Category Archives: Blog

Welcome to our updated website

We’re still putting on the finishing touches but we’re excited about the new look and updates so we brought it out now.  Our website is different from many other plastic surgery practice websites- no stock photos of impossibly beautiful models.  All the photos you see on the site are of our patients and our staff.  Many thanks to Ginny Weaver (Ginny Weaver Design) and Stephanie Weaver (Sweetweaver Web Works) for their hard work, expertise, and collaboration in helping us put all this together.  Brian Goodman and Tim Nauman did some great photographs of our patients and staff and we appreciate those patients kind enough to let us use their before and after photos to help others understand our procedures.  We’ll be adding more photos and updated content soon to make our site even better.

We wanted to create a website that informs you about our practice and the procedures we perform and mirror what we do in our office.  We try to inform and educate our patients and help them choose the treatment that is right for them.

Please let us know what you think.  If you have suggestions, spot typos, or see areas for improvement in our “first draft” please let us know so we can continue making improvements.

Breast reduction surgery and obesity

Numerous studies and our own large experience have shown that breast reduction surgery is very successful in relieving symptoms in a wide range of patients, regardless of their weight. However, studies have shown that obese patients (defined a Body Mass Index of 30 or more) undergoing surgery are more prone to complications at the time of surgery and during recovery.   While the overall risks of complications still remains low with breast reduction and the surgery goes very well for most patients regardless of their age, breast size or weight, we want to make you aware of these increased risks that we have noted in performing several hundred of these procedures.

Wound Healing Problems    The blood flow to the skin and breast tissue is altered by the removal of breast tissue and skin undermining during surgery. The effect of this decreased blood flow increases the risks of wound healing problems more in obese patients. While these wound healing problems are generally minor and do not require additional surgery, it may mean that there are areas along the incision lines that will require wound care (antibiotic ointment application and gauze) for several weeks. While healing is delayed the final result is usually not significantly affected.

Persistent folds on the sides and back   Many patients who are significantly obese have folds of excess skin and adipose tissue that extend from the side of the breast and wrap around the chest to the back. These cannot be removed by breast reduction surgery alone and require a more extensive procedure which is outside of the scope of the standard breast operation covered by insurance. We will do our best to minimize and improve the appearance of these folds during your breast operation but cannot eliminate them entirely.

Major complications  Major infection, bleeding, cardio-respiratory problems, blood clots, and other significant complications seem to occur more often in obese patients in some studies but we have not observed this in our practice. If we feel the  risk of these complications is too high because of other medical conditions we will not perform the surgery. The incidence of all these complications is very low making it difficult to spot any trends in our practice.

Minor complications  The appearance of scars, changes in nipple sensation, asymmetry, post operative pain, and others do not appear related to the patient’s weight at the time of surgery in our experience.

Some practices reject patients for breast reduction surgery based solely on an elevated BMI. We feel this is arbitrary and wrong and our experience proves it. We have had great success in performing breast reduction surgery on all patients regardless of weight, age and breast size and welcome the opportunity to care for these patients.

Microneedling

All I can say is “Wow”.  We’re really impressed with the results we’ve been getting with microneedling!   Although this skin treatment has been around for years with so-so results, the new technology which refines and mechanizes this technique with high speed untrafine micro needles is giving us better results at a lower cost than anything we’ve seen.  We now have a treatment that we can use year round with lower cost and less downtime than laser treatments and we’re finding it’s great for skin rejuvenation and even acne scarring.

I have to give our aestheticians, Patty and Cheri, total credit for this one.  They urged me to take another look at microneedling, a technique I had looked at a number of years ago when it was being done with mechanical rollers and was unimpressed.  They arranged for a demo of the SkinPen in our office on some patients and staff and we liked what we saw.  We completed our training and in just over 2 months they have done over 100 treatments, mainly on the face, neck, and chest.  Patients love the results and are telling their friends.  We have introduced this at our Topeka Elite Esthetics office as well with similar enthusiasm.  In over 20 years I’ve never seen a new treatment, device, or procedure that was so rapidly embraced and asked for by our patients.

Those of us who have been in the skin rejuvenation field for many years  are accustomed  to hearing the exaggerated hype that comes with any new product, procedure, or device. We tend to be pretty skeptical.  But we think this one is the real deal and is here to stay.

 

Welcome Dr. Durland!

We’ve got some exciting changes in the works at Lawrence Plastic Surgery.  Dr. Samantha Durland  is going to be bringing her practice to our office starting in August.  Many of you may know Sam from her many years spent practicing at Lawrence OB-GYN Specialists.  She has decided to leave her current practice location at Lawrence Memorial Hospital and set up an independent practice providing GYN services.  We have known Dr. Durland for years and are excited to announce that she will be basing her practice at our Lawrence office. As a large percentage of our patients are female, it seemed like a natural fit to invite Dr. Durland to share our space.  She brings a wealth of experience, surgical skill, and boundless enthusiasm into our office and we can’t wait for her to get started!

This practice situation is unique to Lawrence and (to our knowledge) the region.  Combining plastic surgery services, aesthetician services, and gynecologic services all in one location provides a better way to serve our patients and Dr. Durland and I look forward to collaborating with one another. We are currently in the process of reconfiguring our space which involves moving some offices, adding equipment, rearranging furniture and doing some light construction.  All of this means a little more mess and mild chaos at times for the staff, so please be patient while we try to make this transition as smooth as possible.  As usual, everyone at the office has been great during all this, even when it involves putting in extra hours, moving file cabinets, and doing the dirty work that any move involves. It helps that we have something really great to look forward to when this new chapter in our practice starts in August!

We’ll be providing more updates as this process continues.  Stay tuned!

 

 

 

 

 

20 Years and Counting

We recently held a 20 year celebration party at Lawrence Plastic Surgery.  It was a very special evening for us attended by many of the patients, staff, friends, family and special people that have been with us along our journey.  I want to thank all those who attended and ,especially, my terrific staff that conceived and organized this great event.

Over the years we have grown, changed, and adapted to the changes around us.  Times change, patients change, and medical care changes.  We’re now doing many new surgical procedures or the old ones in a very different way than we did  20 years ago. Nipple sparing mastectomies and immediate reconstruction with acellular dermal matrix products have changed breast reconstruction dramatically.  No drain abdominoplasties, no drain breast reductions, circumvertical mastopexies, routine use of silicone implants, neck lifts, short scar face lifts, and many other procedures are giving us better results and making recovery easier for our patients.

On the non-surgical side things have changed even more dramatically.  Botox, dermal fillers, laser techniques, IPL treatments, microdermabrasion, chemical peels, and other non-invasive treatments have added a whole new dimension to plastic surgery practice worldwide and these procedures play an important part of our approach to patients.  Most of these were not a part of my practice, or anyone else’s, when I first started.  Now, I can’t imagine how we got by without them.

As things around have changed it makes me even more grateful for the things that have not.  I’ve been supported  from the beginning by a wonderful family, a hardworking and loyal staff (most have been with me over a decade),  a cohesive and highly competent medical community, a first rate hospital and surgery center, and  innumerable patients that have referred their friends and family members to our practice.   To all of these people I am extremely grateful for keeping me and the practice thriving for all these years.

So thanks to everyone for the great evening and the 20 years that led up to it.  We’ll do our best here to adapt and adjust to changes in the coming years but remain true to our core.  Providing quality care in a welcoming and friendly atmosphere is what brought us this far and will sustain us in the future.

 

Lifestyle Lift Shuts Down

An article in the Wall Street Journal on March 2, 2015 began with the sentence, “Lifestyle Lift, a nationwide chain of cosmetic surgery centers, abruptly shut down the majority of its business Monday and said it is considering filing for bankruptcy.”  Apparently various locations around the country have responded differently with some continuing to only see their existing post op patients, some closing their doors altogether, some seeking some type of reorganization to stay open, etc.  Because some patients in our area have asked us in the past about their services we tried to get information today from the LifestyleLift.com website (“under renovation”) and called the phone number for the Kansas City location to find out their status (no answer ).

I have never been a fan of cosmetic surgery franchises.  It wasn’t too many years ago that many patients in Kansas City and elsewhere were lured by the promise of quick, guaranteed results for  fat reduction without surgery to their local Lipodissolve location.  With a barrage of marketing and aggressive sales techniques Lipodissolve grew rapidly but then abruptly closed as the number of disappointed patients mounted.  Patients were left with no clear place to turn for help and many were unable to recover the refunds and deposits they were due.  It appears many Lifestyle Lift patients may be in the same situation.

I won’t make any judgements here on the surgical outcomes of the patients cared for in these offices.  I’m sure there are some patients with great outcomes, some with poor ones, and everything in between.  One can easily go to various online review sites and find these stories and photographs.  What was most troubling to me was their marketing created the expectation  there was some magical procedure that you could only get at a Lifestyle Lift franchise that would completely change the way you look with almost no pain, recovery time, or risk.  Those of us with years of experience in plastic surgery knew this simply wasn’t the case and creating these kind of false expectations nearly always results in disappointment.   In my training at Johns Hopkins and Vanderbilt the surgeons I worked with taught me to promise little but deliver a lot.  It appeared the Lifestyle Lift marketers were doing just the opposite

While I could take pleasure in seeing the local Lifestyle Lift franchise close and those annoying ads finally disappear from my television, I don’t.  I feel bad for the patients who were caught in the middle of this abrupt closing, having potentially lost money or finding their local office closed when they returned for a follow up visit after their surgery.  I feel bad for the physicians who chose to work for the company as I’m sure there were many who were fine surgeons that genuinely cared for their patients and wanted to just operate, leaving  the marketing and financial side to someone else.  And I feel bad for the employees at these locations who are now suddenly without a job or paycheck.

There’s a lesson to be learned from this to all patients considering cosmetic surgery.  Beware of slick marketing, high pressure sales techniques, and anyone offering a “revolutionary” procedure that promises to be far better than anything done before.  Beware of franchise operations, which may be more beholden to stockholders than their patients and subject to the whims of the financial world.  Chose a surgeon with experience, credentials, and a reputation for quality, not a franchise location with great ads.  Franchises and chains work well in the world of  fast food, but not so well for surgery.

Finally, we would be glad to see patients who have been to a Lifestyle Lift office and need  some assistance or just advice regarding their post op care.  No judgement, no “I told you so”- let’s admit it, those ads and other marketing were  pretty effective!    We’ll be glad to help out any way we can.

 

Botched!

A new TV reality show called “Botched” has a lot of people talking. In case you haven’t seen it, the show focuses on people who have had previous plastic surgery procedures who are dissatisfied with their outcome and seek to have corrective procedures. Like most “reality” TV programs, they feature some colorful characters and at times the show is a little over the top. But many people find it fascinating to watch and perhaps wonder if their own plastic surgical procedures can be corrected.
We see patients like this fairly commonly. They have had procedures elsewhere and see us to discuss corrective procedures. In reality, most of these patients haven’t been really been “botched” but come to see us for a variety of reasons. When patients are unhappy with their results, we always urge them to discuss this with their original surgeon. Sometimes, however, their original surgeon may not be available (retired, moved, etc). They may feel uncomfortable undergoing further procedures by they same surgeon when they feel they no longer have a good doctor-patient relationship. Whatever the reason, we are always happy to see these patients and can usually help them.
Sometimes the corrections are fairly easy and straightforward and patients are relieved to hear that they have a problem that is easily fixed. In other cases the correction can be complicated and we welcome these challenges. Finally, we see some patients who may be unhappy with their result but we have to be honest with them and say their previous surgeon has done the best job possible given their anatomy and a better result may not be achievable. We’d rather be honest up front than create false expectations.
Some plastic surgeons would prefer not to “fix someone else’s mistakes.” We welcome the challenge. So whether your original operation was truly “botched” or just deteriorated over time, come see us and we’d be glad to give you our opinion.

Abdominoplasty and BMI

We were recently asked by a patient how BMI affects our decision to perform abdominoplasty. We thought this was an excellent question and I’ll paraphrase it below.

Every case is individual and I don’t necessarily have a cutoff or absolute BMI number that determines if I will or won’t do an abdominoplasty. I lot of factors play into the decision.

I tell all my patients I want them to be at a stable weight before the surgery. Significant weight changes after the surgery can compromise your result. I don’t insist patients reach an “ideal” weight, but at least I’m not trying to aim for a moving target.

Lower BMI patients are generally going to get a better result than higher BMI patients, but I’ve had many higher BMI patients who were extremely happy with the amount of improvement we were able to achieve. They were realistic in their expectations and I was able to meet or exceed these.

In the higher BMI patient, I consider multiple factors before deciding if I will recommend an abdominoplasty. These include:

Overall health and potentially complicating medical conditions
Age
Weight distribution
Previous abdominal scars
Potential for improvement
Patient expectations
and other factors

If I don’t feel the operation can be done safely or the result will fall short of the patient’s expectations, I’ll tell them at the consultation. I’d rather disappoint them at our initial consultation than have them be disappointed (or endangered) by the operation.

The Team Approach to Breast Reconstruction

As recent articles in the media have stressed, successful breast cancer treatment and reconstruction involves close collaboration among all those treating the patient. Angelina Jolie and her plastic surgeon have been very public about her mastectomies and reconstruction and have helped shine a light on the importance of a close, collaborative relationship among the doctors and patients. We couldn’t agree more.

We are fortunate to have such a team here in Lawrence, and have recognized the importance of this team approach for many years. Even before establishing the Breast Center around 10 years ago we were already working closely with our general surgeons, oncologists, pathologists, and others to begin planning a treatment strategy for the patient shortly after the diagnosis of cancer was made. As reconstructive surgeons, we often meet with patients early in the process to discuss available options and make suggestions as to the most appropriate reconstructive approach and timing (immediate or delayed). Most importantly, we have often already been in communication with your other providers before we even meet you for the first time and continue to work closely with them throughout your treatment. Even if a patient chooses not to undergo reconstruction at the time of her mastectomy, we can help her make this informed decision and even become involved in the mastectomy planning, so that incisions are placed to make reconstruction easier in the future if the patient should change her mind.

Breast reconstruction should not be seen as an isolated procedure but part of a collaborative effort to treat the breast cancer patient and restore her to physical and emotional health. Communication is an old fashioned, low-tech approach that consistently makes our advanced treatments work better.

No-drain Abdominoplasty

Traditional abdominoplasty procedures have always involved the placement of drains to prevent abnormal fluid collection beneath the recently moved skin to prevent fluid collection.  These are flexible tubes placed during surgery which attach to small suction bulbs, continuously pulling out fluid for the first few days or occasionally weeks after surgery.  The drains are left in place until the fluid output decreases, and then are removed during an office visit.

What’s wrong with drains?

While having drains in place after an abdominoplasty is generally not painful, many patients find them to be a real nuisance.  They must be emptied 2-3 times a day, can be difficult to conceal under clothing, the site where the drain exits the incision or drain requires care, they sometimes clog, and they may inhibit showering or bathing.  If they are removed too early, fluid may accumulate beneath the incision which will require drainage.

The No Drain abdominoplasty

When performing a no-drain abdominoplasty, additional sutures are placed between the abdominal wall and the overlying fat and skin, closing off the space where fluid would otherwise accumulate.  In addition to making drains unnecessary, the sutures are used to relieve some of the tension on the final skin closure, potentially helping to keep this scar from widening.  The procedure takes a little longer to do, but the convenience and comfort for the patient after the operation certainly makes it worthwhile.

We can’t perform a no-drain abdominoplasty on every patient, but find that it is possible for most.  Be sure to ask us during your consultation if we can do it for you.