Michael L. Spann, MD
Aesthetic and Reconstructive
Plastic Surgery
Schedule today501 319 56689500 Kanis Road, Suite 502, Little Rock AR
2200 Ada Ave, Conway AR
A member of Arkansas Plastic Surgery
Dedicated to the Art and Science of Cosmetic
and Reconstructive Surgery
Procedures
Having trained extensively in all areas, Dr. Spann is proud to offer all forms of plastic and cosmetic surgery. In the following pages you will find general information of some of the procedures Dr. Spann provides. We encourage you to review them and contact us with any questions that may arise. Please visit the website often as information is constantly updated.
Coming soon! Video discussions by Dr. Spann.
Breast Augmentation
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Photos
The Procedure
Breast Augmentation, technically known as augmentation mammoplasty, is a surgical procedure performed to enhance the shape and size of a woman's breasts for the following reasons: (1) to enlarge breast size, (2) to correct a breast volume reduction that may occur after pregnancy, (3) to correct an imbalance in breast size and (4) as a reconstructive technique following breast surgery.
The Method(s)
Depending on your anatomy and specific desires or concerns with scarring and pain, Dr. Spann will recommend one of the three methods of inserting and positioning your implant: periareolar (around the nipple area), inframammary (beneath the breast), or axillary (in a skin crease under the arm). The breast tissue and skin will be lifted through the incision, either above or underneath the chest wall muscle (pectoral muscle), to create a pocket. Your implants will then be positioned beneath the nipples.
Ideal Candidate
Ideal candidates for breast augmentation are women seek improvement, not perfection, in their physical appearance. Physically healthy women with realistic expectations are great candidates.
Surgery and Anesthesia
Dr. Spann will perform your breast augmentation in a fully-accredited surgery center or in a hospital outpatient facility. Breast augmentation can be performed in one to two hours with general anesthesia, allowing you to sleep through the entire operation. Local anesthesia, though rarely recommended, combined with a sedative can also be used. In this case, you will be awake and may feel slight discomfort.
Recovery
For a few days following a breast augmentation procedure, you are likely to feel tired and sore. However, most of your discomfort can be controlled with prescribed medication. The majority of patients are up and around in 24 to 48 hours, and return to work within 4 days. The full recovery period is specific to each individual as well as to the level of activity required with her daily functions. Within your one-week post operation visit, your gauge dressings will be removed and you may be given a surgical bra. You will also be given massaging instructions to prevent implants from hardening. Since Dr. Spann uses absorbable sutures, no stitch removal is required. Specific post operative instructions are provided to our patients before and on the day of surgery.
Risks
Although breast augmentation is relatively straightforward, there are risks associated with surgery and specific complications associated with this procedure. These include: capsular contracture, infection around an implant, change in sensitivity of the nipples, and implant breakage and leakage. While only a small percentage of women actually experience these complications, it is important for you to understand the risks and consequences of a breast augmentation procedure. Dr. Spann will discuss specific information regarding these risks with you during the consultation.
Your New Look
Many women who have undergone breast augmentation are extremely satisfied with their fuller appearance, most stating its positive effect on personal self-confidence and outlook. The decision to have breast augmentation is a highly personal one, and it is the goal of Dr. Spann and Arkansas Plastic Surgery to customize a safe and effective surgical program to help you achieve your desired appearance.
Breast Lift (Mastopexy)
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The size and shape of your breasts, size of your areolas, and the extent of sagging are amongst the main factors considered by Dr. Spann when determining the best mastoplexy technique to use. Variations of breast lift surgery are derived from the number and length of incisions needed. For instance, the Crescent Lift involves one fine incision made at the upper edge of the areola. In the Binelli, or Circle Lift, the incision is a circular line that follows the natural edge of the areola. In a Lollipop Lift, the incision is similar to that in a Circle Lift, with the addition of a vertical line that also extends from the bottom of the areola to the breast crease. This technique allows for a greater lift and is generally performed on women who have lost a great deal of breast tissue and have significant skin excess at the bottom of the breast.
Perhaps the most common breast lift technique is known as the Anchor-shaped Incision, or Full Lift, in which three incisions are made in an anchor shape around the natural contour of the breast. The first incision is placed around the areola, extending above it and creating a new position for the nipple. The second incision is placed vertically between the nipple and the bottom of the breast. The third incision runs on the underside of the breast just above the fold under the breast. Excess skin will be removed where the incisions have created flaps, as well as the when the nipple and areola are moved to a higher location on the breast. The nipple and areola remain connected to the underlying breast tissue and associated nerve and blood supply to reduce chances of sensation loss.
Common candidates for breast lift surgery have one or more of the following conditions: (1) drooping breasts of satisfactory size, (2) breasts lacking substance or firmness, (3) downward pointing nipples and areolas, particularly if they are positioned below the breast crease, (4) difference in firmness, shape, and size of breasts. Results are generally longer lasting when the breast lift procedure is performed on smaller breasts, than when performed on large and heavy breasts. Pregnancy and breast feeding?
Dr. Spann will perform your breast lift surgery in a fully-accredited surgery center or in a hospital outpatient facility. Breast lift surgery can be performed in one to three hours with general anesthesia, allowing you to sleep through the entire operation. Alternatively, a breast lift may be performed using local anesthesia and intravenous sedation. In this case, you will be awake and may feel mild discomfort. Small drain tubes may be placed in your breasts to help avoid the accumulation of fluids.
You will wear an elastic bandage or surgical bra over gauze dressings after surgery and should anticipate bruising and swelling of the breasts for at least a day or two. Mild discomfort is not abnormal for two to seven days following the surgery and can be managed by prescribed pain medication. Within one week, the bandages or surgical bra will be replaced by a soft support bra, which should be worn for the next three to four weeks. Your surgical drains will be removed and dressings changed at this time. Generally, stitches will be removed in stages over a period of approximately three weeks, beginning about one week following surgery. Most breast lift patients resume normal activities within one to two weeks following surgery, but are recommended to avoid strenuous sports for about one month. Complete recovery instructions and information will be provided to you by the office, prior to surgery, after your surgery, as well as during your post operative visits.
Fortunately, few significant complications have stemmed from breast lift surgeries. Some of the potential complications may include bleeding, infection, and reactions to anesthesia. Permanent loss of sensation in the nipples or areas of breast skin occurs rarely.
Many women who have undergone breast lift surgery are extremely satisfied with their fuller, more uplifted breasts as well as the improved position and size of their areolas and nipples. Though the incision scars may initially be lumpy or pink in color, they will heal and fade to thin white lines over time. Fortunately, these incisions are often located in areas easily concealed by clothing, even low-cut necklines. The results of your breast lift should remain fairly constant, unless a significant amount of weight is gained or loss. Nonetheless, gravity, pregnancy, and the effects of aging will eventually alter the size and shape of virtually every woman's breast. Secondary breast lift is an option and those who have breast implants in conjunction with their breast lift may find the results to last longer.
Breast Reduction
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Breast reduction, technically known as reduction mammaplasty, is the removal of breast tissues. It is designed for women with large, pendulous breasts who experience a variety of medical problems caused by excessive weight and low center gravity of their breasts, ranging from back and neck pain and skin irritation to skeletal deformities and breathing problems. Disproportionally large and heavy breasts may also diminish a women's sense of self-esteem and independence as it makes fitting into clothing, participating in sports, etc. difficult. The procedure removes fat, glandular tissue, and skin from the breasts, making them smaller, lighter, and firmer. It can also reduce the size of the areola, the darker skin surrounding the nipple. The goal is to give the woman smaller, better-shaped breasts in proportion with the rest of her body.
Individual factors and personal preferences will determine the specific technique selected to reduce the size of your breasts. The most common procedure involves a short vertical scar only incision that circles the areola, extends downward, and follows the natural curve of the crease beneath the breast. With this method, Dr. Spann removes excess glandular tissue, fat, and skin, and moves the nipple and areola into their new position. He then brings the skin from both sides of the breast down and around the areola, shaping the new contour of the breast. Liposuction may be used to remove excess fat from the armpit area.
In most cases, the nipples remain attached to their blood vessels and nerves. However, if the breasts are very large or pendulous, the nipples and areolas may have to be completely removed and grafted into a higher position. (This will result in a loss of sensation in the nipple and areolar tissue.) Stitches are usually located around the areola, in a vertical line extending downward, and along the lower crease of the breast. In some cases, techniques can be used that eliminate the vertical portion of the scar.
Breast reduction is usually performed for physical relief rather than simply cosmetic improvement. Most women who have the surgery are troubled by very large, sagging breasts that restrict their activities and cause them physical discomfort. In most cases, breast reduction isn't performed until a woman's breasts are fully developed; however, it can be done earlier if large breasts are causing serious physical discomfort. The best candidates are those who are mature enough to fully understand the procedure and have realistic expectations about the results. Traditionally, breast reduction is not recommended for women who intend to breast-feed.
After surgery, you'll be wrapped in an elastic bandage or a surgical bra over gauze dressings. A small tube may be placed in each breast to drain out blood and fluids for the first day or two. You may feel some pain for the first couple of days-especially when you move around or cough-and some discomfort for another week or more. Dr. Spann will prescribe medication to lessen the pain. The bandages will be removed a day or two after surgery, though you'll continue wearing the surgical bra around the clock for several weeks, until the swelling and bruising subside. If your breast skin is very dry following surgery, you can apply a moisturizer several times a day, but be sure to keep the suture area dry.
Breast reduction is not a simple operation, but it's statistically safe when performed by a qualified plastic surgeon, such as Dr . Spann. Nevertheless, as with any surgery, there is always a possibility of complications, including bleeding, infection, or reaction to the anesthesia. Some patients develop small sores around their nipples after surgery; these can be treated with antibiotic creams. Some patients may experience a permanent loss of feeling in their nipples or breasts. On a rare occassion, the nipple and areola may lose their blood supply and the tissue will die. (The nipple and areola can usually be rebuilt, however, using skin grafts from elsewhere on the body.) Another side effect of breast reduction surgery is that it leaves permanent scars on the breasts. The vertical and horizontal scars are most visible, and the scars remain after the breast is completely healed. Breast surgery scars are typically larger and less smooth on smokers, since smoking blocks oxygen received by the body during the healing process. You can reduce your risks by closely following Dr. Spann's advice both before and after surgery.
Of all plastic surgery procedures, breast reduction results in the quickest body-image changes. You'll be rid of the physical discomfort of large breasts, your body will look better proportioned, and clothes will fit you better. However, as much as you may have desired these changes, you'll need time to adjust to your new image-as will your family and friends. Be patient with yourself, and with them. Keep in mind why you had this surgery, and chances are that, like most women, you'll be very pleased with the results.
Facelift (Rhytidectomy)
Facelift, technically known as rhytidectomy, is a surgical procedure to improve visible signs of aging in the face and neck such as: sagging in the midface, deep creases below the lower eyelids, deep creases along the nose extending to the corner of the mouth, fallen or displaced fat, loss of muscle tone in the lower face resulting in jowls, loose skin, and excessive fatty deposits under the chin and jaw. Often times, other procedures can be performed in conjunction to a facelift, to enhance the overall outcome. For example, a facelift is frequently combined with a forehead lift, eyelid surgery, nose reshaping, or skin treatments such as chemical peel, dermabrasion or laser resurfacing. Other popular procedures include: facial implants, soft tissue augmentation to re-contour the facial structure, resurfacing techniques to improve the tone and texture of facial skin, and injections to reduce wrinkles. In evaluating a patient for rhytidectomy, Dr. Spann will assess the thickness, texture and elasticity of the patient’s skin, as well as the severity of wrinkles and folds. The hairline will be examined to determine where incisions can be discreetly placed. All of these factors, including bone structure and underlying tissues are important considerations in developing an individual surgical plan. Depending on the patient’s desired degree of change and his assessment, Dr. Spann may recommend a traditional facelift, limited incision facelift, or a neck lift.
Traditionally, the incision is placed in the area of the temple hair, just above and in front of the ear, and continues around the lobe, circling the ear before returning to the point of origin in the scalp. (A neck lift incision often begins in front of the ear lobe and wraps around behind the ear ending in the lower scalp). The skin is raised outward before Dr. Spann repositions and tightens the underlying muscle and connective tissue. Some fat may be sculpted or redistributed from the face, jowls and neck; excess skin may also be removed. For men, the incision is aligned to accommodate the natural beard lines. In all cases, the incision is placed where it will fall in a natural crease of the skin for camouflage.
After trimming the excess skin, Dr. Spann will close the incisions with fine sutures, which permit surgery without shaving hair from the incision site. Once healed, the incision lines from a facelift are well concealed within the hairline and in the natural contours of the face and ear.
Ideal Candidates
Those interested in a facelift procedure should be physically healthy, a non-smoker, and have specific, but realistic goals in mind for the improvement desired. Any one or combination of the following conditions may indicate that you are a good candidate for a facelift: (1) a deep line or fold, running from the corner of the nose to the corner of the mouth (2) jowls, or loss of a well-defined jawline (3) deep wrinkles in the cheeks and sagging of the “highlight” areas of the cheekbones (4) loose skin, wrinkles, vertical “cords” or excess fatty tissue in the neck. A facelift can improve all of the problems listed above. It cannot, however, correct conditions such as sagging eyebrows, excess skin and fatty deposits in the upper and lower eyelids, or wrinkles around the mouth. Dr. Spann and staff can provide further information about treatments to address these other issues.
Rhytidectomy, or facelift, can be performed in a hospital, free-standing ambulatory facility, or office-based surgical suite. Depending on the extent of the surgery, the procedure can take from two to four hours. When the procedure is performed with a combination of mild sedatives, local anesthesia, or a mild intravenous anesthesia, the patient will experience little discomfort. Following the surgery, Dr. Spann will apply a dressing to protect the entire area where the incisions have been made.
When the procedure is completed, a bandage could gently be placed around the face to minimize swelling and bruising. A thin tube may be present to drain any excess blood or fluid that may collect under the skin. Even though most patients experience very little pain after the surgery, medication may still be prescribed. Some degree of swelling and bruising is unavoidable, and Dr. Spann may instruct patients to use cold compresses to keep swelling to a minimum. If dressing has been applied, it will be removed within one to two days. The facelift patient will also be instructed to keep his head elevated when lying down, to avoid as much activity as possible, and to report any undue discomfort.
If a drainage tube was inserted during surgery, it will be removed on the first or second day after surgery. All sutures and staples are usually removed within five to ten days following the surgery. Dr. Spann generally recommends that patients avoid vigorous activity following this procedure. Straining, bending, and lifting should be avoided during the early postoperative period. Patients will also be instructed to temporarily avoid exposure to direct sunlight and for the long-term, to be conscientious about the use of a sun block to protect the skin. It is recommended that patients prearrange for post-surgery support from family and friends. Recovery usually takes two to three weeks, though many patients go back to work in two weeks. Scars are usually not noticeable after enough time has passed for them to mature. In any case, they are easily disguised in natural skin creases, by the hair, or in persistent cases, by makeup until total healing has occurred. Bear in mind that the aging process continues after surgery and that some relaxation of tissues will occur over the first few weeks.
Though there are few risks in facelift surgery and thousands are performed every year, some risk exists in any surgery. Potential complications include hematoma (an accumulation of blood under the skin that may require removal), infection and reactions to anesthesia.
You can help minimize certain risks by following the advice and instructions of Dr. Spann, both before and after surgery.
The results of your facelift may be dramatic or subtle, depending on how you looked before the surgery as well as the specific goals that you and Dr. Spann have established. Since the healing process is gradual, you should expect to wait at least several weeks for an accurate picture of your “new look.” Additional minor changes, or settling, may occur over several months.
Labiaplasty
Growing numbers of women are choosing a below-the-belt plastic surgery called labiaplasty for a host of reasons, including genital pain, cosmetic reasons or to enhance sexual satisfaction. Labiaplasty is a surgical procedure to trim down and shape the inner lips (labia minora) or outer lips (labia majora) of the vagina or both. The labia minora is the inner flap of skin that covers the clitoris and vagina. The labia majora is the part of the labia on the outside of the body. The reasons that the labia may be elongated or asymmetrical vary. It could result from sexual intercourse, childbirth, genetics or the aging process.
Labiaplasty Candidates
Candidates include women with enlarged inner and outer vaginal lips that cause pain or self-consciousness. For example, a long labia may cause pain during sexual intercourse, exercise or even while wearing tight-fitting jeans. Fully developed young women and adult women, who are in good health make the most appropriate candidates. However, women who have any underlying medical conditions that would limit elective surgery may not be good candidates. The surgery is not designed to enhance sexual pleasure or satisfaction. If your goal is to increase sexual satisfaction, talk with your surgeon about other procedures that may be more appropriate. This is not the only type of cosmetic surgery that can be performed on the vagina. Vaginal rejuvenation, for example, involves tightening the vaginal and perineum area, which can become stretched during childbirth. Some surgeons suggest vaginal rejuvenation may increase sexual pleasure for both partners.
Labiaplasty Risks
In 2007, The American College of Obstetricians and Gynecologists issued a position statement warning against cosmetic surgery of the vagina. The group stated that the risks of the procedure outweigh its benefits at this time.
Risks include:
Infection, Bleeding, Temporary numbness, Asymmetry between the inner and outer labia lips, Pigmentation changes
Decreased feeling in that area, Pain, Excess scar tissue buildup (appearing as lumps on the treated area), Hematoma (break in blood vessel, causing localized blood-filled area or blood clot), Puckering or creases of the skin, Sexual dysfunction
Preparing for the Procedure
It is a good idea to stop smoking and consuming alcohol for at least a week before surgery. Talk to your surgeon about ways to quit smoking for good. Your plastic surgeon will likely suggest that you stop taking certain medications, including aspirin, non-steroidal anti-inflammatory drugs (NSAIDs) and blood thinners, all of which can increase bleeding risk. Certain herbal remedies may also increase bleeding risk. Just because a product or preparation is "all-natural" does not mean it is safe. For example, vitamin E, omega-3 fatty acids, green tea and gingko biloba all may increase bleeding risk during and after surgery. Make sure you tell your surgeon about everything that you are taking. Never stop taking any medication abruptly without first speaking to your doctor. Do not have sexual intercourse the night before the surgery.
The Labiaplasty Procedure
After an initial consultation and thorough review of your medical history, your surgeon will schedule the procedure. It usually requires a local anesthetic and is done on an outpatient basis. The actual surgery takes about two hours. During surgery, larger or uneven inner vaginal lips are cut and shortened using specialized scissors, a scalpel or a laser. In addition, the labia majora, on the outside of the body, can be reduced with either surgery or liposuction if needed. A hoodectomy, which exposes the clitoris in an attempt to increase sexual stimulation, may be performed at the same time. The appropriate incision location depends on many individual factors, including the configuration, texture and size of the labia. The doctor will then suture the incision closed with dissolvable stitches.
After surgery, you can't have intercourse for about four weeks, and your genitals will be tender and swollen for several weeks. What's more, your labia and the surrounding area may be slightly bruised.
Buttock Augmentation
Fat transfers have been used for more than 100 years to fill in facial flaws such as hollowed cheeks and sunken eyes or indented scars. Today, fat transfers are used to augment many other areas of the body, including the buttocks, bicep, tricep, calf muscles, breasts, hands, and penis. Fat transfers are considered the traditional method for surgically rounding out the edges of a small localized area of the body as compared to the newer body implant approach in which implants are used to produce a more shapely appearance required by a larger area of the body. You can also read our surgeon discussions of fat transfers and body implants. The beauty of a fat transfer is that the materials used to augment the desired body part are your own fat cells. This makes the procedure unquestionably biocompatible and non-allergenic. Also, a body fat transfer feels more natural than a body implant. The goal of the procedure is to improve the appearance of the localized body-part area that needs improvement. The results of this particular plastic surgery may be unpredictable. The reason is that much of the injected fat is absorbed, leaving an average of about 40 percent in place. Patients may require more than one treatment to achieve the best results. Each time the procedure is repeated, more fat is accumulated in the treated area. This tends to offer longer-lasting results, even lifetime results.
Is Fat Transfer Right for Me?
Exercise is the best way to improve the appearance of your body; however, aging and genetics may make workout programs unrealistic for certain small areas of the body. Genetically, fat may be unevenly distributed causing disproportional features. Patients in their mid 30s to 70s who have lost volume in a specific body area may benefit from fat transfers. Realistic expectations are extremely important in the decision for a fat transfer. Talk to your plastic surgeon about alternative treatments that may also be suitable for your condition.
The Fat Transfer Procedure
Body fat transfers are most often performed by a board-certified plastic surgeon. The location of the procedure may be the doctor's office, outpatient center, or hospital. The procedure may take up to two hours. The procedure is often performed under "twilight sedation," which includes a combination of medications that make you feel sleepy and numbed, but awake. The procedure may be performed under general anesthesia, while you are asleep. You should discuss the type of anesthesia with your doctor. The waiting time before returning home depends on the amount of fat that is transferred. The procedure varies depending upon the technique used by the doctor and the area to be treated. The most commonly treated locations are the buttocks, chest, calf, and bicep or tricep muscles. The procedure can be described in three steps:
Antiseptic is applied to two areas: 1) the location where the fat will be removed and 2) the treated area, where the fat will be injected.
The fat cells are typically removed from the buttocks, stomach, or thighs using liposuction. The doctor uses a cannula (a thin hollow tube) that is connected to a vacuum device to remove fat cells. After the fat cells are suctioned by the cannula, the fat cells are processed and purified by the doctor. In some cases, the doctor will use a technique that spins the fat cells before the cells are injected beneath the skin. Some doctors do not spin fat. Different doctors may use different techniques of spinning fat. A bandage may be applied. It takes three to four days for the first capillaries in the body to reach the transplanted fat cells. Unfortunately, during those three to four days, up to 60 percent of the transferred fat cells will die. For this reason, doctors will overfill the treated area to allow for the dissipation of transferred fat cells. Since many of the transferred fat cells may eventually be reabsorbed in the body, the results may be unpredictable. The results of fat transfers may last about three years. Many cases result in the transfer lasting a lifetime. Each time the procedure is repeated, more fat is accumulated in the treated area. This tends to offer longer-lasting results.
After Fat Transfer Surgery
After the procedure, you may need someone to drive you home. You may also need someone to help you with daily living activities during the time specified by your doctor. The doctor will instruct you to limit activity, including exercise, for up to three weeks after the procedure. Within two to three days after the procedure, the bandage is removed by the doctor. Patients can begin to shower after the bandage is removed. There is typically some swelling and some bruising. The swelling may last for several weeks. However, bruising will subside within a few days. The treated area may be reddened within the first 48 hours. Discomfort can be managed with oral medications. Scabs may form at injection site as well. Unmanageable pain or any symptoms that are progressive or abnormal should be reported to the doctor immediately. Normal activities can often be resumed almost immediately, except that you are advised to stay out of the sun. Patients should notice a marked improvement after the procedure. However, final results may not be evident for several months or longer.
Complications and Risks
Complications are possible with any medical procedure, but complications from fat transfers are infrequent. The most common, but infrequent, complications of fat transfers include uneven skin texture, infection, abscess, excessive bleeding, or scarring. If fat is injected into two or more areas, patients may have asymmetry whereby the fat appears uneven in different areas. Treatment for complications can range from oral medications to surgical intervention, depending upon the extent of the complication. Following the doctor's instructions before and after the procedure can reduce the risk of complications.
Costs
The fat transfer procedure includes three costs: local, regional, or general anesthesia fees, facility fees, and surgeon's fees. Other cost factors include the doctor's skill and training, the geographic location, and the technique. It is difficult to establish an average cost for the fat transfer procedure because every case is unique. Since body fat transfers may be performed during other procedures, anesthesia and facility fees may be combined with those procedures. The total fees for fat transfers can range from a minimum of $5,000 to $10,000 or more. When fat transfer surgery is a medical necessity, such as after a traumatic injury, some or all costs may be covered under your insurance plan. Surgery for a cosmetic purpose is not covered. If the cost of the fat transfer surgery is difficult for you, ask your surgeon about payment plans. For financing options and tips, continue reading about Patient Financing.
Implant Size and Type
In some cases, secondary or revision rhinoplasty may be required, to correct problems that persisted or developed after the initial nose surgery. Many physicians also offer "non-surgical nose jobs," in which injections of facial fillers alter minor areas around nose. Though this approach can be more affordable and performed in less time than traditional plastic surgery, it has limitations.
