IN THE WESTERN WORLD THE POPULATION IS AGEING BUT REMAIN FITTER, BOTH PHYSICALLY AND MENTALLY , THAN EVER BEFORE.

ECONOMICAL AND SOCIAL CHANGES DICTATE THAT A GREATER NUMBER WORK BEYOND THE AGE OF 60.

TODAY 30 % OF AMERICANS CONTINUING WORKING BETWEEN THE AGE OF 65 AND 70.
PHYSICAL WELL BEING ASSOCIATED WITH YOUTH IS PRIZED IN OUR SOCIETY. THEREFORE AN INCREASING NUMBER ARE SEEKING SURGICAL ASSISTANCE TO MAINTAIN OR IMPROVE THEIR FACIAL APPEARANCE.
OF COURSE THE YOUNGER THE PATIENT SEEK FACIAL SURGERY THE BEST RESULT WILL BE OBTAINED.

OUR APPROACH FOR FACE LIFT IS:

NON-EXTENDED FACE LIFT.

IT HAS ANTERIOR INCISION RETROTRAGAL FOR EVERYONE  IN SPITE OF THE GENDER AND SHORT DISECTION OF THE SMAS AND ALSO A POSTERIOR INCISION  THAT GOES BEYOND THE EAR AND GOES IN 90 DEGREES ANGLE TO THE POSTERIOR SCALP.
IT IS THE MOST COMMON USE TECHNIQUE IN OUR CENTER.
I USE TUMESCENSE SOLUTION AND AT THE SAME TIME A NECK LIPOSUCTION IF IT IS NECESSARY. IN THIS PROCEDURE I ALWAYS LET A DRAIN IN EACH SIDE THAT ARE REMOVED IN 24 HOURS GENERALLY.

LIMITED SCAR TECHNIQUE:

IN THIS TECHNIQUE ONLY AN ANTERIOR INCISION IS MADE, THIS INCISION FOLLOW THE SIDE BURN CONTOUR, AT THE HELICAL ROOT IT TURNS INFERIORLY CONTINUING IN A RETROTRAGAL POSITION.
AT THE INFERIOR MOST EXTEND OF THE LOBULE IT TURNS POSTERIORLY FOLLOWING THE JUNCTION OF THE LOBULE AND NECK SKIN, BUT DOES NOT EXTEND ONTO THE POSTERIOR ASPECT OF THE CONCHA.
THIS PROCEDURE IS INDICATED IN PATIENTS WHO HAVE LIMITED SKIN EXCESS IN THE NECK AND A REASONABLE CERVICO-MENTAL ANGLE.
THE RECOVERY IS VERY FAST IN THIS SITUATION. I DO NOT USE DRAINS HERE BUT A SPRAY OF PLATELETS AND GROWTH FACTOR IS APPLIED BEFORE CLOSURE OF THE SKIN. Up

IT IS A PROCEDURE FOR IMPROVEMENT OF THE SHAPE AND SIZE OF THE ABDOMINAL WALL.

IT IS A SURGERY WITH A LONG HISTORY IN THE MEDICAL FIELD AND TODAY IT HAS BEEN RE-BORN IN POPULARITY AND FREQUENCY AS THE CLASSIC TECHNIQUE AND  AS THE NEW LIPOABDOMINOPLASTY  AS THE AVELAR TECHNIQUE. THE RESULTS OF THE ABDOMINOPLASTY TODAY ARE VERY PLEASANT FOR BOTH THE PATIENT AND THE SURGEON. I WLL EXPLAIN QUICKLY THE MAIN DIFFERENCES OF THESE FOUR SITUATIONS:
1-ABDOMINOPLASTY ALONE.
2-ABDOMINOPLASTY WITH LIMITED LIPOSUCTION TOGETHER.
3-ABDOMINOPLASTY  WITH DEFERRED LIPOSUCTION .(ABDOMINOPLASTY FIRST AND FEW MONTHS LATER LIPOSUCTION OF THE ABDOMINAL WALL AND WAIST).
4-LIPOABDOMINOPLASTY. (AVELAR TECHNIQUE}

ABDOMINOPLASTY ALONE:

IT IS USED IN PATIENTS WITHOUT LOCALIZED FAT DEPOSITS, USUALLY IN NORMAL WEIGHTS PATIENTS AND WITH ONLY EXCESS OF SKIN IN THE ABDOMINAL WALL AND FLACCITY OF THE ABDOMINAL MUSCLES.

ABDOMINOPLASTY WITH LIMITED LIPOSUCTION:
 
I PERFORM THE ABDOMINOPLASTY AND MINUTES BEFORE I PERFORM LIPOSUCTION OF THE WAIST AREAS WITH EXCELLENTS RESULTS AND WITHOUT COMPLICATIONS. TODAY OUR DISSECTION IN THE SUPRAUMBILICAL AREAS IS IN FORM OF TUNNEL IN THE MIDDLE LINE TRYING NOT TO DISTURB THE VASCULARIZATION ABOVE THE UMBILICUS.

ABDOMINOPLASTY WITH DEFERRED LIPOSUCTION;

I PERFORM ALWAYS ABDOMINOPLASTY FIRST AND EIGHT MONTHS LATER I CAN PERFORM LIPOSUCTION OF THE WHOLE ABDOMINAL WALL.
SOME SURGEONS PREFER WAIT ONE YEAR FOR THE LIPOSUCTION OTHERS WAIT LESS TIME.

LIPOABDOMINOPLASTY (AVELAR TECHNIQUE).

IN THIS SITUATION I PERFORM LIPOSUCTION OF THE WHOLE ABDOMINAL WALL AND WAIST USING APROXIMATELY 4-5 LITERS OF TUMESCENSE SOLUTION AS ANESTHESIA (KLEIN SOLUTION).
AND ONCE I FINISHED WITH THE LIPOSUCTION I LIBERATE THE PATIENT’S UMBILICUS AND I DETACH THE INFRAUMBILICAL SKIN.
IN THE SUPRAUMBILICAL AREA I CLOSE THE FASCIA OF THE RECTUM MUSCLES IN THE MIDDLE LINE IF IT IS NECESSARY THROUGH SMALL DISECTION OF 4 CMS OF DIAMETER IN THE SUPRAUMBILICAL AREA AND RESPECTING THE PERFORATING VESSELS THAT EMERGE IN THIS ZONE.

THEN THE SKIN IS SUTURED TO THE PUBIC LOW SKIN AREA AND THE UMBILICUS GO THROUGH THE SKIN IN THE RIGHT POSITION,

BEFORE I CLOSE THE SKIN IN THREE PLANES A SPRAY OF PLATELETS AND GROWTH FACTOR IS APPLIED TO THE AREA AND WE DO NOT USE DRAINS AT ALL.

PATIENT ARE INSTRUCTED WALK HALF A MILE THE NEXT DAY, WE SEE THE PATIENTS IN DAY THREE AND IN DAY FIVE THE PATIENTS RETURNS TO THERE  NORMAL ACTIVITIES AND I REMOVE THE STITCHES IN THE  UMBILICAL ZONE AT DAY SEVEN AND THE PATIENTS ARE DISCHARGED.

I HAVE NO FOUND SEROMA, HEMATOMAS, SKIN OR FAT NECROSIS WITH THIS TECHNIQUE AND NEITHER THROMBOEMBOLICS DISORDERS. Up

OUR METHOD FOR BREAST AUGMENTATION CONSIST OF 10 STEPS.

1-INITIAL CONSULTATION; HISTORY AND PHYSICAL EXAMINATION.

2-THE PATIENT IS THE ONLY ONE TO DECIDE WHETHER AUGMENTATION IS NECESSARY.

3-I  COUNSEL THE PATIENT THAT THE MORE BREAST SURGERIES PERFORMED ON A PATIENT, THE MORE LIKELY THE COMPLICATIONS.
I REFER TO THE BODY DYSMORPHIC SYNDROME THAT ARE THOSE PATIENTS THAT THEY ARE LOOKING FOR SURGERIES IN SPITE THAT MINIMALLY OR NOT IMPROVEMENT AT ALL WILL BE OBTAINED.

4-WE POINT OUT THE FOLLOWING SITUATIONS:
FAMILY HISTORY OR PERSONAL OF BREAST CANCER
ANY PREVIOUS EPISODE OF BLEEDING, THROMBOEMBOLISM,
PAST SURGERIES OF THE BREAST OR CHEST.
MEDICATIONS TAKEN BY THE PATIENT AS: ASPIRINE, NON-STEROIDAL ANTI-INFLAMMATORY DRUGS, VITAMIN E, HERBALS,ESTROGENS,COUMADIN, DIET PILLS OR ANY NATURAL PILLS.
TWO WEEKS BEFORE AND AFTER SURGERY THEY MUST BE STOPPED.
ALWAYS I ASK WHETHER THE PATIENT SMOKE OR NOT (IT CAN IMPACT WOUND HEALING OR MAY CAUSE NECROSIS.). ALCOHOL OR ANY OTHER ADDICTION.
I ASK HISTORY OF DIABETES MELLITUS BECAUSE UNCONTROLLED DIABETES INCREASES THE RISK OF SLOW HEALING AND WOUND INFECTION. I ASK FOR HIGH BLOOD PRESSURE, ASTHMA, HEPATITIS OR ANY SERIOUS DISEASE THAT I DID NOT MENTION.
I ALSO ASK FOR ANY PREVIOUS SURGERY AND ANY PREVIOUS GENERAL ANESTHESIA TO SEE HER TOLERANCE TO ANESTHETICS DRUGS.
I ASK FOR ANY FAMILIAL HISTORY OF MALIGNANT HYPERTHERMIA.
ANTI-CONCEPTIVE PILLS SHOULD BE STOPPED ONE OR TWO WEEKS BEFORE THE SURGERY

5-PHYSICAL EXAMINATION:
I RECORD STERNAL NOTCH TO NIPPLE DISTANCE.
I RECORD DIAMETER OF AREOLAR TISSUE.
I RECORD DISTANCE OF LOW AREOLAR BORDER TO INFRAMAMMARY FOLD.
I RECORD THE DISTANCE FROM INFRAMAMMARY AREA TO LOW COSTAL BORDER. (IN ORDER TO SEE IF THERE ARE ENOUGH SPACE TO LOW THE INFRAMAMMARY BORDER.
I RECORD THE BREAST DIAMETER FOR BETTER CALCULATION OF THE BEST IMPLANT FOR EACH PARTICULAR CASE.
FINALLY I SEE THE VOLUME OF THE PATIENT OWN BREAST AND ITS CONTRIBUTION TO THE FINAL RESULT.
ALWAYS I EXPLAIN THE PATIENT THAT INDICATIONS FOR BREAST IMPLANTS IN THE MOST COMMON SITUATIONS ARE:
NORMAL BREASTS.
PTOSIS GRADE 1.
PSEUDO-PTOSIS.
IT IS MY IN MY ROUTINE AUSCULTATION OF HER HEART  AND THE LUNGS SOUNDS IN WHICH CASE I ESTABLISHED HER NORMALITY.
COMPLETE BLOOD TESTS, BLOOD PREGNANCY TEST AND FIVE MINUTES BEFORE SURGERY I REPEAT PREGNANCY TEST; THIS TIME IN URINE.
HIV TEST,COAGULATION TEST,ECG,MAMMOGRAM IF 40 YEARS OF AGE OR OLDER OR AT ANY AGE IF FAMILY HISTORY OF BREAST CANCER.
CHEST X RAY AT 40 YEAR OF AGE OR OLDER, OR AT ANY AGE IF HISTORY OF ASTHMA,BRONCHITIS OR PREVIOS RESPIRATORY SYMPTOMS.
TODAY MANY SURGEONS ORDER THE CHEST X RAY AS A ROUTINE PRE-OP.
CLINICAL CONSULTATION OR CLEAR FOR SURGERY AS NEEDED.

6- INFORMED CONSENT ARE EXPLAINED TO THE PATIENT WITH POSSIBLE RISKS AND COMPLICATIONS AND ARE GIVEN TO HER FOR SIGNING.

7-FINALLY THE EVALUATION OF THE IMPLANTS PERFORMED IN THE OFFICE WITH THE USE OF VARIOUS SIZES OF IMPLANTS PLACED IN THE BRASSIERE AND USING A MIRROR TO DETERMINE WHAT LOOKS BEST.
THE SURGEON SHOULD MAKE SURE THAT THE PATIENT DECIDES ON THE SIZE  AND IS NOT INFLUENCED BY ANYONE ELSE.
THE PATIENT OWN IMAGE SHOULD BE DETERMINING FACTOR.
I EXPLAINED THE TYPE OF IMPLANT(SALINE, SILICONE. ROUND OR ANATOMICAL, SMOOTH OR TEXTURED,SUBMUSCULAR OR SUBGLANDULAR WITH ITS PROS AND CONS.
ALSO THE SURGICAL INCISION AND TECHNIQUE (AXILLARY, PERIAREOLAR, TRANSAREOLAR, INFRAMAMMARY,AND THE UMBILICAL APPROACH.)

8-IT IS A GOOD IDEA A SECOND VISIT BECAUSE RAPPORT CANNOT USUALLY BE ESTABLISHED EASILY ON THE FIRST CONSULTATION.

9-PREOPERATIVE AND POSTOPERATIVE INSTRUCTION ARE GIVEN ORALLY AND IN WRITING.
I USE THREE MEDICATIONS: ANTIBIOTICS DURING EIGHT DAYS, PAIN KILLER USUALLY FOR THREE DAYS AND ANTI-VOMITTING MEDICATION.
PREOPERATIVES PHOTOS ARE A STANDARD.
POSTOPERATIVES PHOTOS I TRY TO OBTAIN THEM TWO MONTHS LATER BUT MANY PATIENTS FAIL TO COME FOR PHOTOS ONLY.

RECORDS ARE COMPLETE, ACCURATE AND DETAILED.

10-FINALLY “THE SURGERY”.

What Size Breast Implants Should I Get?

Choosing the right size implant is generally the most important decision a woman and her plastic surgeon will make. Being realistic and following your doctor’s recommendations is very essential for the best result possible. Your cosmetic surgeon will have several different styles, profiles and sizes from which to choose. Having a variety of breast implant options helps ensure you get the results you desire. For now, we’ll just focus on how to select a breast implant size that’s right for you.

Let’s start with the basics. Breast implants are measured in cubic centimeters (cc’s), not cup sizes. This is because the size of the breast implant you select will depend on the shape and size of your chest. Here’s a little more helpful information about breast implant size. The average 375cc breast implant is equal to a little over 1.5 cups of gel or saline filling. Now, you may also ask, “How much do breast implants weigh?” Well, each cc of saline or gel weighs about one gram. So a pair of 375cc breast implants is going to weigh just about 1.5 pounds.

The most important thing you need to know about choosing a breast implant size is that you have to be realistic. In fact, your plastic surgeon will examine the amount of breast and skin tissue you already have in your chest. This will help him/her determine if you have enough of both to cover the breast implant size you are considering. If you want a breast implant size that is too large for your existing breast tissue and chest size, your cosmetic surgeon may warn you that your breast implant edges may be visible or palpable following your surgery. Also, if you get excessively large breast implants, there is a chance your breasts could droop or sag more than you would desire. So, again, it’s important to be realistic about breast implant size. Ultimately, you’ll have to choose a breast implant that “fits” your body for the long term.

So when it comes to breast implant size, you have many options. Just tell your surgeon what your desires and expectations are, and she’ll give you more information about different breast implant options that are realistic for you.

Use this 3D Breast Augmentation Body Model to visualize your body type with different breast implant sizes. Also visit this Before and After Breast Augmentation Photo Gallery to get a better idea of what breast implant size will provide you with the shape you desire.Up

I USE A SUPERIOR-MEDIAL FLAP OR THE SUPERIOR FLAP ONLY INTERNALLY, REDUCTION OF AREOLAR TISSUE IF IT IS NECESSARY AND THE SCAR IN THE SKIN WILL BE AN INVERTED -T.

TODAY MANY SURGEONS AT THE SAME TIME PUT IMPLANTS BUT THERE ARE MORE RISKS OF NIPPLE-AREOLA NECROSIS.

I REMEMBER TO THE PEOPLE THAT SEVERAL MONTH LATER YOU CAN RECEIVE AN IMPLANT TO YOUR BREAST MORE SAFELY THAN WITH THE COMBINATION OF BREAST REDUCTION WITH BREAST IMPLANTS. Up

CONCEPT OF LIPOSUCTION:

IT IS SUCTION OF THE FAT UNDER THE SKIN IN ANY AREA OF THE HUMAN BODY AFTER INFILTRATION OF TUMESCENSE ANESTHESIA. (KLEIN SOLUTION).

LIPOSCULPTURE:

IT IS REMODELING THE HUMAN BODY WITH LIPOSUCTION.

METHODS OF LIPOSUCTION:
1-SAL
2-PAL
3-UAL
4-LASER
5-EPMAL.

BRIEF DESCRIPTION OF EACH METHOD:

SAL: (SUCTION ASSISTED LIPOSUCTION)

1-CANNULA WITH SYRINGUE.
2-CANNULA CONNECTED TO A SUCTION ELECTRIC MOTOR            
PUMP.(TRADITIONAL LIPOSUCTION) I USE A NEGATIVE PRESSURE OF 20 IN OF MERCURY.

PAL: (POWER ASSISTED LIPOSUCTION)

1-MICRO-AIR: (AIR-DRIVEN INSTRUMENTS) CANNULA CONNECTED TO A MACHINE THAT WITH AIR MOVE THE CANNULA FORWARD AND BACKWARD (GO AND COME) AND WITH A ROTATION MOVEMENT TOO.(VIBROLIPOSUCTION) (LIPOMATIC). ALSO THE CANNULA IS CONNECTED TO A SUCTION ELECTRIC MOTOR PUMP FOR SUCTIONING.
IT GIVES 30-45% OF MORE FAT ASPIRATED.

2-ELECTRIC: AN ELECTRIC EQUIPMENT PRODUCE THE MOVEMENT OF THE CANNULA AND IT IS ALSO CONNECTED TO A SUCTION ELECTRIC MOTOR PUMP. EXAMPLES; NU-MED ELECTRIC HAND PIECE, BYRON AIR DRIVEN HAND PIECE, MED-TRONIC POWER SCULPT CONSOLE WITH HAND PIECE.

3-WATER-JET LIPOSUCTION: A MACHINE IMPULSE A JET OF FLUID THROUGH AN ORIFICE IN THE CANNULA AND THROUGH OTHER ORIFICE IN THE SAME CANNULA THE FAT IS ASPIRATED WITH A SUCTION ELECTRIC MOTOR PUMP. (TRADITIONAL SYSTEM)
IN THIS CASE WE USE SODIUM CHLORIDE 3 LITERS WITH 1 ML OF EPINEPHRINE WITHOUT LIDOCAINE.(LESS TOXICITY).

ALL OF THESE CANNULAS HAS A DUAL PORT SIDE AND ONE OF THEM IS CONNECTED TO A SUCTION ELECTRIC PUMP.

UAL: (ULTRASOUND ASSISTED LIPOSUCTION)

TWO PREVIOUS GENERATIONS OF ULTRASOUND CANNULAS FAILED.

BUT A 3RD GENERATION OF ULTRASOUND CANNULAS PRODUCE EXCELLENTS RESULTS AND ALMOST NO COMPLICATIONS,
A SOLID PROBE WITH DIFFERENTS GROOVES IS USED.
50%  LESS ENERGY THAN PREVIOUSLY IS USED.
CONTINUOS OR PULSE MODE IS USED WHEN VIBRATORY ENERGY IS DELIVERED IN SHORT DURATION BURTS REFERRED TO AS VASER MODE OR VAL MODE. THEN EMULSIFIED FAT IS MORE EASILY REMOVED WITH ASPIRATION CANNULAS. (TRADITIONAL LIPOSUCTION) THAN NON-EMULSIFIED FAT TISSUE.

LASER LIPOSUCTION:

1-SMARTLIPO: IT LOOKS TO BE UTIL IN REMOVING SMALL AMOUNT OF FAT. LASER LIQUIFIED THE FAT BY ITS ENERGY AND THEN IT IS SUCTIONED. THE OPTIC FIBER OR PROBE GOES INSIDE THE FAT UNDER THE SKIN

2-LLLL: (NEIRA 4-L) (LOW LEVEL LASER LIPOSUCTION) IT IS A METHOD THAT USE AN EXTERNAL DIODE LASER WITH A WAVELENGHT OF 632 NM. ALSO WE CALLED IT “EXTERNAL BEAM COLD LASER” INTENSITY OF 10 mW, WE USE 2, 4, 6 MINUTES EXPOSURE IN EACH SPECIFIC AREA AND 1.2, 2.4, AND 3.6 J/CM.

THE LASER IS APPLIED FROM A DISTANCE OF 26-30 CM TO THE SKIN AND ALMOST AT THE SAME TIME WHEN WE INFILTRATE THE KLEIN SOLUTION.
THE PROBE DOES NOT GO INSIDE THE FAT IT IS APPLIED EXTERNALLY. ONCE THE FAT IS EMULSIFIED IS SUCTIONED WITH THE ELECTRIC SUCTION PUMP. (TRADITIONAL LIPOSUCTION).

IT IS GOOD TO CLARIFY THAT IN ANY METHOD OF LIPOSUCTION WE HAVE TO INFILTRATE THE TUMESCENSE ANESTHESIA. (KLEIN SOLUTION) COMPOSED OF LACTO-RINGER, LIDOCAINE AND EPINEPHRINE.
LACTO-RINGER MAY BE SUBSTITUDED WITH 0.9% OF SODIUM CHLORIDE.
INCLUSIVE IN THE WATER-JET LIPOSUCTION THE SOLUTION GOES FIRST BUT WITHOUT LIDOCAINE. (LESS TOXICITY).

EPMAL: (EXTERNAL PERCUSSION- MASSAGE ASSISTED-LIPOSUCTION).
WE USE A DOUBLE HEADED PERCUSSION MASSAGER OVER EACH REGION FOR 5 MINUTES BEFORE LIPOSUCTION AND AFTER INFILTRATION OF TUMESCENSE SOLUTION. THE FAT IS EMULSIFIED AND THEN ASPIRATED WITH THE TRADITIONAL LIPOSUCTION.

WHAT ABOUT THE FUTURE:

I BELIEVE THAT THE FUTURE IS: ULTRASOUND LIPOSUCTION (VASER LIPOPLASTY) AND/OR LLLL (LOW LEVEL LASER LIPOSUCTION).

WHY SO DIFFERENTS METHODS:

THEY ARE IN ORDER TO OBTAIN THESE GOALS:

1-MORE FAT ASPIRATED.
2-LESS EFFORT TO DO THAT. (DECREASE WORK ON THE PART OF THE LIPOSUCTION SURGEON)
3-MORE UNIFORM RESULTS.
4-LESS TIME IN THE PROCEDURE. 
5-MINIMAL COMPLICATIONS.
6-POST-OPERATIVE PERIOD MORE COMFORTABLE WITH LESS PAIN. Up

THESE ARE TECHNIQUES THAT I USE TO ELEVATE THE BREAST TO THERE ORIGINAL POSITION AND OF COURSE TO GIVE THEM A MORE YOUTHFUL APPEARANCE.

THE NEGATIVE SITUATION ARE THE SCARS THAT REMAIN.

DEPENDING OF THE GRADE OF PTOSIS . I REFER TO PTOSIS AS THE FALLEN AND SOMETIMES ATROPHIC BREASTS.

I PREFER TO USE FOUR GRADES OF PTOSIS.

PTOSIS GRADE 1: MINIMAL PTOSIS. THE NIPPLES ARE AT OR BELOW 1 CM OF THE INFRAMAMMARY LINE.
IN THIS SITUATION I TREAT THE PATIENTS WITH A BREAST AUGMENTATION ONLY.

PTOSIS GRADE 2: MODERATE PTOSIS. HERE THE NIPPLE IS 2 CM APROXIMATELY BELOW THE INFRAMMAMARY LINE.
HERE I PERFORM SEMILUNAR MASTOPEXY ( I REMOVE A SUPERIOR SEMILUNAR AREOLAR TISSUE AND AT THE SAME TIME AN IMPLANT IS INSERTED FOR BETTER RESULTS.

IN THESE TWO PROCEDURES THE SCAR IS VERY GOOD AND ALMOST NOT PERCEPTIBLE.

PTOSIS GRADE 3: HERE THE NIPLES ARE 3 CMS OR MORE BELOW THE INFRAMAMMARY LINE AND THERE IS EXCESS OF SKIN IN THE BREAST.
BUT THE NIPPLES POINTS LITTLE BE TO A DOWN POSITION.
HERE I PERFORM TWO TECHNIQUES:

1-CONCENTRIC MASTOPEXY IN WHICH A PIECE OF SKIN AND AREOLAR TISSUE IS EXCISED IN FORM OF A RING. I CLOSE THE SKIN IN PURSE-STRING FASHION BUT BEFORE I INSERTED THE IMPLANTS. THE REMAINING SCAR IS AROUND THE AREOLA WITH EXCELLENTS RESULTS AND IN SOME SITUATIONS I EXPLAINED TO THE PATIENTS THAT IF THEY DO NOT WANT A NOTICEABLE SCAR THIS IS A GOOD OPTION .

2-VERTICAL MASTOPEXY: HERE THERE ARE MORE EXCESS OF SKIN AND A VERTICAL LINE WILL REMAIN AS A SCAR BETWEEN THE LOW BORDER OF THE AREOLA AND THE INFRAMAMMARY LINE DUE TO THE FACT THAT SKIN HAS TO BE EXCISED. AN IMPLANT COULD OR NOT BE USED. MANY TIMES IN THIS SITUATION A SMALL TRANSVERSAL SCAR WILL REMAIN IN ORDER TO ACCOMMODATE THE EXCESS SKIN IN THE LOW AREA, SOMETIMES WITH BETTER RESULTS.

PTOSIS GRADE 4: THE MOST SEVERE IN WHICH THE ONLY ALTERNATIVE WILL BE A SCAR IN FORM OF INVERTED-T.
HERE THE NIPPLES ARE MORE THAN 5 CMS BELOW THE INFRAMMARY LINE AND THEY ARE POINTED TO THE FLOOR. IT IS THE MOST SEVERE CASE. THE GLAND COULD BE ATROPHIC OR NOT.

IN PTOSIS GRADE 4 TODAY OUR APPROACH HAS CHANGED IN THE SURGICAL CORRECTION. MANY YEARS AGO I USED THE INFERIOR FLAP INTERNALLY IN THE RESECTION OF THE GLAND BUT I NOTICED THAT THE SUPERIOR AREA OF THE GLAND BECOME TOO FLAT AND THE NIPPLES WITH THE YEARS TO COME HAD A  TENDENCY TO GO UP, THAT WERE THE REASONS WHY IN THE LAST 10 YEARS I PERFORM THE SUPERIOR-MEDIAL FLAP OR THE SUPERIOR FLAP ONLY AND I NOTICED THAT THE UPPER AREA OF THE GLAND REMAIN FULL WITH THE NIPPLES IN EXCELLENT POSITION BUT ALSO I NOTICE THAT THE VERTICAL AND TRANSVERSE SCAR WERE OF MUCH BETTER QUALITY AND LESS NOTICEABLE.
OF COURSE IN THE SKIN OUTSIDE AN INVERTED-T SCAR WILL REMAIN BUT ALSO SHORTER THAN BEFORE. Up

IT IS A PROCEDURE IN WHICH I REMOVE THE SUPERFICIAL VARICOUS VEINS  BY TWO DIFFERENTS PROCEDURES;
1-AMBULATORY PHLEBECTOMY.
2-AMBULATORY STRIPPING OF THE VEINS.

SEQUENCE:
STUDY AND PHYSICAL EXAMINATION.
I INSPECT THE AREAS OF THE VARICOSITIES (USUALLY THE LEGS AND THIGHS) AND WITH SPECIAL INSTRUMENT IN A DARK ROOM I DRAW A MAP OF THESE VEINS.
THE MAP IS TRANSLATED TO THE FILE AND A COMPLETE WORK UP IS ORDERED:

COMPLETE BLOOD TEST
COAGULATION TEST.
HIV TEST.
PREGNANCY TEST
EKG

AND MOST IMPORTANT OF ALL A DUPLEX (SONOGRAM WITH DOPPLER) OF THE LOWER EXTREMITIES IS ORDERED TO SEE THE ARTERIAL AND VENOUS FUCTION AND PERMEABILITY OF THE DEEP VENOUS SYSTEM.
THEN THE PATIENT IS SCHEDULED FOR SURGERY ALWAYS WITH LOCAL ANESTHESIA..

I PERFORM FREQUENTLY AMBULATORY PHLEBECTOMY WHICH CONSIST OF TUMESCENSE ANESTHESIA IN THE LEG OR LEGS AND A VERY TINY INCISION WITH # 11 BLADE I GRASP THE SICK VEIN WITH A VEIN GRASPER ALL OVER THE LEG UNTIL FINALLY THEY ARE AVULSED . THE LEG IS ELEVATED AND LAYERS OF COMPRESSION IS PERFORMED.
NO SUTURE IN THE INCISIONS AND ONE MONTH LATER I STAR PERFORMING SCLEROTHERAPY FOR THE MICRO-VARICOUS VEINS THAT REMAINS.
VERY RARELY I HAVE TO TIED A COMMUNICATING VEIN DUE TO BLEEDING.
AN ASPIRINE 325 MG IS GIVEN TO THE PATIENT AT THE END OF THE SURGERY AND BEFORE GO HOME THE PATIENT WALKS FOR 30 MINUTES IN MY OFFICE. I DO NOT REMOVE THE LEG COMPRESSION FOR ONE WEEK AND IT IS EXTRAORDINARY SEE HOW AT THE END OF SEVEN DAYS THE PATIENTS DOES NOT HAVE ANY BRUISING NEITHER EDEMA.
THE PROCEDURE IS ALMOST PAINLESS.

THE SECOND PROCEDURE IS STRIPPING OF THE VEINS.

IN THIS PROCEDURE A PLASTIC CATHETER IS INSERTED IN THE MOST INFERIOR AREA OF THE INTERNAL SAPHENE VEIN (LARGER) AND IT EXITS IN THE INGUINAL AREA THROUGH A SMALL INCISION BEFORE IT ENTERS IN THE SUPERFICIAL FEMORAL VEIN.

IN THE LOW AND UPPER AREAS OF THE SAPHENA VEIN I TIED AND CUT THE VEIN DISCONNECTING THE VEIN FOR ITS CONTINUITY AND PULL THE STRIPPING UP THROUGH THE INGUINAL AREA AND THE VEIN COMPLETELY IS EXCISED.
THIS CAN BE DONE FOR THE EXTERNAL OR SMALLER VEIN TOO.

THIS PROCEDURE IS ALSO DONE WITH LOCAL ANESTHESIA USING TUMESCENSE SOLUTION. (KLEIN SOLUTION).
ASPIRINE 325 MG AT THE END OF THE PROCEDURE.
ONE WEEK OF COMPRESSION.