Abdominoplasty - (The Kirn iTuck ®)

The Kirn iTuck® operation operation combines 3 advances in surgical technology to create an outpatient operation which achieves the contour difference obtained in standard abdominoplasty while seeking to minimizing pain and recovery time.

The iTuck® involves removal of excess skin, removal of excess fat, and tightening of the muscle layer of the abdominal wall. The iTuck™ also includes liposuction of the hips and the flanks as far as can be accomplished with the patient lying on their back as a standard part of the procedure without extra charge. Three technical innovations are incorporated into the iTuck® procedure:

1. NO DRAINS: Progressive Tension Sutures are placed internally in surgery to secure the skin back down to the muscle wall thereby eliminating the need for drain tubes. This technique also provides for maximizing the amount of skin removal and dramatically reducing, perhaps eliminating, seroma formation. Seroma is when fluid collects under the skin flap. Since Dr. Kirn began incorporating the Progressive Tension Suture technique in 2010, no seromas have occurred.

2. PAIN CONTROL: In the operating room, a long-acting numbing medicine, Exparel® (www.exparel.com) is placed into the muscle wall where it has been tightened, the perimeter of the zone of dissection, and the incisions. The purpose is to decrease pain in the immediate post-operative interval. The Exparel® lasts roughly 72 hours after surgery. It allows the patient to return to their home, or a local hotel room, comfortably after surgery rather than requiring an overnight hospital stay. By the time it has worn off, the soreness has usually decreased naturally and patients are able to control the majority of their pain without need of narcotic pain medication.

3. ENHANCED RECOVERY: The Ivivi SofPulse® system (www.sofpulse.com) is used postoperatively in the Kirn iTuck® . This battery operated device creates a very low strength pulsed electromagnetic field which decreases the inflammation normally following surgery. Less inflammation generally translates to less pain. The SofPulse® system has scientifically been shown to decrease inflammatory body chemicals in an objective, scientific, analysis. (Plast. Reconstr. Surg. 2010 Jun;125(6):1630-1. & Aesth. Plast Surg. 2008).

Nearly all Kirn iTuck® are performed at the Lexington Surgery Center as an outpatient procedure. A comfortable patient will be more comfortable at home than in a hospital. Also, the risk of exposure to hospital-type bacteria is minimized if the patient never enters the hospital.

Most patients can anticipate soreness for the first few days after the operation and should remain in a flexed position to decrease tension from the incision for the first two to three days. Patients who have jobs with low levels of physical activity can usually return to work in one week. Lifting heavy weights (>20 lbs.) should be avoided for six weeks after surgery.

In summary, the Kirn iTuck® enhances patient experience by combining multiple established technologies to maximize shape and make the recovery as easy as possible.

Liposuction

Liposuction is one of the most commonly performed cosmetic surgery procedures. It's easy to understand why since it provides a dramatic contour improvement through tiny incisions. Further, the recovery is rapid. As with all plastic surgery procedures, liposuction must be uniquely customized to your needs and goals. The only way to determine what is right for you is to come in for a consultation. Alternatively, a complimentary computer imaging session with Dr. Kirn's nurse can be very educational and provide a lot of useful information.

Dr. Kirn uses a state of the art power-assisted liposuction (PAL) system as well as the SAFE lipo technique. He has used the PAL system for several years and has upgraded the system as new technology became available. Unlike laser and ultrasound techniques, the PAL does not add energy or heat to which can injure tissue. The PAL makes more efficient use of each pass of the liposuction cannula which seems to minimize swelling and bruising. Also, it allows improved treatment of more fibrous body areas. SAFE lipo is a refinement of PAL in which two additional steps are added to enhance the quality and smoothness of the result. “SAFE” is an acronym with “S” indicating Separation of fat, which is the first step and uses a special cannula on the PAL to prepare the area for fat removal. “A” is for Aspiration, which is the normal process of liposuction, again using the PAL equipment. Lastly, “FE” stands for Fat Equalization. This is the third step and consists of passing the same cannula used for Separation through the treatment area to provide a final smoothing.

Liposuction incisions are ¼ inch or less in length. Every effort is made to locate them in natural skin creases to further decrease their visibility, however, that is not always possible. A good general rule is to anticipate one or two incisions per treatment area.

Dr. Kirn performs most liposuction procedures using general anesthesia at the SCA Lexington Surgery Center, which is an accredited outpatient surgery center. Our goal is to provide the best surgical outcome in a setting that insures maximum patient safety and comfort. Occasionally, a small area of liposuction can be performed in the office, when the procedure can be completed using local anesthetic only.

Most patients experience some soreness following a liposuction procedure, but this is usually very minimal. Therefore, most patients are back to their usual daily activities within 3-4 days after the procedure. Commonly, liposuction is performed on a Thursday or Friday and patients return to work on Monday. Patients are usually placed into a compression garment on the surgical table. The garment provides support to the treated areas during the first one to two weeks after the procedure. Some of the anesthetic fluid will leak out of the incisions for the first 48 to 72 hours. Patients usually notice a visible improvement in the contour of the treated areas within a few days of the procedure as the swelling resolves. It takes several weeks to get to the final result since the skin must retract to the new contour.

Liposuction charges are determined by "area." You must be alert to subtle differences when inquiring about surgical fees. For example, we consider liposuction of left and right hips to be a single area - not all surgeons take this approach. We usually plan to treat all of the desired areas in a single session. While this may result in a higher initial cost, it will frequently be less than multiple small sessions.

Mommy Makeover

Pregnancy, especially multiple pregnancies can result in undesirable changes in the breast and abdomen which cannot be corrected by diet and exercise. Therefore, after completion of pregnancy, many patients desire a restoration of their pre-pregnancy contour, or perhaps an improvement. Mommy makeovers almost always involve a combination of breast surgery and tummy tuck, but may also include liposuction of one or more areas.

The breasts undergo dramatic change with pregnancy. During pregnancy, and afterward if breast feeding is done, the breast gland increases in size. The skin envelope of the breast must increase to accommodate the larger gland and accompanying milk. Afterward, the gland shrinks and the milk dries up. The skin may or may not shrink back down. The breast size may decrease and the breast may have a droopy appearance. Surgical options to correct these issues include breast augmentation, breast lift or a combination of the two.

Pregnancy also impacts the abdomen significantly. As the baby grows, the abdominal wall muscles are pushed outward and apart to accommodate the increasing size of the uterus. Similarly, the skin must stretch. Significant weight gain usually accompanies this process as well. After the baby is delivered, a few months must be allowed for the abdomen to shrink down. Rarely does it return exactly to its pre-pregnancy shape. The muscles usually remain somewhat separated, and there is usually some extra loose skin and possibly some extra remaining fat. Muscle separation and excess skin can only be corrected with surgery. The Kirn iTuck™ abdominoplasty is an excellent choice to address extra skin, muscle separation, and fat. As with all of Dr. Kirn's procedures, the first step in a Mommy Makeover is a consultation to review your specific needs, outline the available options, and review computer imaging.

Body Contouring Overview

Body contouring is performed to achieve shape change in areas which have been resistant to diet and exercise. Body contouring can also be used to address undesirable shapes which have resulted from weight fluctuation or pregnancy. Dr. Kirn performs a wide variety of body contouring procedures ranging from power assisted liposuction, to the innovative Kirn iTuck abdominoplasty, to buttock and hand rejuvenation. The paragraphs below provide additional detail on these options. Always keep in mind that the first step to achieving your surgical goals is a consultation which will include a complete review of your options, discussion of the risks and benefits, and computer imaging to simulate possible surgical changes.

Body Contouring After Massive Weight Loss

More and more patients are achieving massive weight loss (MWL) either as a result of diet and exercise or surgical weight loss procedures. Following weight loss, time must be allowed for the patient's weight to stabilize and for the skin to retract as much as it will. Surgery to correct extra skin is usually performed no earlier than one year after a stable weight has been achieved.

The most common areas treated surgically after MWL are the neck, arms, abdomen, flanks, and thighs. As with all surgeries, the selection of and the procedure itself are tailored to the patient's needs and goals. Many patients require multiple procedures which are performed over months to years. Dr. Kirn prefers to keep all body contouring following MWL on an outpatient basis. Thus, a thorough planning session is conducted at the time of the initial consultation to determine the best ways to combine operations in a safe and efficient manner while avoiding the need for hospitalization.

It is important to ensure that the patient's nutritional status is good before proceeding with any surgery after MWL. Laboratory testing is usually required to confirm acceptable protein and electrolyte levels. Good nutritional status is necessary to ensure proper healing.

Following MWL, the neck is treated similar to the operation described in the FACE section. Treatment of the neck alone, as opposed to combination face and necklift is more common following MWL than with neck lift simply due to aging or hereditary reasons.

Arm Lift (Brachioplasty) is described in the section devoted to that topic.

Contouring of the abdomen after MWL can be performed using standard abdominoplasty techniques / the KIRN iTuck™ , or may involve a more extensive procedure depending on how much skin there is to remove. Some patients have extra skin in both the horizontal and vertical directions. For this circumstance, a vertical incision may need to be combined with the standard horizontal abdominoplasty incision. Known as a fleur-de-lis abdominoplasty, a T shaped scar results. From time to time, this operation is divided into two separate sessions, where the horizontal incision is performed initially, and then the vertical incision is added later if needed. Always, the goal is to limit visible scars as much as possible. Please see the section on Tummy Tuck for additional information.

Medial thigh lift is performed from time to time, but involves the most significant recovery period of any of the procedures following MWL, and thus is usually left until last. It is rarely combined with other MWL operations. Dr. Kirn performs medial thigh lifts using a vertical incision which runs downward along the inner thigh.

Buttock Augmentation / Buttock Lift

Buttock fat grafting, commonly known as the Brazilian Butt Lift (BBL) is a surgical procedure in which your own fat is transferred from other body areas to the buttocks with the goal of contour enhancement. Although similar to fat grafting in other body areas, the quantities of fat required for buttock enhancement are significantly greater. Multiple body areas must be liposuctioned to harvest enough fat for buttock grafting.

Buttock fat grafting, commonly known as the Brazilian Butt Lift (BBL) is a surgical procedure in which your own fat is transferred from other body areas to the buttocks with the goal of contour enhancement. Although similar to fat grafting in other body areas, the quantities of fat required for buttock enhancement are significantly greater. Multiple body areas must be liposuctioned to harvest enough fat for buttock grafting. Alternative treatments including buttock implants and buttock lift procedures have been around for many years. Historically, buttock implants have a multitude of potential problems associated with them and have never gained widespread use. Similarly, buttock lift procedures where skin is removed to pull the buttocks upward, are prone to unsightly scars and healing problems. Dr. Kirn does not perform either of these procedures. The BBL, by contrast, is a natural procedure which transfers your own fat to replace lost volume or add volume where it has not previously existed. A major bonus to the procedure is that the liposuction used to harvest the fat provides a further improvement of body contour. Fat may be taken from any body area suitable for liposuction.

A limitation of the BBL is that you must have enough fat located in other body areas to serve as donor material for the transfer. So, this can pose a difficulty for very slender patients. It is not possible to use fat from someone else, nor is there currently any practical man-made alternative. A consultation visit is the best way to determine if you are a candidate for the procedure.

Since BBL is a relatively new procedure in the plastic surgery world, the process is being refined in an on-going manner. A recent technical innovation has been the vibration-expansion concept. The power assisted liposuction system is used both for harvest of the fat and re-injection. Our practice has used the power assisted technology for liposuction since the late 1990's. The liposuction fat aspirate is collected in a sterile reservoir. Extra fluid from the liposuction is drained off. Then, the process is reversed. The power assisted system moves the cannula back and forth rapidly (vibration) allowing it to glide through the tissue more smoothly and with less trauma. For re-injection, a special flared cannula is used which gently spreads the tissue (expansion) to create a space for the grafted fat. A pump transfers the fat out of the sterile reservoir back through through the cannula into the buttocks.

As with other fat grafting procedures, not all of the transferred fat will survive. This is the most unpredictable element of the BBL procedure. Fat survival also tends to be an individual, patient-specific characteristic. Although the BBL is not capable or correcting cellulite or dimpling, they may be somewhat improved. The BBL is a contouring procedure intended to enhance shape or restore lost volume. Grafted fat is fragile and therefore avoiding pressure (sitting) on the buttocks is important for 2-3 weeks after surgery.

The presence of some large blood vessels in the buttock muscles adds an element of risk to this procedure which is not common with other fat grafting procedures. If fat inadvertently enters into one of these large vessels it can travel to the heart or lungs which can cause serious problems or death. As of the time of writing, BBL carries the highest mortality rate of any plastic surgery procedure.

Hand Rejuvenation

Hands can be more telling of age than the face or body. Thus, hand rejuvenation can be an important adjunct to an anti-aging program. Hands take on an aged appearance due to tissue volume loss as well as sun damage creating brown spots or other lesions. Volume loss makes the hands look excessively thin. The tendons and veins on the back of the hand become more visible.

Sun damaged skin is usually treated with a combination of skin care products and laser. The VersaPulse® laser is effective at treating brown spots and discolorations. Sometimes, cryotherapy (freezing) is used to remove other lesions related to sun damage.

Volume loss in the hand is treated similar to volume loss in the face either with fat grafting or dermal fillers. Dr. Kirn prefers fat grafting since the currently available fillers do not seem to hold up over a sustained period of time in the hands. Typically, fat grafting requires multiple sessions to achieve the desired result. Fat grafting results vary in term of longevity and the number of treatments needed. Both laser and fat grafting are performed in the office.

Arm Lift (Brachioplasty)

Some patients develop extra skin on the arms as a result of time, sun damage, weight loss, or as an inherited tendency. Treatment is determined according to the source of the problem. If there is extra fat only, liposuction alone may be sufficient treatment. Liposuction may be performed either limited to a specific area, or circumferentially around the arm. If the problem is extra skin, a brachioplasty is appropriate. This operation involves trading the extra skin for a scar on the arm. The goal of surgery is to place the incision in the most favorable location so that it is hidden while the arm is at your side. The scar usually extends from the armpit down to the elbow. As with all plastic surgery incisions, every effort is made to have the scar be a thin line. Ultimately, scar quality is strongly dependent on the patient's own body healing process.

Arm Lift is an outpatient procedure and generally does not involve significant recovery time. Tapes are usually applied to the incision and the patient may be asked to wear a compression garment or Ace wrap for a few days after the procedure.