Individuals who have undergone gastric bypass for weight loss are left with redundant skin located throughout their body. This excess skin can be located in their arms, face, chest, breast, abdomen and thighs. In order to correct this excess loose skin, the patient must undergo multiple surgeries to eliminate this loose skin. It is not uncommon that an individual who has lost over 150 pounds will undergo two to three surgical procedures to correct all of these problems. In my office, I have a long discussion with the patient about what concerns her most about her body. Depending on her desires, the excess skin can be removed from the abdominal, back, thigh upper, arms or breast areas. Insurance generally covers the marked loosenes of skin in the abdominal area if there is noted to be excess rashes located underneath the abdominal pannus. A patient must understand that there will be permanent scars, but these scars blend well over time. I have found that patients are extremely satisfied with these operations since no diet or excercise will help eliminate this marked looseness of skin.
Today skin cancer is very frequent. This is due to a large degree from excess sun exposure we have growing up. Occasionally these cancers can be herefitary. Most patients believe that their dermatologists are the best doctors for treating these problems. However when one realizes the extensive surgical training a plastic surgeon receives, it is easy to understand that the quality of surgical care is superior.
Not all plastic surgeons trat skin cancers. For this reason, the patient must inquire of that doctor before making an appointment.
In my practice I see several patients a day for facial and body lesions. My first step is to determine whether a biopsy needs to be done. If the lesion appears to be suspicious for skin cancer, a shave biopsy is performed and the ledion is sent to the lab. After the pathologist examines the lesion and the diagnosis is skin cancer, treatment options are discussed. In most cases, minor surgery is required to remove the lesion. Frozen sections or immediate pathological examination is performed to insure free margins around the tumor. At this time, reconstruction using skin flaps or skin graft is performed. After several months of healing, these surgical scars blend well with minimal, if any deformity. The doctors in my community realize the superior cosmetic appearance following a plastic surgeons care and treatment of these problems. It is important that the patient realizes the advantages of a plastic surgeon performing skin cancer excision and reconstruction.
Our Neck is often one of the first areas to show early signs of aging. Tissue changes include loose, wrinkled or hanging skin. Hereditary conditions cause excess fat in the neck creating a double chin. The combination of tissue decent, fat accumulation and exposure to the elements can have a profound impact on neck contour and skin quality. When the skin becomes slack under the chin, it can create an unattractive “waddle” or “turkey” neck. Occasionally the muscles of the neck become more prominent and sometimes appear as vertical cords. Loose skin and fat deposits can also produce jowls or jowl line contour deformities.
In order to correct these problems, surgical intervention is required. Frequently a full face lift is most effective. My patients are shown that the face and neck are in continuity and in order to achieve facial harmony, neck and facial tissues must be tightened together.
However depending on the degree of neck and facial skin aging, selected patients can undergo isolated neck lifts. In these patients, hair line incisions are made behind the ear which is unnoticeable. Some patients with minor degree of neck loosening can undergo temporal or short scar lifts. Essential to these procedures are the patient’s desires and expectations. Patients with neck fullness can undergo liposuction alone which allows for secondary skin contraction and tightening.
Today most patients desire a short healing period, minimal scars and natural results following facial surgery. Depending on the patient’s age, skin quality and amount, short scar techniques are now available. With these techniques, incisions are made at the hair line or behind the temporal hair line and may extend in the contours of the ear. These incisions are essentially invisible once healing has occurred.
The main advantages of these techniques are the minimal scars and face recovery time. Surgery can be performed under local anesthesia. The surgery takes approximately two hours to complete. The bruising and swelling are minimal, allowing the patient to return to work within seven days. Make up is applied at one week and exercise is resumed in two to three weeks.
The results of this surgery are impressive. My patients are thrilled with these procedures. They are amazed at how much younger they appear but lack the stigmata of surgery. Their friends constantly tell them how good they look but are unable to detect that surgery has been performed. This is a procedure that I highly recommend in the patient who has the correct facial anatomy.
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Dr. Wald is a board certified plastic surgeon, with over 20 years of experience. Our office is located in Orange County, in the city of Fullerton. If you would like to schedule a consultation with Dr. Wald, please contact our office at 714-738-4282.
The hallmark of a youthful face is a well defined jaw line with a sharp line between the face and neck. If excess fat develop underneath the chin and along the jowl line with good skin tone and minimal excess skin, liposuction can be performed. In this procedure, one or two small incisions are made on the underside of the chin and/or in the crease around the earlobes. A canula or hollow tube is place beneath the skin and into the fatty tissue. Using this canula, this excess fat is broken up and suctioned out eliminating the double chin and creating a nice contour of the neck.
I recently saw a thirty-year-old woman from Yorba Linda who complained of excess fullness in her neck. She said her mother and father both have this problem and despite diet and exercise, she was unable to lose this fat. After liposuction of her neck, she developed a youthful, natural and clean neck. She returned to work after three days and was extremely pleased. She said this procedure had changed her whole life and her attitude about herself.
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Loose wrinkled abdominal skin and excess fat in the lower abdomen is a common problem. This may occur following pregnancy or weight loss or for genetic reasons. Occasionally liposuction may be the only treatment needed for a protruding abdomen, if the skin tone is good. But if the patient has loose skin and lack of tone in the abdominal area, then an abdominoplasty, commonly called a tummy tuck, may be required.
Abdominoplasty has become one of the most popular procedures I perform. Today the modern woman wants to regain her figure after child bearing, wearing fitted clothing and look natural in her overall contour, both sitting and standing. The best results are achieved with careful incision placement, skin and fat reoval and recreating a natural umbilicus (belly button). The key to a natural umbilicus is placing the scar deep within the contour of the belly button. The stomach muscles are also tightened to flatten the abdomen. Women who have dieted and exercised and unable to correct these problems are excellent candidates for this surgery.
My patients return there abdomen to a beautiful shape that looks great in pants and swimwear. A two week period of time is required for recovery. With modified abdominoplasties, the patient will return to work within ten days. The scar length varies with the women’s contouring and is easily covered by her swimwear and underwear. This is one of the most satisfying operations that I perform.
The nose is a very prominent part of our face. A nose that is long, short, narrow or wide can be considered attractive. The most important aspect in judging the aesthetics of a nose is whether it fits one’s face in a complimentary way. A nose that is in harmony with other facial features blends in.
Nose reshaping (rhinoplasty) can be done for cosmetic or reconstructive (breathing issues or trauma) purposes. Insurance will cover breathing impairment or a traumatic nasal deformity. Not uncommonly, patients request a combination of cosmetic and reconstructive surgery.
The patient must be extremely be extremely diligent in finding a nose surgeon. The skill of the plastic surgeon is the key factor in achieving the type of result that each patient desires. I many instances, the best results are those that are subtle. A surgeon who has performed several hundred rhinoplasties is best suited to perform this surgery. Even with extensive experience, revisional nasal surgery may be needed. The number of re-operations tend to be markedly higher in the untrained hands.
Most people today would like to look younger without undergoing any surgery and having minimal, if any, down time. We are all busy in our daily lives and with the present economic conditions; we would like benefits of youth with out much expense and bruising.
Botox and fillers (Hylaform, Restylane, Juvederm, and Radiesse) are quick remedies for the aging face. Botox paralyzes for three months the muscles over our nose, forehead and around the eyes. This prevents an angry appearance or scrowling typically seen by hyperactive glabella muscles. Forehead wrinkles and lines around the eyes are also softened when paralyzed by Botox. After performing over two thousand injections Botox, I have never seen a problem. The Botox must be injected by a competent person, preferably a doctor. I see everyday patients who say they were injected at a med spa and say they have seen minimal results. I explained to them that a lot of places charge small feel but also dilute the Botox several times more than the recommended amount. This marked dilution lessons the effects of Botox, usually resulting in an unhappy patient.
Facial fillers plump up lines or wrinkles or depressions that we develop as we age. By injecting these fillers into these areas, the wrinkles are lessoned. These substances last approximately six months and Radiesse can last up to one year.
When using both fillers and Botox in combination, a youthful combination can occur without any down time and minimal cost.
Breast reduction surgery is generally recommended for woman experiencing health problems associated with very large heavy breasts. Several medical conditions have been associated with large breasts including back and neck pain, skin rashes, breathing problems, shoulder indentations from tight bra straps and poor posture. It is also associated with a decrease sense of attractiveness and self confidence.
Breast reduction is usually performed to relieve physical symptoms and may be covered by insurance. Insurance companies usually require photographs and a letter from the plastic surgeon prior to any surgical intervention. If it can be shown the medical necessity is indicated, then the surgical procedure would be covered.
Many techniques are available for breast reduction. Traditionally and inverted “T” approach is used. This includes incisions around the areola down the center of the breast and in the infra mammary crease. Today much smaller incisions are available. Depending on the patients breast shape, size and amount of sagginess, a donut shaped vertical scar technique may be used. In my practice, almost all incisions have healed beautifully with minimal scarring.
Robert M Wald Jr. M.D.
Breast Augmentation is performed to enhance the size and shape of the breasts. Today silicone has been approved for all woman. In my practice, it is very important to explain the differences between silicone and saline implants. Silicone is softer and more natural then saline implants. There is also less rippling with silicone implants. A woman must realize that if she chooses a silicone implant, that MRI’s must be performed periodically to look for a rupture. The rupture rate for implants is approximately 3% within the first ten years. All the studies have indicated that silicone is safe with no established systemic effects. Even though silicone implants are modestly more expensive, from my observations, women believe the extra price is worth the advantages.
Robert Wald M.D.