How is a Nipple Areolar Reduction Surgery Performed?

The surgery you're observing is a nipple areolar reduction (nipple lift surgery). This is for a young patient who has larger, widened areolar tissues, and wants a smaller areolar size (periareolar mastopexy). In order to do this, we remove the excess areolar skin and then elevate the breast skin in a circumferential manner around the areola so it's loosened. Then I use a suture called a GORE-TEX Suture that is extremely strong and versatile and does not stretch. I use this in a "cartwheel-style" pattern and cinch it in to reduce the size of the areola. The entire breast tissue will come in and you will get a really nice, small areolar diameter.

Nipple Areolar Reduction Before and After Photos

7 Questions from RealSelf, Answered

Board certified plastic surgeon Dr. Usha Rajagopal performs dozens of different procedures every week. Patients come to her with questions about every stage of treatment: from preparation to recovery.  This week we’ve gathered some commonly asked question taken from RealSelf.com.

RealSelf.com is the definitive community for cosmetic surgery, plastic surgeon review, and procedure referrals on the web. Through RealSelf.com, Dr. Usha extends her expert knowledge to help everyday people better understand cosmetic surgery.

Today, Dr. Usha briefly answers 7 questions from the site, ranging from injectables to liposuction, to labiaplasty and more.

Question 1: Botox vs. Kybella in Jaw and Chin?

I had wanted to get Botox on my chin/ jaw area to make it appear more defined. I was wondering if this would remove any fat around that area. Would Kybella be a better option? I have very slight fat around (these areas), I just wanted it more defined. Thanks!

Dr. Usha: Both products work well for various indications in this area. Kybella is very effective in dramatically defining the jaw by removing bulk in the submental (double chin area) as well as jowl areas. Botox works well in narrowing the jawline in patients with square jaws. I have also found Botox very effective in redefining the jaw and neck area of older patients by treating the Platysmal bands of the neck in a procedure called "Nefertiti Lift."

Question 2: Labiaplasty Recovery: How Long Does It Take?

How long is the typical recovery period for Labiaplasty? What can I expect during the recovery period?

Dr. Usha:

  • You will generally need 3-4 days at home to recover.

  • Take Tylenol or the pain medication prescribed by your plastic surgeon to relieve your pain/discomfort. DO NOT take aspirin or ibuprofen because they can increase bruising and bleeding.

  • Shower the day after surgery.

  • Clean the incision site with hydrogen peroxide and put antibiotic cream/ointment on daily.

  • Your stitches should dissolve within 2-2 ½ weeks.

  • Swelling and tenderness should disappear within 6 weeks.

  • It will take between 6 months to a year before you will see the absolute final results.

Question 3: Should I Try to Lose Weight Before Liposuction?

I have scheduled my liposuction in about a month. I weigh approximately 142 lbs now, and am 5'4''. Should I maintain my current weight or try to lose a few pounds between now and then? I have been trying to lose weight and I'm not sure how much weight is even possible for me to lose in a month. Thanks!

Dr. Usha: If you plan to lose a significant amount of weight (30lbs or more) then it is a good idea to do this prior to surgery. If it is more like 5-10lbs, it will not make much of a difference to do this prior to or after liposuction.

Question 4: Can the O-Shot help with Urinary Incontinence?

Dr. Usha: The O-Shot procedure can treat both stress and urge urinary incontinence for 90% of women, while increasing lubrication in the vagina. Many women experience uncomfortable vaginal dryness and urinary incontinence caused by aging, pregnancy, menopause and other medical conditions.

Urinary incontinence can affect women of all ages, but the issue is most prevalent among older women. Another benefit of these injections are more youthful and smoother looking vaginal lips. Femilift is another non-surgical procedure that helps with urinary incontinence.

Question 5: How long will PRP for Hair Loss take to see the results?

Dr. Usha: You will start to notice results in about 4 to 8 months after your PRP hair regrowth procedure. This follows the normal hair growth cycle. With six to twelve months most patients will see remarkable improvement in volume and quality of their hair growth

Hair continues to thicken the next 12 to 15 months. And results can last for months or at time even years.

Question 6: Do You Lose 50 CC's with Behind the Muscle Silicone Implant Placement?

I am getting silicone breast implants on Friday and am really scared of going too big. I am currently a "B"; I want to be a "C". I have chosen 350cc in hopes they will look like the 300-325 implant I tried at my doctor's office.

Dr. Usha: Placing any breast implant below the muscle will cause the implant to loose a small amount of projection. Though the exact amount isn't quantifiable, your estimation is reasonable.

To choose a breast implant, place the implant in your bra. When the implant feels a little too big, you've probably found the right size.

Question 7: Is It Normal to Be Swollen and Hard After 2.5 Months Post Liposuction on Abdomen?

I had liposuction on abdomen 2.5 months ago. The swelling has gone down a little and it is not too tender now. I still have problems with numbness sensation in my abdomen. My abdomen also feels a little hard. Is this normal? When will most of the swelling go away? ...Is there something wrong?

Dr. Usha: It is completely normal to experience numbness and firmness in the area of the body where liposuction was performed.  When undergoing some sort of trauma to the tissue, the body naturally develops scar tissue which can feel firm and numb to the touch.  

Over time (generally 4-6 months), these areas will soften and sensation will return.  Massaging the scar tissue is one way to speed up the healing process.  I have my patients start doing daily massages about 1-2 weeks post op.  If self-massaging isn't enough, ultrasound massage treatments may be an option.

If you have additional questions about any of the procedures covered in this post, contact our office to schedule an appointment. Dr. Usha is a skilled specialist in vaginal rejuvenation procedures and has served the Bay Area for over 20 years. Book your free consultation and evaluation with her today.

Dr. Rajagopal is a RealSelf Top Doctor

The RealSelf Top Doctor (TOP) is a recognition awarded to less than 10% of doctors on RealSelf. This status is earned by achieving high patient satisfaction (as reported in RealSelf reviews), getting favorable feedback on their expert answers, and after investing significant time in Q&A and other doctor activity.

Realself Q&A: Will Pregnancy Ruin my Breast Implants?

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Dr. Rajagopal's Answer on RealSelf:

When you become pregnant, your breasts go through changes due to the hormonal fluxes in your body—they enlarge, and sometimes change shape. In some rare cases, these changes are permanent, and pregnancy can actually leave you with fuller breasts. Generally, however, these changes are temporary, and last only until you have stopped breast-feeding your baby, after which point your breasts will go back to a smaller size. When this occurs—especially if your breasts changed size significantly during your pregnancy—you may develop stretch marks or lose breast tissue and experience sagging when your breasts return to their former size.

While such changes are obviously not very appealing, breast implants do not really have any bearing on the extent to which sagging or stretch marks will occur. Such side effects can manifest whether or not you have had breast augmentation surgery—across the board, plastic surgeons agree that implants do not tend to cause complications or exacerbate the aftereffects of pregnancy upon your breasts. Stretchmarks, for instance, are genetically linked, so implants will not increase your chances of getting them unless you are already prone to developing them. Furthermore, breast implants should not impair your ability to breast-feed: augmentation surgery can be done without affecting how your milk ducts or nipples function.

The effect that pregnancy has upon the breasts varies from woman to woman, making it difficult to predict exactly how your breasts will look afterward. A number of factors—including your age, your inherent skin quality, whether or not you’re a smoker, and the extent of your breast tissue enlargement—play a part in determining the end results of pregnancy in an individual; you won’t really know what’s going to happen until you are no longer lactating. Keep in mind, however, that what kind of implants you have makes a difference. Subpectoral implants—implants that are underneath the muscle in your chest—are supported and buffered by the muscles surrounding them, so the changes to your breast tissue do not affect them. Subglandular implants, however—implants placed above the muscle in the breasts—rely on the breast tissue itself for support, and so are more likely to fall after pregnancy. On a more positive note, if you are someone who has a particularly tight skin envelope before your pregnancy, the stretching that you’ll experience when your breast size increases may actually be beneficial—it can actually make your breasts look more natural afterward.

If you haven't gotten your breast implants yet and plan to have a baby soon, your doctor may advise you to wait until after your pregnancy to have surgery done, since it’s impossible to know exactly how your breasts will respond to pregnancy until you’re going through it. Also, if you experience extreme changes in breast size during pregnancy and while breast-feeding, you may want to consider getting some work done post-pregnancy if your breasts don’t return to a size and shape you’re happy with. If this occurs, consult with your doctor three to six months after you stop lactating to find out if this is a step you should take.

Dr. Rajagopal is a RealSelf Top Doctor

The RealSelf Top Doctor (TOP) is a recognition awarded to less than 10% of doctors on RealSelf. This status is earned by achieving high patient satisfaction (as reported in RealSelf reviews), getting favorable feedback on their expert answers, and after investing significant time in Q&A and other doctor activity.

Love Your Upcoming Look With Vectra 3D

Thinking about going under the knife? You’re not alone.

Hundreds of people opt to undergo popular surgeries like tummy tucks and breast augmentations each day. However, though there are 15 million different procedures completed in the US each year, you may still wonder how a procedure might look on you.

While it can help to have a doctor present photos of someone else’s surgery, what about yours? Each person’s body has shapes, pigments, and contours unique to themselves. Even after a face-to-face consultation, many find a typical 2D “preview” of a look isn’t enough to clear the fog of prospective surgery.

This is why one of the most frequently asked questions in our office is simply “what will I look like after my surgery?”

Patients like you want to know their outcomes before surgery, not after. While there’s no absolute way to project the future, new technology has made this more possible than ever. Introducing the powerful 3D Vectra XT imaging system, available at our Center.

What Is Vectra?

The Vectra imaging system, by Canfield Scientific, Inc, is revolutionizing the pre-surgery experience. It uses cutting edge technology to capture and digitally manipulate high-resolution images of your body.

With the Vectra, each 3D image captured uses your real dimensions, proportions, shapes and skin tones. It provides patients an in-depth way of previewing surgery like never before. Vectra is the tool of choice for patients seeking a breast augmentation or facial procedures such as rhinoplasty.

The digitization process takes only a few minutes. Vectra is an all-in-one system designed to capture the face, breasts, and body. With Vectra’s advanced software, your doctor can propose and demonstrate treatment plans: not to mention highlight areas of change.  

A few features of the Vectra include:

  • Automated Measurements - Experience accurate simulations of your real body

  • 360° Body Images - View your operation from every angle

  • Before and After Overlays - Compare the future to the present all at once

  • Dynamic Soft Tissue Modeling - Simulate the look and gravity of an implant

  • Simulated Body Contouring - See body volume change after surgery

  • Complementary Procedures - Preview multiple procedures at the same time

Why Choose Vectra?

While features speak for themselves, the results speak louder. Our patients feel empowered and have peace of mind with Vectra imaging. Some of the incomparable benefits of Vectra over traditional 2D imaging include:

  • Precision Planning: Take the guesswork out of the preparation equation. Detailed images can be used by your doctor to outline a plan of action for your individual procedure.

  • Clear Communication: Stay on the same page as your doctor. Ensure you have the same results in mind with detailed, demonstrable before and after simulations.

  • Multiple Outlooks: Compare your options before moving forward. View and compare different procedures/implant combinations to choose a look you’ve always wanted.

  • Informed Decisions: Make your decision with the ultimate resource. Choose to undergo surgery with the latest technology, with information tailored to you.

  • Satisfied Expectations: See the look before you leap. With an accurate preview of your body, you can love your upcoming look before it happens.

It’s 2017. You don’t have to expect the unexpected when it comes to life changing surgery. Check if your cosmetic surgeon has a 3D Vectra scanner. If you would like to read more about Vectra’s scope of power visit the Vectra website and click here.

At the Plastic Surgery and Laser Center, we carry a 3D Vectra XT for full body projections. Our Vectra is capable of scanning face and body for many procedures. Dr. Usha is a pioneer in female-specific procedures, including labiaplasty and breast augmentation. We use the newest in medical technology in all our procedures.

For more information about Vectra or to schedule an appointment with Dr. Usha click here.

Hair Loss: 5 Paths to a Full Head of Confidence

In today’s media-driven world, all attention is on the face. And yes, the area right above it.

Hair loss is an issue for men (and women!) of all backgrounds and ages. Male pattern balding affects tens of millions of men in the United States alone. 33% of American men begin to show signs of balding before the age of 35; while a staggering 40% of women show hair loss before 40.

It can be devastating to lose the defining feature of health and youth. There are several ways thinning hair affects the average person. These include changes in:

  • Confidence
  • Sex Appeal
  • Ability to Style
  • Appearance of Age

You may try to mask issues with hairstyles or with hats and caps. But many seek more permanent solutions, other than doing away with it allIf you’re man or woman who’s confused about the solutions out there, here’s news: you’re not the only one. The age-old problem of hair loss hasn’t changed in history (though the treatments have!).

Today, there are more options than ever before. These include a swath of natural supplements, drugs, lasers, transplant techniques and regrowth treatments. It can be difficult to navigate through each type. Here are 5 popular treatments (along with a healthy lifestyle) that can well put your hair back in your hands.

1.) Propecia (Finasteride)

Originally designed to prevent prostate cancer, Propecia comes with a beneficial side effect of hair loss prevention. Finasteride is the first drug in history to treat male pattern baldness. It works by blocking the production of a male hormone in the scalp (DHT) that shuts down follicles that cause pattern baldness. Careful though, Propecia is a committed treatment and isn’t for women. Once you stop taking Propecia the hair you’ve retained with the drug will be lost within 3 to 8 months. Side effects may include loss of sexual desire or impotence.

2.) Minoxidil

The most well-known hair loss medication is Rogaine, which uses minoxidil. It’s the only FDA-approved drug for the condition other than Propecia. There are oral and topical applications of the drug. Minoxidil both slows the progression of hair loss and promotes the growth of new hair. It works by widening blood vessels, allowing more blood, oxygen, and nutrients to reach follicles.

This is also a lifetime-use treatment. Once you stop using a minoxidil product, your hair will thin at the same rate as before. Side effects include shedding, unwanted body hair growth, itching and allergic reactions. Often Propecia and minoxidil products are used in tandem to treat hair loss on dual fronts.

3.) Laser Light Therapy

Laser treatments come in several forms, including professional laser light treatments and at-home devices. Laser therapy applies photons to tissue helping to revitalize weak cells. Some devices stimulate blood flow which may promote new hair growth. It’s not a direct baldness solution; light therapy has shown to maintain hair for some. And there are critics questioning its effectiveness. A benefit of using a laser light is that the side effects are minimal and these can be used in conjunction with other treatments.  

4.) Hair Transplant

Hair transplants are a well-established, long-term answer to baldness. There are two types of hair transplants: follicular unit strip surgery and follicular unit extraction. Both move hair from one part of the body to another. Strip surgery transplants a strip from the back of the head. The unit extraction method moves grafts of smaller sections for transplant. Once hair is moved it will begin to regrow as usual over time. Downtime for transplants ranges from 3 to 10 days. The risks include bleeding, scarring, infections, unnatural hair growth, and dying follicles. Healing can take months and you may need several transplants for full coverage.

5.) PRP + ACell

PRP (platelet-rich plasma) + ACell injections is a new technique used to treat baldness through follicles and hair roots. This treatment is two part. ACell slows down thinning by providing a structure hair follicles can build upon. PRP, often used in sports medicine, amplifies natural healing. This may promote new hair growth and slow hair loss when applied to damaged hair follicles. Injections are composed of factors from your own blood: so risks are low and there is zero downtime.

A downside of ACell + PRP is that it’s an advanced technique not available everywhere. Treatments typically last a year. We offer this treatment at our Bay Area location.

Visit San Francisco Plastic Surgery and Laser Center’s PRP + ACell for Hair Regrowth page for more information about this procedure.