Jeffrey M. Kenkel, M.D., FACS
I am 5'9" and 145 pounds. I love my body but my hips seem to go out, then in, then out again at the thighs. I want to fill in what I call "the gap" that is taking away from the figure I want. I don't want to gain weight to have this done, I just want to have fat injections to fill in this area. Do you think I have enough fat at my weight to fill in the gap without having to gain extra weight?
Women often have a variable depression between their hips and outer part of their thighs. The outer silhouette can be improved with liposuction. Bringing the hip and outer thigh areas in and perhaps adding fat to this area are solutions to the situation you are experiencing.
I would recommend seeing a board certified plastic surgeon who is an ASAPS member to discuss how this might be best handled for you.
Can a recent tummy tuck cause capsular contracture in a breast when the agumentation was done 10 months ago?
I am 48 years old and was just told by my plastic surgeon that I have capsular contracture of the right breast, stage 3, after only having had the surgery ten months ago. I have read that mammography cannot be performed in cases of capsular contracture. What are my options for breast cancer screening? Could a recent "tummy tuck" done 8 weeks ago, have caused capsular contracture?
Capsular contracture remains a challenging entity to treat as we still don't completely understand its origin. It is likely due to some type of bacterial infection which may not manifest itself for some time. It could be months or even years. It is thought that the implants may contain "biofilms" which are "indolent colonies" of bacteria that get activated. It is unlikely that the abdominoplasty caused this.
I would definitely go back and see your surgeon. There may be ways to try and improve this non-surgically. Ultrasound and even some medications may be helpful.
Capsular contracture does make it more difficult for mammography because the implant cannot be displaced for the exam. MRI can be used but is expensive and may have some false results associated with them.
What are the side effects of exposing newly lasered skin to sunlight (without applying sun block) during the healing period?
I had two laser sessions on some nevi and six non-ablative laser sessions on post acne scars. During treatment (6 months) I didn't apply sun block regularly. It was about 200 hours collectively of exposure to indirect sunlight coming from the window when indoors, or in a car, fluorescent light, and some direct sunlight. What are the risks of side effects? Is there a risk of malignancy (in skin or nevi) due to exposing freshly lasered skin to sun during its healing, as laser treatments make skin more sun sensitive?
It is hard to say specifically. Surface treatments remove some of the protective elements of the skin so you are a bit more sun sensitive which can lead to pigmentation and other aging changes. I don't feel the non-ablative treatments will put your skin at the same increased risk but still may have an effect. Cumulative sun exposure and "burning" can enhance your risk for malignancy.
Is it OK to have twilight anesthesia instead of general anesthesia for a facelift and eyelid surgery?
Will twilight anesthesia be OK for a 4+ hour facelift, along with upper and lower eyelid surgery?
Janet, thank you for your excellent question. The type of anesthesia performed is usually determined by both your plastic surgeon and the anesthesiologist they work with. In many cases, the procedure you described could be done under twilight. In our institution our anesthesiologist prefers general anesthesia for most of what we do. The most important thing is that you are cared for by an ABMS board certified plastic surgeon and anesthesiologist in an accredited facility.
J. M. Kenkel, MD
I want to have a facelift, upper and lower eyelid surgery, nose reshaping and a browlift. I also want a breast lift with implants, a tummy tuck and liposuction of the waist, buttocks and upper thighs. How much of this surgery can be done at one time? I am a 53 year old female in good physical condition. I am a non smoker with no health problems except chronic back, neck and shoulder pain which is controlled with pain medication.
MC, this is a great question. While you raise many concerns that can be addressed with plastic surgery, the most important question you raise is about patient safety. So how do we determine what is a safe number of procedures to combine in one operation? The short answer is it varies completely on the patient and the types of procedures done. Obviously the stress that a facelift puts on the body is totally different than that of a tummy tuck. We also try to limit how much time you are under anesthesia in one sitting. In my hands, your requests would require a minimum of 2 but likely 3 procedures. It would be very important for you to discuss this with your board certified plastic surgeon, ASAPS member. Every patient is different, so a procedure(s) that is tailored to your needs would be determined. Thanks so much for raising important safety issues.