Labiaplasty

Q: After the birth of my two children, my labia have remained enlarged creating discomfort and making it hard to wear certain clothing. Is there something that can be done?

A: Aesthetic surgery of the female genitalia is becoming more popular as social acceptance of these cosmetic and reconstructive procedures continues toward mainstream. The situation you describe is one of the most common complaints I hear. Usually secondary to childbirth, enlarged labia can also be genetic in origin. I actually see more younger women with this complaint than those post-childbirth. Reduction Labiaplasty is a procedure for women who have a problem with large labia minora or asymmetric labia. Labiaplasty permits the reduction of large labia to reduce their outward appearance and correct misshapenness or irregularities. In addition to the aesthetic outcome which by itself can greatly enhance self-esteem, better local hygiene, relief of chronic irritations and less interference with sexual intercourse have been seen as the main benefits. It is very common for many of my patients to say that they were unaware of this procedure, and had they known about it, they would have had it done years ago.
In general, the procedure involves the surgical removal of the excess, protuberant tissue while maintaining the natural contours of the labia without visible scarring. In some cases, the excess tissue extends above the clitoral hood which can also be reduced. The actual incision depends on the specific anatomy but uniformly heals well with no visible scars. The newest technique involves removal of an inferior wedge of tissue thereby preserving the natural edge of the labia. Other ancillary procedures can also involve contouring the labia majora or mons area, often using minimally invasive techniques such as ultrasonic liposuction. In most instances, reduction labiaplasty can be performed under local anesthesia in the office with minimal post-operative discomfort and quick return to work.
To learn more about female aesthetic genital surgery, please log onto my website at www.drhainer.com or come in for a complimentary consultation.

SmartLipo

With so many different liposuction techniques now available it’s no wonder so many potential candidates are confused about which method to chose. First, it is important to start with the basic concepts of liposuction. Liposuction is a form of body contouring where fat is removed from various problem areas a patient may have via small, thin hollow “cannulas” that aspirate the fat from the body. The best candidate for liposuction contouring is near his/her ideal body weight and has good elastic skin quality such that when the fatty tissue is removed the skin can essentially shrink wrap and create a nice smooth contour. Liposuction is a contouring technique, not a weight loss method. Those patients who are significantly overweight, have large fluctuations in their weight, or who have poor skin quality are not candidates. Liposuction is not a remedy for cellulite, which by the way has no permanent remedy. And remember, despite tiny incisions, liposuction is real surgery, with real blood loss, with potentially serious, complications. So chose your surgeon carefully and insist they be board certified Plastic Surgeons.
As for the technique, every form of liposuction involves infiltration of a tumescent solution into the fatty tissues as the first step. This fluid often contains lidocaine for anesthesia and epinephrine to constrict the tiny blood vessels in the fatty tissue thereby minimizing blood loss and postoperative bruising. Once the fluid is infiltrated, small- caliber hollow cannulas ( 2mm-4mm in diameter) are used to suction out the fat. In traditional liposuction (SAL or suction-assisted lipectomy) the fat extraction is purely mechanical yielding a chunky, yellow fat slurry. It’s a time consuming procedure, physically demanding on the surgeon and is as much science as artistry. Now comes the confusion.
The next technique on the complexity ladder is PAL or power-assisted lipectomy. In this method, the cannula is now power assisted either with an electric or air driven motor. So instead of the surgeon doing all the mechanical work, the cannula vibrates back and forth (about 90 cycles/minute) making it easier on the surgeon. Kind of like an electric knife as compared to a traditional one.
UAL or ultrasonic-assisted lipectomy is the next method. With this technique, the cannula is now part of a more sophisticated device that generates ultrasonic vibrations at the tip of the cannula. This energy does two things, it essentially liquefies the fat but also creates heat. The tumescent fluid does help absorb the heat but care must be taken because burns can occur. In the early days of UAL,it was thought that the heat that is generated beneath the skin surface could help stimulate the skin to tighten or shrink wrap, but that is only the theory and in practice ,the skin tightening effects are unimpressive at best. Two UAL devices exist,the Lysonics device which I use can deliver both continuous or pulsed energy or the VASER device which is only pulsed. So when UAL is used, the mechanical effort is minimal, surgeon fatigue is minimal, because the fat is essentially being melted. These devices however, do not extract the fat out efficiently, so traditional cannulas still need to be used to remove the fat slurry,which is now frothy yellow like melted fat rather the the chunky fat with more traditional techniques.
So finally there is the newest technique, known as “SmartLipo”. This device uses a laser, specifically an Nd:Yag laser to melt the fat and also coagulate tiny blood vessels in the fat. The cannula is only 1mm so the access incisions are small. Heat is generated and the claim is that this device can also significantly tightened the skin .So well in fact is the skin tightening effect, that physicians who offer SmartLipo say patients with even very lose skin can achieve remarkable results. Well, the reality is that this device albeit using a smaller cannula than the other methods is no more efficient at fat extraction than UAL. The skin tightening is completely unproven and claims of skin tightening are not FDA approved and there is no clinical evidence of this effect. And lastly, the fat still needs to be extracted by traditional cannulas. So while the claims by Cynosure, the company who sells the SmartLipo device are lofty, there is little science to back up these claims. For my money, I’d rather have a Smart Surgeon and good old fashioned DumbLipo!

Eyelids

Q: My coworkers keep telling me I look tired and when I look in the mirror my eyes look dark and puffy. Is there a solution?

A: Without question, your eyes are the focal point of your face. They truly are the windows to your soul. The more youthful the eyes, the younger you look. Unfortunately, aging, gravity, and even heredity can dramatically affect the appearance of your eyes.

Aging of the upper eyelids usually causes skin excess, puffiness, and heaviness. In some cases, the eyebrows and forehead may be contributing factors. A proper exam will assess these issues to determine if a browlift may help. In some patients, the upper eyelid heaviness is so extreme that the visual fields are compromised. In these instances insurance may actually cover the costs of correcting the upper eyelid problem.
The surgical procedure called a blepharoplasty is designed to remove the excess skin and fat of the upper eyelids and restore their youthful look.

The lower eyelids can also significantly contribute to the puffiness and dark circles. In some cases, excess skin is removed while in others the skin is tightened with laser or chemical peels. The excess fatty tissue can either be removed or repositioned to fill in the hollowing beneath the eyelids (the so-called tear trough deformity). In older patients, the eyelid itself needs to be tightened and repositioned to restore a more youthful contour and shape.

During your initial consultation, all of these factors will be addressed and considered. By doing so, an appropriate treatment plan will be outlined to restore the youthful appearance of your forehead, eyebrows and eyelids. Please feel free to call for a complimentary cosmetic consultation or log onto www.drhainer.com.

Breast Augmentation/Breast Lift

Q: Since the birth of my second daughter, I’ve gone from a firm 36C to a saggy 34B. Will implants help?

A: Your dilemma is not an uncommon one. Pregnancy is only one cause for your problem. Some women never develop breasts while other women simply get smaller or atrophy with age. Whatever the cause, nonetheless, breast implants may be the solution to your problem, or at least part of the solution. Breast augmentation using implants will definitely restore lost fullness to your breasts and may even solve the shape issue. For women with small breasts implants are clearly the best solution. However, if your breasts have developed significant droop or ptosis, you may also need a breast lift or mastopexy.

In essence, breast augmentation is designed to enlarge the breast volume while providing a small amount of lift effect. A mastopexy is purely aimed at restoring the shape of your breasts without changing their size. So, if you are content with a B cup then a lift is all you need. If you also desire larger breasts then you may need both a lift and augmentation.

The degree of ptosis will determine what type of mastopexy is needed to achieve the desired result. The more ptotic the breasts, then the more extensive the lift. During the initial consultation, measurements will be taken to assess just what kind of mastopexy will work for you. For additional information on breast augmentation and breast lift surgery procedures, log onto www.drhainer.com or call my office for a complimentary consultation.

Body Contouring

Q: I’m 5’4” tall and weigh 135lbs, exercise 3 times a week, and watch what I eat. Yet, I can’t seem to lose the bulges of my outer thighs, hips and stomach. Is there help for me?

A: I see many patients who share the same scenario. Despite exercise and diet, certain problem areas persist. These localized areas of adiposity or fatty deposits are in many cases genetic. Patients will often comment that others in the family share the same body structure. In some instances the problem areas develop after pregnancy or weight loss. No matter what the cause, the solution typically involves a so-called body contouring procedure. Body contouring can be classified into excisional and nonexcisional.

Nonexcisonal body contouring is simply another way to say liposuction (also known as suction-assisted lipectomy or SAL). Liposuction involves the removal of fat via small, access incisions through which thin metal rods or cannulas are inserted. These cannulas are attached to a specialized suction device so that as the fat is disrupted it is removed through the cannula. Liposuction also involves the injection of large amounts of fluid (tumescent fluid) just prior to the actual suctioning, which usually contains an anesthetic (lidocaine) as well as epinephrine, which constricts blood vessels and thereby minimizes bleeding and bruising. Most of this fluid is then removed with the fat. Traditional SAL is therefore a mechanical process of breaking up the fat and removing it with suction. Newer methods exist which also utilize ultrasonic energy to disrupt the fat (ultrasonic-assisted lipectomy or UAL) or vibration energy (power-assisted lipectomy or PAL). A well-trained, experienced, board certified plastic surgeon will use each as needed to obtain the optimal results.

The key for successful liposuction however is the skin. Once the fat is removed, the skin must shrink and reshape. Healthy, elastic skin will recoil. Older, sun damaged, stretch-marked skin will not. Which brings us to excisional body contouring. Excisional simply means “cutting away” the excess. Tummy tucks (abdominoplasty), arm lifts (brachioplasty), inner thigh lifts, and buttock lifts are all examples of excisional body contouring. The hallmark to all of these procedures is that not only must fat be removed, but excess skin must also be removed to obtain the desired result. In many cases, liposuction and excisional body contouring are combined. The main point to remember is that with significant skin excess or poor quality skin, liposucton alone will not solve the problem.

The final point to mention is that body contouring is designed to optimize shape. It is by no means a method of weight reduction. Patients must fall within 15-20% of their optimal weight before body contouring should be considered. If someone is more than 20% above their target weight then they should lose those extra pounds before proceeding with body contouring. Conversely, body contouring procedures also will not prevent future weight gain. So it is important to continue regimens that maintain your optimal weight.

During the initial consultation and examination, decisions will be made regarding the quality of skin and the quantity of fat excess so that the appropriate procedure will be selected to obtain the optimal results. For further information about body contouring procedures log onto http://www.drhainer.com/ or call me for a complimentary consultation.

Tummy Tuck

Q: I have been considering a tummy tuck but am afraid of the pain with this procedure. Is there a less painful alternative?

A: An abdominoplasty or tummy tuck is undoubtedly one of the more extensive body contouring procedures. The procedure involves the surgical removal of excess skin and fatty tissue of the abdomen as well as tightening of the underlying abdominal muscles. It is a form of excisional body contouring whereby the extra tissues are surgically removed. For women who have had children, the underlying muscles have often separated and stretched causing a so-called diastasis recti. This diastasis or separation is sutured together creating a tight abdominal wall which acts much like a muscle corset. The tighter the corset, the better the overall shape and contour that can be obtained.

Unfortunately, surgical muscle tightening is ultimately what causes pain. Historically, abdominoplasty procedures have always been associated with a painful recovery. For the past 4 years, I have been using a sophisticated pain control mechanism called the Stryker Pain Pump. This device was first developed for orthopedic surgeons who use it after shoulder, knee or hip surgery. The pump is a completely automated device that delivers a long-acting anesthetic agent via thin catheters to the site of pain. For the orthopedic patient, this usually involves a joint. For tummy tuck patients, the catheters are positioned directly on top of the muscles that have been stitched together. The pump lasts 3-5 days and has dramatically reduced the pain associated with surgery, with some patients actually having no pain at all. For most, the need for additional pain medications is significantly decreased thereby reducing narcotic related complications and speeding the recovery process. For my practice this device has proven extremely effective and I use it for all of my tummy tuck patients. For more information log onto my website at www.drhainer.com or www.stryker.com/instruments/painmanagement.

Endotine Forehead Lift

Q: What is an Endotine forehead lift?

A: A forehead lift or browlift is intended to reposition drooping eyebrows and soften creases of the forehead and between the eyebrows. The traditional “open” browlift involves a long ear-to-ear scalp incision (bicoronal) that is used to elevate the forehead and eyebrow tissues, remove excess skin and reposition the eyebrows. This long incision leaves an unsightly scar often with scalp numbness and a long recovery time. The “endoscopic” browlift uses small 1-inch incisions behind the hairline through which a small endoscope is inserted to detach the same tissues. The forehead and eyebrows are then repositioned and held in place by two small “endotine” devices. The endotine is a small triangular-shaped device that holds the tissues with small, sharp prongs. Once the tissues have healed, this device simply dissolves away. In essence, leaving no trace and no scars. For me this has revolutionized how I do browlifts. Recovery is fast, swelling is minimal and the results are dramatic.
Recently, this endotine device has been redesigned to be used as a method to lift the cheeks, also through inconspicuous incisions. This so-called endotine midface or malar lift is also changing the way I do cheek lifts. For more information about the endotine forehead lift or the midface lift, call for a complimentary consultation, log onto my website at http://www.drhainer.com/ or, log onto the official endotine website at http://www.coaptsystems.com/.