A person is considered obese when his or her weight is 20% or more above normal weight. The most common measure of obesity is the body mass index or BMI. A person is considered overweight if his or her BMI is between 25 and 29.9; a person is considered obese if his or her BMI is over 30.

To measure your BMI:

BMI = Weight (lb) / (Height (in) x Height (in)) x 703 For example: if your weight is 170 and your height is 5’6” (66”), then the calculation is: (170/662) x 703 = 27.4

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Statistics published in January 2012 by the Centers for Disease Control show that 35.7% of U.S. adults and 16.9% of children are obese. In 2000, no state had an obesity prevalence of 30% or more. In 2009, nine states had an obesity rate of 30% or more and in 2010 this obesity rate has increased to 12 states.

Adult obesity is associated with a number of serious health conditions including heart disease, diabetes, and some cancers. Obese children are more likely to become obese adults. If children are overweight, obesity in adulthood is likely to be more severe.

Obese children are more likely to have:

• High blood pressure and high cholesterol, which are risk factors for cardiovascular disease (CVD).
• Increased risk of impaired glucose tolerance, insulin resistance and type 2-diabetes.
• Breathing problems, such as sleep apnea, and asthma.
• Joint problems and musculoskeletal discomfort.
• Fatty liver disease, gallstones, and gastro-esophageal reflux (i.e., heartburn).
• Obese children and adolescents have a greater risk of social and psychological problems, such as discrimination and poor self-esteem, which can continue into adulthood.

It is important for your doctor to evaluate your calorie intake, exercise activities, medical history, and family history in determining how best to manage a weight problem. A comprehensive program of diet and exercise is the first remedy that should be considered to treat obesity. In recent years, a variety of surgical choices for treating obesity have been popularized.

Next, we will discuss the different types of weight loss surgery options and the guidelines used to determine if someone should consider undergoing these procedures.

Before

After Radiesse®

Radiesse®

Radiesse® is an injectable filler used to thicken the tissue on the back of the hand. It is FDA-approved and consists of calcium-based microspheres suspended in a water-based gel that will immediately restore volume to the hand when injected just below the deep layer of the skin. It also has a collagen stimulating effect that may prolong its usual one-year duration.

Sculptra^®Aesthetic

Sculptra^®Aesthetic is an injectable material composed of poly-L-lactic acid that stimulates the production of collagen in the skin. A very natural appearing restoration of hand volume is produced by the gradual thickening of the skin that occurs over a three-month period. Generally, a series of 2-3 treatments at 6-week intervals are necessary to achieve the desired effect. The results from the treatment can last up to three years at which time maintenance treatments will be necessary.

Fat Grafting

A simple technique of injecting fat under the skin of an aging hand can achieve long-lasting rejuvenation. Your own fat is obtained using liposuction and then specially prepared prior to injecting it under the skin in fine tunnels. Survival of fat depends on it getting a good blood supply and may require several sessions to achieve the desired result. The physical presence of a thin layer of tissue will not only decrease the blue of the dorsal hand veins and the white of the extensor tendons but will also soften the shape of veins and tendons.

Fraxel^® re:store Dual Laser

The new Fraxel^® re:store Dual Laser can be used in addition to volume restoration to improve the surface texture of the skin and lighten brown spots. The new, more superficial Thulium fiber laser (1927 nm) wavelength can better address skin discoloration with minimal discomfort. In addition, the deep penetrating Erbium fiber laser (1550 nm) improves skin quality with collagen remodeling.

Microscopic treatment zones delivered by the Fraxel® re:store Dual laser produce “fractional” zones of heating with every zone surrounded by unaffected skin. This technology enables rapid initial healing with redness and swelling lasting for 2-4 days. There is no visible wound healing but some dryness and flaking will occur during the first week. The treatment regimen consists of 3-5 sessions at about 4 week intervals with beneficial changes continuing to occur for 2 to 3 months after each treatment.

During your consultation, Dr. Forley will discuss which treatment options would be best for you.

Before Surgery

It is best to eat high quality proteins such as a fish, poultry, eggs, nuts and seeds a few weeks before surgery to build up your strength and tissue fibers. Consuming high-fiber foods such as whole grains, vegetables, fruits and legumes; calcium-rich foods such as nuts, fruits, and leafy greens and essential fatty acids such as nuts, seeds, or vegetable oils are also helpful.

Certain amino acids seem to help wounds heal faster, so before—and especially after—surgery, make sure your meals and snacks feature fish, chicken, eggs (especially the whites), brown rice, walnuts, almonds, and sunflower seeds. Some studies suggest that vitamin C and zinc can also assist your body to heal. Drinking a glass of orange juice and eating the daily recommended amount of fruit and produce should provide all the vitamin C you need, while a fortified breakfast cereal is an easy way to get zinc.

It is best to avoid dairy products, sweets, fried foods, and cured meats as these are high in saturated fats and can slow the healing process. Your diet should be lighter a few days before surgery; emphasizing fruits, vegetables, and liquids to help ease the stress on your digestive system. Also avoid stimulants such as coffee and alcohol as they can impair the natural healing process of your body.

After Surgery

Try and eat small, light, low-fat meals throughout the day when recovering from surgery. This can include foods like whole-wheat toast, yogurt, pudding, fruits, soup, small sandwiches and fortified shakes. If a soft or liquid diet is necessary following surgery, consider protein and/or nutrient powders, broths, fresh juices, light soups, and pureed fruits or vegetables such as carrots, squash, mashed potatoes, bananas, or applesauce.

Eat fresh, healthy foods that are rich in nutrients and trace minerals. Protein is particularly important as it will help build your tissues. A protein-rich multivitamin shake may be a good way to start getting more protein after surgery. Eating fiber can help prevent constipation. Good natural sources include prunes, prune juice, figs, apricots, berries and other fruits, vegetables, legumes, and whole grains.

Aim for eight 8-ounce glasses of fluids a day when recovering from most surgical procedures. This helps prevent dehydration, helps fiber work well, and flushes out the bladder. Drink caffeinated beverages sparingly. Avoid junk food, especially foods that contain processed fats such as hydrogenated oils. Olive oil is an excellent natural way to ease inflammation following surgery.

If you have any questions or thoughts on what to eat before and after surgery, please do not hesitate to contact Dr. Forley.

Bottoming Out

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A lengthened nipple-to-inframammary fold distance due to skin stretching after surgery, and the breast pocket dropping lower than desired, can result in the nipple appearing to sit too high on the breast. A droopy or sagging appearance is produced when the skin below the nipple looks stretched and disproportionate in relationship to the overall size of the breast size. By attaching the Strattice™ internally to the fold, and chest muscle, the breast can be positioned in the desired location to correct this problem.

Fold Malposition

Fold malposition is a condition in which the fold under or lateral to the breast fold has become displaced. These folds give the breasts definition and help maintain the shape and position of the breasts. During breast augmentation surgery, a pocket is carefully created under the breast tissue. Breast folds act as important markers for the surgeon when creating the pocket and help to determine the surgical outcome. Loss of skin

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elasticity or a breakdown of pocket boundaries can occur over time due to the aging process and gravity. The inframammary fold, lateral fold, or both may be affected. The breast pocket may drift to the outside of the chest or appear to have dropped and will no longer be in the original desired position. Dr. Forley may recommend the use of Strattice™ to redefine the fold location inferiorly or laterally. This will support and hold the breasts in the desired location and achieve breast symmetry.

Symmastia

The normal appearance of breasts features a natural space between the breasts, which is defined by a gentle fold, referred to as the medial fold. The medial fold separates the breasts, giving them shape, form, and what is often referred to as cleavage. Even if the breasts are naturally large in size or have been enhanced, a degree of separation helps to give each breast definition. Symmastia is a condition in which the breasts sit too close

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together or possibly even touch one another. It can occur following breast augmentation surgery if the breast pocket created was made slightly too large, the breasts have migrated out of their original position, or the fibrous tissue which creates the medial fold becomes weak or stretched. Strattice™ may be used to reinforce and support existing weak or inadequate tissue to restore the natural separation between the breasts.

Wrinkling and Rippling

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The quality of the skin that envelops the breast tissue significantly influences the shape and appearance of the breasts. There is natural and hereditary variation in the amount of elasticity and thickness of each person’s breast skin, which affects the overall appearance of the breasts. A rippled appearance may also occur if the breast augmentation pocket exceeds the optimum size needed to maintain the position of the breast implants. If the breasts migrate out of their original position because the breast pocket is too large, the appearance of rippling may occur on the breast skin where volume is deficient. Many women who have either minimal body fat or thin skin may experience this less than desirable condition, simply known as breast rippling and wrinkling, following breast augmentation surgery. Dr. Forley may consider reducing the size of the breast pocket and using Strattice™ to help provide additional support. Strattice™ is placed at the bottom of the breast to reinforce weak or inadequate tissue, which can help reduce the presence of wrinkles and ripples on the skin surface.

Capsular Contracture

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Capsular Contracture is an unpredictable condition that may occur when naturally forming scar tissue surrounding the breast implant continues to increase in thickness. As thickness increases, it squeezes the implant causing tightness, firmness, and changes in breast appearance. Capsular contracture may occur in one or both breasts and may vary in degree and severity. Discomfort and changes in breast appearance may require additional surgery. Some corrective surgical outcomes may include partial or complete removal of the capsular scar tissue. Strattice™ reinforces weakened and inadequate tissue, which can help Dr. Forley to support and position the breasts in the desired location while allowing re-establishment of natural boundaries.

Augmentation Mastopexy

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Augmentation mastopexy is a breast surgery procedure that enhances both the position and size of the breasts by adding volume with an implant and lifting the breast tissue that has sagged. Women who have lost a significant amount of weight, including those whose breast tissue has changed following childbirth and breastfeeding, are candidates for augmentation mastopexy.Thin, weakened  tissues that may be insufficient to support the bottom part of the breasts can be reinforced with the use of Strattice™. During augmentation mastopexy surgery, Dr. Forley creates incisions using standard surgical techniques and then sutures Strattice™ to the chest wall and pectoralis major muscle to reinforce the breast pocket and help to keep the chosen implant in position. Removal of excess tissue and lifting of the breast is performed after this initial procedure has been completed.

Copyright © 2009 - 2012 LifeCell Corporation

Clinical Uses for Strattice™

• Reinforce the desired position of the breast
• Redefine the location of the fold under the breast by providing support inferiorly or laterally
• Correct complications that may occur after breast implant surgery, such as bottoming out, fold malposition, and symmastia
• Minimize the need for the use of additional muscles to provide a supportive covering layer in the breast
• Reinforce thin breast tissue when implant ripples and wrinkles are present
• Correct capsular contracture or hardening of the breast after implant surgery
• Aid in augmentation mastopexy to enable a stable, long term breast lift

Copyright © 2009 - 2012 LifeCell Corporation

In Part 2, we discuss in more detail how Strattice™ has provided a way to handle each of these clinical situations.

Non-Surgical

Ultherapy®

Before Ultherapy

1 month after Ultherapy

Ultherapy® uses ultrasound energy to safely lift the brow with focused sound waves that create targeted heating of the layers deep to the skin that sag due to the onset of diminished firmness and elasticity.

The deep support layer is tightened without skin disruption because the sound waves penetrate below the surface to produce contraction of the collagen. Following Ultherapy® of the brow, some changes are visible immediately with continued improvement occurring over 3-6 months. The treatment can take as little as 20-30 minutes and last up to 2 years. It can be combined with Botox® Cosmetic to further enhance the position of the brow.

BOTOX® Cosmetic

Before BOTOX

After BOTOX

BOTOX® Cosmetic produces a selective decrease in the downward pull of the muscle around the eye so that the upward pull of the forehead muscle will lift the brow. Very precise injections are utilized to balance muscle activity to produce the desired result. The treatment is simple with only minimal discomfort, requires just a few minutes, and you can resume normal activities immediately. The results will be apparent in a range of 1-3 days. The duration of effect is between 4-6 months.

Surgical

Endoscopic Browlift

Brow ptosis or sagging

An endoscopic browlift provides a more definitive long-term solution to the sagging brow using the latest in innovative surgical technology to provide a safe and speedy recovery. When the heavy tissue is lifted out of the upper eyelid the eye looks fresher, more open, and you appear more energetic. People will stop asking you if you are tired or angry. The procedure is performed under twilight anesthesia with small incisions concealed within the hairline and a special high intensity light and imaging instrument called an endoscope. The attachments of the brow to the underlying bone are released to permit the tissues to be lifted and stretched upward, providing the necessary lift to the brows and reduction of wrinkling. Your forehead area will feel tight for 48-72 hours. This sensation will gradually resolve over the next several days as the swelling decreases. Bruising fades within 5-10 days and can be reduced with the use of techniques described in a previous blog http://drforley.com/blog/reducing-the-risk-of-bruising-following-your-procedure/.

After Endoscopic Browlift

Lateral Browlift

Lateral brow sagging

After Lateral Browlift

Early sagging of the brow can be treated with a more limited browlift via a single temporal scalp incision. The procedure creates a more youthful and rested appearance that looks very natural.

The lateral browlift is usually performed under local anesthesia and may be combined with upper eyelid surgery when upper eyelid skin excess and fat prominence is also present.

Dr. Forley will evaluate your brow during your consultation and discuss with you the best options for your individual needs.

Plastic surgery can improve your appearance and enhance your self-confidence, but finding a plastic surgeon who is qualified and possesses the expertise to handle your concerns skillfully and safely can be challenging. Dr. Forley was recently interviewed by The Plastic Surgery Channel to share his opinion on factors to consider when searching for a reputable surgeon. He noted the importance of understanding the meaning of “board certified” when evaluating a plastic surgeon’s credentials. There are many organizations that claim to offer board certification, but only 24 specialty boards, including The American Board of Plastic Surgery, are recognized by the American Board of Medical Specialties (ABMS). The rigorous credentials and examination process mandated by the ABMS assures the patient that those physicians who achieve board certification by one of their member boards has demonstrated the skills and knowledge necessary to excel in their chosen specialty.

Another useful piece of information is whether the doctor you are considering has privileges to perform the procedure you are asking about in a hospital. Having privileges means that a credentialing panel of other doctors has screened the doctor thoroughly before permission to operate in their hospital is granted. Doctors need to be re-credentialed every two years to maintain their hospital privileges.

Watch Dr. Forley discuss choosing a plastic surgeon on "The Plastic Surgery Channel"

“Choosing a Plastic Surgeon”

Since many plastic surgeons offer office-based surgery, it is important to consider the safety and quality of the facility in which your procedure may be performed. A standard of excellence that you should seek is accreditation of the office facility by an organization such as The Joint Commission, an independent, not-for-profit, national body that oversees the safety and quality of health care for accredited hospitals and office-based surgery practices. Founded in 1951, it is the nation’s oldest and largest standards-setting and accrediting body in health care. Other accrediting organizations are the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) and the Accreditation Association for Ambulatory Health Care (AAAHC).

A key element of a safe and successful surgical outcome is anesthesia. Anesthesiologists certified by the American Board of Anesthesiology are best qualified to offer you an optimal experience both while undergoing the procedure and during the immediate recovery phase. You should ask about who will be giving you anesthesia and what technique will be used.

Once the preliminary qualifications have been evaluated, it is important to schedule a consultation with the plastic surgeon(s) that you are considering. During the consultation, you will be able to get a personal impression of the plastic surgeon and have a chance to get your questions and concerns answered. It is a good opportunity to view before and after photos and assess the level of expertise the surgeon possesses in your area of interest. An office will often try to accommodate requests to speak to other patients so that you can get a first hand account from someone who already had the procedure done. You may also want to ask your friends about the surgeon you are considering as often times word of mouth can be a valuable resource when making a decision.

Non-Surgical and Surgical Procedures

Stop for 7-10 days prior to and following treatment :

• Aspirin or non-steroidal anti-inflammatory medications such as ibuprofen, Motrin, Advil, or Aleve. These medications prevent blood cells, known as platelets, from clumping together to form a clot which stops bleeding. You may use Tylenol for pain as needed.

• Vitamin E, Multivitamins (most of them contain Vitamin E), Fish Oil, Omega-3, Flaxseed Oil, Gingko, Ginseng, St. John’s Wort, and Garlic. These vitamins and supplements also decrease the clotting of your blood.

Platelets must be able to form a clot to stop bleeding and minimize bruising

• Ask Dr. Forley if you have any questions about medications or supplements you are taking.

After your treatment:

• Cold packs can be selectively applied following certain procedures for 5-10 minutes every hour for the first 8 hours to reduce swelling and bruising. Occasionally, the use of cold packs is indicated for the first 2 days. It is important not to use excessive application of cold packs as they can freeze the skin and produce blisters. The use of cold packs will be discussed with you by Dr. Forley.
• Arnica Montana is a homeopathic remedy that may help to reduce post-operative bruising and swelling. It is manufactured by Boiron and VitaMedica and is available in 12C or 30C pellets which dissolve in the mouth (both versions are effective). The recommended dose is 4 pellets/3x per day for 5-7 days or until any bruising resolves.
• Auriderm is a topical gel which contains Vitamin K and has been helpful in decreasing the onset of bruising or in speeding its resolution. We recommend applying it up to 5-6 times a day for 2 days after treatment. You can continue using it on any visible bruises until they disappear.
• Eat fresh pineapple the day of your treatment. Pineapple contains bromelain, a natural anti-inflammatory, which can help to decrease swelling. Bromelain supplements can also be added for procedures where there is a greater tendency for swelling.

Recovery Support Program

Dr. Forley incorporates nutritional supplements and vitamins from VitaMedica to optimize your surgical outcome. VitaMedica’s Recovery Support Program enhances wound healing, boosts immune function, and stimulates tissue growth factors. Inflammation, bruising, and swelling are also reduced. The program starts 2 weeks prior to your surgery and continues for 2 weeks following the procedure.

36 year old female following 3 C-sections

Extra fat or loose skin around the abdominal area can be a persistent problem that does not respond to diet or exercise. When combined with muscle weakness after pregnancy or weight loss, surgery may be the most effective solution to improving the appearance of your tummy. Two procedures to consider are liposuction or abdominoplasty (tummy tuck). Here, we discuss which one may be right for you.

Abdominoplasty

Many factors can affect the contour of your abdomen. Excess fat deposits can produce undesirable bulges or fullness. Childbirth can stretch abdominal muscles to an extent uncorrectable with exercise. Loose skin following childbirth or weight loss can result in an unattractive surface appearance of the abdomen.

4 months following tummy tuck

Abdominoplasty, known as a tummy tuck, is a procedure that improves the contour and appearance of the abdomen by tightening or reshaping the underlying muscle framework and removing excess fat and loose skin. If fat deposits are the only contour problem, they may be correctable with liposuction alone. Muscle that shifts laterally as a result of pregnancy will remain there and creates a weakness that prevents you from attaining a flat tummy. It cannot be returned to its proper midline position with exercise. After significant weight loss, your abdominal skin may become much looser, and sometimes actually hang downward, creating a pleating effect. Skin does not respond to any type of exercise, and similar to stretched muscle, will require a tummy tuck to remove the excess. How much your abdomen can be reshaped depends on several factors. The quality of your tissues is very important and is variable amongst patients. If you are significantly overweight, you’ll get a much better correction if you achieve a more ideal weight before your tummy tuck. To reshape the underlying muscle-based support framework and remove excess skin, incisions are necessary. The length of the incision placed just above the pubis depends on the amount of loose skin correction you require. Any necessary incisions will produce scars. The quality of these scars depends on several factors including your specific healing characteristics. However, most patients view the scars as a worthwhile trade-off for the significant improvement that can be achieved in the shape of the abdomen.

Liposuction

30 year old female prior to surgery

Age, heredity, and hormonal factors can sometimes counteract our best efforts to attain the type of physical appearance we desire. Even in individuals who are not overweight, localized deposits of fat can occur in areas of the abdomen, producing undesirable contours. Liposuction alone can be used to treat the fat when muscle and loose skin are not contributing to the problematic appearance.

Careful assessment prior to the procedure will determine if this is the right procedure for you. First, you must look at your skin. If it does not hang and it snaps back when pinched then you can expect it to contract well after fat removal. When you inhale and tighten your abs, you will be able to determine the contribution made by the fat under your skin to the bulging of your tummy. When you exhale, the added prominence that results is due to muscle laxity. The difference between the two is what can be treated with liposuction.

5 months following liposuction of the abdomen

Small incisions are used to insert narrow tubes or cannulas to suction away the unwanted fat. Remember, liposuction is not designed as a weight reduction procedure, but as a technique to blend body outlines more aesthetically. Surgery needs to be combined with a program of fitness and nutrition to achieve and maintain long lasting results.

During your consultation, Dr. Forley will advise you as to the best treatment options to enable you to achieve the appearance that you desire.

]]> http://drforley.com/blog/tummy-tuck-or-liposuction-which-one-is-right-for-me/feed/ 0 http://drforley.com/blog/lasers-explained/ http://drforley.com/blog/lasers-explained/#comments Sat, 14 Jan 2012 22:54:43 +0000 admin http://drforley.com/blog/?p=1095 What is a laser?
A laser is a wavelength source of high-energy light that is accurately focused and transmitted onto a very small area of the skin. The light travels in one direction, heating the skin selectively based on the wavelength and energy settings of the laser. In some cases, the skin is vaporized with an ablative laser when wrinkles are more severe. Current lasers such as the Fraxel re:store Dual and the Fraxel re:pair are precise and selective, allowing treatment of wrinkles, pores, brown spots, acne scars, and sun-damaged skin.

Ablative vs. Nonablative
There are two kinds of lasers: non-ablative and ablative. Non-ablative lasers, such as the Fraxel re:store Dual, work beneath the surface skin layer, using two wavelengths to deliver energy in “fractional” zones of heating with every microscopic treatment zone surrounded by unaffected skin. By maintaining the integrity of the surface layer of the skin, the downtime is kept to a minimum with this type of laser. Ablative lasers, such as the Fraxel re:pair, provide deeper dermal remodeling of more severely sun damaged skin by heating and vaporizing the treatment zones using fractional carbon dioxide (CO2). Both approaches stimulate collagen growth, improve skin tone, and decrease fine lines and skin discoloration. During your consultation, Dr. Forley will discuss which laser will work best for you.

Treatment and Healing Expectations
Topical numbing cream is applied for 1 hour prior to the treatment to decrease skin sensitivity. During the laser procedure, cold air is used on the skin, making any discomfort manageable but pain medication can also be used if desired. A sedation or “twilight” type of anesthesia may be indicated when an ablative laser is used. A full face treatment takes about 30 minutes.

Fraxel re:store Dual laser treatment produces a variable amount of redness and swelling over the first 3-4 days and dryness and flaking will occur throughout the first week. You are able to return to routine activities within 3-4 days but must use sun protection. Benefits are most evident with three to five treatments, spaced every 4-6 weeks.

Fraxel re:pair laser has a more involved recovery period and requires the area of treatment to be kept moist with gauze soaks and ointment for 5-7 days. The skin will be red and may be covered with a fine crust. Pinpoint areas of bleeding may also occur in the first 48 hours. The treated sites must be protected from sunlight after the procedure. In some cases, a pink surface color may remain for several weeks. You are able to return to routine activities and use make-up after 7-10 days although concealer may be necessary. Often, one treatment is all that is required to achieve the desired result.

Areas of Treatment

The Fraxel re:store Dual laser can treat wrinkles, acne scars, surgical scars, age spots/sunspots, melasma and actinic keratoses. The Fraxel re:pair laser is used for advanced sun damage and wrinkles, irregular texture, and age spots/sunspots. Laser treatment is not a substitute for a facelift nor can the procedure eliminate excessive skin or jowls. However, when combined with surgery, laser resurfacing can enhance the outcome of a facelift by improving skin quality.