What is a free-nipple breast reduction?

I’ve talked a little bit about breast reductions in previous posts, including how a breast reduction is done, as well as the possible complications of breast reduction and what the scars look like. But breast reduction is a broad topic, and there is a wealth of information I haven’t covered yet. In today’s blog I’m going to talk a little bit more about free-nipple breast reduction. First let’s review the two types of breast reduction:

Courtesy of office.com

Courtesy of office.com

  1. Pedicle reduction. This is the most common type performed. In a pedicle reduction, the nipple is left attached to the breast, and its blood flow is supplied by the underlying tissue (the pedicle).
  2. Free nipple reduction. In a free nipple reduction, the nipple is actually removed from the breast and reattached as a skin graft.

Removing the nipple seems like a pretty drastic step, right? And it does completely remove the ability to breast feed, as all of the milk ducts are divided. So why do it? It’s a matter of blood flow. A nipple placed as a skin graft has a lower metabolic requirement (i.e. needs less oxygen and fewer nutrients) than a nipple which remains attached. So free-nipple reductions are done in cases where blood flow to the nipple might be decreased such as:

  • Patients with diabetes.
  • Patients with a heavy smoking history.
  • Very large breasts – in this instance the blood has to travel a long distance to reach the nipple.

But what do your breasts actually look like after a free nipple reduction? For the first week there will be a dressing over the nipple which is held on with stitches. This dressing is called a bolster, and it holds the nipple flat to the underlying tissue both to allow nutrients to diffuse into the nipple and for new blood vessels to grow into the graft.

After the dressing comes off, the nipple may undergo some superficial sloughing, which is when the outer layers of skin peel and flake off. This happens because nipples are fairly thick, and the very outer layers of skin do not get good blood flow initially. This superficial sloughing may result in some irregular pigmentation, especially in darker skinned individuals.

As the nipple graft heals over the ensuing weeks and months, the pigmentation returns. New cutaneous (skin) nerves may also grow into the graft, returning a little bit of sensation to the area. After a year of healing, the nipple graft looks very much like the nipple after a pedicle reduction, although some irregular pigmentation may persist.

 

Do you have any questions about free nipple grafts? Leave them in the comments and I’ll get back to you.

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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.

Are there different types of Butt Lift?

The term “Butt Lift” is used frequently in discussions of Plastic Surgery, but it’s a fairly non-specific term. There are actually three different surgical procedures that can all be referred to as a Butt Lift. Today I’m going to explain the differences between the three, and talk a little bit about what each type of operation can accomplish.

photo credit: shutterstock.com

photo credit: shutterstock.com

  • Butt Lift: The standard butt lift could be considered the posterior version of a tummy tuck. This type of surgery involves excision of excess skin, and is most commonly done in patients who have lost significant amounts of weight. The goal of a butt lift is to lift the butt and make it rounder. This is done by removing only the outer layer of the excised skin, a process called de-epithelializing. The underlying tissue is left attached, and tucked down into the buttock to provide volume. A butt lift will leave a scar at the top of the buttocks, which is generally hidden well by underwear or a bathing suit.
  • Butt Implants: The goal of placing butt implants is to make the buttocks fuller. A silicone implant is placed under the gluteus maximus muscle, in a process similar to breast augmentation. Buttock implants have a higher complication rate than breast implants, however. One reason may be that it is difficult to avoid pressure on the area (i.e. sitting) while it is healing. Implants may have to be removed if they become infected, if they form firm scar tissue around the implant (capsular contracture), or if they rupture. The implants are placed through a small incision hidden in the gluteal cleft (i.e. the butt crack).
  • Brazilian Butt Lift: The Brazilian Butt Lift is really a method of sculpting the entire buttocks and lower back area. The goal of this surgery is to create a round, perky posterior enhanced by a narrow waist. This is accomplished by first sculpting the back and waist with liposuction, then injecting the removed fat into the buttocks as a graft to add volume and enhance the shape. This may also be done in combination with buttocks implants for patients who don’t have enough body fat. The fat that is injected takes as a graft. Some of the fat is resorbed during the healing period, but the fat that survives stays there permanently. The only incisions for a Brazilian Butt Lift are the very small incisions that the liposuction is done through.

Do you have a question about the different types of butt lift? We’d love to hear from you in the comments section!

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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.

IPL fotofacial for black or Asian skin?

I’ve written about IPL, aka BBL treatments in previous blog posts, as well as the difference between an IPL and a fotofacial. IPL treatments are traditionally reserved for people with lighter skin tones. This is because unlike a laser, IPL produces all wavelengths of light, and then uses a filter to block out the wavelengths of light we don’t want to use. Filters aren’t perfect, so what results is a narrow range of wavelengths, as compared to a laser which produces only a single wavelength. The end result is that IPL devices have a tendency to heat the skin up more than a laser would. Darker skin tones (which have more melanin), heat up more, which means there is a risk of burning the skin.

photo credit: shutterstock.com

photo credit: shutterstock.com

Despite this risk, a fotofacial actually can be done on darker skin types. To reduce the risk of burning the skin, I use lower energy settings and different wavelength filters on patients with dark skin. More treatments may be needed to see a result because of this. If you are considering having a fotofacial and you have darker skin, I definitely recommend seeing a physician who has significant experience performing fotofacials on both light and dark skin types.

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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.

Retin A is too harsh for my skin. Now what?

Retin-A is a great product. It thickens collagen, reduces fine lines, and evens skin tone. But as you may have discovered, it is also very irritating. Although some people report little to no skin irritation, most of my patients have to start using Retin A only a few days a week, and gradually increase the number of days they apply it until they are using it every day (I’ve discussed how to use Retin-A in a previous blog post). Even with this graduated dosing, dryness, flaking, and irritation of the skin are very common. So what do you do if you are unwilling or unable to tough out the adjustment period?

  1. Try a different strength of Retin-A. There are several different brands of Retin-A on the market, but most are available in several different strengths. 0.1% is the strongest. I usually start patients on the 0.05% Retin-A, but it also comes in a weaker 0.025% formulation. If you don’t want to buy a whole new tube, just apply half much of the pea-sized amount you typically use. You can mix it with a moisturizer prior to application so that it spreads evenly.
  2. Try some topical steroids to help calm your skin down. Some companies actually combine a steroid with the tretinoin (Tri-Luma, for example), but I prefer to use separate products. Continued use to topical steroids can actually thin the skin, so tns serumyou only want to use the steroid cream for as short a time as possible until your skin adjusts to the Retin-A. I definitely recommend talking to your doctor for product recommendations and instructions prior to starting a topical steroids.
  3. Use a different product entirely. I really love Skin Medica’s TNS Essential Serum. The TNS serum has growth factors as well as vitamin C, vitamin E, retinoids and antioxidants. It improves fine lines and skin texture, and unlike Retin A, you can begin using it morning and night right away with no skin irritation.

Have you found any great tricks for dealing with irritated skin? I’d 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.

Will a face lift make me look unnatural?

This is a great question; many patients are concerned about looking unnatural after having cosmetic procedures done. And we’ve all seen examples of celebrities who look artificial or unnatural after plastic surgery. But I can assure you those are the exceptions. First of all, remember that it is the paparazzi’s job to catch celebrities looking their worst. So many of the photos that you see in those “horrible plastic surgery” before and after photos are taken at awkward angles with unflattering lighting. There may also be photos taken in the postoperative period, when there is still significant swelling. Many photos of Mickey Rourke, for example, appear to be taken shortly after surgery. Joan Rivers is another often-cited example of a celebrity who started to look a bit artificial.

Photo credit: http://www.randomlynew.com/3530/10-celebrities-with-bad-plastic-surgery.html

Photo credit: http://www.randomlynew.com/3530/10-celebrities-with-bad-plastic-surgery.html

So what can you realistically expect after having a facelift?

  • Immediately after surgery you will have swelling and bruising. Your ears will be swollen as well, and may feel tender or full as if you have a cold. If you have drains, they are removed in the first day or two.
  • Weeks 1-2: Your bruising will fade and swelling starts to improve. Your face may feel or look tight.
  • Weeks 3-4: Swelling resolves and the feeling of tightness improves as the skin and underlying tissue stretch and relax. Soon you’ll find that you simply look like a more refreshed version of yourself.

The most common result after a face lift is that you look 5-10 years younger after surgery, and then continue to age naturally. Those people who look very overdone, are often just that: overdone. It takes many, many procedures to create that artificial appearance. If a face lift is something you are interested in, but you’re concerned about looking artificial, I would recommend spending some time looking at real before and after photos. The American Society of Plastic Surgery and Real Self are great places to start, along with the websites of Plastic Surgeons in your area.

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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.