Celebrities, models and socialites have highlighted some severe complications (including death) from undergoing cosmetic surgery in their pursuit of perfection. This is very concerning and makes me reflect on what beauty is all about. I am reminded at this point of Wabi-Sabi, the Japanese philosophy that embraces the beauty of things imperfect, impermanent, and incomplete. It is a beauty of things modest and humble. It would be interesting to see how much of this ancient Japanese philosophy could be embraced in the world of cosmetic surgery and what a difference it could make.

Wabi-sabi represents the exact opposite of the Western ideal of great beauty as something symmetrical, extraordinary and enduring. Wabi-Sabi is about the minor and the hidden, the tentative and the ephemeral: things so subtle and evanescent they are invisible to unrefined eyes.

Simplicity is at the core of things Wabi-Sabi. Wabi-Sabi embraces the “less is more” ideal talked about today, yet often ignored. Cosmetic surgery needs a lot of Wabi-Sabi.

Flabby bellies are notoriously difficult to control through diet and exercise. Liposuction may be beneficial for someone who has extra fat around the abdomen, but anyone who also has lost muscle tone and developed extra sagging skin will require abdominoplasty, otherwise known as “tummy tuck”, to achieve a flatter waistline. A tummy tuck addresses all three major problem areas at once. In one operation we remove excess fat, saggy skin and tighten abdominal muscles that may have become distended with pregnancy or age.

Men and women can develop abdominal wall weaknesses as they age that can be repaired during a tummy tuck. During pregnancy, women lose their waistline as a result of the spreading of the surrounding abdominal muscles. This spreading is referred to as ‘diastasis rectii’ and is not an actual hernia but does cause a bulge from the pubic area to just above the belly button. Men may also experience this spreading following weight gain or in the presence of abdominal hernias.

The modern tummy tuck is not only a removal of skin but also an operation on fat, and muscle. Incisions for a tummy tuck are made below the bathing suit line from hipbone to hipbone and are generally tailored to the patient’s wishes. Some female patients prefer to wear French cut bathing suits. In that case the incision comes up a little higher on the side extension. For those patients who prefer a traditional cut swim suit, the incision is made right at the hip line. In all cases, the incision and resulting scar are fashioned to meet the patient’s wishes and afford them complete camouflage in a bikini or other bathing suit.

Another incision is made around the belly button. While the belly button is left intact, the tissues beneath are elevated from the lower abdomen to the rib cage area and redundant skin is removed, exposing the abdominal wall. At that point, the abdominal wall is tightened by suturing together the abdominal muscles and repairing any damage that occurred during pregnancy or weight gain. At no time are these muscles actually cut. It is the tightening of the muscles that really reduces the waistline. We then perform liposuction on the abdominal wall, waist, hips and “love handles” in an effort to create a smooth, pleasing contour across the entire waistline.

Finally, the abdominal skin above the belly button is stretched down to the meet the incision at the pubic hairline. A small incision is made for the belly button, which will reach back through the abdominal wall as usual. The shape and nature of the belly button doesn’t change unless a patient specifically requests it. Any hernias of the belly button can be corrected. For example, ‘outies’ can be made ‘innies’ or it can be made a bit smaller if the patient so desires.

Patients are usually instructed to wear a girdle or medical compression garment over the entire abdominal area to provide support and comfort while healing. It takes generally two to three weeks to make a complete recovery, and most of our abdominoplasty patients are back to work within three to four weeks.

If you desire a firmer, more youthful-looking body contour, then a surgical body lift may help achieve your goals. It improves the shape and tone of the underlying tissue that supports fat and skin. In addition, the procedure(s) can improve a dimpled, irregular skin surface, commonly known as cellulite.

Body lift surgery essentially sculpts the body by excision of excess skin and fat and reconstruction of what remains into attractive contours. A body lift may include these areas:

1) abdominal area, locally or extending around the sides and into the lower back area

2) buttocks, that may be low, flat or shaped unevenly;

3) groin that may sag into the inner thigh

4) thigh, including the inner, outer, or posterior thigh, or circumferentially

Body lift is performed under general anaesthesia, with the patient positioned on their stomach, and the surgeon removes a large, belt-like segment of skin above the buttocks, up to the lower back. When the wound is closed, the thighs and buttocks are lifted. The patient is turned over and the surgeon continues to work on the front of the thighs and abdomen. Indeed, when a surgeon performs a circumferential removal of skin and fat of the lower abdomen, and when combined with undermining of the thighs, it will lead to a lift of the buttocks and thighs. A body lift can be done in two stages, with a three-month gap between procedures, or as a single-stage surgery.

The results of a body lift are visible almost immediately. However, it may take as much as one to two years, or more, for the final results of the body lift procedures to fully develop. Since weight loss patients have poor skin elasticity, closure must be as tight as possible. However, over-resection of skin followed by overly tight closure of the tissues can lead to wound rupture or to broadly depressed scars resulting from suture pull through, breakage or premature dissolution. At the same time, insufficient removal of skin and low tension closure leaves sagging tissues, skin rolls and/or wrinkles.

A body lift should be seen as a critical step in overcoming obesity, with the potential of ceasing or reducing medications used for diabetes and high blood pressure. Patients need to take steps following surgery to maintain a healthy lifestyle, ensuring that their new shape will be long term.

Injection lipolysis and mesotherapy are not one and the same. Lipodissolve is a trade name created to describe a patent-pending protocol that has been standardised since 2001. The theory of Lipodissolve was developed in the 1990s but the problem still remains that there are no conclusive outcomes from major trials worldwide on the use of such injections.

Currently, doctors have been considering injection lipolysis for cosmetic purposes with two central ingredients: phosphatidylcholine and deoxycholate (PC/DC formula):

• Phosphatidylcholine is a natural glycerolphospholipid comprised of glycerol, two fatty acids, and choline attached. Phosphatidylcholine is a fat emulsifier vital for cholesterol metabolism, and is a component of cell membranes. Phosphatidylcholine also can be found in foods and is currently a dietary supplement, taken in oral form. Although phosphatidylcholine is one of several ingredients used in certain FDA-approved intravenous drugs, it is not FDA-approved in combination with deoxycholate or for use in aesthetic intravenous purposes.
• Sodium deoxycholate, the active ingredient in PC/DC formulas, causes fat cells to undergo a process called oncosis when injected into the fatty layer. Oncosis is basically acute cellular swelling, and the damage caused to the cell membrane cannot be repaired by the cell in many cases. With deoxycholate alone, a very rapid onset of cell death is seen in a very localized region—within the immediate injection area. When phosphatidylcholine is added, the reaction is less harsh and is spread out a little more, causing a more even reduction of fat when the treatment area has a broad surface. A formula combining phosphatidylcholine and deoxycholate is currently the most popular fat-reducing injectable solution, based on its history of efficacy and safety when properly used by doctors. In addition, phosphatidylcholine acts as a buffer to the alkaline deoxycholate, which allows the reaction to progress over a week rather than several hours. More finesse and a smoother result can be seen when the two ingredients are combined.

On the other hand, a mesotherapy treatment may be comprised of many different ingredients. The selection of the ingredients is related to a specific procedure mesotherapy is intended to treat. Those ingredients may include vasodilators, anti-inflammatory drugs, muscle relaxants, proteolytic enzymes, vitamins, minerals, plant extracts, vaccines, antibiotics, hormones, hormone blockers, and anaesthetics. When we explore the history of mesotherapy in Europe, we learn that it is considered a credible procedure that is used for chronic pain and sports injuries. In truth, mesotherapy injection techniques are widely used throughout the world today.

We need to learn more about the effect of treatment of injection lipolysis on body fat mass, fat tissue metabolic function, and systematic markers of metabolism and inflammation; as well as determine mechanisms for fat reduction, side effects, and patient satisfaction. Questions about injection lipolysis still remain including what is the appropriate dose per injection and what is the appropriate total dose per body surface area.

In the future, injection lipolysis may be an adjunct to treatment or the only treatment for small fatty areas, but is unsuitable when compared to the results that can be accomplished through surgical treatment at present. Furthermore, it is my opinion that injection lipolysis should not be implemented in practices until it has been fully studied scientifically to help prove or disprove certain facts. It is our responsibility as doctors to inform and educate our patients and the public about these new treatments.

As with any surgical technique, a surgeon should use whatever will give the best result with the least risk. Short scar techniques for lifting a breast usually refer to procedures that avoid a long incision in the breast fold that is characteristic of a so called Weiss or inverted T pattern breast lift (mastopexy). Lejour, and more recently Hall-Findlay popularised the technique of vertical scar (or lollipop) pattern which avoided the horizontal scar during a breast lift (or breast reduction). Around the same time, Benelli was intensely arguing for a “round block” technique for breast lift that uses an incision around the areolar (periareolar) with no vertical or horizontal scar components.

Regardless of the particular technique, cosmetic plastic surgeons strive to create an “ideal” breast shape with minimal scarring and complications. A patient’s view of what appears beautiful may differ from our own, and we may alter our treatment plan accordingly. One simple short scar technique will never suffice for all patients, and it is critical to understand all major breast lift techniques if we are going to try to satisfy all of our patients.

Typically, a short scar in the midportion of the breast fold is not offensive to most patients, but extending the horizontal incision within 3 cm of the chest  midline or laterally along the chest wall often results in objectionable scars. These extended breast fold scars are potentially visible when the patient wears a small bathing suit or low-cut dress. As such, the use of long breast fold incisions should be avoided if at all possible, including during extremely large breast reductions. Liposuction of the excess lateral breast fullness is a good tool to help contour the final breast shape and shorten the lateral incision.

Patients seeking the ideal breast shape and size are not always perfect candidates for a simple breast lift alone. They may require a breast implant to add volume to the breast especially after childbirth or weight loss. An isolated breast lift or breast augmentation can be relatively straightforward in select patients. However, combining breast lift with a implants during the same surgery can be a risky task for even the most experienced surgeon. Most patients, though, will choose a simultaneous procedure versus a staged one, even when informed of the added risk. In many cases, the added volume of an implant may benefit the patient not only with increased upper-pole fullness, but also with shorter scars because less skin excision is required. However, shorter scars may come at the cost of more tension on the incision sites. This could lead to wider scars and increased risk of wound breakdown.

Keep in mind the following when determining breast lift with or without implants:

• Major sagging with a nipple to breast fold distance greater than 10 cm will be a challenge to treat without a horizontal incision, unless the surgeon is extremely experienced in a vertical breast lift or using a very large implant. Ultimately, controlling the fold position and nipple-to-fold distance is more essential than trying to shorten a scar, particularly in the severely sagging breasts.
• When excessive bunching occurs when using the short scar technique, adding a short horizontal incision or lateral curve at the base of a vertical mastopexy can help improve results.
• In many sagging cases, an isolated periareolar breast lift cannot produce any noteworthy breast tissue lifting and often leads to an unappealing shape.
• Dense, heavy breasts are more difficult to treat with short scars because of the tendency to leave excess inferior pole breast tissue. This can lead to recurrent sagging if not removed or redistributed adequately.
• Patients who have large areolas and want a smaller diameter during augmentation and breast lift will benefit from the addition of a short vertical incision. The addition of the vertical limb helps control tension away from the periareolar scar and allows the surgeon to maintain a smaller areolar diameter (conversely, using a traditional “doughnut” breast lift during simultaneous augmentation carries a high chance of areolar diameter and scar widening even months after the surgery).

As with any surgical technique, your surgeon should use whatever will give the best result with the least risk. The short scar vertical breast lift can be a very rewarding procedure for both patient and surgeon, and can be used in many circumstances depending on the surgeon’s comfort level and experience.

CosmeticCulture is very pleased to announce that we are now offering laser treatment for vascular lesions using the state-of-the-art Vbeam™ Pulsed Dye Laser. With this exciting new technology, we can treat facial veins, sun and age spots, rosacea, scars, warts, stretch marks, fine lines and wrinkles, leg veins, freckles, port wine stains and psoriasis – quickly, conveniently and without pain.

The most exciting aspect of Vbeam technology is that it offers effective laser treatment without the temporary bruising sometimes seen with earlier pulsed dye laser technology, making it quick and convenient for a “lunchtime treatment”. And, Vbeam is so gentle and safe that it can be used to treat infants and children as well as adults.

The Vbeam features a patented Dynamic Cooling Device™ (DCD) that sprays a fine mist of cryogen prior to the laser pulse. This device prevents pain, protects the skin, and enables the laser energy to reach down and gently heat the targeted blood vessels.

Our new Vbeam laser is regarded industry wide as the gold standard for vascular treatment, and now it treats brown spots too. Typical sessions take just a few minutes and yield very gratifying, visible results.

For an appointment to discuss or receive Vbeam laser treatment, call CosmeticCulture at 1-300-GO-COSMETIC.

Women have already nipped, tucked, implanted and vacuumed every other part of their bodies, and are now exploring a new frontier, genital plastic surgery. Fashion influences like flimsier swimsuits, the Brazilian bikini wax and more exposure to nudity in magazines, movies and on the Internet are driving attention to a physical zone still so private that some women do not dare, or care, to look at themselves closely.

Labiaplasty is a plastic surgery procedure of the outer and inner lips (labia majora and minora, respectively), which are both external folds of skin surrounding the vulva (opening of the vagina). Labiaplasty involves the reduction of an elongated lip. A hoodectomy may also be performed at the same time exposing the clitoris in an effort to increase sexual stimulation.

Most women complain that their inner labia are either too big, too uneven or unsightly. These women feel undesirable or unpretty. Even if nobody sees it, they see it. Over the last few years, labiaplasty is growing in popularity. Most patients request labiaplasty for functional or cosmetic reasons. They cite “impingements on lifestyle” as the chief reason for their decision to have their lips redefined. These impingements usually include the inability to wear tight clothing or “thongs”, a reluctance to take communal showers, and the inability to ride a bicycle comfortably or sit for prolonged periods of time. In some extreme cases of overdeveloped labia, women aren’t able to engage in certain sexual practices.
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In the past, surgeons performed labiaplasty via straight amputation of the protuberant parts and then suturing the edges together. This method, however, had its problems and now surgeons use a more refined technique of cutting out a wedge of excess lip tissue and suturing the edges together allowing for a better scar. Labiaplasty is done while the patient is under general anaesthesia as a day case. Post surgery, patients may experience some swelling and mild discomfort, however these are both typically gone after a week or two. The recovery time for a labiaplasty usually ranges from three days to a few weeks. As with any surgical procedure, there are some risks with labiaplasty such as bleeding and infection.

If you’re considering a labiaplasty, it’s recommended that you see a plastic surgeon in your area and meet with them for a consultation. Not everyone is a good candidate for this procedure, and it’s important that you do your homework prior to having this (or any other) procedure done. One good thing with labiaplasty is that it’s predictable, and women are extremely happy.

As we age, the fat compartments found in all areas of the face—including the mouth, cheeks, eyes, and forehead—age at different rates and change in shape, causing hollows and sagging. New research claims that returning volume to these fat compartments improves volume loss under the eyes, eliminates lines around the nose and mouth, and gives more curve to the upper lip, restoring a youthful overall appearance.

When we perform eyelid and brow surgery for the upper face, lip enhancement, liposuction, and facelift for the lower face, we tend to forget about the midface. This is why so many patients have an ‘operated’ look. They were made to look pulled and tighter, but not younger.  One of the key fat compartments (for a youthful look) that the researchers found was deep in the cheeks. They reported that the size of this compartment decreases as we age, leading to “hollowing” of the face, excess skin and the formation of folds that form around the nasolabial folds.

If volume is restored to this deep fat compartment in the cheeks, using either fat, cosmetic fillers, or implants, the result is an immediate improvement in the hollowing of the face and an improvement in the nasolabial folds, more volume in the eyes, which improves the “v-deformity” of the lower lid, and changes in the shape of the lips.  When the injection was done correctly, a smaller volume of fat or filler is needed.

There are several ways to resculpt the face and increase volume in the cheeks. Some options include fat injections, also called liposculpture; collagen and other soft tissue fillers and implants:

Liposculpture uses the patient’s own fat to fill in areas of the face, reducing the chance of infection. The fat can be harvested from multiple sites, providing a natural look.

Collagen and other soft tissue fillers can be used to fill in lines and give the skin a plumper and smoother appearance. When injected beneath the skin, these fillers plump up lines and wrinkles and add fullness to sunken areas of the face.

Facial implants are also used to improve and enhance facial contours. Frequently, these implants will help provide a more harmonious balance to your face and features so that you feel better about the way you look. There are many implants available, manufactured from a variety of materials. They may help strengthen a jawl ine or bring the chin or cheekbones into balance with the rest of the face.

So the key thing to note is that lifting and tightening tends to give a flattened and “older look”. Pumping up the volume in specific areas of the face leads to a more younger, fuller, “better looking” face.

Gynaecomastia or “man boobs”, is a condition where men complain of enlarged breasts (that sometimes cause secretion of milk!), has become a very common problem.    The term comes from the Greek gynae meaning “woman” and mastos meaning “breast”. Gynaecomastia may be present on one side or on both sides and the condition may make the breast(s) tender. Some men and boys have fat on their chests that makes it look like they have breasts. This condition is called pseudogynaecomastia (false gynaecomastia). With an emphasis on the perfect body in today’s world, men with gynaecomastia are often ridiculed by society, which in turn, affects their self-esteem and confidence.

Gynaecomastia is usually diagnosed by examination but occasionally, imaging by X-rays or ultrasound is needed. Blood tests are required to see if there is any underlying disease causing the gynaecomastia. Whether you need tests depends on your age and what your doctor learns from your history and physical examination. Gynaecomastia is common in teenage boys (~65%). If you are a teenager, you probably will not need tests. Your breast enlargement will probably go away on its own in 2 or 3 years. However, younger boys and adult men who have gynaecomastia may need to have some tests. In these cases, it is possible that some kind of disease may be causing the problem.

Some causes for gynaecomastia include:
1) physiological: hormone fluctuations in neonates, puberty, elderly
2) pharmacological: marijuana, steroids, cimetidine
3) pathological: decreased testosterone production, kidney failure, testicular tumours and liver diseases.

Some people are concerned that the breast lump may be cancer. Breast cancer, however, is very rare in males. Lumps caused by cancer in men are usually just underneath the nipple, feel hard, and may also cause dimpling of the skin or a bloody discharge from the nipple. Your doctor will probably be able to tell whether your breast lump is cancer. If there is any question that you have cancer, you will need to have a mammogram and a biopsy.

Some remedies for gynaecomastia include:
1) hormone treatments like testosterone patches or tamoxifen, an oestrogen-inhibiting drug
2) cosmetic surgery can correct this condition depending on the size and composition of the breast.
3) liposuction can be used to remove fatty deposits.
4) compression garments can camouflage the chest deformity and stabilise bouncing tissue bringing emotional relief to some.
5) sometimes the problem can be solved if you stop taking a medicine or using an illegal drug that is causing the problem.
6) if gynaecomastia is caused by a disease or a tumour, this then  will need to be treated.
7) there are also those who choose to live with the condition.

The latest craze in cosmetic surgery is the belly button makeover. With summer just around the corner and trips to beaches planned, more and more women are opting for “umbilicoplasties” for the perfect belly button. Though this procedure is usually done along with a tummy tuck, it is now being done to change an outward protruding belly button to an “innie”. Some women also request for a vertical or a hooded job.

The belly button is formed when the umbilical cord is removed after birth. Some women consider this as a fashion statement and with the fashion trends of belly button piercings etc, more women are paying attention to the belly button. For the majority of the women the belly button is normal, however, sometimes women have the belly button with a protrusion instead. This can also happen after weight loss or pregnancy when the skin becomes loose and hangs over the belly button.

Umbilicoplasties usually involve the use of local anaesthesia. To make an outie an innie, a surgeon makes an incision on the perimeter of the belly button and tacks it down to the muscle lining with sutures. Extra skin around the belly button is also trimmed off. This is a relatively simple procedure which takes around 30 to 90 minutes to perform. Side effects are possible such as tissue injury, bleeding and infection. The recovery period from this surgery is under a week.

Umbilicoplasties offer a smoother, natural and fashionable looking belly button and is ideal for women in the late 20’s or mid 40’s who wish to wear low rise jeans showing off their belly buttons and their belly button piercing.