The body mass index, calculated from the patient’s height and weight in metric units of kilograms per meter squared, is a good method with which to assess the patient’s relative risk-to-benefit ratio for the procedure. Although liposuction may reduce cardiovascular risk, blood pressure, and fasting insulin levels, it should not be considered a treatment for obesity. Patients with inherent risks including those with poor wound healing, infection, deep venous thrombosis, sleep apnea, or a body mass index greater than 30 would benefit from additional counseling, and lifestyle modification should be considered before a body-contouring procedure.

Dr Koo performs a thorough physical examination which includes documentation of the patient’s height, weight, and circumferences of all pertinent body areas. Dr Koo will look at all previous surgical scars including, of course, a possible previous C Section scar and will attempt to remove all possible scars and stretch marks that are within the area that can be removed with an abdominoplasty.

Typically, Dr Koo recommends waiting a minimum of 6 months after childbirth prior to considering any plastic surgery to reshape the breasts and body. This allows time to lose the water weight gain, establish good eating and exercise habits, and allows the skin to retract. With weight and skin tone stabilization, the breasts and abdomen will revert to as mich of the pre-pregancy condition that is possible. For some women, depending on activity level, eating habits, and genetics, this could take up to one or more years.

Dr Koo also recommends waiting until the patient is not considering any more children before major skin resection such as a tummy tuck (abdominoplasty) to prevent relapse of stretch and split of the abdominal muscles again with recurrent pregnancies.

The saggy, flat breasts and lax, loose abdomen and hanging skin can all be removed and abdominal muscles tightened completely to a pre-pregnancy state. The maintenance of the shape and appearance is then up to the patient to continue to eat healthy with regular activity levels which Dr Koo encourages and helps with suggested excercise classes and trainers. If the patient is looking for firm, lifted breasts that are full and round, then a breast implant along with the breast lift may be necessary. She will discuss all the possibilities and let the patient know what surgery is in her best interest for long term results.

Lipodystrophy can be located in the following areas: abdomen, flanks, thighs, arms, neck, knees, back, buttocks, and breasts. Careful physical examination entails site-specific evaluation. Dr Michele Koo examines patients for the presence of occult hernias. Men who present for abdominal liposuction should be examined with particular care, as abdominal prominence may often be attributed to intraabdominal fat, which is not addressed by liposuction. In men interested in body contouring of the anterior chest, the examination of those with gynecomastia may direct the method of surgical treatment. Ultrasound-assisted liposuction or direct excision of skin and breast tissue may be necessary in those with additional fibrous tissue.

Other anatomical areas that require special attention if liposuction is to be performed are the legs and ankles. Patient satisfaction is not as high with liposuction in these areas. Pain can be a prolonged problem and complications are more frequent than with liposuction of most other areas. It is important to understand the patterns of fat distribution and how they relate to the anatomy of the area. The preoperative markings, careful attention to the suction area, and close postoperative follow-up are extremely important for liposuction of the legs and ankles.

Skin evaluation is pertinent in the evaluation of any patient seeking body-contouring procedures. For those seeking liposuction, adequate skin elasticity should be present to allow for skin retraction after surgery. Particular attention should be given to associated wrinkles, laxity, and surface irregularities, including dimpling. Scars should be noted.

Cellulite is a term that is used to describe the lipomatous deposits under the skin that outwardly give the skin a lumpy or orange peel-like appearance. Cellulite is often noted in areas such as the hips, buttocks, or thighs. Cellulite is predetermined by genetics, so even thin women can develop the appearance. Factors such as hormones, pregnancy, and aging may all attribute to the appearance of cellulite. Patients should be aware that liposuction procedures do not address cellulite and may in fact worsen its appearance. In contrast, dimpling is usually considered to be a more isolated area of concavity that may be secondary to underlying scar or fascial attachments and may be improved by the liposuction process.

Any asymmetry or contour irregularities is noted and brought to the patient’s attention. Dr Koo makes additional effort to correct any dimpling or asymmetry intraoperatively; however, this is frequently difficult to achieve. The patient should be aware of possible persistent asymmetry, depressions, and dimpling after the liposuction procedure.

Society of Anesthesiologists status of a patient before scheduling liposuction because it is an important factor in determining the most appropriate location for the procedure to be performed safely.

Various types of anesthesia or anesthesia combinations are appropriate for liposuction, depending on the overall health of the patient, the estimated volume of the aspirate to be removed, and the postoperative discharge plan. Dr Michele Koo is extremely careful about her anesthesia provider and hand picks those that give anesthesia to her patients. Dr Koo is the patients’ best advocate and ensures that all precautions are taken for the safety and well being of her patients.

In smaller volume liposuction cases, anesthetic infiltrate solutions alone may provide adequate pain relief. Termed wetting solution, this anesthetic infiltration solution not only facilitates the procedure but also provides preemptive and prolonged postoperative local analgesia.

5 Doses of lidocaine up to 50 mg/kg have been used; however, it is important to note that plasma lidocaine levels can peak 10 to 12 hours after infiltration when epinephrine is present in the wetting solution. Lidocaine toxicity has been implicated in a series of liposuction-related deaths. Signs and symptoms of lidocaine toxicity can be seen at plasma levels between 3 and 6 μg/ml. Initially, patients may experience lightheadedness, drowsiness, tinnitus, a metallic taste in the mouth, slurred speech, and numbness of the lips and tongue. At higher plasma concentrations, shivering, muscle twitching, tremors, convulsions, central nervous system depression, and coma may result. Respiratory depression and cardiac arrest can also occur with higher doses. Marcaine is rapidly absorbed, poorly reversed, and has a long half-life, making it a less suitable agent for subcutaneous infiltration in liposuction procedures.

Epinephrine is a critical additive in the infiltrate solution. It is recommended that doses of epinephrine not exceed 0.07 mg/kg, although doses as high as 10 mg/kg have been used safely.

Moderate sedation or analgesia, termed conscious sedation, is defined as purposeful responsiveness, with response to verbal or tactile stimulation evident. No airway intervention is required; however, supplemental oxygen may be administered as indicated. Patients demonstrate adequate spontaneous ventilation, with maintenance of cardiovascular function. Although numerous agents can be administered to achieve this level of sedation, it is imperative that the physician be adequately trained in anesthetic medications and airway management if intravenous sedation is planned without the presence of an anesthesia professional. In limited, smaller volume liposuction cases, intravenous sedation may be administered to maintain patient comfort.

In general anesthesia, the patient is unarousable, even with repeated painful stimulation, and independent ventilatory function is often impaired. Patients often require assistance in maintaining a patent airway, and positive-pressure ventilation may be required because of depressed spontaneous ventilation or drug-induced depression of neuromuscular function. As with any surgical procedure, medication is titrated to effect, and a certified anesthetic provider is present for any procedure under general anesthesia.

The physician is primarily responsible for providing and supervising anesthesia and analgesia. A certified registered nurse anesthetist or other qualified health care provider may administer anesthesia, but only under direct physician supervision, unless state law specifically provides otherwise. Dr Koo has a core staff that she works with that is completely trained and familiar with her methods, techniques, and preferences and only that staff is allowed in her operating room. Dr Koo and all operating room and key facility personnel are fully trained to recognize emergencies and complications.

The dry technique was the first method developed. It was performed under general anesthesia without the infiltration of subcutaneous solutions before insertion of the liposuction cannula. Substantial swelling and discoloration is a common consequence of the dry technique. This technique is also associated with a large amount of blood loss, with suction aspirate consisting of 20 to 45 percent blood. These sequelae sharply limited the amount of fat that could be removed without transfusion or hospitalization, which resulted in the abandonment of this approach, except in limited applications. The dry technique is not recommended for suction volumes greater than 1000 ml because of the amount of blood loss incurred. The dry technique should never be used in conjunction with ultrasound-assisted liposuction.

The wet technique entails injecting 200 to 300 ml of infiltrate or wetting solution, with or without additives, into the operative field before insertion of the liposuction cannula. Small doses of the vasoconstrictor epinephrine were added to the infiltrate, which significantly decreased the blood loss to 4 to 30 percent of the aspirate. The wet technique was the method of choice in the early 1980s.

The superwet technique, developed in the mid-1980s, uses 1 ml of solution for each 1 ml of fat to be removed. The surgeon’s preoperative estimate of the suction aspirate is considered in this technique. The infiltrate solution consists of saline or lactated Ringer’s solution with epinephrine and, in some cases, lidocaine. Using larger volumes of subcutaneous infiltrate, blood loss generally decreases to less than 1 percent of the aspirate volume.

The tumescent technique was introduced in 1985. It uses the largest volume of infiltrate and involves infusing 3 to 4 ml of the infiltrate solution for each planned milliliter of aspirate. Drug concentrations in the tumescent infiltrate solution vary, but typically they consist of a range of 0.025% to 0.1% lidocaine and epinephrine 1:1,000,000 in a lactated Ringer’s or normal saline solution. Estimated blood loss with the tumescent technique is approximately 1 percent of the aspirate, comparable to the superwet technique.

Since the advent of epinephrine-containing wetting solutions and sophisticated fluid management techniques, increasingly larger volumes of liposuction aspiration have been reported. Large-volume liposuction, defined as a total aspirate of 5000 ml or greater, can be a safe and effective procedure when patients are carefully selected and when anesthetic and surgical techniques are properly performed. Meticulous fluid balance calculations are necessary to avoid volume abnormalities, as metabolic alterations and fluid shifts result from medication effect, hypodermoclysis, and surgical technique. General practice guidelines recommend overnight observation postoperatively for patients undergoing large-volume liposuction.

Dr Koo is very precise and accurate with the preoperative marking and discusses the areas of liposuction during the preoperative consultation several times prior to the surgery and again on the day of surgery to ensure that the patient understands completely the areas to be contoured and they coincide with the areas of concern for the patient. This is essential to satisfactory results. Patients are marked with a fiber-tip marking pen in the upright position or standing. Areas to be avoided, such as the zones of adherence, is noted carefully.

Dr Michele Koo uses multiple-access incisions for almost all areas because removing all fat from a single access incision may lead to depressions around the access site and contour deformity. Incisions are placed in natural skin folds and asymmetrically to limit visibility of the resultant scars.

Dr Koo places the patient in the appropriate position for access to the treatment site. If multiple areas are to be treated during a single operation, it is convenient to prepare the patient circumferentially so that all areas of the trunk and extremities may be treated without repeated preparation and repositioning. Dr Koo feels that she is able to achieve the most optimal results with circumferential liposuction along with the tummy tuck (abdominoplasty) repositions the patient intraoperatively to better treat and evaluate surgical progress and symmetry.

A thorough operative record includes documentation of each stage of the liposuction procedure. The infiltration solution mixture should be documented and the volume of subcutaneous infiltrate used should be noted as well. Oftentimes, surgeons will note the amount of infiltrate and volume of aspirate by body area and record the total volumes for the entire procedure. This information, along with intravenous fluid administration and monitoring of vital signs and urine output, are important factors for maintaining adequate fluid management intraoperatively and postoperatively. A diligent fluid management strategy between the surgeon and anesthesia provider is important for avoiding volume overload sequelae.

Sequential compression devices should be in place before a general anesthetic is used in most liposuction procedures. Patients who undergo other types of anesthesia or minor procedures may do so without sequential compression devices.

The use of postoperative compression for 6 weeks is usually indicated after liposuction procedures to minimize edema and support the soft tissues. The various compression modalities and garments available for each area can be extremely useful but must be tailored to the area of treatment. The use of a foam material underneath the compression garment to increase compression and protect areas of irritation is frequently beneficial.

No single liposuction technique is best suited for all patients in all circumstances. Factors such as the patient’s overall health, body mass index, the estimated volume of aspirate to be removed, the number of sites to be addressed, and any other concomitant procedures to be performed should be considered by the surgeon to determine the best technique for the individual patient.

Ultrasound-assisted lipoplasty. Introduced in the late 1980s, ultrasound-assisted liposuction uses a cannula or probe to deliver fat-liquefying ultrasound subcutaneously. This technique permits the removal of fat from fibrous areas such as the upper abdomen, back, and flanks with greater ease, especially during secondary procedures. To prevent thermal injuries while performing ultrasound-assisted liposuction, two technique rules are of critical importance. First, the ultrasound probe or cannula must be kept in motion. Second, the infiltrate solution is a required component of ultrasound-assisted liposuction because it plays a crucial role in the process of fat emulsification and cooling the heat generated in the process. The dry technique should never be used in ultrasound-assisted liposuction, regardless of the planned volume of aspirate.

Suction-assisted lipoplasty. Suction-assisted lipoplasty is the most commonly performed aesthetic procedure in the United States. Suction-assisted lipoplasty procedures use an external source of suction to facilitate the removal of fatty tissue.

Power-assisted lipoplasty. Power-assisted lipoplasty is an approach in which the system that drives the cannula is a power source other than the surgeon’s arm. Systems are either electrically driven or gas-driven by nitrogen or compressed air tanks. A small motor moves the 2- to 4-mm cannula tip in a forward and backward motion, replicating the motion of the surgeon and decreasing physician fatigue. The cannulas are small and flexible and are comparable in length and diameter to standard suction-assisted liposuction cannulas. Power-assisted liposuction is effective for large-volume removals, fibrous areas, and revisions. It is typically used in conjunction with the tumescent or superwet technique. The excessive vibration of the cannula and the noise of the power system are the two main disadvantages of this technique.

Combination ultrasound-assisted lipoplasty and suction-assisted lipoplasty. A combination of techniques may be used for treatment of various areas of lipodystrophy.

Other. Syringe aspiration of fat has been used for addressing superficial irregularities independently or in conjunction with another liposuction modality. This method for aspiration may result in less blood loss and has been reported to be a more precise and accurate mode of fat removal. The main disadvantage of syringe aspiration is prolonged operating time. This technique is effective for sensitive and smaller volume areas, such as the neck. It also is commonly used for harvesting fat for transfer, as less mechanical damage to the fat cells allows for a greater percentage of viable cells for transfer.

Embolism may occur from fat or venous thrombosis. The signs of pulmonary embolism may be shortness of breath or difficulty breathing. Deep venous thrombosis may be present with calf or leg pain, Homan’s sign, swelling or erythema of the lower extremity, persistent tachycardia, and/ or mild pyrexia. The thrombus is not usually palpable. Treatment of deep venous thrombosis may entail anticoagulation or placement of a venous filter. Patients who develop a pulmonary embolus may undergo thrombectomy or thrombolysis as well. Although the exact pathophysiology of fat embolism syndrome remains somewhat controversial, signs or symptoms of fat emboli after liposuction require emergency medical care, as permanent disability or fatality may result.

Advances in the understanding of fluid management in the care of the patient undergoing liposuction has increased the margin of safety of this procedure. Firm guidelines for the appropriate amount of fluid resuscitation have yet to be established; however, there are multiple formulas and fluid balance calculations for determining the appropriate balance of intravenous fluid administration and subcutaneous infiltration. The key to appropriate perioperative fluid homeostasis is proper patient selection and consistent communication between the surgeon and the anesthesiologist with regard to perioperative fluid replacement and urine output. The surgeon should be cognizant of all fluid administered and removed with aspirate and excreted as urine output to avoid problems with hypovolemia or fluid overload.

Fatal complications secondary to liposuction may be attributed to anesthetic cardiopulmonary complications, necrotizing fasciitis with overwhelming infection, hypovolemic shock, fat embolism, pulmonary embolism, disseminated intravascular coagulopathy, or intraperitoneal and bowel perforation. Less common reports of death resulting from liposuction procedures have also included toxic shock syndrome, acute respiratory distress, and hypersensitivity to medications or instruments used during the procedure.

Intestinal or organ perforation from the liposuction cannula, though rare, usually occurs with a preexisting abdominal scar. The abdomen, thorax, retroperitoneum, and major vessels in the subcutaneous space are all potential areas into which a cannula can be misdirected and potentially result in major injury. Kidney perforation has been reported. Symptoms of organ perforation may not become apparent for several days. When internal organs are violated, patients may present for follow-up with symptoms of an acute abdomen, and an emergent laparotomy may be indicated to assess the extent of damage and to repair injury, as visceral perforations and their associated infections may be fatal. Gentle technique and awareness of the possibility of misdirection of the cannula in the presence of a scar will prevent this complication.

The total blood loss involved in suction-assisted lipectomy is principally dependent on (1) the amount of blood present in each milliliter of aspirate and (2) the absolute amount of aspirate. Total blood loss can be estimated as the percentage of blood in the aspirate multiplied by the total amount suctioned. Clinically, the blood loss is rarely a limiting or significant factor in cases in which total aspirate is less than 1000 ml, regardless of the infiltration method used. The dry technique results in a suction aspirate containing 20 to 45 percent blood.

Any of the complications described in the previous section can also occur in the later postoperative period. Surgeons should recognize additional complications that may present as convalescence continues.

Patients with a higher body mass index have been found to have a significantly increased risk for developing postoperative seromas. Ultrasound-assisted liposuction has also been associated with a slightly increased risk of seroma formation. Suggestions for decreasing the incidence of seroma include expressing any remaining fluid before closure; using a single suture to close incisions, allowing for fluid egress; applying a well-fitting compression garment; and encouraging the patient to ambulate soon after surgery. Simple aspiration is the most common treatment for a seroma. An implantable catheter or drain can be used to avoid repeated aspiration.

Although large areas of skin loss is rare, ulceration or friction injury is more commonly noted at the entrance site from incorrect use of the cannula, tension on skin margins, or an incision that is too small for the instruments used. Burns have also been associated with ultrasound-assisted liposuction, as the ultrasound cannula can become very hot, and prolonged contact with the skin may result in skin damage.

Infections can occur and have been known to progress to serious and life-threatening conditions if not appropriately attended to. Many surgeons will prescribe perioperative antibiotics to minimize the risk of infection. Physicians who perform liposuction should be familiar with the signs and symptoms of conditions such as toxic shock syndrome and necrotizing fasciitis.

The most common postoperative sequelae of liposuction are contour irregularities; these may be considered complications if they persist for over 6 months. Because contour irregularities may be secondary to postoperative swelling and skin elasticity, they may be treated conservatively for at least 6 months after the initial operation. However, for areas of excessive fat removal or insufficient fat removal, secondary liposuction, fat grafting, and dermolipectomy can be considered to address the persistent area(s) of concern. Nonsurgical treatments for early contour irregularities include manual lymphatic massage and Endermologie (LPG Systems, Valence, France). Long-term swelling may be noted in a small number of liposuction patients.

Skin hyperpigmentation may be attributed to several factors. Hemosiderin deposition by ecchymosis, external pressure from bandages applied, and possible friction from the inlet holes of the cannula have been suspected of increasing the likelihood of hyperpigmentation postoperatively. Several areas are known to be prone to hyperpigmentation (e.g., the medial thigh). This effect is more often attributed to ultrasound-assisted liposuction and extended treatment time to a single area (>10 minutes). Patients should also be cautioned that oral iron therapy, exogenous drug administration (particularly estrogen), and sun exposure may contribute to the development of hyperpigmentation after liposuction.

Patients may experience paresthesias after surgery. Patients have reported hypersensitivity and numbness after surgery that may persist for weeks or months. In a small number of patients, these paresthesias may be permanent.

The analysis of the sequelae of liposuction and tummy tucks does not provide specific percentages of complications associated with liposuction. Seromas, infection, and tissue irregularities are the most common minor problems. Deep venous thrombosis, associated with pulmonary embolism and death, is the most frequent serious complication of liposuction. Thus, the prevention and, if necessary, the expeditious diagnosis and treatment of deep venous thrombosis are integral to the care of the liposuction patient.

Dr Koo examines patients who may desire secondary surgery to correct contour irregularities carefully and counsels them to ascertain their realistic goals for surgery. Previous surgical procedures are considered and careful notation is made to document the site of secondary surgery and the anticipated amount of secondary lipoaspirate or augmentation with dermal fat grafts of lipotransfer. Skin resection may be necessary for areas of inadequate skin retraction.

Physical outcome and ease of recovery are not the only factors that define patient and physician satisfaction, as successful body contouring surgery requires a patient to embrace positive lifestyle habits. Dr Koo recognizes the importance of patient education on postoperative alternatives in diet and exercise and will help the patient establish a connection with nutritionists as well as exercise trainers. This will ultimately help the patient maintain successes achieved with the liposuction and tummy tuck procedures.

Dr Michele Koo always maintains a relationship with her patients seeing them post operatively indefinitely thereby making sure that they “check in” for annual breast examinations as well as keeping track of their weight and exercise maintenance. Dr Koo wants to change and enhance the patients life and lifestyle and continues to take care of her patients years after any procedures at no further follow-up charges.

Clearly this is a very complex and difficult question, and as varied and complicated as every single individual teen that is out there…

As a plastic surgeon and a Mother of 3 young adults, 20, 18, and 15, I have significant professional as well as personal experience with this topic. I am very sensitive about this subject given the fact that my 18 and 15 year olds are young independent headstrong women.

I have so many young teenagers and young adults, boys, and primarily girls that inquire about rhinoplasty and breast and body contouring. Often times, the Mother will bring the patient into my office or if the patient is 18 years or older, they themselves make the appointment, pay the consultation fee and attend the consultation alone or with a friend.

Perhaps more at issue is what is the nature of the plastic surgery inquiry. There are many procedures that truly will enhance the self confidence of the teenager that corrects a genetic predisposition, for example, gynecomastia, in young men.

Some male adolescents develop breasts secondary to rapid weight gain, hormones, and genetics. This can be extremely debilitating for the teenager. He refuses to be seen without a shirt on during PE, any sports activity, and then continues to gain weight thereby worsening the amount of actual breast tissue and fat.

Liposuction for gynecomastia in the young adolescent male can be life changing and extremely uplifting. Breast augmentation for the young adolescent girl, however, absolutely projects a different image. While you could make an argument that liposuction for gynecomastia is a necessity like obesity surgery, you would be hard pressed to say breast augmentation is a necessity because it corrects a genetic abnormality. But truthfully, it does.

So what’s the difference? Again, as a Mother of 2 young adolescent women AND a plastic surgeon, I am always torn as to what is the right answer. The truth is, it is completely dependent on the young woman and her parents if they are paying for it. However, after the age of 18, the young woman has total legal rights to sign her own surgical consent and undergo any procedure. So why am I so torn about the issue of breast implants for a 16 or 17 year old.

So why does it seem so wrong for a 16 or even a 17 year old to ask and want a breast augmentation? First of all, call me naive and ignorant, but I still feel that while they are physically ready to have sex, which is what breast enhancement implies, I think they are still too emotionally immature and do not need yet another complex issue to bring drama and angst into an already too tumultuous life. Yes, of course, the teen may be motivated by lack of confidence and self esteem (which is more perhaps the case when there is severe breast asymmetry) but really the teen is saying I am ready or have already been engaging in sexual activities and now want a breast augmentation.

First of all, the recommendation of the Association of Plastic Surgeons is to wait until the age of 18 for saline implants and the age of 23 for silicone implants. That being said, it is still the decision of the parent to allow this to occur and up to the plastic surgeon to discuss all of the legal and medical risks and implications.

This is when I discuss with the patient and the parent if they are involved, the long term implications of a breast implant, the surgical effect on the breasts, the implications for future mammograms, breast cancer, breast feeding etc, etc, but MOST IMPORTANT of all, I personally assess the emotional stability and psychological maturity of the patient and her relationship with the parents and/or boyfriend.

I then make a recommendation depending on my assessment of the patient, the situation, and what the parent has expressed to me. Oftentimes, the parents have called me first to discuss this consultation prior to the actual surgical consultation and they express their true wishes without their daughter in attendance because they don’t want to say no to the daughter who would then become belligerent, nasty, and relentless. The parents are actually asking me for help to say no to their daughter. The parents want me to guide the daughter into making the decision to wait until she is 18.

I believe that is a reasonable request and I ask the patient to return in 6 months or a year or a set amount of time to discuss the surgery (which I would normally for any patient) but in this case even more important as the passage of time may see the patient turn 18 as well as give her time to think about the surgery and its implications.

My personal advice to parents who are extremely against any plastic surgery for their teen before the age of 18…is you hold the pocket book, you make the decision. More than likely your teenager does not have the resources to pay for the surgery and you have the ultimate power and authority (finacially and legally) so don’t give in until YOU are comfortable with it or until they are 18 and whatever age it is when you feel they are making sound choices.

MORE NEXT BLOG ON TEEN RHINOPLASTY AND LIPOSUCTION

Did you know that breast reductions are normally covered by your insurance plan and is one of the best things you will ever do for yourself. You will lift your breasts and stop that awful skin on skin sweating which results from your breasts touching your abdominal skin.

My favorite quote from one of my patients that comes to mind describing the results: “I just went from National Geographic to Playboy.”

That truly is how you will feel way better than nature.

The heavy pulling weight on your shoulders and neck will be relieved with the reduction in size of your breasts. DR KOO guides you as to the size you will be reduced to which will still be proportionate to body but so much lighter and perkier.

Even your tension headaches from the pull of your heavy breasts will be relieved. You will be able to exercise and be much more active helping you lose weight and feel and look even better.

Dr Koo’s office will work with you to make everything very easy and do all the paper work for you. Her office works with patients from all over the United States and especially college students coming home for the summer and the holidays who have limited time to have the surgery and to do all the paper work.

The BREAST REDUCTION is very safe and DR MICHELE KOO is a Board Certified Plastic Surgeon with extensive experience in the surgery and will make sure that everything goes very safely and smoothly for you. She understands what a woman wants her breasts to look like. She will lift your breasts and reshape and resize them to make you feel so much more comfortable.

Most women retain their nipple sensation and are still able to go on to breast feed after a breast reduction surgery. The relief and change in self esteem is profound. This is especially true for the young adult woman or even teenage who are mercilessly teased about their big breasts.

The surgery is not painful with a quick recovery and can most often be performed as an outpatient.

If you’re tired of saggy, heavy breasts that cause you shoulder, neck and back pain, with skin rashes, you need to explore the possibility of a breast reduction, breast lift with DR MICHELE KOO, MD, FACS, ST LOUIS, MISSOURI, 314-984-8331.

DR KOO truly believes that a BREAST REDUCTION is a very safe procedure that will change your life. Your breasts will be lifted, lighter and reshaped. You will feel that your breasts are shapelier and that you are able to do so much more physically than you ever have before. Your friends will keep asking you if you’ve lost weight and you’ll look and feel so much better.

It is difficult for you to exercise and get healthier due to the size and heaviness of your breasts. You are in a negative spiral downward with your large heavy breasts making you more inactive. The more inactive you are the more weight you gain and the more weight you gain the heavier yours breasts become.

(more…)

DR MICHELE KOO, MD, FACS, BOARD CERTIFIED PLASTIC SURGEON, ST LOUIS, MISSOURI 314-984-8331

Most of my patients by the time they call and make an appointment for a breast augmentation consultation have been considering this surgery since their teenage years.

Breast augmentations are very safe and have been performed on woman for 40 plus years. Silicone breast implants are again FDA approved for elective breast enlargements for women 22 years of age and older.

Saline breast implants have always been available for cosmetic breast enlargements and continue to be used safely.

Breast enlargements with breast implants do not necessarily mean that you will be “gi-normous” or that your breasts will be in a different zip code from your body. What it means is that you will be more proportionate for your body and you will feel sexier and more in balance for your height, weight, shoulder and hip circumference. When you are naked or in a swim suit, you will feel more confident and more sexy and in balance. It is about feeling better about your body and being less self conscience not necessarily having breasts that poke out your friends eyes.

I perform the breast enlargement surgery under general anesthesia as an outpatient and the surgery itself takes just under one hour. You will be slightly tired for a few hours after the surgery from the anesthesia but you will have very little pain. You won’t like the tight surgical bra but you must leave the compressive surgical bra on day and night for the first 4 days. You will be allowed to take the bra off and shower after 4 days.

You will return to light cardio activity at 2 weeks and full activity at 4 weeks.

Breast enhancement surgery is safe with minimal recovery. You should not feel that it is only for the wealthy. Breast augmentation with saline or silicone implants is very affordable and we work with a financing company that specializes in cosmetic procedures.

I am extremely honest and straightforward with you about the correct type of breast implant that is best for you depending on your type of original breasts as well as the breasts you want to ultimately have. I will also guide you on your choice of size and style of breast implant that will give you the most natural sexy breasts that are not at all conspicuous and overwhelming for your body. I completely understand woman’s goals of looking sexy but natural with their breasts, that you don’t necessarily want your sexy new breasts to be the center of attention of your body.

DR MICHELE KOO, MD, FACS, BOARD CERTIFIED PLASTIC SURGEON, ST LOUIS, MO 314-984-8331

Before Breast Augmentation

After Breast Augmentation

There are many different sizes and shapes of silicone and saline breast implants which are very safe that can give you very natural looking breasts. You can be pretty much any size you want to be with breast augmentation.

Dr Koo will show you many many before and after pictures of women who have had the same procedure that have breasts that resemble yours. She will also show you pictures of women who have similar height and weight as you to give you a better idea of the shape and size you might want for yourself.  Dr Koo will spend as much time with you as you want to determine what is the perfect breast implant size and shape is for you and whether you should have the breast implant placed under the muscle or breast tissue. These choices are determined by the shape of your breasts, how much breast tissue you have, how low or high you want your breasts and the incision she chooses for your breast augmentation.

She will be able to create the sexiest yet most natural looking and feeling breasts for you with the perfect breast implant for your body.

The first thing you should know about breast augmentation is that this will not be your last surgery. You will need to plan for at least 2 or 3 more surgeries in your lifetime depending on your age at the time of your first breast augmentation. Your breast implants will last approximately 20 years whether it is silicone or saline. Dr Koo recommends that you change the silicone implant at about the 20 year mark or when there is a change in the way the breast implants feel or look.

If your saline breast implants rupture, you will notice a change in size within 3-5 days of the rupture. The saline will be absorbed by your body and the ruptured side will be smaller than the breast that has not ruptured. You should then have BOTH breast implants changed and start at time zero with both breasts.

If you have silicone breast implants, you may not have to change your implants until there is a change in the way your breasts look or feel. Dr Koo’s recommendation is to change the breast implants at approximately 20 years or before if there is a problem. If, however, you are not having any problems, you can wait until there is some change.

Mammograms are recommended yearly starting at age 40. If you have a family history of breast cancer you might need a mammogram as early as age 30 or 35 depending on your breast examination. Dr Koo always follows her patients on a yearly basis without further charge and encourages women to see her every year to teach them how to examine their breasts and to educate them as to how their breasts feel with implants in place.

Dr Koo places the implants over and under the muscle and decides which is the perfect position for you depending on how much breast tissue you have, where your breasts fall in relation to the inframammary crease, and your desire to have higher or lower breasts. There are many many subtleties of breast augmentation and the type and placement of the breast implants that Dr Koo will determine for you and guide you for creating the perfect, sexy natural breasts that can be created with breast implants.

Call Dr Michele Koo, MD, FACS, Board Certified Plastic Surgeon, St Louis, Missouri for the most natural looking and feeling breast implanted breasts possible. She will take care of you throughout the years.

For more information about breast feeding and breast implants and the need for breast lifts after children and as the breasts age with implants in place, see the next blog coming up.

If you are sick and tired of being trapped by your saggy, lifeless, flat breasts and hanging skin with stretch marks after pregnancy and breast feeding there is something you can do about it.

Plastic surgery to remove all that excess skin and fat and lift your breasts to their original position with fullness on top can be achieved safely.

If you are looking for a MOMMY MAKEOVER, you have found the right person in Dr Michele Koo, MD, FACS, St Louis, MO, who is a Board Certified Plastic Surgeon. She will listen to exactly what you want and be able to get rid of that frustrating hanging large belly that has made you depressed for years with liposuction and a tummy tuck (abdominoplasty). At the same time you can address your breasts which may have lost most of the nice sexy full volume and is now hanging on your abdomen. She will examine you and determine if you need a breast lift alone or a breast lift along with a breast implant (breast augmentation) to achieve that full, firm, sexy and lifted breast that you used to have.

MOMMY MAKEOVERS addressing the breasts and tummy in one operation is very safe and Dr Koo will let you know how much can be done at one time safely, and whether you can achieve what you are looking for with only a breast augmentation and liposuction or if you need more contouring by removing skin with a breast lift and tummy tuck.

One of the most important aspects in the success of any surgical procedure is the physical condition of the patient at the time of surgery. Even though liposuction, breast augmentation and a tummy tuck are elective procedures, Dr Koo assesses you using the same standards as those used for anyone who is undergoing any type of surgery. This is very important for your safety and well being. Dr Koo emphasizes your safety above all and ensures that you will have an excellent outcome safely.

Dr Koo specializes in contouring the body after pregnancy and weight loss. She obtains a thorough medical history from all patients who are to undergo a MOMMY MAKEOVER and a diligent physical examination is performed. Surgical history, including previous procedures is obtained for the YOUR safety.

Patients with comorbid conditions such as tobacco use, hypertension, coronary artery disease, chronic obstructive pulmonary disease, diabetes mellitus, hepatitis C, and human immunodeficiency virus are screened carefully. Patients with a history of pulmonary embolism, deep vein thrombosis, or blood clotting disorders require added precautions, such as chemoprophylaxis and sequential compression devices.

Dr Koo uses sequential compression devices in the majority of liposuction, tummy tuck, and breast lift and breast augmentation procedures. Conditions that may increase the risk for deep venous thrombosis include chronic venous insufficiency, family history of thrombotic syndromes, obesity, trauma, severe infection, polycythemia, central nervous system disease, malignancy, homocystinemia, a history of pelvic or lower extremity radiation therapy, and use of birth control pills or hormone replacement therapy.

Medications that the patient may be taking is reviewed, as many common prescribed and over-the-counter medications may affect wound healing and blood clotting. Medications such as aspirin, nonsteroidal antiinflammatory agents, birth control pills, vitamin E, and herbal preparations such as St. John’s wort are recognized to interfere with the coagulation mechanism. Dr Koo recommends avoidance of such agents before surgery. Some medications may also interact with medications used during surgery.

MOMMY MAKEOVER BLOG continues on next Blog

DR MICHELE KOO, MD, FACS, ST LOUIS, MISSOURI, 314-984-8331.

Dr Michele Koo, MD, Board Certified Plastic Surgeon, Member of the Aesthetic Society can create beautiful augmented breasts for you with saline or silicone breast implants. Your breasts can be enhanced to full, round, sexy breasts that still look and feel completey soft and natural. Dr Koo can create the breast cleavage that you have always wanted with breast enlargement using breast implants. 

Dr Koo performs the breast enhancement with either an incision under your breasts or around your areola. She places the implants in one of two positions, either under your muscle or under your breasts. Dr Koo will decide the pocket for your breast implants after she examines you and determine which is the perfect surgery for you depending on what you want your breasts to look like.  The surgery is an outpatient procedure under general anesthesia and you will be able to drive the next day and return to an office type occupation after 1 or 2 days. After the surgery you are given a surgical compression bra which you will wear continuously for 4 days. There is very little discomfort after the surgery and Dr Koo does not need to use pain pumps and you may only need tylenol or an anti-inflammatory medication after for the slight pressure that you feel.

You will be able to do light exercising in 2 weeks and full cardio exercising in 4 weeks. You will look awesome in a swim suit in 4 weeks and be ready for any social event with low cut dresses and tops in 2-4 weeks.

The breast implants that are available now are silicone and saline implants and both are perfectly safe. Dr Koo will use either MENTOR or ALLERGAN NATRELLE breast implants depending on the shape and size of your own breasts and what she feels she needs in order to make your breasts the best that they can be.

The surgery takes less than one hour and you will go home that day and feel fine by that afternoon. There is only some minor discomfort and pressure from the tight surgical bra that Dr Koo gives you. Dr Koo then sees you in the office 4 days after the surgery when you will be able to see your beautiful full augmented breasts.

The breast implants whether it is saline or silicone will need to eventually be replaced in 15-20 years. the replacement surgery is relatively minor and takes even less time than the original surgery if you do not need a breast lift or other procedures with your breast implant replacement. You will be able to still undergo mammograms with breast implants in place. Dr Koo’s office, St Louis, Missouri, 314-984-8331, will make sure that you are seen every year in follow-up with Dr Koo for a professional breast examination and that you will have regular mammograms according to recommendations depending on your age.

At the time of your breast augmentation, Dr Koo can also perform a breast lift if necessary or other procedures to correct any breast asymmetry.

Call DR MICHELE KOO, MD, FACS, 314-984-8331, ST LOUIS, MO, to begin your journey to feeling more confident and sexy with your very natural looking and feeling, full, round, sexy breasts after BREAST ENHANCEMENT - BREAST AUGMENTATION WITH BREAST IMPLANTS.

BEFORE BREAST AUGMENTATION 34A

AFTER BREAST AUGMENTATION 34D

DR.  MICHELE KOO, MD, FACS MISSOURI, ILLINOIS, KANSAS, 314-984-8331

Dr Koo feels that there are certain facts that you should know about breast augmentation and breast implants and she wants you to be well informed. The better informed you are, the better your results will be as she will be able to communicate with you as to what your possibilities are. Her time is your time and she wants your surgery to be as perfect as it can be and that the size, shape, and look of your breasts will be exactly what you picture in your mind.

The following is an article in the Plastic and Reconstructive Journal that Dr Koo wants you to have access to by Dr William Adams of University of Texas Southwestern Medical University, December 2008. Dr Koo has her own techniques that are variants what is mentioned in the article but wants you to understand the preparation and techniques that go into determining your ultimate choice of implants, size, position, shape, and look of your breasts.

A process is defined as a group of practices that are completed successively to reach a goal. For 45 years, breast augmentation has been thought of as an isolated surgical procedure; however, well-documented elevated reoperation rates of 15 to 24 percent over 6 years in successive premarket approval studies have resulted in a critical analysis of this procedure. Factors that impact outcomes have been identified and practice recommendations have been established.

Background: Breast augmentation has been an integral part of plastic surgeons’ practices for over 40 years. Although devices have evolved, patient outcomes are still not ideal, as documented in multiple premarket approval clinical trials. Unlike many other areas of surgery, the practice of breast augmentation has suffered from the lack of a defined process for patient management. The purpose of this study was to clinically define and evaluate the process of breast augmentation and analyze patient outcomes using these practices compared with existing premarket approval trial data.

Methods: Three hundred consecutive primary breast augmentations from 2001 to 2005 were followed prospectively. Each patient underwent a defined process of breast augmentation including structured patient education and informed consent; tissue-based preoperative planning consultation; refined surgical technique; and structured postoperative instructions, management, and follow-up.

Results: The mean follow-up was 2.1 years. The most common complications were rippling and palpability, soft-tissue stretch, and hypersensitivity. The overall reoperation rate was 3.7 percent for the entire group and 4.7 percent and 2.9 percent for saline and form-stable cohesive gel implants, respectively.

Conclusions: Optimizing patient outcomes in breast augmentation requires defining the overall process to allow for enhanced patient outcomes. This is the first report that defines and integrates the entire process comprehensively that is validated by outcomes data. This process is transferable to other surgeons and, using this algorithm, patient outcomes in this study were superior to premarket approval clinical trial data. In summary, approaching this procedure with a global process produces superior patient outcomes in breast augmentation.