Abdominoplasty, or “tummy tuck”, is an operation designed to improve the contours of the abdomen, tighten the abdominal wall and remove excess skin. Childbirth and weight loss are two of the biggest reasons individuals seek consultation for an abdominoplasty. Liposuction can be added conservatively to further sculpt the abdomen. A lipo-abdominoplasty combines traditional benefits of an abdominoplasty with the sculpting ability of liposuction. The technique requires specific preservation of the dominant blood supply to the abdomen while using the liposuction to mobilize the tissue required to cover the abdomen. This technique in combination with traditional plication, or “tightening” of the abdominal muscles gives a more sculpted abdomen in three dimensions. Abdominoplasty alone creates a flatter stomach but potentially less lateral sculpting. Careful examination and communication of your desires and expectations assists in determining whether abdominoplasty or lipo-abdominoplasty can achieve your specific goals.

The decision to enlarge one’s breast can be a very exciting time for a woman.  Whether that’s to replace volume lost following childbirth, or to add volume to your current size, the decision to have breast augmentation requires mutual understanding of the goals and expectations.  Breast augmentation can provide an increase in size as well targeted restoration of areas where you have lost volume. Implants have been developed using either saline or silicone to provide volume. Saline and silicone have different properties and behave differently when placed in the breast.  Saline can provide more superior fullness and a rounder appearance while silicone gives a more natural appearance to breast enlargement. The choice of implants, incisions and final location of the implant will be discussed after a careful examination and dialog between you and Dr Louis.

A breast lift, or mastopexy, is an operation which elevates the volume of the breast mound and or the nipple-areolar complex.  The options available range from augmentation with limited movement of the nipple-areolar complex to more extensive alterations in shape, location and volume.  The extent of scars depends on the degree of change required to meet your goals and expectations. A woman’s body has a range of sizes and location that will match and compliment her figure.  Careful analysis of the chest proportions and general frame is required to determine the appropriate operation.

Although the desire for breast reconstruction can arise from many situations, such as congenital breast issues, the vast majority of women seeking breast reconstruction have been given a diagnosis of breast cancer.  The diagnosis of breast cancer represents an incredibly difficult time in a woman’s life as well as her family’s. Breast cancer can occur in males but with less frequency. Considering breast reconstruction during this volatile period takes time, understanding and a gentle approach.  We strive to make the acquisition of information and choices as easy as possible thru multiple visits and open communication.

The options for reconstruction depend on the nature of the surgery required to treat the breast cancer, your individual anatomy and any additional therapy to that may be required following surgery.  Ultimately the new breast will be completely covered by your own skin. The volume however can come from several places and/or choices. The volume can be replaced with your own tissue by complete surgical removal from one location and reattached in the region of the breast to be rebuilt (DIEP flap).  Alternatively your breast can be rebuilt with your own tissue by direct movement maintaining the connections from one location to the next (TRAM flap). Each of these two examples have their own risks and benefits.

The volume can also be replaced with an implant (saline or silicone).  A tissue expander is a temporary implant that is placed in surgery and filled with saline to a safe volume. Subsequent increases in volume are done in the office  This technique requires a subsequent operation to change the temporary tissue expander to a permanent implant. Depending on many factors, a permanent implant may be able to be placed as a single stage.

Breast reconstruction is a process.  The number of operations or procedures varies based on your own tissue available for reconstruction and other treatment requirements (chemotherapy, radiation, hormonal therapy).  Reconstruction can be done at the same time as your primary surgery to remove the breast cancer, or can be delayed. Some choose to delay reconstruction until a later date for many reasons.  Any and all procedures are covered by insurance, regardless of timing (immediate vs delayed). The process can be individualized and may require a more complex coordination between your treating physicians.

Your team of doctors, nurses and support staff all have the same goal in mind, your wellbeing and success through this difficult time.   Although an immediate reconstruction can have provide significant emotional assistance with processing the changes to your body, the reconstruction can not interfere with the treatment of the breast cancer.  You will be given all the information you and your loved ones need to decide if reconstruction is right for you and the options available.

A breast reduction decreases the size of the breasts and inherently provides a breast lift.  Although the amount of breast tissue to be removed is frequently the primary indicator for insurance companies to assess medical necessity, the location of the excess breast tissue relative to the inframammary fold also contributes to the typical symptom complex of neck and back pain.  The procedure reduces not only the internal excess breast tissue, it reduces the overall amount of skin surrounding the large breasts. The typical design produces an effect similar a breast lift. The breast sit higher on the chest wall in addition to being smaller. A breast reduction can’t promise complete resolution of symptoms, but typically offers substantial reduction if not complete relief.  The procedure is designed to be functional but can dramatically improve the aesthetic appearance of the breast resulting in improved self esteem and comfort with activities & clothing.

The eyelids and eyebrows are a functional unit.  Depending on the findings at the time of examination, as well as your specific goals and expectations, a brow lift may be offered as a part of a particular eyelid procedure.  If a brow lift is truly indicated, a more extensive eyelid surgery can not provide the benefits of a combined brow and eyelid surgery. A more extensive eyelid surgery, or blepharoplasty, without a needed brow lift can actually create more problems without achieving the aesthetic goals.

Techniques have been developed and refined to address changes in the face and surrounding areas.  Multiple techniques exist now to deal with changes associated aging. Volume restoration can be achieved with the choice of multiple fillers. Wrinkles can be directly minimized thru reduction of muscles responsible for a particular wrinkle or wrinkle complex.  The quality of the skin (including texture, hydration, color, tone) can be improved with a combination of products and/or laser and light emitting devices. Although tightening technologies exist, at some point the amount of loose skin requires excision or removal to achieve a desired effect.

The face proper does not live in isolation.  The surrounding areas (forehead, neck, brows) all contribute to the overall impression one has of themselves.  A comprehensive evaluation is required to determine which procedure or product will enhance your appearance while maintaining the natural harmony the face has with the person as a whole.  The changes of aging are subtle from one decade to the next. Correcting the subtle changes from aging requires a careful and thoughtful approach to regain a more youthful, healthy appearance.  The degree of correction may be more subtle than you think. Overcorrection to try and achieve a “younger” appearance my produce unnatural results. Dr. Louis has adapted his unique knowledge of light and shadow acquired while studying architecture to help explain and define the changes associated with aging.   Your consultation with Dr. Louis will determine the combination of techniques, products and/or surgery to ensure preservation and restoration of facial harmony while providing a more youthful and rejuvenated appearance.

Facial rejuvenation can be divided into areas as well as different techniques to achieve the desired goal.  Areas can be broken down into the eyes & brows, the forehead, the face and the neck. Techniques and concepts include volume restoration, altering the formation and persistence of wrinkles by administering Botox, and products designed to improve the tone, texture and quality of your skin.

Although each component can be discussed in isolation, a complete evaluation helps direct treatment options to achieve the desired degree of improvement.  Additionally a complete approach can help prioritize which areas if treated in isolation will give the most improvement for a given cost while maintaining as much harmony as possible.

A traditional facelift removes excess skin while providing a tighter, smoother look.  Multiple techniques have been described and are used to achieve a specific aesthetic outcome.  The decision to have a facelift must be balanced against the relationships with surrounding regions (neck, forehead, general appearance, skin quality and tone).

The degree or extent of a facelift requires coordination with treatment of other factors such as volume, quality of the skin and its contribution to the appearance of an aging face.  A face lift alone may not achieve the results that a combined or customized approach addressing all the variables that affect facial aesthetics.

Multiple forms of fat reduction exist.  Traditional liposuction requires a small incision to be made in the skin so that a small cannula can be introduced to remove unwanted fat.  Small focal areas may be able to be done in an office setting but frequently traditional liposuction requires anesthesia (sedation vs deeper anesthesia).  Newer technologies have been introduced to either “freeze” the excess fat or use different forms of energy such as a laser to reduce the number of actual fat cells.  All of the current options have a role. As the amount of fat cells required to achieve your specific goal, increases, certain techniques provide more predictable results.  As a general rule, liposuction is intended to sculpt focal areas of excess fatty deposits. Larger amounts can be removed but needs to be done so with caution. The choice of techniques or procedures is the most important predictor of a successful outcome as judged by your happiness.  If one choice offers a lower percent improvement over another, then the money paid for the lower percent improvement would certainly be better spent on a more effective technique. A thorough and honest approach is required to ensure you have the information needed to decide which is best for you.

The neck plays a crucial role in overall facial aesthetics.  The perceived appearance should be in harmony with the face. Any discrepancies are easily perceivable and can limit the success of any plan to restore the face to a more youthful, healthy appearance.  Although nonsurgical options do exist, significant restoration usually requires a procedure. Initially Botox can be used to help with platysmal bands and restore the normal angle between the neck and jawline.  Excess fatty areas can be carefully liposuctioned to create the same result. Once the changes have created permanent loss of neck skin support, surgical procedures are available to improve the contour and look of your neck.

Volume provides a more youthful appearance.  The progressive loss of volume is one of the major reasons we begin to look aged.  In addition to the direct effect of decreased prominences and support, the skin appears be looser as the volume decreases.  Sometimes the perception of loose skin is falsely attributed to skin excess. Volume can play a role in restoring a youthful appearance without surgical excision of skin.  In carefully selected patients, volume can push back the need for excisional surgery. The correction may not provide full restoration in such patients. The level of restoration may however provide enough improvement to make the additional costs and/or risks associated with surgery less desirable at a given point in time.  The current choices for volume restoration have increased in number and will be discussed at your consultation

A lipoma is a slow-growing, fatty lump that’s most often situated between your skin and the underlying muscle layer. A lipoma isn’t cancer and usually is harmless but if the lipoma bothers you, is painful or is growing, you may want to have it removed.

There are a few different types of cyst that we can treat. Sebaceous and Pilar cysts are closed sacs filled with cheese type material. The key is remove the sac to try prevention of the cyst coming back. These can be excised in the office.

Ganglion cysts are typically round or oval and are filled with a jellylike fluid. They most commonly develop along the tendons or joints of your wrists or hands.

A Pilonidal cyst is an abnormal pocket in the skin that usually contains hair and skin debris that is almost always located near the tailbone. If a pilonidal cyst becomes infected, the resulting abscess is often extremely painful. These types of cysts may require surgery.

Skin lesions can be either normal age related changes with no associated risks, precancerous or cancerous. Normal age related skin lesions can be treated or merely checked to ensure they are not precancerous or cancerous. If irritated, these can sometimes be treated under insurance. Normal skin lesions that do not fall under insurance coverage can be removed or treated for a nominal fee.

Precancerous skin lesions or “spots” require treatment. Treatment can be excisional (lesion is actually cut out) or ablative (destruction at the surface level using various methods). These precancerous skin growths (sometimes known as actinic keratoses) typically appear as rough, scaly patches that range in color from brown to dark pink. They’re most common on the face, head and hands of sun damaged skin. Treatment is based on the underlying cause or causes of skin lesions so a biopsy is often recommended for problem lesions.

There are three major types of skin cancer — basal cell carcinoma, squamous cell carcinoma and melanoma. Other types of skin cancers exist but are not as common.

Basal Cell Cancer

Basal cell cancer is the most common skin cancer and in general the least worrisome. Basal cell cancers do not spread to local lymph nodes or distant organs (i.e. do not metastasize). They can however grow locally and depending on the location cause problems from growing into structures next to them…eyelids, nose, ect. The treatment is excision or complete removal with pathological examination under a microscope to ensure complete removal. Depending on the size closing the resulting wound can be simple and straightforward or more complex. Complex wounds can require skin grafts or flap reconstruction. In general it is always easier to remove when smaller. Diagnosis can sometimes be made by visual examination but frequently a biopsy is required to confirm the diagnosis.

Squamous Cell Cancer

Squamous cell cancer is the second most common skin cancer and in general is also easily treatable when early. This type of cancer can spread to other organs and lymph nodes. In general it spreads later when the lesion has been present for a little longer. There are variants of squamous cell cancer however that are aggressive from a very early stage or size and require aggressive therapy. Recommendations are to have seen and biopsied as soon as the skin changes suggest a need for a diagnosis. Some lesions may not appear abnormal to you but can be recognized by a trained medical professional. Treatment is typically to have cut out but an early version that is still contained to the upper layer of the skin can be treated with topical interventions.

Treatment Modalities

Treating skin cancers can be performed thru various methods depending on the type and stage of the skin cancer.  Early basal cell skin cancers can be labeled “superficial”.  These are very early and can be treated topically by destroying the basal layer of skin.  These modalities produce a superficial burn and will heal on their own with simple wound care.  The designation of “superficial” is made by the pathologist and reported on the final pathology.  Early squamous cell cancers can be reported as “in-situ”.  This means they are contained in the epidermal layer only and do not extend below the basal layer of skin. These can easily be treated by topical methods.  All melanomas require excision with a margin of normal, non involved tissue.

The method of treating superficial or in-situ skin cancers is local destruction.  This can be done by hand with an instrument, topically with special creams or true ablation using a CO2 laser.  The CO2 laser energy is absorbed by the water in each cancerous cell and causes the cell to be destroyed.  The laser energy can be adjusted in multiple ways to deliver a very controlled destruction with potentially less scarring.  Co2 laser is the primary method we treat superficial or in-situ cancers in our office.

Melanoma is a skin cancer that is increasing in frequency in the United States.  Although melanoma only represents 1% of all skin cancers, it accounts for the majority of the deaths from skin cancer. Melanomas typically present as a skin lesion that is changing colors, frequently black or dark brown.  Additional criteria include variable color, size greater than 6 mm, irregular borders and increasing size. Melanoma can occur in pre-existing moles that may have been present for years if not decades.  A rare form of melanoma can occur that produces no pigment.  Named amelanotic melanoma, the presenting symptoms is a pink to flesh colored skin lesion.  If you develop or suspect any skin lesion is abnormal, see a medical professional to have it evaluated.

Treatment and follow up of melanoma requires coordination of services including a surgeon, dermatologist, oncologist and potentially a genetic counselor.  Additional studies can be performed including genetic analysis of the actual tumor to give some prognostic information regarding follow up and imaging of early stage melanomas.

*If you or a loved one suspect they have a melanoma or a skin lesion in question, or a known melanoma requiring treatment, please call today for an appointment.