1. Discovering the Body You Have Dreamed About…

2. West Magnolia Plastic Surgery 1200 West Magnolia Avenue, Suite 110 Fort Worth, Texas 76104

3. Increasingly more common in the United States in the past decade Health benefits of weight loss widely recognized Reduction in heart disease Improved or resolved diabetes Psychological benefits

4. Significant skin laxity can make working out difficult or uncomfortable Workout clothes ill fitting Breasts too ptotic (saggy) Skin folds with sweating can contribute to rashes, skin breakdown Your new slimmed down frame is draped in so much skin you don’t feel like you’re ‘supposed to’

5. General health dramatically improved but skin laxity presents concerns both physically and mentally Clothes may be ill fitting Loss of volume in face, arms and/or breasts may contribute to an aged appearance Victory of attaining goal weight may be tempered by one’s physical appearance once goal is met

6. Rapid weight loss effects all aspects of tissues, not just the skin you see Decreased skin elasticity Tissue redraping and healing may be compromised Dramatic and rapid weight loss may result in stretch marks that may not have been present at a higher weight Nutritional concerns may contribute to wound healing issues

8. Has evolved into a dedicated subspecialty of plastic surgery Seminars, meetings dedicated only to dealing with the issues specific to this patient population More attention in the past years focused on getting the very best results given concerns unique to bariatric patients Incisions, wound closure, postoperative management

9. What concerns you the most? Face and neck Arms Breast Body Thighs Buttocks

10. Proposed procedures are generally approached in reasonable and obvious groups Face and Neck Breast and Body Arms and Legs No hard, fast rules with this…I prefer to start with the patient’s major concerns and decide from there how to plan the approach

11. Obviously imperative to meet first to make a plan Review medical history thoroughly including all active medications Smoking? Risk of perioperative complications significantly higher in smoker I will not operate electively on smokers for this reason Stop smoking AT LEAST 4 weeks prior, urine nicotine day of surgery and surgery cancelled if positive

12. Additional significant weight loss can alter results 20 or more pounds left to lose until ‘goal’ is an indication to wait for any breast or body contouring Continued weight loss will lead to further tissue deflation and may result in tissue laxity postoperatively A stable weight for 6 months prior to surgery is a good benchmark that a goal has been met Unless it is considered a ‘plateau’… This may need to be addressed with the Bariatric Surgeon

13. Meet face to face initially Nothing more impersonal than meeting someone for the first time in a robe Modesty preservation is essential I am very protective of all my patients Acknowledge it may be difficult for patients with significant skin laxity to reveal what they can conceal in their clothing Having a ‘girl surgeon’ is a good thing….I’ve seen it all before!

14. Very important to disclose your complete history All medical history Any and all surgical procedures Smoking history Known wound healing complications with smokers Medications Many can contribute to bleeding or may compromise wound healing

15. Tissue symmetry No one is completely symmetric Extensive measurements to document Existing scarring Prior abdominal surgery may complicate an abdominoplasty (tummy tuck), but this would be unusual Prior breast surgery needs to be considered prior to breast augmentation and/or lift Extremities: excess edema, residual swelling may preclude a safe arm or thigh lift

16. Before and after photos are essential Allows a more critical assessment of the results when compared to the baseline Allows for a more effective review of postoperative results Baseline tissue symmetry Relocations of any scars present preoperatively

17. Fees shown here are clearly estimates and subject to formal consultation Breast and body contouring are not covered by insurance Total fees are inclusive of a number of different fees Procedure fee Anesthesia fee Facility fee Cosmetic insurance Specific covered events within 30 days from surgery Only expenses not covered in cost estimate are prescriptions costs and any imaging necessary for a specific circumstance

19. Most common Plastic Surgery procedure performed nationwide Results in fuller, firmed perkier breasts May be combined with a breast lift

20. Silicone versus saline implants Silicone gel implants FDA approved for cosmetic augmentation since 2006 More natural feel Less rippling than saline Slightly higher capsular contracture rates Slightly more expensive than saline Saline implants Good options if adequate tissue coverage Only option for patients less than 22 years old

21. General anesthesia Procedure takes about 30 minutes unless combined with a breast lift Risks include but not limited to: Loss of nipple sensation Hardening of the implant (capsular contracture) Bra for 6 weeks, full activity at 4-6 weeks

22. Fees are averages and inclusive of all expenses associated with the exception of mammogram, if needed, and prescriptions Silicone implants $6000 Saline implants $5400

23. Results in perkier breasts with improved shape Breasts will not be fuller Breasts may be somewhat firmer Different techniques based on degree of ptosis (deflation) Concentric Vertical Standard

24. ConcentricVertical Standard

25. General anesthesia Outpatient surgery Procedure takes from 1 to 3 hours Dissolving sutures Rarely drains Soft bra 4 weeks Can shower morning after Normal activity in about 4 weeks

26. These are estimated fees and exclude mammogram, if needed, and prescriptions Concentric mastopexy $3500 Vertical mastopexy $5400 Standard mastopexy $7000

27. My most favorite operation in the world! Removes significant excess skin and allows for tightening of the core Flat abdomen More narrow waist May be converted to an extended, or anchor, abdominoplasty if very significant skin laxity is present

28. Umbilicus not removed or relocated Often combined with liposuction of the hips for best contour of the midsection Sometimes performed as a Lower Body Lift if recontouring of the lateral thighs and/or buttocks desired

29. General anesthesia Outpatient procedure Surgery time 2-4 hours if not combined with other procedures Two drains, removed after about 5-7 days Risks include but not limited to: Pulmonary Embolism Seroma, hematoma, infection

30. Indicated for focal areas of retained fat that disrupts the contour of an area Best results when performed with adequate tissue elasticity Tissue must remodel, redrape to the new shape If tissue elasticity abnormal or altered…as is often the case post bariatric surgery…the result may be poor contour with exacerbated skin laxity

31. Standard abdominoplasty without associated liposuction $8600 Extended abdominoplasty (Lower body lift) without associated liposuction $10,800 Liposuction An area represents a specific body part: flanks, lateral thighs, medial thighs $1500 per area

32. Indicated for significant laxity of the lower face and neck Often combined with fat grafting to restore volume to the tissue lost with massive weight loss May be combined with laser resurfacing for extensive fine lines and wrinkles not addressed with redraping the tissues

33. General anesthesia Outpatient surgery Surgery takes about 4 hours unless combined with other procedures Risks include but are not limited to: Injury to nerves or other structures Skin loss, hematoma May be combined with eyelid or brow surgery

34. Routine face, neck lift $10,300 Blepharoplasty Upper eyelids $3000 Lower eyelids $5000 Quad blepharoplasty (upper and lower) $7000 Submental neck lift $6800

35. Brachioplasty Removal of excess skin upper arms Procedure takes about 2-3 hours General anesthesia, Outpatient surgery $7300 Medial thigh lift Removal of excess skin inner thighs Outer thighs and buttocks addressed as part of a lower body lift General anesthesia, Outpatient surgery Procedure takes about 3 hours $8900

45. Injectables Restylane®, Juvederm®, Perlane®, Voluma® General category of fillers Indicated to restore volume to folds, wrinkles Dysport®, Botox® Indicated to soften the action of contracting muscles that result in the appearance of wrinkles Cost determined by amount of product needed Fillers range from $300 to $800 per syringe Dysport® ranges from $150-$500 on average Fillers last on average 12-24 months and Dysport® 3-4 months

46. Using a patient’s own fat to restore volume to areas deflated by aging or weight loss Can be done as office surgery or in the operating room Face Midface, lips, lower lids Buttocks ‘Brazilian Butt Lift’

47. Facial rejuvenation with fat grafting without associated face lift generally performed in the office Premedication with Valium, if desired Nerve blocks for anesthesia Fees average $1500 Gluteal augmentation (Butt Lift) Done in the operating room, general anesthesia Fees range $4000-$5000

48. Treatment of lines and wrinkles not amenable to correction with injection of fat or fillers May be performed as a series of less aggressive office procedures ProFractional, Forever Young BBL™ More extensive, deeper wrinkles and sun damage may require deeper resurfacing Contour TRL Done in the operating room under anesthesia

49. May be coordinated with other procedures Face, neck lift Fat grafting Recovery related to depth of resurfacing Skin care to maintain rejuvenated skin is essential

51. One of the most frustrating aspects of massive weight loss is skin laxity If modest skin laxity is present, surgery to remove the excess skin not always necessary Clearly not an option for significant deflation or skin laxity

52. A minimally invasive technique to administer radiofrequency energy to the tissues The tissues natural response to heating is to contract May be used to tighten skin in many areas Neck Arms Abdomen Thighs Optimal results may take up to 6 months to appreciate

53. Procedure performed in the office Local anesthesia Offer Valium for premedication if desired Takes 30 minutes to an hour to complete Recovery largely uneventful No activity restrictions after 24 hours No compression garments Little to no bruising

54. Neck I had my own neck done…SO easy! $2500 Abdomen I treated my own abdomen… $3000 Arms $3500 Thighs $3500 (front or back)-$6000 (circumferential)