January 14th, 2010 admin
For many women potential loss of nipple areolar sensation is one of their major concerns when considering breast augmentation. Sensation in this area is critically important for a large number of women during sexual activity and thus any potential compromise of sensation in and around the nipple as a result of any breast surgical procedure needs to be carefully discussed during preoperative consultations.
Sensation to the nipple areolar complex usually comes from multiple nerve sources. In most patients the major nerve providing sensation to this area is a branch of nerve traveling with the 4th thoracic rib. This nerve comes off the rib on the lateral side of the breast then travels up inside the breast tissue mound to reach the nipple areolar area. Other nerve branches travel from the more medial sternal and superior breast area to the nipple areolar region and supply additional sensation in varying amounts from patient to patient.
During breast augmentation the location of these nerves is well known to the surgeon and every effort is made to avoid injury. Breast augmentation does require the careful development of either a subglandular or submuscular pocket for placement of the breast implant. The larger implant that is chosen the more dissection that is required.
Some patients are concerned that choosing an infraareolar access incision may increase their chances for alteration of nipple areolar sensation. This approach usually involves making an incision below the areolar and then tunneling away from the nipple to the lower edge of the breast to make the necessary pocket. The infraareolar technique usually does not present any substantial increase for sensation loss.
Long term loss of nipple areolar sensation associated with breast augmentation should not be routinely expected but some degree of temporary sensory changes such as “tingling” can occur due to tissue stretch or swelling. These temporary changes usually clear nicely over the first several weeks postoperatively. I always explore the subject of possible sensory change with every prospective breast surgery patient. Although the incidence of post operative sensory loss is small, every patient needs to thoroughly explore this subject with her surgeon during preoperative consultation.
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January 12th, 2010 admin
Anyone browsing through one of the popular glossy women’s magazines can’t help but be bombarded by the advertising push to promote office based laser assisted liposuction procedures. These ads make many clams such as “immediate results, less recovery time” and my personal favorite-“painless!” Most products or services promoted in this manor naturally raise suspicions among the more skeptical population.
Laser assisted liposuction basically involves the placement of a small fiber optic wire below the skin to heat or “melt” the area of undesirable fat. Once the fat has been heated by the laser light powered wire and reduced to a liquid, it is rolled or expressed out of the skin through a small hole. This procedure is designed to be performed in an office setting under often no more than oral sedation.
Although laser assisted liposuction appears to be a scientifically valid concept. I feel it may not be the most effective method of treatment for the majority of patients who present with fat excess (Lipodystrophy) problems. In my private practice in Mansfield, Texas most patients I see in consultation have substantial fat deposits in the most common problem areas such as the abdomen, flank, thighs, and back.
To effectively and aggressively treat my average patient’s fat issues, I most often use either a conventional suction assisted liposuction or ultrasonic liposuction method. Using these techniques, I can remove more adequate volumes of undesirable fat and substantially increase the odds of obtaining a more dramatic result for my patients. What I have found patients truly want are safe, predictable and dramatic results. In my hands classic and ultrasonic liposuction methods offer the best chance to meet by patient’s desired goals.
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January 6th, 2010 admin
As we all get older our bodies change and our metabolism slows making it much easier to gain and retain fat weight. Our body desperately wants to deposit this excess fat in certain patterns. In women, the fat typically accumulates in the abdomen, hips and buttocks. In men, the favorite spots are the abdomen and flanks or “love handles.”
Love handles are fortunately one of the most cooperative areas to treat by liposuction. Successful liposuction of any body area depends on several factors. One of the most critical factors is how well the skin remolds to the underlying body shape once the problem fat is removed. In my experience, the skin in the love handle region remolds better than any other commonly treated area.
Because of the superior “cooperation” of the flanks or love handle areas to fat removal, surgeons can be more aggressive in treatment of these problem areas with less concern about unfavorable results because of poor skin re-contouring. Aggressive liposuction of the love handle and lower back areas is a key ingredient in optimizing other procedures, such as tummy tucks (abdominoplasty) and buttock augmentation. A tiny trim waist provides great contrast and naturally accentuates surrounding body features. Please see my website or my other related blog articles for additional information and photographs.
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December 3rd, 2009 admin
When is Ear Surgery right for my child?
Parents often inquire-“When should I have my child’s ears pinned back?” Children are not uncommonly born with overly prominent ears that project away from the sides of their heads and often attract unwanted attention from school friends. As children’s ears reach approximately 80% or more of their adult size by the age of 5 years old, it is typically felt to be safe to consider surgical correction at this time.
One of the prime motivations most parents have in considering correction of a child’s prominent ears is to hopefully avoid unkind comments from their small friends. The seemingly harmless “Dumbo” remarks that other children blurt out can begin to take their toll on a small child’s self image and esteem. I have rarely seen any young girl present for otoplasty who did not wear her hair style to conceal her overly prominent ears. Little boys unfortunately do not have this option; they commonly walk in with stocking caps.
As these childhood taunts begin at a very young age, most physicians feel it is desirable to consider otoplasty around the age of 5 or 6 if the problem is of major significance. A child’s perception of themselves or their self image begins to take shape quite early. A good self esteem can help a child be more outgoing, assertive, and eager to participate in youth activities. Poor self esteem can have just the opposite effect.
Prominent ears are usually the result of congenitally overly developed or misshaped ear cartilage. At the heart of the otoplasty is the alteration and reshaping of the abnormal ear cartilage. Most techniques involve weakening and suturing the cartilage from an inconspicuous posterior ear approach. This technique usually easily conceals any surgical scars. Post operatively patients often are asked to wear protective compression garment that resemble sweat bands for a period of 2-4 weeks following the surgery.
Although, corrective otoplasty is not a must for every child with prominent ears for many – it is a liberating experience. No procedure I perform in my practice can compare with happiness I feel when I see the smiles on the faces of these young patients when they return for follow up visits. Please visit Dr. Burkett’s website for more information or to schedule a consultation.
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December 3rd, 2009 admin
Over the last several weeks patients have repeatedly asked me what I think of the new Botax. This newly proposed measure is a 5% tax not only on cosmetic surgical services such as breast augmentation, tummy tucks and facelifts, but also less invasive procedures such as Botox, facial fillers and teeth whitening. This new tax is attached to the current senate version of the health reform bill working its way through congress. When recently asked the reason for the new tax, the architects of the health bill replied, “We simply need more money.”
I feel the authors of this new tax bill view plastic and cosmetic surgeons and their patients as easy defenseless prey for such a measure. I am sure they felt the average voter in the United States would see this tax as simply an extension of the President’s promise to tax only the wealthiest Americans to finance the new health care program and his multiple other social programs.
My practice in Mansfield, Texas serves a wonderful community full of very friendly, hard-working individuals who span the garment of social classes and walks of life. They are marvelous people. The average patient in my practice is a middle income mom with two kids looking to repair the changes from child bearing or the older individual attempting to reverse the ravages of aging. Although they are usually financially stable, the one thing they usually are not – is rich. If President Obama’s promise was to only raise taxes on the wealthiest Americans, the new Botax certainly hits below the belt.
Given the wide range of new and innovative cosmetic services available in the United States today, it is the average American and not the idol rich who is requesting these services with their discretionary income left over after they have paid their already established taxes. Patients desire these services to help repair their self-esteem and increase their confidence. My patients usually say “I am doing this for myself because I feel I have earned it.” Well, President Obama and Congress apparently feel you haven’t.
It is my hope that this new 5% tax, that I am sure at this point seems so defenseless, will in hind site a few years from now be seen as one of the revealing events that opened America’s eyes to the true changes in our way of life that are on the horizon.
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November 20th, 2009 admin
Spider veins are simply varicose veins that are located superficially in the skin. Although a very common problem, women usually present with the question “But Doctor, why do I have spider veins?”
There are several reasons spider veins develop. At the root of almost any varicose vein problems is the failure of the tiny valves on the inside of the vein. These small valves on the inside walls of the veins keep the blood in the veins flowing in a one way direction back towards the heart. Any factor that causes the valves to fail creates varicose veins or spider veins. The most common factors encouraging the development of spider veins include multiple pregnancies, prolonged standing or stress on the legs, hereditary influences and the effect of either natural or supplemental estrogen. As would be expected from reviewing this list of risk factors spider veins are much more common in women than men.
During pregnancy the unborn child compresses the inferior vena cava and creates some degree of outflow obstruction of venous blood from the lower extremities leading to engorgement of the veins, valve failure and the eventual development of varicosities. Wearing support hosiery during the later stages of pregnancy can often help counter this problem but cannot totally prevent spider veins in most at risk women.
Women in professions that require prolonged periods of standing such as hairdressers, flight attendants, teachers and store clerks are at significant risk to develop spider veins. Venous pressure in the legs increases during periods of standing but decreases significantly with walking due to the pumping action of the calf muscles. If long hours of standing cannot be avoided properly fitting graded support hosiery can be a life saver.
Estrogens provide women with their beautiful feminine characteristics but they also have an effect to relax the smooth muscles that line the walls of veins causing them to more easily dilate under pressure creating varicose or spider veins. This effect seems to be especially common in women who have taken estrogen replacement medication for a prolonged period.
Spider veins are commonly treated by one of two methods, serial laser or Sclerotherapy treatments. Having personally used both methods, I can honestly say Sclerotherapy has proven to be the most effective form of treatment for my patients. Sclerotherapy involves the placement of small amounts of a solution into the veins which is designed to cause spider veins to shrink and disappear. Treating the spider veins by this method is safe and causes no harm to the surrounding normal veins.
Most patients require two or three Sclerotherapy sessions spaced several weeks apart to most effectively treat the spider veins. Winter months are usually a great time to begin treatment to be ready for spring shorts and bathing suit season. Please visit Dr. Burkett’s website for additional information or to schedule a consultation.
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November 16th, 2009 admin
Patients considering facelifts often present to my office a little distressed about the whole subject. They usually say “I don’t want to look unnatural or operated on; I just want to look as young as I feel.”
Patients typically have a number of reasons for not wanting to “look so old.” Many patients have worked hard all of their lives and are now ready for retirement and travel and want to be very socially active. These patients want to feel confident in their appearance and see a more youthful face that can be obtained through a facelift as simply an extension of good grooming.
Still some women voice the common question, “I wonder if I am being vain or selfish to consider a facelift?” My answer to this question is “If you feel it would help your appearance and make you feel more confident, I am sure you have earned it!” I feel most women I meet in my private office in Mansfield, Texas have been extremely self sacrificing for their spouses and children all of their lives and they have earned a facelift and much more!
The pleasant surprise is a facelift is not a difficult procedure to have performed. Post operative discomfort is minimum with recovery and return to normal activity is relatively rapid. Today’s facelift procedures are designed to deliver a much more natural, refreshed non-operated appearance. I personally experience a tremendous amount of gratification in simply helping my patient’s just look as young as they feel. Please visit Dr. Burkett’s website for more information or to schedule a consultation.
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November 13th, 2009 admin
Patients often ask me, “Do I need a tummy tuck or just liposuction?” The answer to this question is often easy. There are usually three problems that make patients unhappy with their stomach, too much fat, too much skin, or loose abdominal muscles.
Patients who present with primarily an excess tummy fat problem, but good skin tone, no lower abdominal skin roll and little muscle stretch from previous child birth are great candidates for simple liposuction to improve their abdominal contour. Liposuction has the advantage of minimal scars, little down time and less cost compared to most tummy tuck procedures.
Unfortunately, most patients do have some combination of the big three-too much fat, skin, and loose abdominal muscles. For those patients liposuction treatment alone of their tummies will be a major disappointment. Tummy tuck or abdominoplasty is the correct answer.
I perform the abdominoplasty procedure by first aggressively liposuctioning away all excess abdominal and flank fat deposits. Next loose abdominal muscles (rectus diastasis) are tightened by a suture technique. Finally all excess, loose abdominal skin is removed through a lower abdominal scar easily hidden below the panty line.
Although tummy tuck procedures are more involved and require more recovery time than liposuction, the dramatic improvements they can offer the problem tummy is usually felt to be well worth it. What most of my patients really want is a fantastic surgical result and for many of them abdominoplasty is what truly delivers.
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November 3rd, 2009 admin
Patients considering breast reconstruction following mastectomy for breast cancer have several options from which to choose. Breast can be reconstructed from tissue transferred from another part of the body, such as the abdomen (TRAM flap), the back (Latissimus Flap), or under favorable conditions the remaining tissue on the chest can be used for a very satisfactory reconstruction using a tissue expander technique.
Patients often ask what the advantages of tissue expander breast reconstruction are. In cases of immediate breast reconstruction, using a tissue expander technique adds minimal time and morbidity to the patients’ initial mastectomy procedure. Patients are usually able to leave the hospital much sooner and return to their daily work activities more rapidly as compared to more extensive tissue transfer techniques such as TRAM or Latissimus Flap procedures.
Another advantage of the tissue expander technique for breast reconstruction is the avoidance of additional truncal scars of either the lower abdomen or back that can often times be of an unfavorable quality.
A second simple outpatient procedure is required with tissue expander reconstruction to remove the initial expander device and place a permanent silicone gel implant. At the time of this second procedure the patient and surgeon have an opportunity to further fine tune the final reconstructed breast size and shape through surgical modification and breast implant choice. Please visit Dr. Burkett’s website for additional information concerning breast reconstruction or to schedule a consultation.
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November 2nd, 2009 admin
One of the most common problems seen in patients presenting for body contouring is unattractive rolls of fat and skin in the flank and back areas. All too often patients are more focused on their abdomen because from their perspectives it is the most striking issue noted when they study their figure in the mirror. The back is often neglected by both the patient and her surgeon.
Patients usually assume these problem back rolls are the result of excess weight gain and liposuction can be the quick and easy answer. Unfortunately, in most cases, the problem is more complex and the solution for each patient needs to be individualized. The major cause of back skin and fat rolls in many in individuals is actually skin laxity that develops with aging and weight gain and loss.
Patients presenting with mild to moderate back and flank rolls can be very effectively treated with a combination of liposuction (often ultrasonic aided) and release of the subdermal skin attachments that encourage the skin to create rolls. This skin release procedure can be performed using small instruments through the same 3-5mm incisions used to perform the liposuction phase of the procedure, once released and excess fat is removed, the skin will redrape. Compressive garments are then worn post-operatively for a period of 4-6 weeks.
In cases of more severe back skin rolls, as is often seen in massive weight loss patients, true surgical excision of the major rolls of tissue needs to be performed. This procedure, called an upper body lift can dramatically remove very severe back skin rolls. In this procedure, the loose redundant skin is pulled and tightened in an upward direction with the required scar hidden in the back bra strap area.
The previously “neglected back” is now beginning to receive the attention it deserves. Patients who choose to address problem back rolls are finding it an invaluable addition to more traditional body contouring procedures such as abdominoplasty. Please visit Dr. Burkett’s website for additional information or to schedule a consultation.
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