Following a considerable weight gain often involving 50 to 100 lbs. or more, the skin becomes quite stretched out with associated disruption of elastic fibers. If there is a subsequent substantial weight loss, the outcome will be an excess of skin with little elasticity that just hangs down like a hammock or even bat wings. Not a pretty sight!

Arm lift candidate - right side

Arm lift candidate - right side posterior view

Arm Lift Candidate - right side

Arm lift candidate - left side

A brachioplasty is the surgical procedure that is employed to excise the excess skin and recontour the upper arm in order to obtain a more desirable appearance. It typically involves a T-shaped scar extending from the arm pit (axilla) to the elbow but it can be extended onto the forearm if there is excess skin here as well.

The arm lift surgery can be performed both by itself as well as with various other procedures including a breast lift, breast reduction, liposuction, and even other massive weight loss corrective procedures such as an abdominoplasty and “belt lipectomy”.  Postoperative discomfort is usually fairly mild – more of a tightness sensation. The outcome is usually quite dramatic.

Before arm lift surgery - right side

After surgery

Before arm lift surgery - left side

After surgery

If you would like to obtain additional information on arm lift surgery or on other massive weight loss body contouring surgery procedures such as a tummy tuck, belt lipectomy, and thigh lifts, you can contact my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

The following 62 year old patient underwent a prophylactic mastectomy with breast implant reconstruction 25 years ago (specifically called a subcutaneous mastectomy) due to a strong family history of breast cancer. This was followed by multiple procedures over the years in attempts to improve the outcome. She consulted with me because of the chronic and substantial pain that she was experiencing in both breasts, their extreme hardness as well as the significant and problematic deformities of appearance.

Prior to breast revision surgery - frontal view

Following breast revision surgery - frontal view

Before breast revision surgery - oblique view

Following breast revision surgery - oblique view

Before breast revision surgery - side view

After breast revision - side view

After breast revision surgery

Before surgery

In her photos you can appreciate the marked asymmetries of shape, contour and implant position with the right side being situated too high. The skin has extensive irregularities and folds and in areas is quite thin. Her nipples also are too low relative to the breast mounds creating far too much fullness higher up.

Her breast revision surgery consisted of meticulous removal of deforming scar tissue known as a capsulectomy, reshaping of the breasts and placement of AlloDerm® (a regenerative tissue matrix – dermal grafting material) in both sides for support, contouring, durability and increased tissue thickness. Appropriately configured and sized implants replaced those that were present.

The outcome of all this were significant improvements in the appearance of her breasts for which the patient was extremely happy and quite thankful. It also boosted her self-confidence tremendously.

If you have any questions regarding breast revision surgery, breast reconstruction or any other plastic surgery procedure that I perform or if you would like to schedule a complimentary consultation with me, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

Women don’t have a monopoly on the desire to look the best they can. Men want to look good as well at least as regards certain areas. That is one of the major reasons men exercise and work out – having some nice pecs can do wonders for one’s ego, pride and attractiveness to women. Conversely, enlarged, feminized breasts can be the source of tremendous anxiety, self-consciousness and doubt.

The photos below show a typical case of gynecomastia in a 30 year old man – both before and after surgery which was performed using ultrasonic assisted liposuction. Some men may present with much larger breasts; others with just focal areas of involvement.

Gynecomastia. Frontal view before

Gynecomastia. Frontal view after

Side view before surgery

Side view after surgery

Oblique view before gynecomastia surgery

Oblique view after gynecomastia surgery

As you can see from these photos of gynecomastia and its treatment, the outcome can be very natural appearing masculine breasts with little tell-tale signs of surgery. This patient was extremely happy and appreciative of his results which had a positive impact on his daily life.

If you would like some additional information on male breast reduction surgery for the treatment of gynecomastia, on liposuction for other areas or to schedule a complimentary cosmetic consultation with me, you can contact my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

A variation on this theme involves cosmetic surgery being performed in this country by individuals who are unlicensed, may not even be formally trained or who may be enterprising illegal aliens individuals who exploit their own ethnic community in order to make money. At times, this can be a difficult deception to discern especially for those who are not well educated or at least versed in what to look for or inquire about. These practitioners often lie about their credentials, licensure and experience and may even operate out of a store-front or their home and under the radar.

Such was the case involving two sisters of Mexican descent who were running an illegal cosmetic filler practice in Sylmar, California. Their injection of liquid silicone into the buttocks of a perfectly healthy 22 year old Hispanic female in July lead to her needless death – a horrific but not rare tragedy that can be perpetrated by these illicit operations. The women who performed the injections fled to Mexico.

Deciding where to seek plastic surgery is very important and should be taken seriously – and not just for a breast augmentation, tummy tuck, rhinoplasty or even liposuction – but also for injectables such as Juvederm®, Radiesse® and Botox®. Your decision should be based primarily on qualifications and reputation and then secondarily on price. Though there is never any guarantee of outcome, make sure that the physician that you are considering is either board certified or board eligible by the American Board of Plastic Surgery and is a member of the American Society of Plastic Surgeons (ASPS) which has rigid ethical standards. (I am both board certified by the American Board of Plastic Surgery and am a member of the ASPS.)

If you have any questions regarding my qualification or certifications in plastic surgery or on any cosmetic surgery procedure that I perform or to schedule a complimentary consultation with me, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

Many theories have been advanced to explain this burgeoning of breast volume but there is no one definitive answer. Some feel that it is related to the improved general nutrition in experienced by women during this period of time including increased intake of fruits, vegetables and most importantly, proteins. Others ascribe this change to estrogen and other substances in our foods and environment including hormones injected into poultry and livestock and even from the BPA in plastic bottles. Birth control pills do facilitate an enlargement of the breasts but only in those who are taking them – so this doesn’t explain the global changes that have developed.

During this same period of time that the average size of women’s breasts has significantly enlarged, women have also increased the desired size that they ultimately want their breasts to be.

What are the results of all of this?  More women than ever are desirous of a breast augmentation. Seemingly ironic, at the same time and as a result of other factors as well, more women than ever are undergoing breast reduction surgery. This may seem totally confusing and conflicting but it really does make sense. I have seen these trends in my practice over the last 23 years.

If you would like more information on breast augmentations, breast reductions or on any other plastic surgery procedure that I perform or to schedule a free cosmetic consultation with me, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

Scar revision is the generic term for the surgical approach that is aimed at improving the appearance of these scars and possibly also removing their untoward functional effects. The procedure can improve aesthetics and function but despite the misconception held by many, it will not make the scars disappear in their entirety. Once a scar, always a scar.

Scars can be wide, depressed, elevated, dark, and painful and even affect function such as causing a contracture at a joint. In its most common form, a scar revision would then entail the total or partial excision of the affected area and precise closure of the created defect possibly along with some ancillary techniques. Depending on the multiple factors such as size, location, complexity, health status and age, the procedure may be performed using a local anesthetic, sedation or even general anesthesia.

I see and treat a tremendous number of patients in my practice who present with a wide spectrum of undesirable scars. These include run of the mill wide or elevated scars, thick and symptomatic hypertrophic scars, keloids and burn scars. The improvements in appearance following scar revision can be quite dramatic and satisfying.

If you have any questions regarding scar revision, treatment of burn scars or keloids or any other plastic surgery procedure that I perform or if you would like to schedule a consultation with me, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

The goal for a mastopexy should be to sculpture a natural appearing breast with a conical shape where the nipple-areola complex is situated at the most projecting portion of the breast. Significant deviations from this detract from the result and can lead to understandable dissatisfaction with the outcome. The technique that provides the most flexibility and precision for contouring and rejuvenating the breast three dimensionally as well as appropriately positioning the nipple-areola complex is the anchor shaped approach.

With the periareolar technique(also known as circumareolar, donut or purse string mastopexy), the lift, contouring, removal of excess skin and repositioning of the nipple-areola complex are all performed by essentially creating a donut shaped defect and purse stringing it closed. Clearly, this doesn’t allow for nuanced three dimensional correction. Furthermore, it creates an abnormal flatness precisely where one isn’t desired – where the nipple-areola complex is located and where the most projecting part of the breast should be. Common sequelae of the donut mastopexy are also wide, dysaesthetic scars, abnormally shaped and flattened areola and the appearance of pleats emanating from the areola outwards.

A vivid illustration of these issues can be seen in the photos below of a 36 year old woman who sought my help in consultation for the correction of her suboptimal results. She had undergone a periareolar mastopexy with implants by another plastic surgeon and was extremely unhappy with the outcome. Particularly problematic for her were the prominent scars, irregularities of the areolas and the overall breast shape. Had an anchor shaped scar mastopexy been chosen and performed well, it is highly probable that the outcome would have been far superior.

The results of a periareolar mastopexy performed by another plastic surgeon. The scars around the surgically deformed areola are extremely prominent, wide and unacceptable. Note the pleating effect - lines in the skin radiating outwards from the areola.

The scars from the donut mastopexy are quite apparent from virtually all angles. The flattening effect created by the purse string technique is well delineated in the right breast in this view. Rather than having a perky, conical shaped breast the result here is an abnormal, flattened, underprojecting one.

Unattractive and unacceptable scars on left breast from the donut mastopexy

Associated donut mastopexy scars on right breast

If you have any questions regarding breast lifts with or without a breast augmentation or on any other plastic surgery procedure that I perform or if you would like to schedule a complimentary consultation with me, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

This technique facilitates the removal of an appropriate volume of breast tissue and with greater finesse while allowing for more ideal breast contouring with greater predictability of results, shape and durability. The scar pattern is the same as that of most other techniques. However, the biggest drawback to this approach is that the nipple-areola complexes are removed as “skin grafts” to be placed back on the breasts later in surgery at an ideal position. Their blood supply and nerve fibers are necessarily disrupted and their survival will depend on re-growth of the circulation. Because of this, most nipple-areola complexes will display some degradation of their normal anatomy.

What are some of these visual changes? Commonly, there is loss of some or all of the nipple projection and what may remain is a semblance of a nipple. The areola may also be thinner and not as domal shaped. Darker complected individuals also have a substantial risk of depigmentation of the areolas, either temporary or permanent. As with any skin grafting procedure, there is a risk for partial or total failure of the nipple-areola complex to heal and survive. This risk is higher particularly in smokers, diabetics and those with autoimmune disease.

The photo below demonstrates the appearance of a nipple-areola complex in one of my patients who underwent this free nipple graft breast reduction. She has maintained some nipple projection and has not lost pigmentation.

Breast reduction with free nipple graft

If you would like more information on a reduction mammoplasty or any other plastic surgery procedure that I perform or to schedule a free cosmetic consultation with me, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

It has been my observation that most women with significantly enlarged breasts will exhibit grooves of their shoulders caused by the weight of their breasts compressing their bra straps into their shoulders. The greater the weight and longer the duration before surgery is performed, the deeper these indentations may be. They are usually permanent as well.

The following photographs demonstrates the deep grooves of the shoulders that are one of the more common findings in women seeking breast reduction surgery. An interesting finding here is that the deeper indentation of the right shoulder is also associated with the much larger right breast.

Breast reduction patient with grooving of the shoulders. Note that the deeper indentation on the right is associated with the larger right breast.

Deep groove of right shoulder

Groove of left shoulder

For more information on breast reduction surgery or for any other plastic surgery procedure that I perform or to schedule a consultation with me, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

Is it really worth the risk to travel to a foreign country where rules, regulation and oversight are extremely lax, where the law is generally on the the practitioner’s side and you don’t really know what you are getting? Definitely not! Don’t go to Mexico or similar countries.

Plastic surgery should be taken seriously, whether you are considering a breast augmentation, tummy tuck, liposuction, facelift or any other procedure. This is your body and you do want the best possible results even though there are never any guarantees. Make you decision based on qualifications and reputation, not price, and confirm the information.

Many doctors who perform cosmetic surgery may mislead you into thinking that they are plastic surgeons when they are not. They may even claim to be board certified members of a cosmetic surgery board but this is essentially a marketing ploy to give them the appearance of legitimacy. Be wary.

For most cosmetic plastic surgery procedures, you should make sure that your doctor is either board certified or board eligible by the American Board of Plastic Surgery. Being a member of the American Society of Plastic Surgeons, which has strict ethical standards, is also important. These don’t guarantee an outcome but can surely assist you in making your decision. (I am both board certified by this board and a member of the plastic surgery society.)

If you have any questions regarding plastic surgery qualifications or any cosmetic surgery procedure such as breast enlargement, liposuction, tummy tucks or are interested in scheduling a complimentary consultation with me, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona