Posts Tagged treatment
Reader Question: Help My Seroma Won’t Go Away!
Posted by admin in Dr D's Truth on March 8, 2013
I had a tummy tuck two months ago. Now I have a little water-filled “pouchie” above my couchie where the water waves move when I poke it. My surgeon says it is not a problem and will go away. Should I be worried?
A seroma is a lymph filled pocket in your soft tissues. We are most aware of them when they are just under the skin as they can demonstrate a “fluid wave” phenomenon when they are tapped. Larger scale surgery is more of a risk toward the formation of a seroma and tummy tuck surgery is included.
On the positive side, these things tend to resolve when small and wounds are newer. The longer they manage to persist, the greater the chance that they will not go away, but rather form a scarred in cavity that will tend to stay. In a worst case scenario they can require surgery to fix. Alternate treatments include draining them intermittently with a needle or with a drainage tube or injecting them with a chemical to encourage them to shrink or go away. Opinions as to how often or urgent treatment of a seroma is vary substantially. Left alone they can mar good tummy tuck results, so I like to deal with them quickly. My tummy tuck results have benefited by this policy by my way of thinking. I haven’t needed to re-operate to repair one in over ten years.
Seromas are best avoided. The best ways to do this involve the proper use of drains and compression garments after a large scale operation as well as tailoring that operation to be less risky.
Best Regards,
John Di Saia MD
Originally posted 2011-06-09 07:30:09.
Reader Question: Hard Breast Implants – Will Capsulotomy Help?
Posted by admin in Dr D's Truth on March 5, 2013
I had breast implants and they have become hard over the last few years. Will capsulotomy surgery help?
Breast implants can harden (actually the tissue around the implants can harden) resulting in distortion of the breasts and at times pain. We have discussed the problem (Capsular Contracture) here before.
Significant breast implant hardening does not complicate all breast implant patients, but when it does additional surgery is the only good solution. The process involves the formation of a “capsule” of scar surrounding the breast implant. At times this capsule has an elastic consistency and at other times it can be “studded” by deposits of calcium that make it really rock hard.
Surgery to soften the hardened breast can involve scoring the scarred capsule to release the tension (Capsulotomy.) When the capsule is quite firm or studded with calcium, more involved surgery is in order. Capsulectomy involves the removal of all or parts of that scarred capsule.
Whether either of these treatments will work depends upon the cause of the contracture. Usually the implants can be replaced, but in really severe cases they need to be removed.
What you really need is a good evaluation by an experienced plastic surgeon to figure your best course of action.
Best Regards,
John Di Saia MD
Related:
“What Do I Do With These Old Breast Implants?”
Originally posted 2011-07-06 07:30:03.
Reader Question: Hardened Implanted Breasts
Posted by admin in Dr D's Truth on December 20, 2012
I have had a capsulectomy due to capsular contraction, but now it has returned. I want an explant because they are uncomfortable and look unnatural. My doctor said that since the capsulectomy did not resolve the issue, he recommends having an explant and waiting about 6 months to a year. After my body has healed properly, he said that I can get implants again and will not get capsular contraction again. Is this accurate? Am I less likely to get capsular contraction or will I be free of capsular contraction? I’m also looking for a doctor experienced in explants.
The subject of hardened breast implants (Capsular Contracture) comes up frequently as it is the leading cause of long term dissatisfaction with breast implants. If your breasts tend to hurt or look unnatural, you likely have severe encapsulation (Baker Grade III or IV.) When contracture redevelops quickly after capsulectomy (assuming the operation was thorough,) this is worrisome as it may indicate a high tendency for recurrence. The main question when severe contracture is present is whether or not a cause can be identified. Bothersome contracture doesn’t happen to all patients. This kind of reaction is associated with cigarette smoking, bleeding, infection, silicone gel implants, poor soft tissue coverage and radiation exposure as well as a previous history of contracture. Some of these issues can be minimized in an attempt to reduce the tendency for encapsulation. Preventing the problem is the best solution.
While removal of your implants for a time with later replacement might improve the problem, this is not a “slam dunk” nor is it guaranteed to completely solve it. The results vary substantially. Usually removal with a good capsulectomy is the best thing for comfort. Implant replacement at times is thwarted by recurrence of the contracture.
Then again if you leave the implants in place things will not likely improve as you have had a trial of capsulectomy and replacement already. It is true however that a woman who has had her implants removed and not replaced frequently has them put in once again down the road due to appearance issues. This is not invariably the case however. Some women actually like the look of their breasts without implants after capsulectomy and explantation. The results of such surgery vary though.
These cases need to be handled individually and with a fair amount of disclosure before surgery is performed, so that everyone comes out satisfied. I don’t have one treatment that goes for all patients on the issue due to their inherent variability.
Best Regards,
John Di Saia MD
Originally posted 2011-05-31 07:30:35.
Reader Question: Acne Scarring Treatment
Posted by admin in Dr D's Truth on October 24, 2012
Hello, Dr Di Saia,
I’ve had acne for a few years (it is now almost completely gone) and I am now left with a few but noticeable facial scars. What is the best way to deal with them? What fillers would you recommend? Would a chemical peel or microdermobrasion be enough?? (I personally don’t think it would be). I am 19, by the way. Thank you for your professional advice!
Acne scarring is an extremely variable problem. The treatment depends upon severity and skin type. A single facial peel will likely not be enough to improve any, but the lightest of cases. You really need an individual professional evaluation regarding peels, fillers, and other surgical options as they pertain to your specific case.
Best Regards,
John Di Saia MD
Related:
Originally posted 2005-07-24 15:35:00.
Reader Question: Silicone Lips Treatment?
Posted by admin in Injection Hell on April 12, 2012
Reader Question:
My friend has ridiculous silicone (liquid injected years ago) lips. What can be done to help?
Facial filler injections are much safer today than they have been in the past. The main reason is that the filler agents themselves have improved. This of course assumes that your injector chooses wisely for you. The volume injected is the most common problem these days.
We still read of silicone injections and the mess they can produce. The main reason is that injected silicone tends to become encased in scar and these scar/silicone lumps frequently grow over time. This happens noticeably in old silicone injected in lips frequently. It is a hard problem to address although it can produce a story line for your reality show. Just ask Lisa Rinna. 
All kidding aside, the problem is usually addressed by excision (cutting out the silicone) if conceivable. This is not always possible due to the lack of healthy tissue available to reconstruct the lips to make them look normal.
The moral of this story is: “Just say ‘No’ to silicone injections.”
Best Regards,
John Di Saia MD
Top Searched Acne Treatments
Posted by admin in Medicine in the News on November 28, 2010
Top Searched Acne Treatments on AOL Search:
1. Proactiv
2. Differin
3. Tazorac
4. Benzaclin
5. Retin-A
6. Phisoderm
7. Minocin
8. Vibramycin
9. Zenmed
10. Triaz
“Top Searched” doesn’t mean “best.” Acne needs an individual approach in many patients. Proactiv works well in some patients, but can be over used. For those with sensitive skin, over use can actually make the acne worse.
Retin A works quite well too at the right dose and it went generic recently. Too much or too strong can again make the acne worse with sensitive skin. Low strength generic Retin A will run you 1/3 the $$$$$ and works very well even when used just a few times a week. Don’t use it when you anticipate a good deal of sun exposure in the next day or two as it can make your skin sensitive to sunlight.
Minocin and Vibramycin are antibiotics. Being on them for a long period of time is controversial particularity for the ladies.
Best Regards,
John Di Saia MD
Related:
Reader Question: Pitted Acne Scars – Punch Excision?
Posted by admin in scar surgery on September 30, 2010
Reader Question:
I live in the UK and I am considering punch excision on several pitted acne scars. However, I have read of many people having bad results, such as ending-up with larger scars/holes than before. My main scar is approximately 5mm by 4mm and approx 1.5mm deep. Is is practical to try and improve this size scar with punch excision?
Acne scarring can be improved by various peeling procedures except in areas in which deep pits have developed. For these pitted areas excision and closure is the best treatment. For some reason the term punch excision has become preeminent. A “punch” is a biopsy forceps that removes a core of tissue in the shape of a cylinder. For a small narrow scar this could be used as a removal device, but doesn’t address the bigger issue of closing the wound. It also provides little help for larger pits. Use of a punch for this depressed scar would not be helpful.
By the looks of your image, I would think a small scar revision with a small buried suture would likely work best.
Best Regards,
John Di Saia MD
Related:
Reader Question – Post-operative Constipation?
Posted by admin in breast implant pre-op tutorial on April 29, 2010
What do you do for post-operative constipation?
After any surgery involving anesthesia and post-operative narcotics, patients are often constipated and at times nauseated. Most cosmetic patients have not had internal abdominal surgery, so dehydration and narcotics are usually the reasons.
I tend to advise taking it easy on the narcotics if possible. Adding Psyllium, a natural fiber laxative, with liberal water intake can relieve things without the need for anything more harsh. If you are under the care of another surgeon, you shouldn’t add anything without letting him or her know.
One of the reasons I am so fond of pain pumps for tummy tuck patients is to reduce their need for narcotics after surgery. This really diminishes constipation.
Best Regards,
John Di Saia MD
Dr D – Your Orange County Surgeon
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