggressive liposuction. This approach allows us to achieve spectacular results with only one procedure. Other areas of liposuction can also be performed at the same time. If you smoke you may not be a candidate for this type of tummy tuck.
Mini-abdominoplasty – For minimal skin excess below the belly button a mini-abdominoplasty may be indicated. As the name suggests a smaller incision is used resulting in a shorter scar. Skin will be tightened in the lower abdomen but not in the upper abdomen. Again, the scar will be hidden easily by swimwear. Loose fascia in the lower abdomen can also be tightened with this procedure.
Reverse abdominoplasty – For excess skin above the belly button (epigastric) area a reverse tummy tuck may be needed. This procedure is performed with an incision under the breasts and the skin is lifted up as apposed to being pulled down. A reverse abdominoplasty will have minimal effect on loose skin located below the belly button. The resulting scars are usually hidden under the breasts but scar migration can be a rare complication. Occasionally this technique is combined with a standard abdominoplasty allowing for spectacular results.
Fleur-de-lis abdominoplasty – For large amounts of skin in the epigastric area or if a previous vertical scar exists, a fleur-de-lis abdominoplasty may be indicated. The resulting scar has the shape of an inverted T and the abdominal tissue can be pulled very tight with this approach. This is used most often in post bariatric patients who have undergone an open gastric bypass.
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Diet and exercise are the best means for achieving overall weight loss, but despite healthy eating and high activity levels, some areas of the body tend to retain fat pockets that can detract from a person's appearance. Liposuction at our Cincinnati location can help our patients remove stubborn fat deposits, creating a better proportioned and more attractive appearance. Many areas of the body, including the hips, thighs, buttocks, abdomen, back, legs, arms, and neck, can be treated using liposuction. In the procedure, the area to be treated is first injected with fluid. Then a special slim tube called a cannula is inserted through a small incision and used to siphon away excess fat. Dr. Martin is very experienced in performing liposuction. In Cincinnati, his reputation has grown, due to his extensive training and expertise, combined with the personal attention he gives to each patient.
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With the development of liposuction techniques in the early 1980’s came the possibility of transplanting live fat cells for use in augmentation procedures. Now recognized as one of the most versatile techniques in plastic surgery, fat grafting is used for many aesthetic and reconstrctive applications. In the face fat grafting can be used to fill wrinkles and lines, to augment lips, and to fill out deflated areas (zygoma, nasolabial folds, marionette lines, and cheeks). In the body fat grafting can be used to augment the buttocks, fill in depressed areas (secondary to a steroid shot), or to correct post liposuction deformities. In the hands fat grafting allows for rejuvenation by filling wrinkles and diminishing the appearance of protruding veins. Fat grafting begins with harvesting donor fat from another part of the body using a modified liposuction technique. The fat is centrifuged allowing for removal of saline, blood, and oil followed by placement in small injection syringes. The recipient areas are anesthetized with local anesthesia and the fat is then injected into these areas. The fat consists of living cells and these cells remain viable in their new recipient bed. Fat grafting can result in permanent correction or augmentation but may need to be repeated to achieve this result. It is generally believed that the fat undergoes a 50% resorption rate over 3-6 months and therefore a surgeon should plan accordingly. Never allow a physician to perform a breast augment by fat grafting your breast. This procedure can lead to micro calcifications in the breast which can mimic breast cancer. For pictures of fat grafting click here.
Fat grafting requires an artistic eye and knowledge of advanced techniques to achieve superb results. With a 12 year experience in fat transfer in the Cincinnati and Dayton areas, Dr. Kurtis W. Martin has the experience and skill needed to produce the results you desire.
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Brachioplasty (also known as an arm lift) is a term used to describe rejuvenation of the upper arm and forearm. Advanced age, weight gain/loss, and genetics all play a role in developing large, fatty arms with sagging skin and wrinkles. While training and being in good shape is good for your overall health, no amount of exercise, diet, or targeted workouts will affect the arms. The bottom line is if you want great looking arms, you will require surgical removal of fat deposits and excess skin as well as tightening of the skin and fascia.
The procedure is begun by making very detailed markings of the planned excision and the areas to be liposuctioned. The line of excision (new scar in the arm) is generally located in the interbrachial groove (inner midpoint of the upper arm) where it is least conspicuous. The goal is to have the scar hidden when the arm is viewed from the front or from the back. Next tumescent solution is injected into the arm to achieve anesthesia and to minimize bleeding. Liposuction is then performed with small micro-canulas to remove fatty deposits and to reshape the arm into a more pleasing appearance. Following liposuction excess skin is excised and the remaining skin is pulled tight to complete the lift. Sometimes the excision will continue onto the forearm if excess skin is present. The skin is sutured back together with suspension of the skin to the fascia to prevent the scar from spreading. Usually the excess skin in the axilla (armpit) is removed and tightened as well. This is known as an axillary lift. Advantages of an axillary lift are removal of hair bearing skin (no more shaving) and removal of the sweat glands (minimal sweating). All sutures are placed under the skin so no removal is necessary. A post-operative garment or ace wrap is worn for 1-2 weeks. Pain is low to moderate and normal activity may resume in 48 hours. Some swelling does occur and may take up to 6 months to fully resolve. Complications can include seromas (fluid collections), bleeding, infection, and unacceptable scarring. Secondary procedures are rarely needed.
If you are considering brachioplasty, choose a board certified plastic surgeon with the credentials and experience to achieve the results you desire. Dr. Martin has over a decade of experience performing arm lifts in Cincinnati and Dayton with minimal complications and pleasing results. Call our office for more information or to talk to previous patients who have undergone brachioplasty.
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One of the most common questions patients ask is “will there be scars following my surgery”. Any surgery which requires incisions will leave permanent scars. Initially red and slightly raised, scars take 1-2 years to fully mature and fade to white. Many factors affect the quality of the final scar. Most important is the patient’s genetic ability to heal without excessive scarring or discoloration. Other factors such as trauma, type of closure, and location of scar will also affect the final result. Many products are available to improve scarring. The most effective and least expensive way to improve healing is to tape over the scar and leave it on at all times during the healing process. The tape constantly pushes on the scar causing the scar to flatten and thin out. Massage of the scar also helps healing but one would need to massage a great deal to have any effect. Other products claim to reduce scarring but effectiveness is very hard to prove scientifically. Some lasers and other treatments such as microdermabrasion can also improve scars. Don’t worry if you are unhappy with a scar as most scars can be improved with scar revision. Scar revision involves removing the old scar and resuturing the tissue in multiple layers. All of the sutures are placed under the skin to prevent railroad track type scarring. Steri strips or dermabond glue is placed over the incision to seal off the wound and keep it sterile. Sutures placed under the skin do not need to be removed and will simply dissolve over the next 6 months. Most scar revisions can be performed in the office under local anesthesia. Fees for scar revision depend on the length of the scar and the complexity of the repair. Some scar revisions may be covered by insurance if certain criteria are met.
Women and men have always disliked the spidery, or varicose veins on the lower legs and ankles. These individuals avoid wearing shorts or capris, and this issue can be very frustrating during warm weather and vacations.
Dr Martin offers sclerotherapy for any individual seeking permanent removal of these unsightly veins. His staff provides the knowledge and skills to perform this simple office procedure, and have safely treated many patients with very satisfying results.
Spider veins, reticular veins (deeper but not raised) and many varicose veis (raised, ropey and often painful) are treated by this technique.
The procedure involves tiny injections with hypertonic saline (salty water) into the vein. This solution irritates the inside walls of the vein, which causes the vein to collapse, thereby preventing any blood from flowing through it. The body absorbs this along with the clot that is formed over time. The fee is determined by the number of syringes used. Some veins actually spread like branches on a tree, and can clear with fewer injctions.
Call 513-469-0300 if you would like more information about sclerotherapy.
