Body Contouring | Dr. Forley
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Archive for the ‘Body Contouring’ Category


Sunday, September 20th, 2015

With the holiday season just around the corner, it’s not too soon to be proactive in your diet and exercise regimen. This interesting graphic discusses things you should consider when thinking about weight loss vs. weight management.


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Friday, February 27th, 2015

A tummy tuck will remove excess fat and skin as well as tighten the muscles of the abdominal wall. To achieve the best long term outcome, muscle toning exercises must be part of the plan after the initial recovery period is completed. Usually by 6-8 weeks a program of exercise can be resumed.

Muscles of the TrunkThere are four main muscle groups that determine the contour and appearance of your abdomen: the rectus abdominis, the internal and external obliques, and the transversus abdominis. Increasing the strength and endurance of these muscles will contribute towards optimizing the appearance of your tummy after surgery. Training this muscle “core” with exercise produces a greater degree of coordination and synchronization of the muscles and thereby enhances their function.

It is important to keep in mind that exercising the core muscles will not specifically target fat deposits in the abdominal region. The way to maintain and improve upon localized fat deposits, such as those in the abdomen, is with a healthy diet that will benefit your whole body.

A few options to consider after you have been advised to resume exercise:

The Crunch

As Resistance Training Specialist Phil Arico at David Barton Gym in New York City put it, “The crunch is one of the better exercises to help in the development of abdominal muscle tone. It requires minimal movement, which leaves less margin for improper form and injury. By squeezing between the lower ribs and top of the pelvis, and pulling them together, you create the movement of a crunch. Each repetition should be slow and controlled to allow for more time under muscular tension, a key component in muscle toning.”

The lower back should remain on the floor when a crunch is properly performed. This makes the exercise more effective by isolating the abdominal muscles. The addition of a twist to the crunch movement, with alternate lifting of the shoulders, will add the oblique muscles to the strengthened abdominal wall.

The Plank

A good all around toning exercise that doesn’t require any special equipment and can easily be done at home. You can visualize the exercise by thinking of it as a push up in which you remain in the up position. In some versions, your hands remain directly under your shoulders while other methods keep your forearms on the mat while you elevate your body and hold the pose for up to one minute. Try to keep your body straight and do not allow your hips to drop.

The Stability Ball

Achieving balance on a stability ball engages multiple muscle groups at once. Adding the ball to your plank exercise will fast track your efforts. After lying on top of the ball, put your hands on the ground and allow the ball to roll beneath your thighs while walking your hands forward. Keep your body as straight and stable as you can for 30 seconds while squeezing your thighs and tightening your abs.

A professional trainer will best be able to assist you in safely achieving the optimal results from your exercise efforts.

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Saturday, January 31st, 2015

Patients who undergo surgery to improve the appearance of their abdomen can enhance the outcome after recovery with some targeted efforts at weight management and exercise. The abdominoplasty or tummy tuck will handle three problem areas:

  1. Excision of excess and redundant skin
  2. Reduction of fat deposits
  3. Tightening of the abdominal muscles

Before & After 31 year old female 3 months following a tummy tuck

Although the surgery provides improvements that are often unachievable with even the most diligent efforts at diet and exercise, the best outcomes are attained when patients become active participants in the long term enhancement and maintenance of the results.

There are two primary problems that cannot be altered surgically:

  1. Internal or visceral fat excess located below the abdominal muscles
  2. Muscle tone

Both of these areas require a committed effort that balances a moderate caloric intake with exercise. Reducing internal fat and increasing tone in the muscles that have been tightened as a result of the surgery will produce an even flatter abdominal contour. In the next blog, we will offer recommendations on how to make these goals a reality following a tummy tuck.

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Monday, December 22nd, 2014

The decision to proceed with a tummy tuck often follows a period of exhilaration at starting a family followed by distress at the consequences of pregnancy on the appearance of the tummy. The effect of pregnancy on the skin, fat, and muscle of the abdomen varies from person to person. In some cases, the contour of the tummy can be restored with exercise and a healthy diet. In many cases, however, the effects of pregnancy on skin elasticity and muscle spreading away from its natural midline position, known as diastasis, will limit the benefits of even the most conscientious exercise and diet routine. Dr. Forley uses advanced techniques in tummy tuck surgery to make the desired goals of self improvement a reality for women who are unable to do so on their own due to the anatomic changes that have occurred following childbirth.

In the following video, a mother of two shares her thoughts on deciding to have a tummy tuck and how she feels about the results.



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embrace® Advanced Scar Therapy

Saturday, October 19th, 2013

Achieving the most favorable scar appearance after surgery is dependent not only on the quality of the repair performed at the time of surgery but also on the mechanical forces that affect healing during the post-operative period. Control of the natural tension of skin during wound healing has been shown to minimize hypertrophic or thickened scars after procedures such as tummy tucks or breast surgery. Until now, none of the scar treatment modalities commonly used have been able to regulate wound tension in a manner that will impact on the final appearance of the scar.


embrace® Advanced Scar Therapy, a new FDA-cleared technology that helps reduce tension on the healing scar, enables us to enhance the results of surgery for our patients. The treatment involves the application of an adherent, water resistant elastic sheet that is stretched and applied to either side of the scar. Skin tension is actively reduced during the healing process due to the contraction of the device following its application. It is comfortable to use and normal activities, including showering and exercise, can be performed during the 8 week treatment course. Clinical studies have consistently demonstrated the efficacy of this device when compared to untreated scars.

embrace effect

Dr. Forley is now offering embrace® Advanced Scar Therapy to his surgical patients and will discuss its use with you during your consultation.

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Wednesday, June 20th, 2012

After weight loss surgery, resuming normal life can be a challenge. The most significant change is the amount of food that can be eaten. Most weight loss surgeries reduce stomach capacity to a few ounces or less of food or liquid. This means that there will be less energy, in the form of calories, available for daily activities. Recovery time will vary but many people return to normal activities within six weeks of the surgery.


Copyright © 2011 American Society of Plastic Surgeons

The reduction in the amount of food that can be consumed assists in the weight loss that results following surgery. Those who lose considerable weight are left with loose or excess skin in various parts of their body. A variety of cosmetic procedures are available to help remove this sagging skin and improve body contour. For example, a body lift removes excess skin and fat from the abdomen, hips, thighs and buttocks. Abdominoplasty tightens muscle and removes excess abdominal skin and fat. A brachioplasty or arm lift will tighten the sagging upper arm skin that frequently accompanies weight loss in the rest of the body. A mastopexy or breast lift is often combined with procedures to tighten the loose skin in the lateral chest that remains after weight loss.


Copyright © 2011 American Society of Plastic Surgeons

It is important to understand the there will be permanent scars from all these procedures. However, the incisions are designed to make the final scars as inconspicuous as possible. Patients usually feel that the benefits of the surgery are worth the scars that are needed to produce the desired result. During the initial consultation with Dr. Forley, the body contouring procedures that are recommended and the sequence in which they should be performed will be discussed. In general, once the ideal body weight is achieved following weight loss surgery, it should remain stable for 4-6 months before any body contouring procedures are performed.

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Tuesday, May 22nd, 2012

Weight loss or bariatric surgery consists of a group of  surgical procedures which alter your digestive system in a way that enables you to lose a significant amount of weight by reducing nutrient absorption or limiting the amount of food you can eat. When efforts at diet and exercise have failed to produce the desired weight reduction results, a person who meets the accepted screening criteria may be a candidate for bariatric surgery.

A person with a body mass index (BMI), discussed in our previous blog, of 35-39.9 is considered obese and, in conjunction with a weight-related health problem, is considered a candidate for weight loss surgery.  A BMI of 40 or higher is considered extremely obese and would also be a potential beneficiary of these procedures.  However, additional medical guidelines and lifestyle changes must be met to be accepted for these procedures.WEIGHT LOSS SURGERY

Weight loss surgery requires a lifetime commitment to maintaining a healthy lifestyle. Weight related health problems that can benefit from these procedures include: heart disease, high blood pressure, type 2 diabetes, gastroesophageal reflux, and sleep apnea.

The three most widely practiced types of weight loss surgery include Gastric Bypass, LAP-BAND®, and the Gastric Sleeve.

Gastric Bypass

The smaller, upper part of the stomach is stapled, separating it from the rest of the stomach. The net result is that the amount of food you can eat is reduced. The small intestine is rerouted and connected to the smaller stomach pouch.


A silicone rubber band is placed around the top of your stomach, creating a very small stomach pouch. When you eat, you feel full very quickly. Food slowly filters down from the smaller pouch into the lower part of the stomach and then into the rest of the digestive tract. The band can be adjusted afterwards and is reversible.

Gastric Sleeve

About 85 percent of the stomach is surgically removed in this procedure. The remaining stomach takes the shape of a tube or sleeve.

Weight loss surgery is performed under general anesthesia and can take one to four hours for gastric bypass surgery, 30 minutes to one hour for Lap-Band Surgery and up to four hours for gastric sleeve resection. Most are done using laparoscopic technique through small incisions. A hospital stay may be required.

It is best to consult a surgeon who specializes in these types of surgeries to determine your options for treatment. A good place to start is the American Society for Metabolic & Bariatric Surgery website.  The procedures that can be performed to treat the consequences of large volume weight loss on the appearance of the body will be discussed in our next blog.

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Sunday, January 29th, 2012
TUMMY TUCK 36 year old female following 3 C-sections

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.


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.

TUMMY TUCK 4 months following tummy tuck

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.


TUMMY TUCK 30 year old female prior to surgery

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.

TUMMY TUCK  5 months following liposuction of the abdomen

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.

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Friday, December 30th, 2011

Men have become an increasingly common presence in the plastic surgeon’s office. Competition in the workplace and the prevailing youth culture have combined to create a desire for self-improvement that may not have seemed as important 15 or 20 years ago. The minimal downtime procedures performed today make their acceptance amongst busy professional men and women very high. The most frequent non-surgical procedures men are having done in our office are BOTOX® Cosmetic, injectable fillers, and Ultherapy®. Surgery often is performed to treat baggy eyelids, excess neck, hip, and tummy fat, and gynecomastia or male breast enlargement.


BOTOX® Cosmetic

Botox® Cosmetic provides a non-surgical way of reversing the crow’s feet, laugh lines, and frown lines produced by the underlying contraction of facial muscles. “Also known as Bro-tox, Botox is one of the most popular non-surgical cosmetic treatments for men” say Philadelphia dermatologist, Dr. Ringpfeil. It works by enabling a smooth skin appearance as a result of blocking the muscle contraction and overlying skin wrinkling produced by nerve impulses. The untreated muscles will allow for normal facial expression to remain unaffected. The treatment lasts from 4-6 months and is performed 2-3 times per year to maintain youthful appearing skin.

Injectable Fillers

Injectable dermal fillers composed of hyaluronic acid, such as JuvedermUltra and Ultra Plus, Restylane®, and Perlane® are indicated in the treatment of folds, wrinkles, or hollowing that results from facial aging. “By adding volume, wrinkles and folds appear smoother and facial contours appear more youthful” says Dr. Forely. The duration of effect is up to 12 months.

48 year old male before treatment

48 year old male before treatment

6 years following ongoing treatment with Restylane®

6 years following ongoing treatment with Restylane®

Another filler we offer is Sculptra® Aesthetic. This product is composed of poly-L-lactic acid (PLLA), an injectable biocompatible material that stimulates the production of the skin’s own collagen. The natural appearing restoration of youthful facial contours is made possible by the skin thickening that results from the gradual deposition of the new collagen. Generally a series of 2-3 treatments at 6-week intervals are necessary to achieve the desired effect. The youthful appearance that results from the treatment can last up to 3 years at which time maintenance treatments can be utilized.


Ultherapy® is a new type of non-surgical treatment that uses ultrasound energy to safely lift and tone the skin without any downtime. The ultrasound image on the viewing screen allows Dr. Forley to see precisely the level at which the ultrasound energy is being delivered. Ultherapy® apparatThe deep layers of the face and neck that have lost their elasticity and firmness over time are targeted by the heat-producing sound waves. Although one treatment is frequently all that is needed, more significant facial and neck sagging may require an additional treatment after 3-6 months. The duration of results can vary but you can generally expect up to 2 years of benefits from Ultherapy®.


Blepharoplasty (Eyelid Surgery)

Eyelid Surgery 75 year old male before

75 year old male before surgery

Eyelid Surgery 2 years following upper and lower

2 years following upper and lower eyelid surgery

Loose, sagging, bulging tissues of the eyelids can make the eye appear smaller and lead to others asking if you are tired or stressed. Blepharoplasty or eyelid surgery removes excess loose skin and fatty tissue that produces sagging and heaviness of the upper or lower eyelids. The eye appears larger, less tired, more open, and brighter.

Liposuction (Neck, Hips, & Abdomen)

Liposuction is a contouring procedure that removes bulges to achieve a more aesthetic blending of body outlines. The type of physical appearance men desire can be counteracted by age, heredity,lack of exercise, and poor eating habits. Long lasting results are achieved when surgery is combined with a program of fitness and nutrition. Liposuction removes excess localized fat deposits through tiny incisions using small tubes or cannulas. The overlying skin contracts to fit the new profile. Areas such as the neck, hips and abdomen are the most often targeted areas for men.

Liposuction Before


Liposuction 6 months after liposuction of the hips

6 months after liposuction of the hips

Gynecomastia (Chest)

Gynecomastia 36 year old male before

36 year old male with gynecomastia

Gynecomastia 8 months after gynecomastia surgery

8 months after gynecomastia surgery

Excessively large male breasts, known as gynecomastia, can produce a feeling of self-consciousness about body image that can inhibit lifestyle choices and daily activities. In most cases, the glandular and fatty tissue enlargement of the male breasts begins during puberty. It is usually a benign condition, but can be associated with hormonal abnormalities that may need additional evaluation. Gynecomastia procedures improve the large breast size by reducing the volume and prominence of the breast fatty tissue using liposuction and directly removing excess glandular tissue via an incision at the lower edge of the areola. Skin excision is rarely necessary as it will generally retract during the healing phase. In addition to the improved appearance, patients also find they are comfortable participating in social or sports activities that they were either unable or unwilling to do before surgery. During your consultation Dr. Forley will discuss and recommend those options that he feels will give you the best result.

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Monday, September 12th, 2011

Stress is a normal psychological and physical reaction to the ever-increasing demands of life. Juggling multiple responsibilities such as work, home life, care giving, and relationships can lead to excess stress. Stress can manifest itself in a variety of emotional, behavioral, and even physical symptoms that vary enormously among different individuals. The impact of stress on your efforts to maintain your results after body contouring surgery can be significant and needs to be understood so that it can be managed.


A variety of hormones are released by our body as it responds in a defensive manner to the external trigger of stress. Cortisol is a primary hormone associated with weight gain that gets released due to stress. An excessive amount of cortisol in your system with chronic stress can slow your metabolism. Weight gain will occur even with the same caloric intake and activity level that you had prior to the stressful period in your life. A slowed metabolism that is then paired with stress-induced cravings for less healthy food choices is a set-up for weight gain. There is also evidence that stress induced cortisol secretion increases the deposition of central, deep, stored fat within the abdomen that can be very difficult to reduce.

Common physical symptoms include sleep disturbances, muscle tension, muscle aches, headache, gastrointestinal disturbances, and fatigue. Mood changes, like irritability and depression, can be associated with stress due to alterations in your blood sugar levels. It is also known that people under stress have a greater tendency to engage in unhealthy behaviors, such as excessive use or abuse of alcohol and drugs, cigarette smoking, and poor exercise and nutritional choices. The symptoms of stress and changes in behavior need to be identified to help you implement successful stress reduction.

An important step in stress management is exercise. Since it evolved from a primitive “fight or flight” instinct, stress primes our bodies for action. Exercise on a regular basis helps to turn down the production of stress hormones and associated neurochemicals. Thus, exercise can help avoid the damage to our health that prolonged stress can cause. In fact, studies have found that exercise is a potent antidepressant that combats anxiety and aides many people in sleeping well. “Mindful” activities like yoga and Tai Chi can help you avoid the chronic, uninterrupted stress that is so harmful to your well being as well as your efforts to achieve a long lasting result from your body contouring procedure.

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