This pleasant 66 yo old patient came to see Dr. Medalie at Cleveland Plastic Surgery in Beachwood, Ohio. She was seeking primary breast augmentation to help with her transition from Male to Female gender affirmation. After a complete evaluation and consultation, 360 cc silicone breast implants were chosen for the procedure. She underwent the breast augmentation procedure in a 1 hour outpatient surgery and is shown 3 months post-op. She is very pleased with her early breast implant results.
This pleasant 48 yo woman came to see Dr. Medalie at his Beachwood office. She was seeking body contouring and was interested in tummy tuck and breast lift as well as arm and inner thigh lifts. After discussing the risks and benefits of all procedures she elected to undergo an abdominoplasty in addition to an arm lift (brachioplasty). She is shown in the above before and after photos 6 months after her arm lift surgery and is very happy with her results.
Brachioplasty, also known as an arm lift, is a cosmetic surgical procedure that reshapes the upper arm to improve its appearance:
What it does
Brachioplasty removes excess skin and fat from the upper arm, from the armpit to the elbow. It also tightens sagging skin and supportive tissue.
Who it’s for
Brachioplasty is often performed after significant weight loss, but it can also be done for other reasons, such as aging or pregnancy.
How it’s done
A plastic surgeon makes an incision on the inside or back of the arm and removes excess skin and fat. The procedure usually takes 2-3 hours and can be performed under general anesthesia or twilight anesthesia.
Results
Brachioplasty can give the upper arm a more toned and balanced appearance. It can also make the arm look smoother and smaller.
When combined with other surgeries
Brachioplasty is often performed at the same time as other surgeries, such as body contouring around the midsection or inner thighs and breast lift procedures.
Labiaplasty and clitorla hood reduction Before and After photo showing reduced labia minora now recessed below the edges of the labia majora and clitoral hood reduced to match the size of the labia.
This patient came to see Dr. Medalie at his Beachwood office asking about labiaplasty which is also known as labia minora reduction. The labia minora are the inner labial lips and can be irritating if they protrude beyond the labia majora (the outer labial lips). The patient had a great deal of extra tissue which was making it uncomfortable for her to perform normal daily activities. Her goal was to have the protruding labia trimmed so that no tissue projected beyond the edges of the labia majora. She also asked for clitoral hood reduction to maintain symmetry with the smaller labia. The procedure was done in Dr. Medalie’s office under local anesthesia with mild oral sedation (Ativan) and she is shown 3 months after surgery. This demonstrates how well and quickly the labia heal. It also shows how much extra tissue can be removed from the labia minora in one local ssurgery. Below is information from the American Society of Plastic Surgery that I have added some notes to as well.
What Is A Labiaplasty?
The term labiaplasty refers to a procedure that reduces the length of the labia minora. It is the most commonly performed vaginal rejuvenation procedure and it can relieve symptoms women experience from twisting and tugging of the labia.
Reasons Patients Want A Labiaplasty
Women opt for surgery for a variety of reasons, including pain from twisting and tugging of the labia when riding a bike or during intercourse, itching, irritation and self-consciousness.
What Does A Labiaplasty Do?
The goal of the procedure is to reduce the labia minora so that they don’t hang below the hair-bearing labia majora. A labiaplasty may be performed to reduce asymmetry when one is longer than the other, or, more commonly, to reduce the length of both labia so that the labia no longer twist, tug or fall out of a bathing suit.
Anesthesia For A Labiapasty
Labiaplasty is a procedure that can be done under either local anesthesia with oral sedation or under general anesthesia.
Labiaplasty Procedure
The most common type of labiaplasty is the trim procedure, in which the extra tissue is removed and sewn up directly. I personally believe that this is an inferior procedure compared to the wedge resection and almost always perform some type of wedge resection. Next in popularity is the wedge procedure, which maintains a natural border after a pie-shaped piece of tissue has been removed. Extra folds of the clitoral hood can also be reduced at the same time. Closure is usually done with absorbable sutures.
What Are The Risks Of A Labiaplasty?
The risks associated with labiaplasty include those of most surgical procedures, including bleeding, hematoma and infection. The most common complication is over-resection (this can occur with trim procedures more than wedge procedures). While some women desire an aggressive reduction, this can result in chronic dryness, scarring at or near the vaginal opening and pain with intercourse. Healing problems are more likely to occur with a wedge procedure, particularly if the patient is exposed to substances that cause blood vessels to shrink (such as smoking).
Recovering From A Labiaplasty
Most patients take a week off from work, during which they can reduce swelling and pain by icing with a cold pack sandwiched between the patient’s underpants and an elastic garment, like Spanx. This can be done “twenty minutes on, twenty minutes off.” The patient can also lie with her bottom elevated to reduce swelling.
Patients can resume wearing tampons or having intercourse after four to six weeks.
While the most distorting swelling is gone by 6 weeks, residual swelling may take several months to disappear.
What Are The Results Of A Labiaplasty?
Labiaplasty typically results in shorter labia that no longer hang down below the level of the hair-bearing labia majora. Most patients who experienced symptoms from twisting and tugging of their labia generally find relief after surgery. According to multiple studies, labiaplasty surgery is associated with a high satisfaction rate of over 90 percent.
Peri areolar approach FtM top surgery pre and post op results (post-op at 7 years)
This pleasant 231 year old trans man came to see Dr. Medalie in regards to FtM “top surgery”. He had a fairly small chest and was a good candidate for the peir-areolar “keyhole” approach and simultaneous chest contouring by limited liposuction. His gender affirming surgery was performed as an outpatient and took approximately 90 minutes to perform. In his after picture he is shown 7 years post peri and is very pleased with his contour. He also embarked on an excellent exercise regimen and built up his body musculature to highlight his improved chest contour. The peri scars in the post op picture are hidden at the outer edge of the areola. *Results may vary
Below I have attached some information from my main web page that discussed the surgical options for top surgery. Here is a link to that page:
Top Surgery For Transgender Patients
The procedure is based on the following:
Size and shape of breast
Elasticity of skin
Patient’s needs and preferences
PERI: In general, patients who have smaller breasts can have the entire surgery performed by having a small incision at the outer edge of the areola from 12:00 to 6:00 o’clock. A lighted retractor and surgical scissors are used to perform a complete sub-cutaneous mastectomy. Liposuction of the chest is also performed as needed.This provides the most optimal results and can be almost invisible after it heals. If the skin appears a little looser at the start of the case then a complete peri-areolar incision is made. A small amount of skin is removed (in a doughnut pattern , also known as-“peri-areolar or “purse-string” mastopexy”). A subcutaneous mastectomy is performed and then the outer edge of the skin is closed with a purse-string to the newly down-sized areola. By necessity, the edges of the incision around the nipple will be “scalloped” or bunched up initially. This settles down to a great degree over time. If the patient understands that scar revision may be necessary, this is a very reasonable approach. The nipple may experience compromise of its blood supply and also have sensation or erectile capacity changes.
Double Incision: In those patients with a large amount of breast tissue with excessive skin of poor quality and droop, it is usually recommend to remove the excess skin and breast tissue in the crease of the pectoralis muscles (elliptical or double incision mastectomy) and put the nipples and areolae back on as grafts. This surgery has the advantage of immediate and predictable results. I can contour the skin flaps and place the nipples where I want to. It has the disadvantage of permanently altering the sensation and erectile capacity of the nipples (and sometimes the pigmentation), and it leaves larger scars on the chest. Over time they fade and flatten out. At each end of the scar, “dog-ears” may form. These are small bunches of tissue created by the closing of the ellipse as a straight line. They tend to settle down over time, but may need to be revised. I always try and address the dog ears at the time of surgery but this may extend the length of the scar. Dog ears are more likely in patients who are heavier and have more tissue to start with. I always perform liposuction of the central and lateral chest (to flatten the dog ears) as well as the area in front of the armpit. I have been asked why a scar may meet in the center of the chest on some top surgery results but not on others. This is dependent on pre-existing anatomy. If the tissue meets in the middle (such as in the example right below) then the scar by necessity will meet in the middle (this can’t be seen in the example because of the patient’s chest hair.)
This 37 year old patient came to see Dr. Medalie at his Beachwood, Ohio clinic to discuss mommy makeover with a tummy tuck surgery and breast augmentation. She elected to have a full abdominoplasty (also known as a tummy tuck) with liposuction of the abdomen, flanks and sides as well as breast augmentation with 370 cc saline breast implants. The surgery was performed as an outpatient and the patient is shown 6 months after her body contouring and breast augmentation procedure. She is extremely happy with her new body and mommy makeover. Below is information from the American Society of Plastic Surgery. Plastic Surgery results can vary
What Are The Steps Of A Tummy Tuck Procedure?
A tummy tuck procedure includes the following steps:
Step 1 – Anesthesia
Medications are administered for your comfort during the surgical procedures. The choices include intravenous sedation and general anesthesia. Your doctor will recommend the best choice for you.
Step 2 – The Incision
A full tummy tuck requires a horizontally-oriented incision in the area between the pubic hairline and belly button.
The shape and length of the incision will be determined by the amount of excess skin. Once the abdominal skin is lifted, the underlying weakened abdominal muscles are repaired.
A second incision around the navel may be necessary to remove excess skin in the upper abdomen.
The upper abdominal skin is pulled down like a window shade. The excess skin is trimmed and the remaining skin is sutured together. A new opening for the belly button is created. The belly button is popped through to the surface and sutured into position.
Step 3 – Closing The Incisions
Sutures, skin adhesives, tapes or clips close the skin incisions.
Step 4 – See The Results
Your tummy tuck will result in a flatter, firmer abdominal contour that is more proportionate with your body type and weight. Get more information about tummy tuck results.
Step 2 – The Incision
Incisions are made in inconspicuous areas to minimize visible scarring.We will discuss which incision options are appropriate for your desired outcome. Incision options include: along the areolar edge (peri-areolar incision), the fold under the breast (inframammary fold) and in the armpit (axillary incision). I prefer the IM fold approach because recent literature suggests that it is associated with a lower incidence of capsular contracture. Ths incision for a silicone implant is by necessity larger than one for a saline implant because the silicone implant is pre-filled and the saline implant starts empty.
Incisions vary based on the type of breast implant, degree of enlargement desired, your particular anatomy and patient-surgeon preference.
Step 3 – Inserting And Placing The Breast Implant
After the incision is made, a breast implant is inserted into a pocket either:
A. Under the pectoral muscle (a submuscular placement)
B. Directly behind the breast tissue, over the pectoral muscle (a submammary/ subglandular placement)
C. Dual-plane which is partly under the muscle (in the upper pole) and partly under the breast (lower pole). This procedure is more frequently used in women who have had children and have some droop to their breasts.
The method for inserting and positioning breast implants depends on the type of implant, degree of enlargement desired, your body type and your surgeon’s recommendations.
Step 4 – Closing The Incisions
Incisions are closed with layered sutures (that dissolve) in the breast tissue and with sutures, skin adhesive and surgical tape to close the skin.
Over time the incision lines will fade. The quality of scar depends on many things, including your genetics, exposure of your body to nicotine and infection.
Step 5 – See The Results
The results of breast augmentation are immediately visible. Typically they start high and then over time settle to a lower and more natural appearance. I usually tell patients that what they see is not what they get until 3 months after the surgery.
*Plastic surgery results can vary from patient to patient and are not guaranteed
This 38 year old patient came to see Dr. Medalie at his Beachwood, Ohio clinic to discuss tummy tuck surgery. She had three children and extreme laxity of the abdominal wall musculature as well as loose skin and extra fatty tissue. She elected to have a full abdominoplasty (also known as a tummy tuck) with liposuction of the abdomen, flanks and sides. The surgery was performed as an outpatient and the patient is shown only 3 months after her body contouring procedure. She has an excellent early result and is extremely happy with her new abdominal contour. Below is information from the American Society of Plastic Surgery. Plastic Surgery results can vary
What Are The Steps Of A Tummy Tuck Procedure?
A tummy tuck procedure includes the following steps:
Step 1 – Anesthesia
Medications are administered for your comfort during the surgical procedures. The choices include intravenous sedation and general anesthesia. Your doctor will recommend the best choice for you.
Step 2 – The Incision
A full tummy tuck requires a horizontally-oriented incision in the area between the pubic hairline and belly button.
The shape and length of the incision will be determined by the amount of excess skin. Once the abdominal skin is lifted, the underlying weakened abdominal muscles are repaired.
A second incision around the navel may be necessary to remove excess skin in the upper abdomen.
The upper abdominal skin is pulled down like a window shade. The excess skin is trimmed and the remaining skin is sutured together. A new opening for the belly button is created. The belly button is popped through to the surface and sutured into position.
Step 3 – Closing The Incisions
Sutures, skin adhesives, tapes or clips close the skin incisions.
Step 4 – See The Results
Your tummy tuck will result in a flatter, firmer abdominal contour that is more proportionate with your body type and weight. Get more information about tummy tuck results.
This pleasant 28 year old to see Dr. Daniel A. Medalie of Cleveland Plastic Surgery at his Beachwood office to inquire about breast augmentation.. She is 5’2″ and 110 lbs and wanted to go from a regular A cup to a full C cup after surgery. She chose to proceed with the surgery in an outpatient setting and had a successful 1.0 hour procedure. The implants placed were 350 cc saline breast implants. The patient is shown 6 months after her breast enhancement and is very pleased with the results. She has increased her bra size from 32A to 34C. *Results may vary
Step 1 – Anesthesia
Medications are administered for your comfort during the surgical procedure. Dr. Medalie prefers light general anesthesia with the patient breathing fully on her own.
Step 2 – The Incision
Incisions are made in inconspicuous areas to minimize visible scarring.We will discuss which incision options are appropriate for your desired outcome. Incision options include: along the areolar edge (peri-areolar incision), the fold under the breast (inframammary fold) and in the armpit (axillary incision). I prefer the IM fold approach because recent literature suggests that it is associated with a lower incidence of capsular contracture. Ths incision for a silicone implant is by necessity larger than one for a saline implant because the silicone implant is pre-filled and the saline implant starts empty.
Incisions vary based on the type of breast implant, degree of enlargement desired, your particular anatomy and patient-surgeon preference.
Step 3 – Inserting And Placing The Breast Implant
After the incision is made, a breast implant is inserted into a pocket either:
A. Under the pectoral muscle (a submuscular placement)
B. Directly behind the breast tissue, over the pectoral muscle (a submammary/ subglandular placement)
C. Dual-plane which is partly under the muscle (in the upper pole) and partly under the breast (lower pole). This procedure is more frequently used in women who have had children and have some droop to their breasts.
The method for inserting and positioning breast implants depends on the type of implant, degree of enlargement desired, your body type and your surgeon’s recommendations.
Step 4 – Closing The Incisions
Incisions are closed with layered sutures (that dissolve) in the breast tissue and with sutures, skin adhesive and surgical tape to close the skin.
Over time the incision lines will fade. The quality of scar depends on many things, including your genetics, exposure of your body to nicotine and infection.
Step 5 – See The Results
The results of breast augmentation are immediately visible. Typically they start high and then over time settle to a lower and more natural appearance. I usually tell patients that what they see is not what they get until 3 months after the surgery.
*Plastic surgery results can vary from patient to patient and are not guaranteed
This 45 year old patient came to see Dr. Medalie at his Beachwood, Ohio clinic to discuss tummy tuck surgery. She had seven children and extreme laxity of the abdominal wall musculature as well as loose skin and extra fatty tissue. She elected to have a full abdominoplasty (also known as a tummy tuck) with liposuction of the abdomen, flanks and sides. The surgery was performed as an outpatient and the patient is shown only 3 months after her body contouring procedure. She has an excellent early result and is extremely happy with her new abdominal contour. Below is information from the American Society of Plastic Surgery. Plastic Surgery results can vary
What Are The Steps Of A Tummy Tuck Procedure?
A tummy tuck procedure includes the following steps:
Step 1 – Anesthesia
Medications are administered for your comfort during the surgical procedures. The choices include intravenous sedation and general anesthesia. Your doctor will recommend the best choice for you.
Step 2 – The Incision
A full tummy tuck requires a horizontally-oriented incision in the area between the pubic hairline and belly button.
The shape and length of the incision will be determined by the amount of excess skin. Once the abdominal skin is lifted, the underlying weakened abdominal muscles are repaired.
A second incision around the navel may be necessary to remove excess skin in the upper abdomen.
The upper abdominal skin is pulled down like a window shade. The excess skin is trimmed and the remaining skin is sutured together. A new opening for the belly button is created. The belly button is popped through to the surface and sutured into position.
Step 3 – Closing The Incisions
Sutures, skin adhesives, tapes or clips close the skin incisions.
Step 4 – See The Results
Your tummy tuck will result in a flatter, firmer abdominal contour that is more proportionate with your body type and weight. Get more information about tummy tuck results.
This pleasant 32 year old mother of two came to see Dr. Daniel A. Medalie of Cleveland Plastic Surgery at his Beachwood office to inquire about breast augmentation.. She is 5’6″ and 118 lbs and wanted to go from a regular A cup to a full C cup after surgery. She chose to proceed with the surgery in an outpatient setting and had a successful 1.0 hour procedure. The implants placed were 330 cc silicone breast implants. The patient is shown 6 months after her breast enhancement and is very pleased with the results. She has increased her bra size from 32A to 34C. *Results may vary
Step 1 – Anesthesia
Medications are administered for your comfort during the surgical procedure. Dr. Medalie prefers light general anesthesia with the patient breathing fully on her own.
Step 2 – The Incision
Incisions are made in inconspicuous areas to minimize visible scarring.We will discuss which incision options are appropriate for your desired outcome. Incision options include: along the areolar edge (peri-areolar incision), the fold under the breast (inframammary fold) and in the armpit (axillary incision). I prefer the IM fold approach because recent literature suggests that it is associated with a lower incidence of capsular contracture. Ths incision for a silicone implant is by necessity larger than one for a saline implant because the silicone implant is pre-filled and the saline implant starts empty.
Incisions vary based on the type of breast implant, degree of enlargement desired, your particular anatomy and patient-surgeon preference.
Step 3 – Inserting And Placing The Breast Implant
After the incision is made, a breast implant is inserted into a pocket either:
A. Under the pectoral muscle (a submuscular placement)
B. Directly behind the breast tissue, over the pectoral muscle (a submammary/ subglandular placement)
C. Dual-plane which is partly under the muscle (in the upper pole) and partly under the breast (lower pole). This procedure is more frequently used in women who have had children and have some droop to their breasts.
The method for inserting and positioning breast implants depends on the type of implant, degree of enlargement desired, your body type and your surgeon’s recommendations.
Step 4 – Closing The Incisions
Incisions are closed with layered sutures (that dissolve) in the breast tissue and with sutures, skin adhesive and surgical tape to close the skin.
Over time the incision lines will fade. The quality of scar depends on many things, including your genetics, exposure of your body to nicotine and infection.
Step 5 – See The Results
The results of breast augmentation are immediately visible. Typically they start high and then over time settle to a lower and more natural appearance. I usually tell patients that what they see is not what they get until 3 months after the surgery.
*Plastic surgery results can vary from patient to patient and are not guaranteed
TUMMY TUCK BEFORE AND AFTER SURGERY PHOTOS PART 2 BY DR. MEDALIE
This 32 year old patient came to see Dr. Medalie at his Beachwood, Ohio clinic to discuss tummy tuck surgery. She elected to have a full abdominoplasty (also known as a tummy tuck) with liposuction of the abdomen, flanks and sides. The surgery was performed as an outpatient and the patient is shown 9 months after her body contouring procedure. She is extremely happy with her new abdominal contour. Below is information from the American Society of Plastic Surgery. Plastic Surgery results can vary
What Are The Steps Of A Tummy Tuck Procedure?
A tummy tuck procedure includes the following steps:
Step 1 – Anesthesia
Medications are administered for your comfort during the surgical procedures. The choices include intravenous sedation and general anesthesia. Your doctor will recommend the best choice for you.
Step 2 – The Incision
A full tummy tuck requires a horizontally-oriented incision in the area between the pubic hairline and belly button.
The shape and length of the incision will be determined by the amount of excess skin. Once the abdominal skin is lifted, the underlying weakened abdominal muscles are repaired.
A second incision around the navel may be necessary to remove excess skin in the upper abdomen.
The upper abdominal skin is pulled down like a window shade. The excess skin is trimmed and the remaining skin is sutured together. A new opening for the belly button is created. The belly button is popped through to the surface and sutured into position.
Step 3 – Closing The Incisions
Sutures, skin adhesives, tapes or clips close the skin incisions.
Step 4 – See The Results
Your tummy tuck will result in a flatter, firmer abdominal contour that is more proportionate with your body type and weight. Get more information about tummy tuck results.
