What is the Difference Between Varicose Veins and Spider Veins?

Abnormal leg veins are a common complaint among men and women. They may appear as spider veins, varicose veins, or both. The two types of abnormal veins are treated differently, and by different types of doctors. So how do you know which one you have?

Varicose veins are enlarged veins which most commonly appear in the legs. They may appear bluish, red, or flesh colored, and are ropy or twisted looking in appearance.

Photo Credit: Wikipedia.com

Photo Credit: Wikipedia.com — Varicose Veins

Photo Credit: Wikipedia.com

Photo Credit: Wikipedia.com

Veins have valves that prevent blood from flowing the wrong way. The movement of the leg muscles helps move the blood back toward the heart, and the valves prevent the blood from backflowing. When these valves become incompetent and no longer function correctly, the blood pools in the legs, causing varicose veins. There are several factors that contribute to the development of varicose veins:

  • Increasing age
  • Family history of varicose veins
  • Obesity
  • Sitting or standing for long periods of time without moving around

Varicose veins may cause throbbing, cramping, or aching pain in the legs. The legs often become swollen as well. Varicose veins are a medical problem, and insurance will cover treatment for varicose veins that are symptomatic. Varicose veins are treated by a vein specialist (phlebologist) or a vascular surgeon.

In comparison to varicose veins, spider veins are much smaller (see image below) and are present just under the surface of the skin. They may appear in any area of the body, but most commonly appear on the legs and on the face.  Spider veins are also caused by a backup of blood. They commonly appear in association with varicose veins, but may also appear in people without varicose veins. Spider veins are commonly associated with

  • Hormone changes. Spider veins often appear during pregnancy.
  • Damage to the skin. Spider veins may appear near the site of a trauma such as a cut to the skin, or a surgical site.
Photo Credit: shutterstock.com

Photo Credit: shutterstock.com — Spider Veins

The good news is that effective treatment options are available for both spider veins and varicose veins. The Women’s Health webpage put out by the Department of Health and Human Services has a great information page if you’d like to find out more.

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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

Complications After Tummy Tuck

I’ve discussed how an abdominoplasty, a.k.a. tummy tuck, is performed in previous posts. Today I’d like to delve a little deeper into subject by discussing the possible complications. I’ll divide these into normal expected postoperative sequelae, and true complications.

shutterstock.com

shutterstock.com

Normal postoperative side effects include:

  • Numbness: Abdominoplasty surgery involves elevating the skin up to the level of the ribs and removing the excess. This process means that small cutaneous nerves which give sensation to the skin are divided. So numbness over the abdomen is normal after abdominoplasty. The nerves take several months to regrow, and there may be permanent numbness right over the incision.
  • Swelling: In addition to dividing the nerves, raising the skin up means that lymphatic system is disrupted as well. The lymphatic system is responsible for draining excess fluid from tissue and rerouting it back into the blood supply. Disrupting this system results in swelling, which may take several months to completely resolve.
  • Bruising: Bruising is very common after most types of surgery surgery, and can take a few weeks to resolve.
  • Excess skin. Skin does stretch over time. If you have an abdominoplasty and then gain weight or become pregnant, your skin may stretch, resulting in laxity.

True complications:

  • Blood clots: Blood clots in the deep veins of the legs known as a DVT (deep vein thrombosis), and can happen after periods of immobilization, including anything from surgery to a long plane ride. The risk is increased with age, smoking, hormonal birth control, and certain medical conditions. If a clot forms, part of it can break off and travel to the lungs. This is known as a pulmonary embolism (PE), and can actually be fatal. Fortunately the risk of both DVT and PE are very small. Your physician will assess your risk preoperatively, and may start you on a blood thinner in the postoperative period if your risk is higher than average.
  • Hematoma: A hematoma is a collection of blood that develops in a surgical site. This is a risk of any type of surgery, and abdominoplasty is no exception.
  • Seroma: A seroma is a collection of clear fluid within a surgical site. This is the fluid which your lymphatic system normally drains. To prevent this fluid from collecting, drains are placed after surgery which stay in place for 1-2 weeks. If either a hematoma or a seroma develop after surgery, they can usually be drained in the office, and only rarely would require a return to the operating room.
  • Wound healing problems are also a risk of any type of surgery. If a wound-healing problem develops, it usually shows up as a small area of the incision which heals more slowly than the rest. A more severe wound healing problem occurs if some of the skin on the abdomen does not have good blood supply after surgery, and dies. This is called skin necrosis. It is more common in patients predisposed to healing problems, such as diabetics or smokers. It can also happen if liposuction is done over the abdomen at the same time as an abdominoplasty.
  • Infection:  Antibiotics are given before the start of surgery to prevent infection. This is a very rare complication after abdominoplasty.
  • Contour deformities may also occur after abdominoplasty. The skin over the upper abdomen is thicker than the skin over the lower abdomen, and this can result in the edges of the incision being uneven. This will get better as the swelling resolves, but a scar revision may need to be done down the road if there is a significant step-off between the top and bottom of the incision, or if the incisions bunch up at the ends.

This isn’t an exhaustive list, but it does cover the more common, and more serious, risks of abdominoplasty. If there are other topics you’d like to learn about, I would love to hear them!

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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

Can I Breastfeed after Breast Reduction?

Breast reductions are commonly performed on women of child bearing age. For this reason, it is critical that women considering surgery understand the impact that breast reduction may have on their ability to breast feed. We’re going to cover this topic today. If you don’t know much about breast reduction surgery, you may want to read up on how the surgery is performed.

Photo credit: shutterstock.com

Photo credit: shutterstock.com

There are two main types of breast reduction surgery, and they affect breast-feeding differently:

  • In a free-nipple breast reduction, the nipple is removed completely from the breast and placed back on as a skin graft. This severs the milk ducts, thus making breast feeding after surgery impossible. This type of reduction is not particularly common, and is generally reserved for patients with exceptionally large breasts, or medical conditions which put them at risk of healing problems, such as diabetes or smoking.
  • In a pedicle breast reduction, the nipple is left attached to the underlying breast tissue. This means the milk ducts are left intact, and breast feeding should be possible. But some breast tissue has been removed, meaning the breast might not make as much milk as it would have without the reduction surgery. Overall, however, the success rate for breastfeeding after breast reduction appears to be fairly similar to the success rate for women who have not had breast reduction surgery.

So what does this mean for you? If you are planning on having children, and breastfeeding is extremely important to you, then the safest course of action is to wait to have breast reduction surgery until you are finished having children. If you are unsure about breastfeeding, then at least be certain you understand how breast reduction surgery can affect your ability to breastfeed.

 

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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

Who Should I go to for Fillers?

Injectable cosmetic medications such as Botox and fillers are a hot commodity for physicians. With the decreasing reimbursements provided by insurance companies, a wide variety of practitioners have entered the injectables market as a way to bring in extra revenue. Laws vary by state, but you may find your dentist, oral surgeon, family practice doctor, Ob-gyn, or medical spa offering Botox and fillers. Many states also allow nurses to do injections if overseen by a physician.

courtesy of Office.com

   Photo Credit: Office.com

With the wide variety of locations available for treatment, which is really the best option? For the purposes of this discussion, I’m going to divide medical practitioners into two broad groups: those that learn injectables as a natural part of their training, and those that add injectables to their practice later as an additional revenue stream.

Into the first group would fall Plastic Surgeons and Dermatologists; these specialties learn how to inject Botox and fillers as a routine part of their training.  Otolaryngologists (ENT) learn injectables to a varying degree as well, and some otolaryngologists actually do extra training in a cosmetic fellowship. Finally, oculoplastic surgeons, who are ophthalmologists that did additional training in cosmetic surgery, are trained in injectables as well.

The second group, practitioners who add injectables to their practice as an additional revenue stream, would include everybody else. From a purely technical perspective, injecting Botox or fillers is not difficult. And doctors and dentists all learn how to perform injections of other medications while training. So what makes cosmetic injectables different? For one thing, performing cosmetic injections requires having a sound understanding of facial anatomy. Understanding how the facial muscles interact and how the soft tissues and bony framework change with age, allows for more effective treatment. So although a dentist or Ob-gyn may be able to safely inject Botox, I would argue that a Plastic Surgeon or Dermatologist would be able to use Botox more effectively.

So what about nurse injectors at either a physician’s office or medical spa? I think it really depends on who is over seeing the nurse injector. Most nurse injectors I have worked with are very well-trained, but ultimately they learn from and use as a resource the physician that oversees them. So if you go to a nurse injector overseen by a Plastic Surgeon or Dermatologist, the nurse injector has that person’s experience to draw upon if there are any questions or concerns. A nurse injector overseen by a Primary Care physician, on the other hand, may not be as good a choice to go to.

Where was the strangest or most surprising place you saw offering Botox or fillers? We’d love to hear about it! (The most surprising place for me was on a cruise- for some reason I just didn’t expect that.)

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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

Breast Augmentation – where is the incision located?

I’ve touched on the topic of breast augmentation in prior posts, including the recovery, how long breast implants last, and the different types of breast implants. But it occurred to me today that I’d never explained some of the basics of breast augmentation. Today I’m going to discuss the types of incisions used in breast augmentation, and where the implants are placed. In a future post I’ll explore the possible complications of breast augmentation.

Breast implants can be placed through a few different types of incision:breast-augmentation-incisions asps

  1. Inframmary: this hides the scar in the crease under the breast, and is my preferred incision for a couple reasons. First, it allows excellent access to dissect out the pocket where the breast implant will be place. Second, breast implants do not last forever. And when they are removed, this is frequently done through an inframmary incision. If you’re likely to have a scar in this area at some point in the future, why not limit the overall number of scars and do the initial operation through this inicision as well?
  2. Periareolar: this hides the incision in the transition between the areola and the lighter surrounding skin. The incision is smaller than an inframammary, so it can be difficult to get a larger silicone implant in through this style of incision. Cutting through the breast tissue itself may also expose the implant to bacteria from the milk ducts, which theoretically could raise the risk of infection, although this has not been proven. I tend to reserve a periareolar incision for when I plan to do a mastopexy along with the augmentation.
  3. Axillary: this incision is hidden in the axilla, or armpit. A camera is used to visualize the implant pocket during surgery. It can be difficult to place implants in precisely the correct position when the incision is so far away. And I personally don’t like this incision because it is visible when wearing a sleeveless blouse or tank top.
  4. Umbilical: known as a TUBA, or transumbilical breast augmentation, this hides the scar in the upper curve of the belly button, or umbilicus. This isn’t a very popular type of incision, for the simple reason that the breasts are a long way from the belly button. It is difficult to place implants precisely where you want them over such a long distance. In addition, this incision limits your implant type to saline. Saline implants are placed in the breast empty, and then filled, whereas silicone implants are filled by the manufacturer. And it’s simply impossible to squeeze a full silicone implant through such a small incision.

And that’s it- those are the four types of incisions currently used to place breast implants. Have you had a breast augmentation? If so, where is your incision?

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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.