Gulfshore Life Column


Ask Dr.Fox

Dr.Fox answers questions about cosmetic surgery for body procedures.


Q: Dear Dr. Fox: My friend mentioned she had a minimal arm lift done by you last year. I have been looking at my arms and I cannot stand what I see. With summer approaching I do not want to wear sleeveless shirts due to my upper arms. I am pretty fit, I try to eat right and work out but I just can’t seem to tighten up my upper arms. How do I know if a minimal arm lift would work for me?

A:A minimal arm lift, or modern brachioplasty, has an incision in the underarm area, and it is mostly to tighten the skin located in the front part of the arm. The traditional brachioplasty addresses the excess tissue in the back of the mid-upper arm. The standard brachioplasty, or long arm incision, reshapes the under portion of the arms. This procedure is for excessive sagging skin that droops downward when the arm is extended. Either way, an arm lift is a rather painless procedure with a quick return to normal activity.


Q: Dear Dr. Fox: I have always wanted to get rid of the pooch I have on my lower tummy. Recently, I have started thinking about a tummy tuck to help me feel more comfortable in my skin. I was ready online that there is a procedure called a mini-tummy tuck, can you tell me how it differs from a regular tummy tuck and which would be best for me?

A: A tummy tuck, or abdominoplasty, reduces the tissues from both the upper and lower abdomen. I perform what is called a Brazilian abdominoplasty, which also cinches in your waistline giving you more of an hourglass figure. If your upper abdomen looks pretty good then we may be able to perform a mini-abdominoplasty, which only reduces tissues from below the belly button. It depends on the patient and how much fatty tissue and skin laxity is there. Sometimes combining a little liposuction to the upper abdomen with a mini-abdominoplasty is the patient needs for a beautiful result. My goal for my patients is always to choose the procedure that will make the most impact with the least expense and the shortest downtime. When we meet in person, I can tell you which procedure would be best for you.


Q: Dear Dr. Fox: I have what looks like a fat roll that is in front of my armpit by my bra. Is there anything that can be done about this?

A: That’s a very frequent complaint among women. Another common area of complaint is in the back above your bra line. Both of these areas can be quite easily remedied with some liposuction, and depending on the patient, some skin excision, which is hidden in the normal lines of your armpit. It is really a minimal procedure that will have you back to your normal routine quickly.


Q: I would like to get some liposuction done but there are so many different types I have read about and I do not know which one is best. What are your thoughts?

A: It does not matter if you use the cool lipo, smart lipo, power assisted lipo, or any other lipo modality; it is the surgeon using the machine that is the most important factor. Liposuction is not only about fat reduction, it is about contouring the body shape. For example, when I perform liposuction on an abdomen, I make sure the waist looks longer and leaner in addition to reducing the lower belly fat. Liposuction works very well for certain parts of the body such as the back folds, fullness around the bra line, love handles, and works great to shape the buttocks. Once the body shape is changed, it will remain changed even with weight gain. You will never gain in the same proportion as you did before. It is surprisingly simple and east post-operatively, you can return to normal activities in just a few days.


Q:  I am disappointed with what has happened to my body since I started menopause. I just do not have the same shape that I used to, and fat is depositing in areas it never did before. I have heard some scary things about liposuction and tummy tucks, but I think I will never be totally comfortable with myself if I do not do anything. I am still gaining weight and really want to stop this from getting worse. Help!

A: I applaud you for seeking to improve your life. Knowledge about both procedures will help you with your decision. Both procedures can be preformed safely. Liposuction is a rather simple procedure that, when performed in moderate amounts, it can be quite easy to heal from. In addition, both tummy tuck and liposuction can improve your cardiac health by reducing the fat around the middle, and tummy tuck is wonderful for easing back pain- not to mention looking better in clothing., which has enormous positive emotional effects. Sometimes plastic surgery is what is needed to break life’s habits. I know from my experience it is much more difficult to stay focused on a diet then when we were younger. Maybe there are too many great restaurants in Naples. We often find that our patients lose weight after a tummy tuck. Our patients all say that they are less hungry after they undergo tightening of their abdomen. Remember, we also tighten the waistline and bring you back to your youthful figure. Keep in mind that many people from Hollywood are not born perfect; some just have good plastic surgeons.


Q: Is there anything that you can do with these two problems I have? My love handles are not loveable anymore at 55 years old, and now I have “man boobs” Where muscle used to be. I have always been in fairly good shape and am not what you would consider fat at all. I think this runs in my family. I cannot tuck my shirt in anymore (thank goodness it is not in fashion now) and I have to wear at least one size bigger than I am to hide my chest. How significant of a procedure is this and what is the downtime. – Gary. M. – North Naples, FL.

A: Good news. Both areas can be taken care of by simple liposuction. The discomfort is little to none, and the down time is only is only a few days, although I have seen people go back to work in two days, I would suggest at least three or four days off. Once the fat is gone it does not come back in the same proportion. You also will not accumulate fat in other areas in abnormal proportion. I often see patients who desperately or intellectually need a change in their life. The most successful change is to change how we perceive ourselves. Our mind continually tells us negative feedback, “I’m old, fat, lazy, and not sexy anymore.” No matter how intelligent, strong minded, or skilled a person is it is rare to combat those labels we give ourselves. Even Oprah battles these concepts. If plastic surgery can quiet our negative inner voice by eradicating the superficial thing on our face and body that makes us less powerful, then plastic surgery is an important part of living life to the fullest.


Q: I really do not want to miss out on my golf and tennis game. How long do I really have to stop playing after I get a procedure?

A: Your question is so popular that is happens to be the first thing patients will say when I finished a procedure. “When can I play tennis of golf?” I answer that it will be usually faster then they expect. I have dancers, and avid athletes return as little as two weeks after most procedures. Some procedures do take an extra week.


Q: I am a single woman who stays in Naples for the winter months. I would like to get a tummy tuck; however, I really do not have anyone who can take care of me afterwards. How can I get the procedure with this limitation?

A: I set up my overnight stay so family members, friends, husbands, and boyfriends do not have to take care of you after surgery. I feel secure knowing that nurses are tending to my facelift and tummy tuck patients’ every need. We make the overnight stay very luxurious (although it is not priced that way), but it its main purpose is to make the postoperative experience stress-free and even enjoyable. Some of our patients have never experienced this level of nurturing (some do not want to leave and even stay a week). When I arrive in the morning to round on my patients, I always sit down with them. I smell Belgium waffles with fresh strawberries, coffee (decaf), and omelettes in the kitchen. Dinner is homemade organic chicken soup, wild salmon, organic asparagus, and maybe tiramisu for dessert.


Q: Let’s be honest. I need to lose weight. I am on the “see food” diet and cannot help doing the restaurant tour almost every other night. My middle and my husband’s middle are ever-expanding with good wine and good food. Should we do a tummy tuck or liposuction to help us from having to expand our wardrobe? I have told myself that 12 was my limit in size, but I think my buttons are struggling to hold everything in place. Help! I want something that lasts and gets me off this bad habit of living.

A: Tummy tuck is one of the most lasting procedures and, yes, most of my patients (over 95%) lose more weight after a tummy tuck. Because we tighten the middle as well as the waistline, the extra support seems to reduce appetite. In addition, a tummy tuck is usually only need once, so enjoying the benefits early is an advantage. If you need tightening of your skin and muscle layer, a tummy tuck is best for you. If you have solid strong muscles and excellent skin strength but excess fatty tissue, then liposuction is a great option. I find that 50% of my patients keep the weight off long-term with liposuction, and the patients who get back to the same weight later still have a better contour and shape in clothing.


Q: Dear Dr. Fox, My mother had major excess skin on the back of her upper arms. When I was little, I made fun of my mom and told her that she had wings. I do exercise, but it seems like my genes are working against me. Since I use commercial airlines, I have no need for my own “wings.” I have talked to a couple of surgeons, and they do not do arms. I never wear anything sleeveless because I am so embarrassed by my arms. Is there anything you can do to make them better?

A: I do not know why other surgeons do not perform arm-lift surgery or brachioplasty. I find that this procedure, especially in Florida, is very rewarding for lots of people, and in fact, I perform quite a lot of arm procedures. No one wants to alter the way you dress just to hide a body part you do not feel comfortable with. Arm-lift surgery or brachioplasty is an easy surgery with a minimal downtime that allows a quick return to normal activities. There are two types or of arm-lift surgery. A modern brachioplasty, which is an incision in the axilla or armpit area, is best for candidates without a lot of hanging tissue who need limited tightening. A standard brachioplasty used a longer incision to allow the surgeon to remove all the excess skin and tissue necessary so that you will be comfortable going sleeveless again. I would be happy to tell you which surgery would be best for you.


Q: Vacation time is coming soon, and I want to know how much time I need to recover after surgery. I have two weeks of vacation, and I think it would be a great time to get something done.

A: Recovery times differ depending on what surgery you choose. For a breast augmentation or even a tummy tuck, you really need a week off from work. For a facelift, in a slender women or man, one week may be enough, but usually recommend two week so that you do not have to be self-conscious. For procedures such as liposuction or arm-lifts, recovery is only a few days, although taking a few extra days for yourself is a nice idea when you are healing. The summer is one of our busiest times for surgery since many people like you have vacation time during the summer months.


Q: Dear Dr. Fox, Since 40 years old I have had ever growing back fat which I am so disappointed with. It seems that I also have extra skin. Can liposuction work on me even with all of this skin?

A: Good news! The back skin has a very thick dermis which means, after liposuction the skin retracts beautifully. I have seen women in their 70’s have nice smooth backs after liposuction. The procedure has a downtime of only a couple of days. And can be accomplished in less than an hour.


Q: A new lipo dissolving pill that is advertized on T.V. prevents you from needing liposuction. What do you think of it?

A: If it worked I’d be taking it myself!


Q: Dear Dr. Fox,  I can’t stand my arms. I am tired of wearing a ¾ sleeve.  My personal training hasn’t helped a bit. Help!”Sleeveless in Seattle”.

A:Arm lifts are a very rewarding procedure with very little down time.  There are two types of arm improvements that can be accomplished.  The first is an incision in your axillary area (under your arm pit) which improves how your arm appears from the front.  The long arm incision improves the excess skin and looseness of the arm and tightens the entire upper arm. Patients often come into the office for their post op visits wearing a sleeveless shirt, so you could be “Sleeveless in Naples”!


Q:  Dear Dr.Fox, My friend had a tummy tuck in Upstate New York and said that she feels more wide waisted now afterwards. Why is that?

A:If a surgeon only tightens in the midline for a tummy tuck, it then can compress the abdomen and make the waist wider. Think about what happens if you push a balloon that is sitting on a table. The balloon will spread out to the sides. If your friend’s surgeon only tightened in the midline, the remaining tissue will get squeezed out to the side and give you that wide waisted appearance. In order to avoid a wider waist after tummy tuck, it is essential to tighten not only the midline muscles but also the side muscles. This reduction in total volume of the abdomen also assists with weight loss after tummy tuck. By doing it this way my patients typically have anywhere between a one to four inch reduction in their waist lines and for women who have never had a waistline before, now have an hourglass figure.



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