Dr. Sanders

“The only things certain in life are death and taxes.”

This oft-quoted statement of Benjamin Franklin rings as true in 2011 as it did 250 years ago. Other comments on the topic span the years between then and now. For instance, Franklin also said, “If Patrick Henry thought that taxation without representation was bad, he should see how bad it is with representation.” Another wag opined, “Death and taxes may be certain, but we don’t have to die every year.” Will Rogers suggested, “The income tax has made more liars out of the American people than golf has.” And finally, after ObamaCare health care legislation was introduced, one senior citizen noted alarmingly that it would mandate decreased health care for certain seniors and said, “ObamaCare – Death and Taxes Rolled Into One!”

Regardless of one’s political views, the inevitably of death and taxes is certain. One other certainty that should be added to the list, however, is the quest for personal beauty. Whether it is by means of cosmetics or surgery, both men and women ardently pursue this goal. Despite the recent economic recession, the likes of which this country had never seen, the quest for improved appearance continues unabated. After a 9% drop in 2009, the number of cosmetic surgeries performed by members of the ASPS (2011 American Society of Plastic Surgeons’ Annual Statistics Report) has rebounded, increasing by 2% for the past two years. 2011 found the top procedures as:

• Breast Augmentation
• Nose Reshaping
• Liposuction
• Eyelid Surgery
• Facelift

For the first time since 2004, facelifts were among the top five procedures, replacing tummy tucks. This reflects the increasing number of baby boomers as well as the popularity of less invasive/shorter recovery facelift variants such as the MACS-Lift. Other movers include lip augmentation, up 49% last year due to the increasing popularity of permanent implants. The hassle and discomfort of twice yearly lip injections is being replaced by a single procedure (PermaLip Implants) performed under local anesthesia that gives soft and naturally shaped lips with normal sensation.

Even more rapidly growing is the number of cosmetic minimally-invasive procedures which managed a 1% increase in 2009 – the depths of the recession – and has increased by 5% and 6% in the past two years. In order of popularity for 2011, these were:

• Injection of Botulinum Toxin (Botox, Dysport)
• Soft Tissue Fillers (e.g. Juvederm, Restylane, Fat
Injection)
• Chemical Peels
• Laser Hair Removal
• Microdermabrasion

Overall there was a 5% increase in the total number of all cosmetic procedures, both minimally-invasive and surgical. This overall growth is being primarily driven by a substantial rise in minimally-invasive procedures. In the past 11 years, the growth rate of the minimally-invasive procedures has been 3 times greater than the surgical procedures, reflecting the eagerness of the consumer to exchange the greater cost and increased downtime of surgery for the decreased cost and more rapid recovery of the minimally-invasive procedures, even if it means more frequent trips to the plastic surgeon’s office.

If you would like further information about the Macs-Lift, PermaLip Implants, or other procedures mentioned above, please contact my office.

Virtually every year I make a pilgrimage to Miami in the 2nd week of February to attend what I consider to be the finest plastic surgery meeting in the world – The Baker-Gordon Symposium. The annual event is named after Tom Baker, its originator and also the plastic surgeon that popularized the chemical peel in this country. 46 years ago the symposium began when Tom Baker and Howard Gordon, two young plastic surgeons, invited several well-known plastic surgeons to come and speak to other plastic surgeons about their particular areas of interest. It has become a famous event, attended by several hundred every year. Not only do doctors travel from around the U.S., but many come from around the globe, particularly from the Latin American countries. There are lectures in the morning by invited speakers who then perform live or videotaped surgeries in the afternoon to demonstrate what it was they spoke of in the morning. They must, “Put up or shut up!” The hosts of the symposium keep up a lively conversation with the speakers during lectures, panels, and live surgeries, making it an interactive learning experience. I have my favorite seat in the second row where I sit amongst others who come back to their favorite seats year after year. It makes for wonderful camaraderie as well as for an opportunity to exchange views and ideas with each other during the sessions.
The evenings are spent dining in Miami, enjoying the marvelously illuminated skyscrapers, and walking around in balmy weather with cooling breezes. What a treat for the mind and the senses!
A few highlights from this year’s meeting that may be of interest to my readers:
• Non-surgical skin tightening remains in its infancy. If you’re interested in the type of result you get with surgery, dream on! It’s not even close yet!!
• Non-surgical fat removal is a bit more promising, but still the significant results that liposuction delivers cannot even be approached by the best of the techniques.
• Ultrasonic, Laser, and Radiofrequency assisted liposuction produce heat that leads to fat cell death, inflammation, and more scarring in the area of liposuction that can produce unsightly skin dimpling and irregularities that are challenging to treat. The majority (74%) of plastic surgeons in this country favors traditional (51%) or power assisted (23%) liposuction as opposed to these other modalities.
• Buttock Shaping (Gluteal Sculpting in “Doctor Speak”) is enjoying a surge in interest as plastic surgeons recognize that treatment of this oft-neglected area is key to achieving a pleasing surgical result. Fat Sculpting by means of liposuction and fat injection is used most often in Gluteal Sculpting with implants having a role of lesser importance.
• There is a lesser degree of capsular contracture with saline as opposed to silicone breast implants. Furthermore, the rate of leakage seems to be about the same with both, but with the leak being obvious with a saline implant but requiring an MRI for detection with a silicone implant.
• Fat injection to the breast is beginning to play a more important role in breast augmentation. Although many breast augmentation candidates want a projecting look that can only be achieved with implants, there may still be a role for fat injection in their cases if they are willing to put up with the hassle of using a BRAVA breast suction device that must be worn for several weeks before their operation. If a patient develops intractable capsular contractures, fat injection may soften the contracture or may even take the place of the implant. Furthermore, should the implant be somewhat more visible than the patient desires – especially in thinner patients – fat may be able to soften the look.

On the way home from Miami, I couldn’t help but drop by the Kennedy Space Center for a few “out of this world” shots!
Should you have further questions, please contact my office.

If someone were to ask what has been the greatest advance in plastic surgery in the last 200 years, what would be the answer? Some might suggest liposuction, others the invention of the medical laser, and others injectables like Juvederm and Botox. I would suggest something a bit different!

What do liposuction, laser treatments, and the use of injectables have in common? The answer is the use of anesthesia! Liposuction is done either under sedation, general, or local anesthesia and the solution that is injected into the area of proposed liposuction contains an anesthetic agent. Laser treatment is usually done after the application of a numbing cream or under local, sedation, or general anesthesia. Injectables either contain a local anesthetic agent or the procedure is done under anesthesia of some sort. Were it not for excellent anesthesia, far fewer folks would be willing to undergo a procedure for the sake of appearance!

When did anesthetics originate? They were known in ancient Greek and Roman times, frequently being herbal in origin. Alcoholic drinks were used as well. Nitrous oxide, also known as laughing gas, as well as ether came to the forefront in the mid 1800’s and began to be used to anesthetize patients who were going to have surgery. This type of anesthesia was known as inhalational anesthesia. The patient merely inhaled or breathed the anesthetic gas, fell asleep, and painless surgery was then performed. Since the mid 1800’s, many other agents have been invented, allowing safe and pleasant anesthesia.

The first local anesthetic widely used was cocaine. It was introduced in the mid 1800’s as well, and many others such as Xylocaine have followed.

Morphine, which is found in opium, was first isolated in the early 1800’s and became widely used once the hypodermic needle was introduced in the mid 1800’s. Many other intravenous anesthetic agents have been invented such as Propofol.

I use inhalational, intravenous, and local anesthetic agents in my practice. Sometimes the choice is made by the patient. For instance, a MACS-Lift can be done under local anesthesia, although some patients prefer sedation anesthesia which is done with intravenous Propofol and sometimes a bit of inhalational agent. At other times, the choice is mine, as in breast augmentation that requires the relaxation of the chest muscles by means of intravenous agents for insertion of an implant beneath the muscle.

Regardless of the technique of anesthesia used, it is done safely and pleasantly. The advance of anesthetic techniques over the past 200 years allows for this and certainly has played a major role in the increased popularity of plastic surgery.

Should you desire further information, please contact my office.

Not everyone who wants enlargement of the breasts wants a breast implant. They are foreign bodies and are therefore more prone to problems like scar tissue contracture, infection, rippling, and unnatural appearance. An option would be to use your own body’s tissues – fat for example – or something else that is very similar. This is actually being done in Europe with breast injection of hyaluronic acid, a normal component of our skin. Hyaluronic acid is the active ingredient in Juvederm and Restylane that are used for facial injections. Although this type of breast enlargement is not permanent, this technique may be ideal for the woman who needs a quick boost for a beach vacation!

What about the use of your own body’s fat to give a permanent breast enlargement? The earliest breast augmentation was actually done in this way. In 1865, a German surgeon removed a lipoma – a fatty tumor – from a woman’s back and implanted it into her breast. Because it lacked a blood supply, the lipoma did not survive. More recently doctors have been removing fat and injecting it into breasts. This fat is suctioned out by means of a modified liposuction technique, purified, and injected. The injection places the fat into tiny tunnels within the breast that allow blood vessels to grow into the fat and nourish it. Approximately 60% of the fat survives, making 1-1 ½ cup size breast enlargements possible. Even slender women can undergo this procedure, provided that some excess fat can be found. Frequently the thighs provide the source for the fat, allowing for a moderate breast enlargement as well as body contouring with the liposuction.

A concern with this fat injection technique for breast augmentation has been the appearance of small calcifications in the breasts when some of the fat fails to survive. Can these be distinguished on mammogram from the calcifications that occur in breast cancer? The answer seems to be yes. In fact, one of the best uses for fat injection for the purpose of breast augmentation is in women who are undergoing reconstruction following breast surgery for cancer. Although fat injection alone cannot completely reconstruct a missing breast, it can be used to add fullness to deficient areas after the major reconstructive work is done.

In many cases a woman who wants breast augmentation with fat injection has a very tight breast. The BRAVA system can be used to stretch the breast tissue over a period of weeks to months to prepare the breast for fat injection. The BRAVA system is an appliance that is worn over the breasts for a portion of each day. It places a suction force on the breast, stretching it and actually causing a limited degree of breast growth. Once the skin and breast tissues are looser, the fat can be more readily injected.

Is fat injection a substitute for augmentation with implants? No!! The enlargement is less than most of my patients want and the look may be a bit too natural. In cases of rippling or a desire to add additional fullness to an area that the implant cannot fill, however, fat may be a useful adjunct to implant surgery.

Should you desire further information, please contact my office.

Where is the best location for a breast augmentation incision? Some plastic surgeons have very definite preferences, but what are the facts in the matter?

There are basically 4 incisions that can be used:
• Around the undersurface of the areola – Periareolar incision
• Beneath the breast in the fold – Inframammary incision
• Through an incision in the armpit – Axillary incision
• At the top of the belly button – Umbilical incision

The umbilical incision is limited to saline filled implants since a silicone implant will not fit through the small tunnel that leads up to the breast. Although some surgeons report good results with the umbilical approach, it may be difficult to precisely create the pocket for the implant, producing a disappointing result. In addition, liver and lung injuries have been reported.

The axillary incision has the advantage of avoiding a scar on the breast. I, however, have found this incision to leave a scar that may be quite noticeable with sleeveless clothing such as bathing wear. In addition, it is difficult to position the breast implant in the popular “dual plane location” in which the upper part of the implant is covered by the upper portion of the pectoralis major muscle and the lower part of the implant lies in front of the lower part of the pectoralis major muscle. Many plastic surgeons, including myself, believe that the dual plane location is the optimal position for the implant in most patients, another reason for not using the axillary incision.

The periareolar approach is the most versatile in my hands. It tends to produce a scar that heals very well. The beauty of the periareolar approach is that an incision located at the precise junction of the dark areolar skin and the lighter colored surrounding skin is difficult to see. Of all the incisions, however, this one is associated with the greatest chance of inability to nurse a child after surgery. There may also be a slight increase in the risk of altered nipple sensation compared with the other incisions and perhaps a slightly greater chance of contracture of the scar tissue that surrounds the implant requiring corrective surgery.

The periareolar incision can only be used when the areola is of sufficient diameter to allow for insertion of an implant. A saline implant can be inserted in cases of a diameter as small as 1 inch on stretch of the skin, but this may traumatize the areolar skin and produce problematic scarring. A silicone implant requires a diameter of at least 1 ½ inch on stretch of the skin for a small implant. Larger implants require larger diameters to avoid skin injury as well as to avoid implant damage that can predispose to leakage.

The inframammary incision was the original incision used for breast augmentation. If the incision is made precisely in the fold beneath the newly augmented breast, it usually heals inconspicuously, although problematic scarring can occur. If the scar migrates upward from the fold after surgery is completed, it tends to stretch out and be more noticeable. More and more surgeons are using this incision because it avoids the milk ducts that are important for nursing and also avoids the bacteria found in these ducts that may contribute to painful and disfiguring scar contracture. If scar contracture does occur, however, treatment through the inframammary incision may be more difficult.

If a breast lift is going to be done at the same time as the breast augmentation, the implant is usually inserted through the uplift incision.

Ultimately the choice of an incision is one that a patient should make in consultation with her plastic surgeon, but the guidelines listed above may help guide the process.

Should you desire further information, please contact my office for an appointment.

This weekend I travelled to Atlanta while sitting in my office in Encino! I attended the Atlanta Breast Symposium, a world-class event, by means of a webcast. This was my first experience with this type of thing. By attending a meeting via webcast, one does give up the camaraderie of fellow plastic surgeons, but it is still very worthwhile. In an ideal world, doctors would go to medical meetings in person, but as one fellow webcast viewer who is a professor of plastic surgery in Puerto Rico texted, “It sure beats no meeting!” After all, I still had the opportunity to see everything at the meeting on my computer screen, including live surgery. I did so without spending 16 hours of travel time (this includes driving to and from the airport in both Atlanta and L.A. plus waiting time at the airport) as well as ~$2500 for airfare, cabs, meals, and course tuition. The course cost me only $349, which includes the opportunity to review the course videotape for 3 months, and allowed me to see patients in L.A. on Friday from 9 AM onward and do surgery Friday afternoon. Had I flown out for Atlanta on Thursday to make the meeting by Friday morning, I would have needed to cancel surgery on Thursday and Friday as well as missing office hours on Thursday and Friday. Wow! I never realized how expensive meetings were in terms of time, missed opportunities, and finances!! It was a bit of an adjustment getting up at 3:15 AM on Friday in order to work out and make it fully dressed to my office by 5 AM, but I am an early riser anyway- plus I slept in my own bed for 3 nights!

So what did I learn at the Breast Symposium? Several things that were of interest:

• 3-D Simulation of the results anticipated from breast augmentation is now, “Ready for Prime Time!” The preoperative simulated results from the Canfield Vectra XT 3-D Imager were compared with the actual postoperative results. Impressively, they were virtually identical! This is very exciting, since the #1 question that patients ask at their initial consult is, “What will I look like after surgery?” I have not yet seen results showing breast uplifts, but what I have seen is a great improvement over what has been available until now. This technology is also very helpful for patients who want to compare their anticipated appearance with different sizes and styles of implants. I use imaging in my office for breast and nasal surgery cases and this newest piece of technology may find its way to my “wish list.”

• The use of ADM’s (Strattice and Alloderm) for the treatment of capsular contracture is very promising. Capsular Contracture (CC) is the #1 complication after breast augmentation surgery. CC is the squeezing down of the normal scar tissue that grows around every breast implant and that leads to an unattractive look, can be painful, and can interfere with mammograms. ADM stands for Acellular Dermal Matrix and is marketed under the names Alloderm and Strattice. It is nothing more than skin from a human or a pig. It has been treated so as to remove all cells so that just the collagen framework remains. When treating CC, the scar tissue around the implant is excised and the part of the implant that is not covered by muscle is then covered by the ADM. Although it is expensive (adding ~$4,000 to the surgical fee), it is great to know that we now have something additional to use in cases of CC that do not respond to removal of scar tissue/massage/Singulair/strict sterile technique.

• In my post of January 7, 2012 (http://www.drsanders.com/blog), I mentioned the use of a device used to suspend the breast by means of internal sutures, thus accomplishing a “scarless breast lift.” A patient who was operated at the previous year’s meeting had undergone such a procedure by the inventor of the device. We were able to see that person interviewed on video and to see their current appearance as well as their pre-op photos. The inventor of the device, Dr. Jack Fisher, spoke about the results. The device offers a subtle improvement by lifting the nipple up by ~1/2 inch and also shifts breast tissue upward to a degree. Hopefully further refinements in the device will yield even more improvement.

For those of you who are concerned that my continuing medical education efforts may be slipping, don’t worry! I have not given up actually going to medical meetings and will be off to Miami in 3 weeks!! This is the real deal – I will actually be there in person – no virtual trip. A full report will be forthcoming on a future blog. I will also be able to give you the latest on the Kennedy Space Center, which is nearby!

Should you have any questions about any of the above, please contact my office.

Is there such a thing as a “Scarless Breast Lift”? Breasts droop for many reasons such as pregnancy, weight loss, and advancing age, but the common thread in all of these cases is that the supporting ligaments of the breasts and the overlying skin have been stretched out. These supporting ligaments, called Cooper’s Ligaments after an English surgeon from the 1800’s, are thin bands of tissue that pass from the underlying pectoralis major muscle, through the breast, to the undersurface of the overlying skin, giving support to the breast tissue. They are like a root system that passes through the breast tissue, giving it shape and supporting it. If they are stretched out by pregnancy, weight gain, or age, the breasts will tend to droop. The larger and heavier they are, the greater the degree of drooping that occurs. As the ligaments stretch or weaken, the skin initially offers some resistance to drooping of the breast, but it will also stretch out with time.

How can one correct this situation without a scar? The most obvious approach would be to tighten Cooper’s Ligaments. If you try to surgically shorten them, however, they tend to restretch rapidly and there is the issue of scarring. Newer non-invasive techniques that involve lasers designed to create collagen inside the breast are being tried. There is also a recently developed technique that involves the use of permanent sutures that pass through the breast and are tied to another permanent suture placed just below the collarbone. This supports the breast tissue as a “Man-Made” Cooper’s Ligament, although the duration of the effect is uncertain.

Although the scarless techniques just mentioned may offer some benefit to the woman with a minimal degree of drooping, they are of little help to women with more of a problem. For these women who have a great deal of excess skin, the best approach involves surgically tightening the skin overlying the breast that results in a lifting of the breast. All of these procedures, however, create scars and are therefore not scarless. Surgeons attempt to decrease the detectability of the scars by minimizing their length or by hiding them in the fold beneath the breast or around the areola where they are not as easily seen. These operations that surgically tighten the skin create a “pushing up” of the breast, as opposed to the Cooper’s Ligaments that “pull up.” As a result, surgical breast lifts produce breasts that tend to be flat on the top, something which surgeons seek to overcome in a variety of ways. These include the insertion of breast implants to fill out the upper breast, upward suspension of the breast tissue by means of an internal mesh, or ingenious tunneling of breast tissue beneath the pectoralis muscle that allows the muscle to hold the breast up. In this country, however, the use of implants is the most widely used and time-proven technique.

On a final note, there are some tricks that I use to give a breast lift that is almost scarless.

• If there is not a great deal of drooping, inserting an implant through a minimal incision will itself give an uplifted look to the breast, much as blowing up a balloon lifts the balloon. The resulting scar is virtually “scarless.”
• One can also lower the fold at the bottom of the breast at the time of implant insertion that will result in a lift of the nipple.
• Finally, the Circle Lift technique – takes out a “donut” of skin from around the areola and then pulls the outer skin edge into the areola in a purse string fashion – will lift the nipple and breast to a limited degree and produce a scar that tends to fade into the edge of the areola and is difficult to see in most cases.

For more information on these topics please contact our office.

Thirty years ago most lower eyelid lifts were done in more or less the same way: An incision was made though the skin just below the eyelashes, fat was identified and some removed, excess skin and muscle were trimmed, and the skin incision was closed. The results were mixed – some patients had a good result, others had a hollowed out look, and others developed a pulling down of the eyelids.

Over the past 30 years things have changed dramatically. No longer is the incision made through the skin, but is made on the inside of the lower eyelid. In many cases, skin is no longer removed, but it is tightened with a laser or a chemical peel. The fat is frequently left in place, and in many cases fat or fillers like Juvederm are added. We’ve now gone from eyelids that are hollowed out to eyelids that look as though they need to go on a new year’s diet!

So which is the correct operation? As with all operations in plastic surgery the right one is the procedure that gives the result that patients want, and for most patients that result is a natural looking lower eyelid with minimal puffiness and smooth skin. The lower eyelid should transition smoothly into the cheek. To achieve this look, it’s sometimes necessary to remove fat and in other cases to leave the fat alone, move it around, or add something to plump out any sunken areas. In other words, individualize the operation for each patient. A cookie cutter approach doesn’t work!

A smooth look may also require something more than lower eyelid surgery. The cheek fat may have fallen under influence of gravity, leaving behind a groove where the lower eyelid meets the cheek. By lifting the cheek fat back to its correct position with a cheek lift, a smooth lower eyelid-cheek junction can be obtained.

On a final note, I mentioned the possible need to add something to the lower eyelid to plump out a sunken area. Some doctors will use fat injections. Unfortunately, I have seen many unhappy patients who have lumps from that procedure and that no amount of further treatment can undo. In my experience it is far safer to add Juvederm or Restylane. These take a few minutes to inject, a smooth contour is obtained, and the results tend to last 1 or 2 years.

For further information, please contact my office.

Women who had breast augmentation surgery in the 1990’s and 2000’s had saline implants inserted in most cases. As those implants are now nearly 20 years old, many are being replaced. Some leak, others are replaced because women want a different size, and others develop capsular contracture as the surrounding scar tissue squeezes down on the implant and produces an odd appearance, mammographic difficulties, and pain. As women come in for implant replacement surgery they are faced with a choice between saline or silicone replacements. Which is better?

First of all, a bit of background is helpful. Silicone implants were the original breast implants. In the early 1990’s, however, concern over leakage and other issues prompted the FDA to limit access to them. Saline implants became the new face of breast augmentation. Several years ago, however, the FDA lifted many of the restrictions on silicone implant usage, allowing women over the age of 21 a choice of saline or silicone implants.

What are the differences?

• When you examine the implants outside the body, the silicone implant feels much more natural than the saline implants. When placed inside of a person, however, they feel much more alike. There is also no significant difference in mammograms between the implants and the risk of capsular contracture seems to be about the same as well.
• An advantage to the silicone implants is that they leak less frequently and therefore last longer.
• Silicone implants are now filled with a more cohesive silicone gel that “sticks together” more than the original silicone gel that was more liquid in character. As a result, if there is a leak from a newer silicone implant, the silicone is far less likely to leak into the surrounding tissues because of the stickier nature of the silicone gel. When they do leak, however, it may be difficult to detect the leak, prompting the need for an MRI scan. On the other hand, when a saline implant leaks, it usually deflates within 48 hours, making the leak easy to detect. To some degree, manufacturer’s warranties cover replacement of the leaking implant in the case of both saline and silicone.
• Another advantage to the silicone implants is that they wrinkle less than do the saline implants. This is especially true in women with small breasts and minimal subcutaneous fat.
• Saline implants cost several hundred dollars less than silicone implants.

So which is better? Answer: There are advantages to each!

For example:
• A woman under 22 must use saline implants.
• If a person has a great deal of breast tissue, there is going to be less concern with the chance of wrinkling with a saline filled implant.
• Some women are put off by the difficulty one may have in detecting a leak from a silicone implant, finding the need for an MRI unsettling. On the other hand, having an implant deflate may be equally unsettling, favoring the choice of a silicone implant.
• A very slim woman may prefer the lesser degree of wrinkling that comes with a silicone implant, and she may also appreciate the longer life expectancy as well.
• Someone for whom the softest and most natural result is important may lean toward a silicone implant.

In the end it’s a bit like the difference between chocolate and vanilla ice cream. Both are good, but each flavor has its enthusiasts!

To help you better understand the difference between the implant types in your particular situation, please contact the office for a consultation.

Several times every year a man will come to my office seeking treatment for his “beer gut.” In the past this was almost always related to a desire for improvement of the appearance, but nowadays there is the additional concern about a large waistline predisposing a person to heart disease and type 2 diabetes. Does plastic surgery play a role in the treatment of this problem?

Liposuction can reduce the amount of subcutaneous fat in the abdominal area. Subcutaneous fat is located directly beneath the skin. If the skin tone is good and there is a significant amount of subcutaneous abdominal fat (you’re able to pinch at least an inch), liposuction can reduce the amount of fat and the skin will shrink down to give an excellent result. If the skin tone is not so good, a combination of liposuction and skin removal may be considered. Because abdominal muscle tone is generally good in men because there has been no muscle stretching from pregnancy, the procedure is usually less involved than a traditional tummy tuck, leaving a low scar hidden by undergarments or bathing suits.

If the fat is located beneath the muscle layer of the abdomen so that it surrounds the internal organs (so called visceral fat), liposuction cannot be used to reduce this. Weight loss is the correct treatment. Not only will weight loss improve the appearance of the abdomen by reducing the amount of internal fat and the bulge that it produces, but will also decrease the waist circumference and thus reduce the risk of heart disease and type 2 diabetes. An informal poll of my patients finds that most of the successful weight losers use a combination of diet and exercise. After the weight loss is complete, men will sometimes return to have skin removed from the abdomen if it does not tighten on its own.

Please contact our office should you have further questions.