The DeLuca Plastic Surgery Learning Corner and Blog

Nothing But Neck – Kybella vs. Liposuction To Treat Neck Fat

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Fullness of the neck due to excess neck fat can be treated with both invasive and non-invasive strategies. Reduction of this fat can give better definition to the jaw like and neck and make patients look younger and more fit.

Kybella

Kybella is a non-invasive injection that has been recently approved by the FDA to help improve the appearance of fullness associated with the submental fat of the neck in adults. Young adults, with a moderate amount of excess fat and good skin tone are usually good candidates.

During a office based Kybella treatment, the neck is first cleaned and numbed with topical lidocaine. A pattern is drawn on the neck and the product is injected into the fat of the central neck – dissolving the fat. The body then absorbs the fat over several weeks. There is swelling that occurs and may be bruising and some numbness in the area during this time. The injections are usually done once every six weeks and it usually it usually takes at least two treatments to achieve the desired improvement. (more…)


The Skinny on Liposuction

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What is Liposuction?

Liposuction is a body contouring procedure that reduces fat under the skin to address trouble spots throughout the body.

Traditionally liposuction has been used to tweak areas resistant to exercise such as the love handles, the lower abdomen, the neck, and the buttock. Liposuciton is performed through small access incisions hidden in inconspicuous areas. Because of this, the recovery is relatively quick compared to more invasive surgery, and the restrictions after surgery are few.

Unfortunately, however, liposuction does not have the ability to address any excess skin laxity. The overall success of the procedure depends on the skin retracting back after the fat is reduced. The ideal candidates are young patients with good quality, elastic skin. In patients where the skin does not retract, a skin tightening procedure can be performed to address the excess loose skin.

Not sure if you need skin tightening? Check out our blog post: “Do I Really Need A Tummy Tuck?.

Liposuction treatment areas

Can I Use Liposuction To Help Jump-Start My Weight Loss?

An alternative use of liposuction is as a debulking procedure during weight loss to “jump start” the process of slimming down. This procedure results in a modest weight loss and an incremental improvement in contour that helps motivate patients to continue losing weight through dieting and exercise.

Compared to traditional liposuction, debulking liposuction focuses on performing the procedure quickly with large cannulas to get rid of as much fat as possible in as short a time as possible. This change in focus keeps OR and anesthesia time down and, therefore, significantly reduces cost. There is less attention paid to fine contour refinement and, therefore, patients must accept that there may be contour irregularities that may need further tweaking with contour focused liposuction or surgery in the future.

Recovery After Liposuction

As with any surgery, the pain after liposuction is usually worse in the 2-3 days immediately after surgery and tends to improve after that. Management of pain is usually through a combination of narcotic and non-narcotic pain medications taken by mouth, oral medications that lessen muscle spasm, and long acting local anesthetics injected during surgery or infused from a small pump.

Post-operatively, patients who have liposuction of their torso are placed into an specialised compression garment with smoothing foam backing. Patients wear this for the first two week after surgery. At that point, Dr. Tauber then recommends patients transition to a Spanx OnCore Firm Control Open-Bust Bodysuit or a Spanx Power Conceal-Her Medium Control Open-Bust Bodysuit (available on Amazon) for smoothing compression for the next month.

Get more details on the management of swelling and scars in blog post: Post-Operative Care After Plastic Surgery.

The ability to return to work and everyday activities is variable and depends on many factors including the type of work, the pain tolerance of the patient, and the extent of the procedures. Most patients are ready to return to their lives in 2 weeks.


Do I Really Need A Breast Lift?

The decision to do a breast augmentation without lift versus a breast augmentation with a breast lift, however, is less based on patient preference and more dictated the saginess, the nipple position, and the ratio between the breast volume and the amount of excess skin that is present.

How Ptotic Are My Breasts?

The gold-standard method of assessing the need for a breast lift is the “pencil test.” Standing in front of a mirror, lift the breast and lay a pencil in the fold under the breast and allow the breast to settle over the pencil. Look at the position of the nipple in relation to the pencil.

Pencil Test For Determining Degree of Breast Ptosis
Pencil Test For Breast Ptosis

The lower the nipples and breast are below the pencil and the more excess skin you have, the greater the chance you will need a breast lift and the more of a breast lift you will need. If your nipple and a majority of your breast are at or above the pencil (Normal), you will likely get a great result from a breast augmentation alone. Larger implants can shift this equation slightly for patients that have borderline ptosis (Grade 1).

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Hollow Cheeks – Treatment with Implants, Fat Transfer, and Fillers

What Causes Hollow Cheeks

The aging, hollow face is typified by soft tissue decent and volume loss. These stigmata of growing older are manifest by the development of nasolabial folds, marionette lines, and jowls combined with a sunken mid-face and hollow cheeks.

In recent years, DeLuca Plastic Surgery has looked past skin tightening as the solution for all of these complaints and has recognized the role that volume loss contributes to the appearance of aging, hollow cheeks. This volume loss occurs as the soft tissue (and even bone) of the face resorbs over time as we get older or secondary to weight loss. To combat these changes we utilize a variety of techniques including several types of non-invasive facial fillers, fat transfer, and facial implants.

Facial Implants

Projection of the cheeks and mid-face is due to the interaction of the bones of the face and the overlying skin and soft tissue. Facial implants are used to add a more substantial foundation to hollow cheeks by adding projection to the bones of the face in patients that have experienced significant resorption as they age or who have always lacked projection.  Skeletal implants are powerful tools to modify the framework of the face and can produce dramatic results. In our practice, these implants are often combined with soft tissue augmentation, such as fat transfer, to treat hollow cheeks – restoring harmony and symmetry.

Facial Implants Used in Treating The Thinning Face
Types of Facial Implants

Read: “Top Cosmetic Surgeries For Men”

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The Brazilian Butt Lift – Baby Got Back

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There has always been a fascination with the posterior of women, however, over the last few years plastics surgeons have seen the demand for the Brazilian Butt Lift to skyrocket. This new found focus has still not eclipsed breast augmentation or liposuction as the procedure of choice, however, the influence of celebrities such as Kim Kardashian and Nicki Manaj have caused demand to surge 58% over the last year.

Dr. David Tauber and DeLuca Plastic Surgery have seen requests for buttock augmentation increase year over year during he same time period. In response to this demand we have recently began offering our patients the world famous Brazilian Butt Lift.

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Current Trends in Labiaplasty – The Edge vs. The Wedge

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Women seek labiaplasty for many reasons ranging from discomfort with intercourse and pinching in tight clothing to purely cosmetic reasons. According to the American Society for Aesthetic Plastic Surgery there has been a significant increase in the number of these tissue reduction and restructuring procedures — an astonishing 48 percent rise in 2014 from 2013. Workout gear is becoming tighter and women are becoming more self conscious about how they look in lycra enhanced tight clothing.

Although there are variations in technique and equipment used, labiaplasty most often involves reducing the size of one or both of the labia minora through one of two basic techniques. Both techniques attempt to preserve the nerves to the skin within the mucosa instead of simply removing it. In addition,  both techniques can be extended to reduce some of the excess clitoral hood.

The first technique is a straight-line (trim) excision. It reduces the excess tissue in straight line front to back. This technique is more straightforward and has the added benefit of reducing the unsightly thickened free border of the labia. There are variations on trim that include the Lazy-S Labiaplasty and the Extended Excision Labiaplasty.

Labiaplasty Incisions
Labiaplasty Incisions

The second most common technique is the wedge excision. It reduces a pie-shaped wedge of tissue from the central portion of the labia. The remaining tissue at the front and back is then brought together and closed. This technique preserves the free border, however, it is more complex and requires additional incisions to reduce the dog-ear that forms. There are variations to the original wedge resection including the the Z-Plasty Wedge Labiaplasty, the Hockey Stick Wedge Labiaplasty, and the DOVE (Double Opposing V-Plasty with Extended Deepithelizing) Wedge Labiaplasty.

The choice of technique is based on patient preference and is tailored by Dr. David Tauber to each patients needs. A detailed examination will help delineate the best surgical treatment.

Get more details on the management of swelling and scars in blog post: Post-Operative Care After Plastic Surgery.


Botox and Facial Fillers – The Fountain of Youth (Without The Knife)

What Is Botox?

Botox is an injectable used to lessen the movement of specific muscle of the face in an effort to target wrinkles created by the contraction of facial muscle groups. The areas that are treated most often include the forehead, the area between the eyebrows, and the crows feet (on the side of the eyes). The goal is to soften these tell-tale stigmata of aging without leaving the face looking flat and emotionless. This can be a difficult needle to thread. If done correctly, however, Botox can make the face look younger, raise the eyebrows, and make the eyes look more open.

Botox Before and After
Botox Before and After – 7 Days (courtesy Allergan)

Botox is injected using a very fine needle into the affected areas. Most patients experience little discomfort and by the time they return home or to the office any redness or swelling has disappeared. The affect begins to be noticed over the next week and lasts for about 3-6 months until the effect, again, slowly fades out.

Read: “Botox Basics”

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Blepharoplasty with Fat Redraping – Solutions For Aging Eyes

Aging eyes are characterized by the development of wrinkles, fine lines, drooping skin, midface hollowing, and eyelid bags. These changes make patients look tired and angry. The bulging of the lower eyelids occurs as the tissue wall (orbital septum) that holds the fat in the orbit begins to weaken and stretch. Traditional blepharoplasty attempts to address this bulge by reducing the fat.

This approach to treating the aging eyes reduces the bulge, however, it can produce two unwanted effects. The first is an unmasking of midface hollowing that was masked by the fullness of the bulging lower eyelids. The second occurs as the face continues to age. Over time, the orbital fat begins to lose volume. This produces hollowing around the eyes. If the fat is reduced during a blepharoplasty, this hollowing is accelerated. This leaves the patient with a skeletal look that is difficult to correct.

Read: “Blepharoplasty (Eyelid Lift)”

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Clinical Diagnosis in Plastic Surgery by Dr. David Tauber

DeLuca Plastic Surgery would like to congratulate Dr. David Tauber on the publishing of the book, Clinical Diagnosis in Plastic Surgery.

Clinical Diagnosis in Plastic Surgery by David Tauber, MD

Clinical Diagnosis in Plastic Surgery systematically presents a collection of entities, syndromes, and diseases that are diagnosed and treated by plastic surgeons, hand surgeons, otolaryngologists, oral surgeons, and dermatologists.

The goal is to document an extensive array of signs and visual clues that are critical to the diagnostic process, thereby enhancing the clinician’s ability to identify relevant diagnostic features and make correct diagnoses. Skill in recognizing deformities and disease processes by observation is of vital importance in plastic surgery, which is very much a visual surgical specialty. In drawing together key diagnostic signs, this book will spare readers the onerous task of searching through endless resources, books, and websites.

A helpful appendix details the various classification systems used in the book with the aid of appropriate diagrams. Clinical Diagnosis in Plastic Surgery is intended for students, residents, practicing physicians, and surgeons in all of the affiliated fields of plastic surgery. (more…)


There is No “Right” or “Best” Age for a Facelift

Nice Face The facelift is experiencing a bit of a renaissance it would seem. I have patients of all ages ask about the surgery and whether or not they would be a “good” candidate for the procedure. It’s a good question.

Fifteen years ago, the average age of a patient was about 60 to 65 – today it’s closer to 45 to 50.

Why? Previously, patients were waiting until signs of aging had become extremely visible before opting to ‘turn back the clock’ 10 to 15 years (which is what a well done facelift can do). These days, patients are taking a more proactive approach in reducing the appearance of aging skin – and so are opting for less extensive lifts in their 40s and early 50s. That said, there’s absolutely no “right” or “best” time to undergo a facelift and if anything, having the procedure a little later on makes for an even more dramatic* result (because the face ages at a faster rate the older we get, so the difference between 30 years old and 40 is less than 40 and 50). (more…)


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