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Will it hurt?

24 Nov

Pain is such an abstract and obscure concept. You can’t really define it. It has so many dimensions. In the hospital, we assess pain on a scale of either facial expression charts or numerically from 0-10. Zero being no pain, and 10 being the worst pain you’ve ever felt in your life. It is an individual experience; the numerical response to a stimulus can differ drastically from person to person. So, whether or not something will hurt is relative.

    Source: http://www.pamz.com

On a Scale of 0-10…

What’s the most painful thing I’ve ever experienced? First, a broken heart. That took a really long time to recover from… and I definitely still have scars! The second most painful thing I’ve ever endured is being in a car accident, which I also still have issues from. I’ve never gone through childbirth, never been divorced, still have both my parents, and never had a kidney stone. So my list has room to change. I’d like to point out that my list does not include Botox, Fillers, or my recent surgery. But that’s what this post is about. Do aesthetic procedures hurt as much as people think they will?

Beauty is Pain

We’ve all endured painful treatments in the name of beauty. Ever tweezed your eyebrows? Waxed your lip? Burned yourself with a curling iron? Stuck an eyelash wand in your eye? Walked more than a street block in stilettos? All painful, but relatable, every day examples of things women do in the name of beauty.

If you asked 100 women the same question, you’d get a 100 different answers. This is because women never have a “yes” or “no” answer. It’s always a story. So here’s a comparison story.

Q: How painful are stilettos?

A: Well, that depends.

  • How big are the stilettos
  • How long are you wearing them for
  • How far will you need to walk in them
  • Who makes them
  • How often do you wear stilettos
  • How often do you wear those particular stilettos (i.e. are they broken in)
  • What condition are your feet in (i.e. do you have any blisters)
  • What size are the stilettos vs. what size are your feet (i.e. does the shoe fit)
  • What are the road conditions for which you will be walking in them (i.e. changes in elevation)
  • What are the weather conditions for which you will be wearing them (i.e. rain or snow, inside or out)
  • Etc, ect, ect.

So, when you ask how badly something will hurt, there are many conditions which will change the outcome. It’s hard to explain the pain factor of beauty. The “Universal Pain Assessment Scale” does not really work when it comes to women and what they’re willing to endure. So… I decided to paint my own comparative scale. Because I love “Paint” (the computer program) and I love making stuff relatable.

The “LK Aesthetic Comparative Assessment Scale”

I’m not going to lie. This took me a long time to create, and it’s pretty scientific (although has no reliability or validity, it is merely my projections). This is how it works. Each treatment is rated in 3 dimensions on a scale of 1-5. Then those 3 numbers are added.

Chemical Peels

Laser Hair Removal


Laser on the Face



Eyeliner Tattoo


Botox


Fillers


Some fillers hurt more than others. The worst is the lips. I used that for the pain scale, but other areas hurt much less.

Tear Troughs    2

Cheeks        2

Marionette Lines    3

Naso-Labial Folds    3

Plastic Surgery

In all fairness… I think surgeries could be subcategorized. I heard liposuction isn’t really that bad. I guess it depends how well you are medicated too. Pain is relative.

I Hope this gave some perspective! Remember, this scale holds no scientific basis.

XOXO. LK.

My Breast Augmentation: Day Before and Day of Surgery

24 Oct

**Disclaimer: I wrote this 2 days post-op and still medicated with narcotics. If anything I say makes no sense… there will be a retraction printed in the future. I just am so excited to write this!!!!

Getting Implants– Entry 1.

October 17: The Day Before

What does one do the day before surgery? I realized I would be out of commission for a good week. In a normal week, there is work and cleaning, and grocery shopping. Preparing for being out for a week, I needed to do extra cleaning, work, and grocery shopping. I had to make sure all my laundry was cleaned and put away. There was food in the refrigerator. My boyfriend tried to convince me I had to make up for a week’s worth of sex (oh boys!). All my meds had to be picked up. I had to pack for my friend’s house… the normal stuff. I also had to get my gel nail polish taken off, my hair extensions fixed, and my eyelash extensions filled (normal? I’m not sure…?).

I got home from work at 11:30, just as Aaron was getting home. I got in the shower, washed my hair, and had my last drink of water (no food or water after midnight). I hadn’t been scared or nervous all day. But I usually do have difficulty sleeping when I’m nervous. Aaron gave me a night-night cocktail (aka Nyquil and ibuprofen) and slept like a baby (not medically prescribed mind you—do not try this at home).

October 18: 5am

Ungodly hour. Normally the only time I make the exception to be awake this early is if:

  1. I’m still up partying from the night before (which hasn’t happened since my UMass Amherst days—I SWEAR……….)
  2. I’m leaving on a plane for Mexico with the Donohue’s (from Donohue’s Bar and Grill in Watertown which is the most fun bar EVER).
  3. I’M GOING TO GET MY BOOBS DONE!!!!

I threw up a zip up sweatshirt (I didn’t want to put on anything that would have to go over the head) and some sweat pants. Don’t forget, it’s difficult to put your arms up over your head post op. Then that age old question hit me. Do I wear underwear? I decided there was probably super special sexy hospital underwear to put on. So I skipped. (They did give me some super sexy briefs at the hospital as I expected.)

Don’t I look hot at 5am?

5:15 AM

I of course forgot to pick up my post op meds (which you should ALWAYS do before surgery). My awesome boyfriend took me to the 24 hour CVS to pick up my vicodin, oxycodone, and antibiotics.

6:00 AM

Caitlyn McGrath arrives in a Ford 950 (whichever the really, really big one is). Cait normally drives a Volkswagen. I’m all like, Cait, why do you have this ginormous vehicle? And she’s all like… Well I didn’t have gas in my car, so I took my boyfriends. So I’d like to give a shout out to Pat from the Sitchiute Fire Department for lending the getaway car. We did have to make a 3 point turn at one point. It was not pretty. (Female Quincy drivers = THE worst).

Are you PSYCHED?!?!” she asked me. I was like, Cait, it’s 5 o’clock in the morning. Please. Stop yelling. (I don’t even think she really was yelling).

Cait is one of the lead medical aestheticians at the office and is in Nursing School, so she got super top secret clearance to be in on my case. Like FBI style. I’m so glad she was there. She knew every doctor/nurse/surgical assistant that walked into my room. And confirmed with me that they were all THE best.

6:15 AM

My nurse Maureen comes in, does my vitals, asks all my medical history questions, and inserts my IV (perfectly on the first try might I add). I signed a bunch of papers and started to get a little nervous, but like that first day of school nervous. That excited, this is going to be awesome kind of nervous.

7:00 AM

The doctor arrived and marked my breasts for the incisions. Then the nice nurse anesthetist came in and gave me something to relax through my IV. I remember being wheeled into the OR room. 5. 4. 3. And see ya later. I was out for the next few hours.

Apparently I woke up at spoke to Caitlyn a little bit, but I definitely don’t remember that.


All bandaged up.


The bandages stay on for about 7 days. You can’t get them wet (i.e. no showering. Iiiiiiick).

2:30 PM

My friend Jen P. came and picked me up and drove me to my other friend Julie’s (when I say this surgery was a TEAM effort, I am not kidding!). Julie is an awesome recovery room nurse and she and I decided it would be best if I stayed with her for the first two days post op. I am SO glad I did.

Even with the meds I was on I was still in a good amount of pain. Julie had to bear hug assist me up off the couch (I couldn’t push up with my arms because it was too painful). She also helped me keep a medication schedule and made sure I got my meds every 3 hours. And last, and most embarrassingly, she helped me pull my pants up when I had to use the bathroom.

5:00 PM

My boyfriend came and brought me beautiful flowers and told me how much he loved me. Awwwwww. He also brought me his fleece because it smells like him and I’m a dork and it helped me sleep.


6:00 PM

The party reallllllyyyyy begins. Kathy Nash (owner of KN MedSpa in Natick) arrives. I am really lucky to have such great friends to take care of me, medicate me, dress me, and help me keep my mind off of the surgery. It is not uncommon to have feelings of being overwhelmed or depressed after surgery. My crew kept a close eye on me to make sure I was mentally and physically stable. Errrrr… baseline…. for me.

  • A Funny Nurse’s Note From the Girls –


Baci, D.O.G. wearing my A sized bra. Awwwww. He looks like such a tuff guy… in a bra.


What! We couldn’t let Baci D.O.G. have all the fun.

A little comparison was in order from old bras to new bras.

October 19

Feeling like a million bucks. Staid on my medication schedule. It’s important to do this for the first day or two post op because you don’t want to get behind with pain. It’s hard to catch up. But I was up walking around once an hour. Feeling pretty good. I know pain worries a lot of people, but at most I felt uncomfortable right before I needed my meds.

Julie took me to Corbu Salon in Cambridge so my friend Devon could wash my hair (felt soooo good!) while Julie got hers highlighted. Thank god for all my friends in the hair industry as well! I mean, I might not have been able to shower for a week, but at least my hair could look good!

My post-op follow up is 10/24. So expect another post about post-operative care shortly!

As of today, I am SO happy. I’ve waited years to do this, and it has been the ONLY thing that has ever bothered me about my body. It’s hard to feel comfortable in your own skin, but whatever helps you do it, then do it. Just don’t go overboard!

xoxo LK

Getting Implants– Entry 1

7 Sep

I’ve been working in Plastic Surgery for a few years, and I’ve never been under the knife. I finally made the decision to book a breast augmentation. This is my experience, from a patient point of view.

August 27, 2012

I guess I would consider this day an emotional roller coaster! I had just finished a brachioplasty with the plastic surgeon (as a surgical nurse) when I was called into his office. Long story short, surgery is booked for October 18.

My first reaction was obviously excitement. There may have been a point where I was jumping up and down… and clapping.

Of course, on this day, my mother was meeting my new boyfriend for the first time. Do I tell her? Do I tell my dad? Do I tell my boyfriend’s parents who have probably already read about it on facebook? Honestly, I’ve actually never questioned telling anybody anything I do (although, in hindsight I’ve questioned whether or not it was always appropriate); it was a really odd feeling! I figure, I’m a terrible liar, so I might as well just say it like it is:

“Mom, I’m getting a boob job.”

Things don’t really faze my mother at this point. There was a moment of déjà vu back to the night before my 18th birthday, when I told her I was getting a tattoo.

“How big?” she asked.

“Proportional” I answered. (I gave the wrong answer when I was 18, and I am fortunately not the owner of a GINORMOUS back tattoo, THANK GOD for my mother telling me to make it small!).

“It’s your body, whatever makes you happy.” Aw, mom!

It’s Your Body

Making the decision to undergo plastic surgery should never be anyone’s decision but your own. It should never be for a guy or under peer pressure of a friend. It is a major decision, and as with any surgery, it has risks. I’ve wanted to do this for years, but either I haven’t had the time or I haven’t had the money!

I want to be more proportional. I want my clothes to look good on (or off). And I don’t want to dread bathing suit season!

My reasons for doing this are healthy, and I am very happy with my decision.

August 9,2012 – My Consultation

Choosing size, shape, and style

There are a lot of options to consider when deciding on implants! The first question many ask is: “how big?” expecting an answer in cup size, I guess. But implants don’t come in cup size. They come in cc’s (cubic centimeters). In order to determine the size, shape, and style of implants that are best suitable, there are several things to consider:

  • Symmetry of your breasts
  • The width of your breasts in proportion to the chest wall
  • The characteristics of your breast tissue – how much tissue do you have? How much stretch do you have in your breast tissue?
  • Your goals and expectations for surgery
  • The location of the incision and the implant placement

The Age Old Question: Saline vs. Silicone

Saline

Silicone

Contents

Filled with sterile salt water.

Filled with soft, elastic gel.

May be pre-filled to a predetermined size, or filled at the time of surgery to allow for minor modifications in implant size (good for asymmetrical breasts).

Pre-filled and may require a longer incision for implant placement.

Consistency

Amount of fill affects the shape, firmness, and feel.

Feels and moves like natural tissue.

Risks

scar tissue, breast pain, infection, changes in nipple sensation, implant leakage or rupture.

same as saline.

Rippling

More likely

Less likely

Cost

Less expensive

More expensive

I chose silicone, because it is more natural looking and feeling.

Under the Muscle or Over?


The implant is placed in a pocket either directly behind the breast tissue (right) or underneath the pectoral muscle which is located between the breast tissue and chest wall.

I chose under the muscle.

Incisions, Incisions, Incisions?


An incision can be made either underneath the breast, just above the crease, around the lower edge of the areola or within the armpit.

One of the advantages of a saline-filled implant is that, because it is filled with saltwater after being inserted, only a small incision is needed. Often, an incision of less than one inch is made underneath the breast, just above the crease, where it is usually quite inconspicuous.

Another possible location for the incision is around the lower edge of the areola. A third alternative is to make a small incision within the armpit.

Once the incision is made, the surgeon creates a pocket into which the implant will be inserted, either under or over the muscle as previously discussed.

Smooth or Textured

The surface of the implant can be smooth or contoured. The contoured implants have little bumps on them (like gripping). They are teeny tiny. It’s hard to describe and the pictured don’t really help. But anyways, this keeps the implant exactly where it is placed.


smooth, round

textured, round

I choose textured.

Round or Oval Base

The base of the implant (or the back I guess you would call it when it’s inserted) can come in round or oval.

round

oval base (see how it’s wider)

We are still deciding this one. Leaning towards oval base.

Projection

The amount the implant sticks can be determined by the base to width ratio of the implant.

High Profile Implants

Have more projection per measurement of base diameter than a moderate profile breast implant. An added benefit of the high profile breast augmentation is that in order to create the profile, the side wall of the implant has more height, which may reduce visible rippling. These high profile breast implants will provide more anterior projection (front projection).

Moderate Profile (regular / standard)

These are the standard, creating a ‘normal’ profile. With a full and rounded look, this moderate profile breast implant adds a significant amount of dimension and volume to a woman’s breast. This could create a wider chest appearance, which would benefit those with a narrow chest.

Low Profile Implants

These breast implants have less projection per measurement of base diameter than a moderate profile breast implant.


Example:

200cc High Profile Implant (top in picture) is 9.8cm wide and 9.8cm tall. The projection is 4.9cm

210cc Moderate Profile Implant (bottom in picture) is 10cm wide and 11cm tall. The projection is 3.8cm.

Drawing not to scale. Sorry!

I chose moderate profile, again, because I want the most natural look.

Round or Contoured Implant Projection

Prior to Sientra’s new implant (more on Sientra below) the contoured implant eventually became more round due to the body’s muscle pulling on the silicone gel. The new “gummy bear” implant will keep it’s shape.

round shape

contoured

We are still discussing this as well, but we are probably going with contoured.

Breast Implant Manufacturers

Currently there are 3 companies that manufacture breast implants in the U.S. As of recent, a cohesive silicone gel implant manufactured by Sientra was approved by the FDA (after 8 years of clinical trials). I had heard of this hot new option in New Beauty Magazine (best magazine ever) a year or so ago. They have been nicknamed “gummy bear implants” because, like the candy, the implant has a rubbery consistency that holds its form well over time. This product is the most natural-looking breast shape, and lasts for many years.

The Sientra Implant has the lowest leak rate of all the implants currently approved. Even if the outer shell is ruptured, the silicone gel in the implant remains cohesive and doesn’t migrate to other parts of the body. (I would have tested this theory, but I’m not allowed to cut the implants in half at the office…)

The implant is the most natural looking. Because silicone gel is more cohesive, the risk of shell collapse producing a rippling effect seems to be lower. The implant is also fit to the person’s size and body type.

Less scar tissue
forms with this implant type. Capsular contracture is the medical term for scar tissue buildup and hardening around the implants – a condition that can be painful, and in severe cases, require surgery. The rate of scar tissue buildup appears to be much less with gummy bear implants.

I’ve basically been looking at breasts and reading about breast implants since the middle of August. (Is this what it feels like to think like a man?) Here are some sites I found interesting about Sientra’s new silicone implant (the second two are video’s).

http://www.sientra.com/

http://abcnews.go.com/Health/gummy-bear-breast-implants-future-breast-augmentation-surgery/story?id=16370362#.UEiTF2Hh-pg

http://www.huffingtonpost.com/2012/04/09/gummy-bear-breast-implants_n_1413122.html

My Consultation Sizing


Before

492cc Implant

Before

492cc Implant


Why I Chose To Have an Eyelid Lift

28 Aug

A Note from Me:

The following is a note from a patient about their experience with blepharoplasty, or an eyelid lift. The patient has been a client and friend of mine for years, and had started doing Botox to lift her eyelids, although ultimately, she wanted surgery. I encouraged my client to talk to a plastic surgeon, just to get an idea of what the surgery was like, and when would be the best time for her to undergo this procedure. The patient decided to book surgery after her consultation.

I was able to assist in the procedure at the Newton Surgical Center location. Because the patient was also a friend of mine, we had previously arranged for me to take care of her post-op as well. The surgery itself was only about 2 hours start to finish. The patient stayed home for the next few days, but had very little pain or swelling. The best advice we can give: keep frozen peas in plastic baggies in the freezer and switch them out every 20-30 minutes. Ice decreases swelling, and the peas are light weight and mold to the shape of the eye. I knew there was some use for those things (I am not a fan of peas!).

I would like to thank this client for sharing her story!

(Do you like my shirt? I thought the eyes were appropriate for this post! Wow… I officially have started matching my outfits to my blog posts… maybe I’m becoming more like my mother (the kindergarten teacher) who has a festive turtleneck for every holiday of the year. I did match my diva weave to the Fourth of July this year…)

  • LK

Blepharoplasty (Eyelid Lift)


Blepharoplasty, or “Bleph,” is a surgical modification of the eyelid. Bleph’s are performed both for functional and cosmetic reasons. Cosmetically, the heavy, drooping eyelid gives the illusion of a tired appearance. The lower eyelid bleph is almost always done for cosmetic reasons, to improve the appearance of “bags” and puffiness. (In my experience, eyes are the most concerning feature for women in regards to aging.)

In severe cases, where vision is compromised, everyday tasks (such as driving) can be hazardous. An eyelid lift gives the patient a more awake, alert and youthful appearance and increases the field of vision.

Source: Center for Advanced Facial Plastic Surgery


Whether one is looking to treat their upper lid, lower lid, or both, this procedure is generally the same.  Blepharoplasty is usually performed under local anesthesia in an office or hospital setting.  I’ve assisted in many bleph’s (Observing Surgery: Blepharoplasty).

A crescent shaped incision is made either in the upper eyelid fold or next to the lash line on the lower lid.  Excess skin and fat are removed and small, inconspicuous sutures are left behind.

    


After surgery is complete the eye area can bruise and swell.  Cold compresses (or peas!) can be applied gently to minimize these effects. Antibiotic ointment also needs to be applied for the first couple of days to prevent infection.  Patients will return to for a follow up a week after surgery monitor the healing progress and most return to work soon after that.  The incision lines will fade after approximately two months, but are barely visible.

A Note from a Patient:

I can remember as far back as 6th grade having heavy eyelids. I am almost – and I say almost – 60 years old. For the past 10 years or so, I found myself constantly raising

my eyebrows in hopes that it would raise my eyelids. It became just so natural for me to do that – hence – wrinkles. Can’t win!!

Then I met Laura. Here I am – Miss Deathly Scared of Needles – and I had no qualms about getting shot up with Botox. Instantly there was an amazing difference. She was able to raise my brows so that it took an edge off of my drooping.

As a couple of years went by, I just got to the point where it just wasn’t enough for me. Hey, I am approaching 60, how long am I going to wait to become 40 again. Laura talked to me about seeing a doctor to get my eyes done. He was running a special time of the year sale and who doesn’t like a sale?? But seriously, I made the appointment and met the Dr. I felt so comfortable with his approach and what he had to say.

Originally, I had only wanted to get my top lids done. I had been so focused on them for so long that I didn’t even think about underneath the eyes. The doctor explained the full procedure to me (both top and bottom) and recommended I do both lids. He showed me the excess skin I had, and suggested once I did the tops, I would definitely want to do the bottoms (they were pretty saggy as well!). He said it didn’t make sense to do surgery twice. I was very happy with what he told me and made the appointment.

I was more excited than I was nervous on the day of my surgery AND lucky. I had my own private nurse. Laura picked me up and brought me in for the surgery. She actually stayed and watched the surgery for more of that unstoppable knowledge that she craves. I wasn’t totally knocked out, so I have very faint bits of hearing some things. Apparently, I wanted to get up and help. How thoughtful of me!! When I was done, Laura took me home and took care of me (as much as I can remember). Thank goodness for peas, the best home remedy in the world.

My recovery was so fast. I didn’t have any problems at all. It was amazing. I chose to stay in the house for almost a week just because I am so vain and it forced me to stay home and work. From being so healthy and constant peas on my eyes, my lids started healing over the stitches so they took them out early. Four of my friends came over to see me one day to bring lunch. I think I was in the very purple stage. No one wanted to say anything. My cousin told me later that she was scared to death looking at me. I knew how bad I looked. Now they all can’t believe how amazing my eyes look. I absolutely love them. AND the funny thing is that with all the focus on the lids, the best thing I did was underneath the eye. I would do it all over again in a heartbeat.

Other patient experiences:

Why I Chose to Have a Tummy Tuck.

Why I Chose to Have a Tummy Tuck

10 Jun

The following was written by a patient who had undergone abdominoplasty. She is 40 years old, and had extreme weight loss resulting in extra skin. I think it’s also an important point to mention that she is recently divorced (which is stressful for anyone), and has been thinking about dating again (which is stressful for EVERYONE!). I am very thankful for her to share her story. There are tons of women who want to know more about this procedure.

Abdominoplasty

AKA “Tummy Tuck” is a surgical procedure used to make the abdomen more firm by removing excess skin and fat from the middle and lower abdomen in order to tighten the muscle and fascia of the abdominal wall. The wall is then stitched together making the abdomen more “tight” in appearance. This procedure is great for women who have had kids (they say you never can get your body back after children—”they” clearly haven’t heard of a good surgeon!) and for individuals who have lots of sagging, excess skin after major weight loss.


This procedure is sometimes also done in conjunction with liposuction of the abdomen. But not always. J

Why I chose to have a tummy tuck

I first considered getting a tummy tuck 2 years ago when I was going through a tough time in my life, thinking it might boost my spirits.  My weight had gone up and down for about 20 years and I had maintained a pretty substantial amount of weight for the latter part of those years.  I had just started to lose some weight due to stress and had talked casually to a surgeon about having it done.  He recommended I have a consult and that was as far as I got with it at the time.   

I thought I had made up my mind when I overheard a friend tell another friend that I was planning surgery for all the wrong reasons.  Something in me snapped and I decided against surgery.  I contacted a personal trainer and started on a plan to lose weight and get in shape.  It was not easy.  I had never been one to exercise and it took me a long time to start choosing the right foods.  The same patterns continued where I would lose some weight, but then put it back on.  I was getting frustrated and knew I had no one to blame but myself.  I continued to work out and eat better but I just couldn’t seem to move forward.

A few months ago I saw the same surgeon who told me I should have the tummy tuck.  He knew I had been working out and eating better and I didn’t look much different.  I took his advice this time and had a consult.  What I learned was that I had loose skin that was never going to get smaller with diet and exercise.  On the contrary, the more weight I lost the more loose skin I had.  It got to the point where I felt like it was both mentally and physically holding me back.  I decided to do the surgery.  The hardest part of my decision was telling my personal trainer.  I was afraid he would think I was taking the easy way out and I respect his opinion.  He was great!  He didn’t realize I was dealing with excess skin and he was very supportive.  He asked me a lot of thought provoking questions to verify that I was doing it for the right reasons and he gave me his blessing.  I thanked him and told him I would see him 6 weeks after surgery.

A week before surgery I had a pre-op where they took photos and went over my health history.  Other than the excess weight I was extremely healthy and a good candidate for surgery.  I was a little nervous, but mostly about the recovery.  I wasn’t nervous about the surgery, just about how I would feel afterward.

The morning of surgery I got up early and went to the hospital.  I was greeted by the wonderful nursing staff and then by my surgeon.  Lastly, I was introduced to my anesthesiologist, and that’s where it all becomes fuzzy.  The next thing I know I was waking up and the nurse said hello to me.  My response: Am I skinny now?  She laughed and told me I was.  I was in the recovery room for a short period of time and then two nurses wheeled me to my room.  My only discomfort at this point was bladder pressure (they adjusted my catheter and all was fine) and my back was sore.  Once I was able to adjust myself on the bed I had no discomfort. 

I opted to stay overnight in the hospital and I am glad that I did.  The nursing staff made sure I got meds on a regular schedule and I felt comfortable knowing I had round the clock care.  I had a few visitors who came and made sure I ate and that I was recovering well.  When the nurse came to give me pain meds I asked for Motrin instead.  I had zero pain, which was unexpected, so I didn’t feel the need to take narcotics.  I spent exactly 24 hours in my hospital bed and barely moved a muscle.  I wasn’t sure what to expect with movement so I decided to wait until the next day to move around.

The next morning the nursing staff asked me if I wanted to get out of bed and walk around.  I had them remove my catheter but told them I wanted to wait to get out of bed.  As soon as they left I got up on my own.  I don’t know why.  I think maybe I wanted to know I could do it on my own.  I walked to the bathroom and washed my face and brushed my teeth.  I walked back to the bed for a half hour and then got back up to get dressed in anticipation of going home.  Imagine the surprise the nurses experienced when thy came to check on me and I was dressed and ready to go!  No discomfort!  My only thought was to stay hunched so I wouldn’t compromise my stitches.

My friend, coincidentally a nurse, came to pick me up around noon.  They wheeled me in a wheelchair to the car and I very carefully climbed in.  I was tired but otherwise felt good.  The ride home was uneventful.  I got home and slowly walked upstairs to my bedroom, knowing I would be staying there for a few days while I recovered.  The doctor had told me to get up and walk around a little bit, but only as needed.  I had 2 drains that would let him know if I did too much activity.  I had another nurse friend stay with me the first night home but after that I felt like I could manage on my own.

I was a pretty good patient, or so I thought.  I felt great so I ended up walking around more than I was supposed to.  I washed my hair every day and fed my cats.  When I went for my post op appointment 6 days after surgery I got bad news.  My drains were pulling in too much fluid which meant I couldn’t have them removed.  I was put on bed rest and told to come back in 2 days.  Lesson learned.  I stayed in bed for the full 2 days, only getting up to go to the bathroom.  It worked.  I had my drains removed 2 days later and went back to work 3 days after that.  The removal of the drains was a source of anxiety for me but I barely felt them being removed. 

For 6 weeks I kept my activity to a minimum and followed all my surgeon’s instructions.  I asked the surgeon why I had such a great experience and he said it was probably because I was in shape from working out so much.  My recovery was not exactly typical.  I was a bit tired from the anesthesia but otherwise I felt pretty good.  Physically, I looked a bit out of proportion as I had a lot of swelling but over time everything evened out.  I am now 3 1/2 months post surgery and I couldn’t be happier with my decision.  I am back to the gym and I am now focusing on other areas of my body that need attention.  It’s been a long road but a trip worth taking.


Before and After

Also, check out how hot those panties are!


Before


After

A Note from Me

Sometimes I wonder if people understand that not all plastic surgery is done by super vain and “plastic” looking people. There are many different types of people who undergo the knife each year for reconstructive purposes and to fix something that has affected their self image. Case studies are the best! You should always talk to people who have done the procedure before (unfortunately most people who are elated with results from plastic surgery aren’t usually telling the world their secrets) so here’s some advice from Joan Rivers, Do Whatever You Want, If It Makes You Happy. But First Take This Quiz..

On a serious note, surgery IS serious and if you’re  Thinking about a NoseJob/Breast Aug/Lipo/Tummy Tuck? … Butt Implants?. you should have the list of questions printed from the blog entry to ask your doctor.

I would also like to remind patients NOT to get out of bed without assistance post-procedures. If you are on narcotics (which you probably still have in your system post-op) you are more likely to fall. And then the nurses have to fill out paperwork and it’s REALLY time consuming. Also, if you ever stand up and you feel dizzy, do NOT look down. Those are my words of wisdom for today.

Thanks!

-LK


Observing Surgery: Blepharoplasty

24 Feb

Case Study:

Today I assisted in a blepharoplasty on both the upper and lower lids of a man in his late 50’s. Interesting right? This stuff is not just for women. And before you have any thoughts about it being a gay man you are completely mistaken. This man was a blue-collar, married man.

This patient’s wife, mother, and other relatives had undergone the same procedure. His upper lid was so saggy it impeded his vision tremendously. Genetics plays a large role in how we age, and considering this man had a number of family members who had undergone the procedure, saggy lids clearly ran in his family tree. The women in his family had such great results; the patient was ready to go under the knife. In 3 hours time, he looked about 20 years younger than when he walked in the door, but the most important part for this patient: his vision was improved! He couldn’t believe what a difference it made!


Time:

10:00 am : Patient is given oral sedation and pain medicine. The procedure is done under conscious sedation (patient is awake but comfortable).

11:30 am : Patient has reached adequate level of sedation. Patient is marked on the lids, where the surgeon will be cutting, and local anesthesia is injected into the area.

12:30 pm : The right eye is finished. Top and Bottom lids have been cut and stitched. The patient already states his vision is improved! AND he looks 20 years younger!

1:30 pm : The left eye is finished. Top and Bottom lids have been cut and stitched. The patient is shown his results. The eye is then taped at the sides to kept tension off the sutures.

Stats:

Total time of procedure start to finish: 3 ½ hours

Total time taken off patients face: 20 years

Total cost to patient: $5,250 (Upper only is $3,250 and Lower only is $3,250)

Follow up: The patient will return in 1 week to have the “tension tape” taken off and the non-dissolvable stitches removed (both dissolvable and non-dissolvable are used).

Downtime: About a week of being black and blue, and having the tape on your face. Tape is in though… Tape is the new black! (Just kidding).


(From the ASPS website)

Also known as a “Bleph.” The technical term for eyelid surgery. It improves the appearance of the upper eyelids, lower eyelids, or both by giving a rejuvenated appearance to the surrounding area of the eyes by removing skin and fat. The result gives a more rested and alert appearance.

Almost 200,000 Bleph procedures were performed in 2011, and it remains in the top 5 most popular cosmetic surgery procedures.


Treatable conditions:

  • Upper eyelid surgery can remove excess fatty deposits that appear as puffiness in the upper eyelids.
  • Loose or sagging skin that creates folds or disturbs the natural contour of the upper eyelid, sometimes impairing vision (like in the case study!), can be treated by eyelid lift surgery.
  • Lower eyelid blepharoplasty can remove excess skin and fine wrinkles of the lower eyelid.
  • Bags under the eyes can be corrected by blepharoplasty.
  • Lower eyelid surgery can correct droopiness of the lower eyelids, showing white below the iris (colored portion of the eye).

Is it right for me?

A blepharoplasty procedure is usually performed on adult men and women who have healthy facial tissue and muscles and have realistic goals for improvement of the upper and/or lower eyelids and surrounding area.

You should undergo blepharoplasty surgery for yourself, not to fulfill someone else’s desires or to try to fit any sort of ideal image.

Good candidates for cosmetic eyelid surgery are:

  • Healthy individuals who do not have a life-threatening illness or medical conditions that can impair healing
  • Non-smokers
  • Individuals with a positive outlook and specific goals in mind for blepharoplasty
  • Individuals without serious eye conditions

You must tell your doctor if you have any of these medical conditions:

  • Eye disease such as glaucoma, dry eye or a detached retina
  • Thyroid disorders such as Graves’ disease and under or overactive thyroid
  • Cardiovascular disease, high blood pressure or other circulatory disorders or diabetes

Prevention

If sagging lids run in your family, there are things you can do to prevent going under the knife. Botox is used to lift the lid (but it can only lift so much). Ulthera is also being used as an alternative to surgery. But remember, non-invasive and minimally invasive treatments won’t give you the extent of the result surgery will. If you start doing this alternative procedures at a younger age (say mid 30’s) you are more likely to prevent the need for surgery.

Do Whatever You Want, If It Makes You Happy. But First Take This Quiz.

31 Jan

The following quiz is from Joan River’s HILARIOUS book Men Are Stupid… And They Like Big Boobs.  Even if you are in no way, shape, or form planning on having any sort of procedures, this is still a must read!  (taken directly from page 12-14).  Anything in pink italic is my own interjections.  Because I always interject.

So You Think You’re Really, Really

Ready for Cosmetic Surgery?

Answer the following multiple-choice questions to find out if you’re emotionally prepared to make a big change.

1.  Spending money on myself…

A. is morally reprehensible!

B.  runs against everything my parents taught me.

C.  is fine.  What else should I spend it on?  My kids’ college education?

D.  is a touch call, but being happy is worth any price.

If you answered a., that spending money on yourself is morally wrong, then get back inside the convent, and pray for me because I’m clearly bound for hell.  Even Mel Gibson pays for his own SS uniforms.  If you answered c., remind yourself that spending money is good.

The correct answer is D., that there’s no better investment than your own confidence and happiness.

Joan couldn’t be more right!  Spending money on yourself is ok.  Spend wisely! 

2.  I want to make a change in my appearance because…

A.  my husband has been begging me to get implants since his secretary died.

B.  my friend told me every attractive woman has had something done.

C.  I’ve hated my nose for years, and I’m sick of walking into parties backwards.

D.  when I saw myself in a recent photo, I looked like my mother.

If you answered a. or b., you’re wrong.  Screw your boob-loving husband and peer-pressuring friend.  The one and only reason to get surgery or a non-invasive beauty procedure is for yourself.  If you think having work done will make you a happier, more confident, contented person, go for it.

If you answered d., you’re still wrong.  Those of you who have the fear that you’re turning into your mother, make a shrink appointment.  In the meantime, guess what?  Surgery won’t alter your genetic code.  Even if you’ve had a face lift, you’ll probably still look like your mother.  (This drives my daughter Melissa crazy.)

The correct response is c., because the motivation for change has to come from inside you.

The only reason you should do ANYTHING is for yourself.  I have SO many patients that tell me they don’t want their husband knowing, because they “wouldn’t understand.”  I get into countless debates, mostly with men – but some women, about how someone’s choice to do Botox is their personal preference, and because it’s a very safe procedure, there shouldn’t be as much controversy as there is!  Be supportive of your friend or spouse’s decision.  It’s THEIR body.

3.  The actual surgery will be…

A.  a snap.

B.  the first day of a completely different life.

C.  rough.  It’s major surgery and should be taken seriously.

D.  a bloody nightmare.  I don’t know how I let Joan Rivers talk me into this.

The correct answer is c.  Plastic surgery, from a blow lift to a butt lift, is major surgery and not to be taken lightly.  You have to be prepared to do whatever your doctor instructs you to do, before surgery and during the recovery.  You’re looking at up to a month of convalescence.  It’s not a walk in the park.  But, once the recovery is over, you’ll be thrilled you had the surgery.

The one thing you hear most from women who’ve had cosmetic intervention:

“I wish I’d done it sooner”

(This is also the biggest complaint I hear from women with Botox!)

4.   Self-Improvement is…

A.  selfish vanity.

B.  what we should all strive for throughout our lives, physically, emotionally, mentally.  Otherwise, why not just crawl under a rock?

C.  impossible.  I’m already as good as I’m ever going to get.

D.  embarrassing.  I’m loathe to reveal my insecurities and flaws to myself, let alone a stranger, especially an attractive doctor.

The correct answer is b.  Of course we should all strive to improve ourselves!  The pursuit of betterment is hardly selfish vanity!  Do we educate ourselves out of vanity?  Do we expose ourselves to culture to be selfish?  Physical improvement via cosmetic intervention is on a par with going to the gym, which most people consider to be masochistic but not vain.  Vanity is thinking you’re already perfect.  And if you’re perfect, put this book down and leave the rest of us humans alone.

** I would like to add, attractive doctors exist in Orthopedics (sports medicine) and on T.V. shows for the most part. 

5.  Beauty is…

A.  an unfair societal demand put on women so makeup companies, plastic surgeons, diet-pill manufacturers, and hair salons can stay in business and make tons of money.

B.  in the eyes of the beholder.  When I see a beautiful woman walking down the street, I’m so jealous I want to spit – in her eye.

C.  for the very young and/or the very rich.

D.  within  your grasp, a worthy goal, the way to feel good about yourself and stay vital in the world.

Beauty can be a source of a.) anger, b.) jealousy, and c.) envy.  You wouldn’t have those negative emotions if you felt beautiful yourself.  Imagine being free of jealous, envy, and anger-and not having first woken up dead and found yourself an angel.

Those who answered d. understand that beauty is within your grasp.  Now go out there and get some!

Ok, I know not everyone loves Joan as much as I do.  (We’re on a first name basis).  But, I think she has some very valid points, and I also think she looks the way she wants to, and she is happy with her results.  She makes millions a year off her surgically altered botox’d up face.  All the power to you Joan.  I hope some day the same is said about me! 

Joan Rivers’ Men Are Stupid… And They Like Big Boobs:  A Woman’s Guide to Beauty Through Plastic Surgery with Valerie Frankel

It’s absolutely hilarious, and discusses procedures from laser to lipo.  I highly recommend it.  I don’t agree with everything she says, but I think she gives mostly valid information!

Body Dysmorphic Disorder

22 Dec

As an employee in the field of plastic surgery, I meet some VERY interesting people.  Our office always have hilarious stories that would be PERFECT for a reality t.v. show, unfortunately… HIPPA (Health Information Portability Protection Act) would make it a little difficult.  One unfortunate, and fortunately small population of beauty-goers is the woman suffering from Body Dysmorphic Disorder.  This syndrome causes a person to be excessively concerned with body image.  The affected individual has such a strong negative self-image it affects their ability to function in daily activities.

As most of us are aware, when we look good we feel better about ourselves.

People with BDD are so critical of their looks, it affects their ability to function as a normal person.  It can cause anxiety, depression and other mental health issues.

In my experiences, the clients I see that suffer from this disorder are GORGEOUS.

So why do they not see what I see?

Mental health disorders are caused by biological, psychological, and environmental factors. (I have a minor in Psychology, any of you UMASS Amherst alum will know the great Professor Halgen who taught Abnormal Pscyhology–one of the best classes I’ve ever taken).  I have observed very low self esteem with these patients.  I have found through talking to these clients they are usually in abusive relationships, and are looking for something they can physically change about themselves to make their abuser “love them.”  Usually people in abusive relationships have a history of emotional neglect and physical and/or mental abuse.

The syndrome typically manifests itself during adolescence (don’t worry, I’m not Botox’ing anyone under 18!) – a time where we all start becoming critical of appearance.  A time where most women start wearing make-up ;).

80% of people who suffer from this disorder have had suicidal thoughts.

For those of you in the beauty industry, you might run into these people from time to time (but probably not as much as I do in my office…).  The only thing you can do with clients like this is to be supportive.  Many of us establish strong bonds with our clientele (who doesn’t LOVE their hairdresser or aesthetician!) and they value our opinions.  If you feel you have a client who might suffer from BDD you should tell them.  This behavior to be constantly critical of yourself is not normal, and professional help is the only thing that can help.

  Do I treat them?

Yes, but I handle with care.  A client with BDD will go to whomever will treat them, and (I don’t know if you know this) but there are a lot of people out there that are driven by money and not morals.  I make it very clear that they have nothing physically wrong with them, and any treatments I agree to with them are solely for preventative purposes.  Beauty treatments are therapeutic to a lot of women, and although I am not a psychologist, I think when I sit behind these people in the mirror and tell them there is nothing wrong with the way they look they are agreeable to doing less drastic changes.

I like to bring up this AMAZING underground cult classic movie that inspired me during a bout of depression (not BDD).  The movie is called “What the Bleep Do We Know: Down the Rabbit Hole” and it is a docu-drama about Quantum Physics (and I bet my last blog post gave you the impression I was less than mature!).  Please, please, please take a minute to watch some of the clip below.  I hope you will find it as inspiring as I have!

After showing my friends the clip I decided it needed a preface.  The movie is about a girl who is deaf and is having a difficult time with life and has a poor self-image (that’s the drama part).  There are clips of Physicists discussing the Theory of Quantum Physics (the documentary part).
 

Quantum mechanics is the body of scientific principles that explains the behavior of matter and its interactions with energy on the scale of atoms and atomic particles.

Basically, your internal thoughts and feelings affect external outcome of a situation.

**If you’d like to know more about String Theory, ask my brother.  He’s the smart one in the family.

Women look in the mirror on average 32 times a day.  We always direct our attention to subtle flaws we have.  But most of us can name a feature that we consider “attractive.”  Everyone has their own unique beauty, and it is healthy to maintain or enhance your natural image.  But beauty starts on the inside, and sometimes we need professional help finding it.

Thinking about a NoseJob/Breast Aug/Lipo/Tummy Tuck? … Butt Implants?

15 Dec

I go with a lot of my clients to their consultations and watch a lot of procedures with a plastic surgeon.  My wonderful friend called me at 8 this morning to ask me what she should ask at her consult (apparently she forgot I am NOT a morning person).  I jumped out of bed though, because I remembered I had a lists!  I love lists ALMOST as much as I love white boards!

I know Plastic Surgery isn’t for everyone, but I think if you are contemplating it, you should be prepared from the beginning; starting with the right surgeon can make all the difference in the world!

Plastic Surgery:  Making the Best Decision

Brief important plastic surgeon qualifications

Please check out www.plasticsurgery.org to see if your surgeon is ASPS accredited.  If they are ASPS accredited you are in good hands.

Each ASPS member must meet the following:

  • At least five years of surgical training and a minimum of two years of plastic surgery training.
  • Board certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada.
  • Trained and experienced in all plastic surgery procedures, including breast, body, face and reconstruction.
  • Peer-reviewed for safety and ethical standards prior to attaining the honor of active membership.
  • Only operates in accredited facilities.

When making the choice:

  • Use your head not your heart in making the selection.
  • Bring before and after photos, if possible, to show what you want.
  • Research the doctor, call other patients for recommendations.
  • Get a recommendation from your bariatric surgeon.
  • Meet the doctor and get to know him or her; you trust yourself to his or her care, so you need to feel comfortable with the person.
  • Use the term “reconstructive surgery” with your insurance company, since “plastic surgery” is often considered to be “cosmetic” or “elective” and hence is not covered.

Questions to ask:

1.  Are you an ASPS member surgeon? If he or she answers “yes” you can rest assured that your surgeon is board certified in plastic surgery, has hospital privileges and only performs surgery in accredited facilities.
2.  Are you board certified by the American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada?
3.  Do you have hospital privileges to perform this procedure?   If so, at what hospital? Is the surgical facility accredited?
4.  Am I a good candidate for this procedure?
5.  What will be expected of me to get optimal results?
6.  What are the risks involved with my procedure?
7.  Will I need to take time off work?  If so, how long?

What you should ask about the procedure

8.  What is the simplest and safest surgery to help me achieve my goals?
9.  How is the surgery performed?
10.  What is the expected length of operation?
11.  Are other options available?
12.  What results can I expect, and how long do the typical results last?
13.  Where will scars be located, and how noticeable will they be?

What you should ask about your surgeon’s experience

14.  How many times has the surgeon performed this procedure?
15.  How long has the surgeon been performing this procedure?
16.  How many times per year does the surgeon perform the procedure?
17.  How many patients have required re-operation or touch-ups?
18.  What complications may occur?
19.  How frequently do these complications occur?

What you should ask about logistical matters

20.  What preparation is required the day before and morning of surgery?
21.  Should my regular medications be taken on the morning of surgery?
22.  What time should I arrive at the surgery location?
23.  Should someone drive me?
24.  Should someone wait at the surgery location or come back later?

 

What should you ask about emergency plans

25.  What emergency plan and equipment are in place to provide for my needs in the event of an emergency?
26.  Are the surgeon and staff certified in Advances Cardiac Life Support? (ACLS)?
27.  Does the surgeon have admitting privileges at a local hospital should problems arise during my office surgery? (Call the hospital to confirm)
28.  How would I be transported to this facility?
29.  Has an adverse event ever occurred in the past?

What should you ask about the recovery process

30.  What kind of care will I require?
31.  When will I be able to go home? Is an overnight stay required, or is one available if I prefer?
32.  Who will attend me in the case of an overnight stay?
33.  Will I need someone to drive me home?
34.  If a problem arises after I go home, who answers calls after hours and on weekends?
35.  If I need to be seen after hours, where will this occur?

36.  If I need help in my home, is a private duty nurse available?  At what cost?

37.  Are any special garments, medications, or diets required during the recovery period?
38.  How much pain/swelling/bruising is to be expected? How long are these likely to last?
39.  How long does the entire healing process last?
40.  How many follow-up visits are necessary?
41.  Who performs the skin care/post-operative follow-up/suture removal?
42.  When can I wear makeup?
43.  When may I return to exercise/bathing/driving/normal activities/work?
44.  At what point will I feel comfortable in a social setting?
45.  What if I am dissatisfied with the results or with the degree of changes achieved?
46.  If touch-ups are necessary when would that be performed?

What about fees

47.  Does the cost depend on where my surgery is performed?
48.   Will I need to see another physician prior to surgery for examination or testing because of a preexisting medical condition?

49.  Who pays this cost? Will my regular family doctor suffice?
50.  If a complication causes me to be transported to a hospital or stay overnight, who pays for this additional cost?
51.  If I request multiple procedures, can they be performed at the same time? What are the cost savings?

52.  What options are available for payment?

53.  Does the office accept credit cards?
54.  Is a payment plan available to patients?
55.  What is the refund policy should I change my mind after paying in full?
56.  Is my surgery covered by my insurance plan?

After discussing all of the factors involved with your proposed procedure with the surgeon, you should have a sense of whether or not the surgeon is right to you.  Take note of and consider whether the surgeon:

  • Listen and understand your priorities, opinions, and requests?
  • Communicate concern, compassion, request and honesty?
  • Instill confidence in you?
  • Display confidence in his or her ability to care for you?
  • Seem distracted, or come across as arrogant or curt?
  • Seem patient and willing to spend time to answer all your questions and discuses your concerns?
  • Condescend; talk down or under estimate your intelligence?
  • Make eye contact or continually jot down notes in the chart as you spoke?
  • Display positive body language?
  • Confuse you or offer clear explanations?
  • Appear to be selling you the procedure?
  • Adequately discuss any preexisting medical conditions you might have?
  • Encourage your family to participate in the consultation and decision-making process?

Do you:

  • Feel that you have established forthright communication and a positive rapport with the surgeon?
  • Trust your life to this surgeon?
  • Feel the Surgeon is acting in your best interest?
Remember, Aesthetic Augmentation is no one’s decision but yours. 

Exercise?!?!… but “Nothing replaces traditional…

23 Nov

Liposuction”

A funny quote from the office. I was invited to observe lipoplasty (aka liposuction).  Of course I was psyched!  Before I receive a million hate mails–remember:  the point of my blog is to give information to everyone.  Just because this isn’t  something your interested in doesn’t mean someone else isn’t.  Beauty IS part individual ideals ;). See Beauty Defined.  Also… I tried not to be graphic but still be informative.  I also had the patients permission to write about her experience.  I may add pictures later.

What to expect during the procedure

The patient had baseline vitals and was medicated with xanex and percocet prior to the procedure.  She was marked by the surgeon in a few places on her neck (it was neck lipoplasty).  After the medication took effect, she was laid on the procedure table.  It is a sedated procedure, so the patient was awake and talking throughout.

Local anesthetic was injected before a small incision was made under her chin.  Then a liquid was injected that was a mixture of drugs that separated the skin from the fat, vasoconstricted (to prevent bleeding), and a numbing agent.  The surgeon separated the fascia tissue holding the skin and fat together and used a suction cannula to suck out the fat.  The neck does not contain much fat to suction, only about 100 cc’s was removed.  The patient felt comfortable throughout the procedure.  The procedure took an hour and a half from start to finish.

Sexy Head Bra

Post care instructions are pretty standard.  6 weeks of recovery time.  PLUS EXTRA BONUS:  You get to wear a sexy head bra!  (This keeps fluid from the area, and keeps the skin tight).  Remember, you may require some skin tightening post treatment.  This patient will be doing Ultera in 4-6 months.  Ultera is AWESOME (blog post coming soon)!  It was a great success and the patient is very happy!

Well what about laser? 

(from the American Society of Plastic Surgeons website)

Laser liposuction

Laser liposuction focuses low-energy waves delivered by a thin laser fiber that’s inserted through small incisions. The laser energy is focused on the part of the body where you’d like to have a fatty pocket removed. After the fat is melted, a small cannula is used to suck out the liquefied fat.

Ultrasound assisted liposuction

The fat is dissolved by the ultrasonic waves that are emitted from the end of a cannula that’s inserted through small incisions. Ultrasonic waves delivered through the cannula emulsify or liquefy the fat. After the fat is liquefied, it is then sucked out through a small cannula.

*Note, these are ASSISTED lipoplasties.  So what about regular laser and fat melting?  It’s not that easy my friends.  These procedures are typically performed in locations that don’t offer plastic surgery as an option.  Watch out for good marketing when it comes to these procedures.I have observed some great results from Zerona, but if home care instructions aren’t followed exactly… don’t expect these procedures to work for you.  And remember: 

Nothing Replaces Traditional Liposuction!

 
** For those of you who believe “nothing replaces traditional exercise” remember:  there are a lot of factors to consider when taking plastic surgery into consideration, and it shouldn’t be a thoughtless decision by ANYONE.  Lipoplasty will not keep the fat off forever, only exercise and a good diet will do that.  🙂 
 

Happy Thanksgiving Everyone!

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