Dallas Plastic Surgery Center FAQs
[“Q: Can exercise tighten up my abdominal skin?”] A: Exercise can tighten and thicken muscles and reduce the fat on your stomach but exercise can never repair muscles which have been widely separated or stretched apart due to pregnancy. Also, exercise cannot eliminate stretch marks or change skin which is loose and overhanging (called a panniculus, which is Latin for “apron”). A tummy tuck can correct all of these changes by eliminating loose, damaged skin and internally tightening lax, stretched out muscles to restore firmness to all layers of the abdomen.
[“Q. Is there a way to avoid a scar? “] A. No, not with a tummy tuck. You have to trade a surgical incision for the excess fat, wrinkled skin, abdominal scars, stretch marks or belly button distortion to get the changes you want the most. You may require an incision that goes from hip to hip, but it’s usually an excellent trade for those who are appropriate candidates for abdominoplasty. Scars vary from person to person. Sometimes the design can be customized to keep it low or shape it to fit under a skimpy French cut and still hide the scar. It’s a good idea to bring the type of swimwear or undergarments you prefer so that your request can be kept in mind when the incision design is planned.
[“Q. Do I need to lose weight before I have a tummy tuck?”] A. If you are in the middle of a successful diet, sometimes we do suggest that you lose weight to optimize the planning of the surgery. Often, it’s reasonable to proceed with the tummy tuck immediately if the weight cannot be reduced or if it is stable. Occasionally, if there is a large weight loss after a tummy tuck a touch-up surgery may be beneficial, but these situations are less common and must be evaluated individually.
[“Q. My upper abdomen and belly button are fine. All that’s bothering me is just the skin below that is hanging. Would I need a tummy tuck for that? “] A. Yes, but possibly not a full tummy tuck. There are three variations of tummy tucks. A mini tuck just tightens loose, separated muscles, much like an internal corset. These are the least common and are only appropriate for patients with good skin, little fat and bulging which is mostly due to loose muscles stretched apart by pregnancy. An extended mini tummy tuck tightens the muscles and also takes off excess skin and fat, tightening the entire area below the navel. The incision is shorter than a full tummy tuck. In another option, the belly button is detached and “floated” downward, instead of being repositioned and tightened which is standard with a full tummy tuck. Each tummy tuck, mini, extended mini or full is specifically designed for the individual torso. We consider where the original navel is located, how much excess skin needs to be removed, where the excess skin is located, and the condition of the underlying muscles in addition to the expectations of the individual
[“Q. How many sizes will I go down after liposuction?”] A. First, it’s important to realize that liposuction is not really a weight loss surgery. Liposuction will reshape bulges and smooth out contours. For this reason the fit of clothing always changes, although the clothing size may not change. In other cases, the clothing size may change significantly depending on your starting point and what areas are treated. Interestingly, the scale weight may not change that significantly even though you may appear to have lost a great deal of weight. Remember that in order to lose the bulges which are treated with liposuction you would have to lose quite a bit of overall body weight on a diet. However by taking those specific pounds away selectively, the body often appears to have lost quite a bit of weight. A pound of fat is about as big as a grapefruit, so if you take off two or three pounds, you can imagine what a nice change it can be in the shape of the thighs, for example, even though a 2 or 3 pound weight loss might not have made that much difference. Most people can tell a difference in their size after the first week even though there is still some swelling. We take photos about six weeks after surgery but you will continue to see subtle changes for up to six months. Computer imaging helps to show a person the minimum change that could be expected after the healing process. This is extremely helpful in helping patients have a realistic expectation, since we can demonstrate reduction of bulges without making other changes.
[“Q. Will the fat come back? “] A. Fat cells are unique in that they do not multiply so areas which have had liposuction will have true removal of the fat cells in that region and they will not come back. However, if you consume more calories than you burn, your body will gain weight. The difference is that after liposuction weight gain is usually more evenly distributed since the fat cells in those bulges which have been treated are gone for good. You should also realize that great results in liposuction involve a partnership between the surgeon and the patient. If surgery is performed and bulges are improved and the patient begins to eat more, exercise less and generally gain weight, the return visit will not be satisfying for the physician or the patient. Both will be disappointed and this is unfair to you and your doctor. The best results are those which use liposuction as a starting point for a better lifestyle, a lower fat diet, healthier exercise and eating habits, and an overall commitment to self-improvement. It’s very difficult to evaluate the result of liposuction surgery if you have gained weight between the liposuction and your final visit. Nonetheless, when bulges are treated the results tend to be permanent. The best areas are stubborn areas which seem to persist even when you are close to ideal weight. These include the hips, thighs and abdomen for women and the abdomen, breast region and love handles for men.
[“Q. I’ve been considering liposuction and have heard about a new technology called ultrasonic. What makes it unique and is it safe? “] A. Ultrasonic (UAL) involves the use of high-energy sound waves to soften and liquefy fat before it is removed. We use the Mentor system which allows smaller incisions due to more advanced technology to cool the probe without requiring the insertion of a plastic skin protector. The probe is advanced through tiny incisions into the site and is especially effective in areas where fat is firmer and more difficult to remove with traditional liposuction. The best areas for ultrasonic liposuction include the upper abdomen, back rolls, waist and enlarged male breasts.
[“Q. Should I lose weight before I have liposuction? “] A. Liposuction can never accomplish what exercise can and often exercise can’t do what liposuction can. If you lose weight with diet and exercise, you will be a smaller version of the shape you are now. Often troublesome bulges still persist and these are the areas best treated with liposuction, areas which really don’t fit the rest of your body. The ideal situation is to be at your perfect height and weight for liposuction and just have sculpting of smaller bulges. However, this is not very realistic for most people. If you are actively losing weight it’s probably best to complete your diet before liposuction if that’s realistic. However we perform liposuction on people of all sizes and shapes and expectations have to be adjusted, depending on your starting weight. If you are significantly overweight you can look like you’ve lost significant weight by treating the bulges, however other areas of excess body fat will persist in areas that aren’t treated so the outcome is different than if you lost the weight first. Most of our patients feel so good about the way they look after the surgery that they have the incentive to pay closer attention to a lifestyle that promotes better health and lower body fat. This is the ideal situation.
[“Q. I had a baby and lost all my weight but my lower stomach has a pooch that will not go away. Will liposuction help? “] A. Sometimes the lower abdominal pooch can be caused by muscle and not abdominal fat. Muscles can be stretched out by pregnancy and may need to be tightened up in order to flatten the abdomen. In some cases there is extra fat and muscle weakness contributing equally to the bulge. Liposuction can take off the fat on the top layer outside the muscle (the fat that you can pinch and grab hold of). A tummy tuck is necessary if the muscles are loose and bulging to tighten the stretched out muscles and flatten the abdomen from the inside. There is not a procedure that can safely take fat from under the muscle on the inside of the abdomen around the organs. An examination can help determine which of these contributing factors need to be treated to give you your best result.
[“Q. Will I have a noticeable incision?”] A. Visibility of scars is a concern for most patients. Several of our staff have had breast augmentation by Dr. Stagnone and can demonstrate their incisions. They are initially pink and over the course of six to twelve weeks the color fades and eventually becomes a pale light color which usually blends in with the adjacent skin. There are three incision sites available. The axilla (armpit), periareolar (lower edge of the nipple) and inframammary (in the breast fold). We offer all three incisions, however most surgeons prefer the inframammary fold approach. We like to sit our patients up after the implants are placed, and through the inframammary incision fine-tuning and sculpting can be performed along the lower border where the shaping is most critical. It is very difficult to perform this fine-tuning through the axillary approach and there is a higher incidence of slightly irregular breast implant position or slightly irregular shape of the inframammary fold. The nipple incision may have a slightly higher risk of nipple numbness. Regardless of your incision site, healing takes time.
[“Q. Can I tan after surgery?”] A. You will be hard pressed to find a bathing suit that doesn’t look good after this surgery. Although we discourage tanning since it prematurely ages the skin, we recognize that most of our patients can’t wait to get out in the sun with their new look in a bathing suit! It is very important to protect your incision during the red or pink phase of scar fading. If the incision itself is tanned during this red phase it often gains additional pigment, resulting in a scar which is a little darker than the adjacent skin. For this reason it is best to protect the scar thoroughly during the red phase. A thin piece of black electricians tape works extremely well for this and can be placed discreetly over the incision during tanning. Remember, some sun even penetrates the fabric of a swimsuit so it is important to protect the incision even through your bathing suit is covering the area until the scar has faded to the color of the surrounding skin.
[“Q. I saw someone at the pool that had a big space in between her breasts. How can someone with implants have that kind of cleavage or a lack of cleavage? “] A. It’s important to realize that you can’t necessarily bring in a picture of the exact breast you would like. Your starting nipple position will determine the position of the final breast mound. If the nipple position is widely spaced towards the side of the chest wall, the implants must be placed under the nipple so that each breast mound looks appropriately positioned. In most cases, there would be a wider separation between the breasts because of such a starting nipple position. In most cases, however, an implant can be selected which is centered under the nipple and extends toward the cleavage area to create an aesthetically pleasing cleavage. We choose an implant diameter to try to create the best cleavage and the best outer silhouette. However, always remember you can only be a bigger version of your original starting place. You may be blessed or somewhat limited by your own starting anatomy.
[“Q. Can you guarantee me that I will not have two grapefruits sitting on my chest? “] A. Round shiny breasts with visible edges of the implant along the upper border are usually due to very aggressive selection of implants. If the starting skin is very tight, it will be difficult to place a very large implant without stretching the skin and creating that round spherical look. It is often better to select an implant which is a little less aggressive in order to have breasts which are more beautiful when they are exposed. If your goal is to have breasts as large as possible so that you can turn more heads with your clothing on, sometimes you must compromise and accept a less natural looking breast when you are unclothed. In general, the more an implant is filled the rounder it becomes and the fuller it becomes on top. We can adjust the fullness on the operating table and we like to sit our patients up and adjust the shape by adding or subtracting volume as the last step in the procedure. For this reason you will be carefully interviewed about the style of breast which you most desire. It does help to bring photos showing what you like or dislike and you can also look through our many, many before and after photos demonstrating different results. The best results come with a moderate amount of breast tissue to begin with and skin which is slightly lax to better drape over the implant. The less breast tissue you have to begin with and the tighter the skin envelope, the more conservative one should often be in implant size in order to get a more natural, soft and realistic appearing breast.
[“Q. I’ve heard that a lot of people regret that they didn’t go bigger after their breast augmentation. Do you find this to be true? “] A. Yes, this is common. Probably about 20% of our patients would go a little bit bigger if they could after everything is healed, but most are actually really happy. The implants are chosen by careful measurement and we’ll usually recommend a size that fills the breast area without creating distortion or too tight a look. After we’ve measured we like to place sizers in a sizing bra so that you can get a preview of the approximate size you will get. If you are a little hesitant but not totally against the larger size range we offer, it’s often best to go with that since it’s very rare after breast augmentation to wish that they were smaller. Also it’s important to try not to focus too much on final cup size, as a goal because bras are all cut differently and there is no international standard defining exact bra cup sizes. Also there are too many variables, such as compression of the implant by your muscle and compression of the breast tissue by the implant which varies from one person to the next, based on different tissue characteristics. Thus it is impossible to accurately predict or guarantee final cup size. Also, it’s important not to focus on the size implant chosen by your friends because, like shoes, each individual has a size that is best for them. Again, it’s a great idea to look at our before and after book to get an idea of how different women look with different size implants based on completely different starting anatomy. If you come to our office for sizing try to remember to bring a tight shirt and a loose shirt so that you can get an idea of how things will look with different outfits. Please understand too that the appearance of the breast with a sizing bra and the implant outside your body is not going to be identical to the appearance when they’re inside and under your muscle. However, at least this gives you an idea of the general size range you’ll be and can help guide you in your final choice.