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The horizontal mastopexy goes by many names, including the “Horndesky Method” and “Ultimate Lift.” This technique enables surgeons to create a new position for the nipple without leaving a vertical scar from the areola to the breast crease. Instead, a horizontal incision is made across the entire breast above the areola, and the surgeon excises the skin below it while preserving the nipple.
Most doctors on RealSelf say that a good compression garment is essential to minimize swelling and bruising, help the skin smoothly adhere to the underlying tissue, and speed up healing; but some don’t think it’s necessary. Doctors who recommend compression garments often have patients wear them 24/7 (with a break for showering) for at least two weeks and then gradually reduce the number of hours they need to be worn over a period of three or more weeks. As a bonus, doctors say, compression helps ease discomfort. Follow your doctor’s instructions.
Liposuction evolved from work in the late 1960s from surgeons in Europe using techniques to cut away fat, which were limited to regions without many blood vessels due to the amount of bleeding the technique caused. In the mid-1970s Arpad and Giorgio Fischer created the technique of using a blunt cannula linked to suction; they used it only to remove fat on the outer thighs. Yves-Gerard Illouz and Fournier extended the Fischers' work to the whole body, which they were able to use by using different sized cannulae. Yves-Gerad Illouz later developed the "wet" technique in which the fat tissue was injected with saline and hyaluronidase, which helped dissolve tissue holding the fat, prior to suctioning. Lidocaine was also added as a local anesthetic. Fournier also advocated using compression after the operation, and travelled and lectured to spread the technique. The Europeans had performed the procedures under general anesthesia; in the 1980s American dermatologists pioneered techniques allowing only local anesthetics to be used. Jeffrey Klein published a method that became known as "tumescent" in which a large volume of very dilute lidocaine, along with epinephrine to help control bleeding via vasoconstriction, and sodium bicarbonate as a buffering agent.
Other variables affecting price of liposuction include the 1) experience of the surgeon and 2) geographic location of the surgeon. An expert liposuction surgeon who has done thousands of liposuction procedures, who consistently achieves outstanding results, and who is in great demand, will often charge more than a less experienced surgeon. Surgeons who are not busy may offer discounts, or entice prospective patients by offering free consultation. Surgeon’s who have had unhappy patients and who do not have a good reputation might also lower liposuction prices in order to attract new patients. In geographic areas where rents and labor costs are high, one can expect higher prices for liposuction.
Surgeons who concentrate on one specific procedure are rare. In other words, you don't find many surgeons who perform breast augmentation, but not face lift surgery or liposuction. If you want liposuction, you should choose a surgeon who devotes a lot of their time to liposuction and body contouring. If the doctor is mainly a face lift surgeon, you might wonder if they are actually capable of providing the best results. Don't be afraid to ask a prospective surgeon how often they perform liposuction, how often they perform revisions for patients whose initial surgeries were performed by other doctors, and details about the surgeon's policy concerning surgery performed to correct his or her own work.
At first, liposuction results may seem minimal. This is standard, as swelling and bruising can obscure the final effects. Skin in the treated area may also appear loose, as it takes time for your body to adjust to its new, slender shape. Most physicians will ask the patient to wear a compression garment to aid in recovery. This will help reduce the long-term effects of post-liposuction swelling, bruising, and scarring.
Any licensed physician can perform liposuction, but it's usually performed by plastic surgeons and dermatologists in their offices with local anesthesia, though it may be performed in a hospital under general anesthesia. No special training is required, though some doctors' professional associations recommend it. When choosing a doctor, you may want to consider whether they have had specific training for liposuction and how many they have performed.
Because of the large pattern of skin cutout with the Inverted T scar (Wise-pattern) the scar complication can look really bad. Here is a photo of one of these wounds using this surgical technique. Although it is not a life threatening problem, this wound complication at the incision location could certainly look very scary to the patient. In addition to scars, this procedure also tends to flatten the breast, instead of making them perky. I no longer perform this technique in my practice as I feel that the other surgical techniques are far superior.