Cellulitis , Treatments

Question:

I'm looking for a good cellulite treatment. Are there any cellulite treatments that are more effective than others? What are my options?

Answer:

I'm looking for a good cellulite treatment. Are there any cellulite treatments that are more effective than others? What are my options?

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The best single way to reduce cellulite is to lose weight through a great diet and regular exercise. Everything else we provide as doctors is second best to this solution. True cellulite is caused by irregularities in the very superficial fat of the skin. Cellulite is caused by excess fat cells pushing out on the skin from underneath and fibrous bands pulling in on the skin.  Unfortunately, that is very close to where the blood supply of the skin is, in the subdermal plexus

There is no way to actually get rid of cellulite although there are treatments to reduce its appearance. All of the following treatments have been touted for their effectiveness in either decreasing or eliminating cellulite

Endermologie treatments incorporated with diet, exercise and drinking plenty of water will offer the best results to fight cellulite.Endermologie is a painless and noninvasive mechanical massage that stimulates the reactivation of fat release and production of collagen and elastin.With a series of at least 10-14 weekly treatments Endermologie produce visible improvement in the cellulite.Once your desired results are achieved, returning for treatments once a month for maintenance is recommended. Endermologie temporarily improves the look but if you stop the treatments, 2 months later all the cellulite is back.

Radio frequency devices will also temporarily help the problem but not completely . Alma Accent :skin cellulite can be improved with this new unipolar radiofrequency device, with fewer treatments and longer lasting results as compared to older options. The older options have typically been bipolar radio frequency and low-level laser devices which have been proven to produce mild skin tightening of cellulite; this new treatment is far more sophisticated . .Another the non-invasive procedure is called Thermage . Thermage is extremely safe, and it takes about one and a half hours in the office. There is no anesthesia, no down time, and no scar. So, for many women, it is worth a try. La radiofrecuencia produce un calentamiento profundo de la piel y del tejido graso que aumenta la circulación de la zona, favorece el drenaje linfático, permite mejorar el metabolismo del tejido graso subcutáneo y estimula la formación de colágeno de las capas más internas de la piel. Este calor consigue de forma inmediata el estiramiento del tejido cutáneo reduciendo los signos de flacidez y deja la piel más tersa. Se utiliza para el tratamiento de la celulitis, de la flacidez, para mejorar la piel.

Cellul
ite is a difficult problem to fix , creams, massages and ultrasound  can  help but are not  so efective. Also, in my opinion, treatments such as lipolysis, mesotherapy,have limited efectiveness.

Microcanula liposculpture improves cellulite by breaking these little fibrous bands and by removing the fat cells pushing out on the skin. It is done under local anesthesia and is probably the only permanent way to help cellulite. Although it is not 100% effective, it is the best we got at this time. Liposculpture at deep levels can sometimes break the septae, or interconnections of deposits of fat, and thereby reduce (not eliminate) the appearance of cellulite. It can certainly make the appearance of cellulite better.

Botox , Side Effects

Question

Has Botox some side effects like droopy eyelids. Is Botox safe?
Helen


Answer

Botox is considered to be generally safe and has received FDA approval as a result. Like any other form of medical treatment, there are associated side effects Botox, such as droopy eyelids.The most common side effects of Botox include mild discomfort at the site(s) of injection, temporary redness at the injection site and possible bruising. Rarely, patients may experience a headache. The incidence of an eyelid droop is very rare occurring in about 1% of patients. It is temporary and usually resolves in a few weeks. Botox is contraindicated in individuals with neurological conditions. . Botox only lasts 3 months, so if you did get a droopy eyelid it would subside when the Botox wears off.
There is no full proof technique to avoid botox side effects. Nobody can actually guarantee that you won't have complication, because there can be occasional variations in a person's muscle distribution width. So side effect can happen to anyone.
Botox is one of the most widely-investigated products on the market. There are over 20 years of strong evidence that points to its safety when it is injected properly by an experienced doctor. botulinium-based drugs are used to treat cerebral palsy and other ills. These patients are receiving Botox in doses that are many, many times larger than the small dose that is used for cosmetic treatments. Like any treatment, it does have some side effects, even when used perfectly. These can include pain, bruising, and allergies in extremely rare cases. Avoid aspirin, ibuphen, vitamin E, and some herbal products to reduce bruising seven days before treatment. Apply ice at the site to minimize bruising & swelling.
It is critical to inject the right dosage or strength of Botox in the right muscles of the face to minimize some common side effects, such as droopy or heavy eyelids or eyebrows.

Bruising is a risk with any injection, so avoid taking anything that can thin your blood for at least 10 days before your treatment such as aspirin. To reduce your risk of a droopy eyelid with a brow injection, do not rub the area that was injected and avoid strenuous activity for several hours after your treatment . Several things I encourage my patients to avoid after Botox: 1) avoid rubbing the treated area for 24 hours, 2) avoid facial massage, Microdermabrasion for 24 hours after the procedure, 3) avoid aspirin, fish oil, excess vitamin E for 1 week before and 24 hours after the procedure
Botox injections can cause side effects if not done properly. However, complications are more frequent when doing the mouth, neck, etc A good plastic surgeon will start with a lower dose and adjust the dosage to get the desired results...we begin first time patients in limited areas and very carefully diagram areas treated and amounts used. From the initial response we can modify what we will later do.
Your plastic surgeon should examine your eyes to determine if you have a compensated preexisting eyelid ptosis. In this case, Botox in the frontalis will reveal your eyelid ptosis. If there is no preexisting ptosis then Botox can cause paralysis of the levator palpebrae. 0.5% apraclonidine drops have been used to improve a Botox induced eyelid ptosis (~2 mm elevation) by contracting the Mueller muscle inside the eyelid.
Droppy eyelids from botox are extremely rare. What is more common is a lower or flatter brow from too much relaxation from botox in the forehead. If your forehead becomes completely relaxed then you may not be able to raise your eyebrows - this leads to a feeling of heavy brow and can make the brow flat and seem like you have droopy eyelids but the eyelids really are just weighed down by the heavy, relaxed brows that are no longer raised up by forehead muscles. The goal of botox is to acheive a balance betwen the muscles that pull down on the brow (the muscles between the eyebrows) and the muscles that raise or elevate the brow - the forehead muscles - so that the net effect is a slight overall improvement of the brow arch making the eyes look more youthful and rested.

The skill part of injecting Botox is understanding the anatomy of the facials muscle, especially around the eye. It is also critical to inject the right amount of Botox in the right places to avoid side effects. If too much Botox was injected above your eyebrows or if some Botox migrates into the levator palpebrae muscle that elevates the upper eyelid, you could get a lid droop .Most of the "side effects" described for Botox are associated with the Botox spreading to adjacent areas that you don't want to treat. Droopy eyelids can occur if botox is administered too close to the brow or if Botox treatment to the glabellar area (corrugator muscles - located medially above your brow) involves migration of the medication to effect other muscles outside your treatment zone. This is very uncommon, but having droopy eyelids can occure when the botox reaches the muscle that lifts up your eyelid. With a smaller volume of seroum with the same amount of botox, the botox is less likely to reach that muscle. Also to avoid reaching that muscle its important to stay away from the eye or the orbital part of the eye.

Labioplasty,Labioplasty Recovery – how long does it take ¿

  


Hi
Labioplasty Recovery – how long does it take ¿
thanks

Answer:
Most women experience only mild discomfort and swelling after labiaplsty and return to work within 4-5 days. The majority of the swelling resolves within 3 weeks and sutures are self dissolving. Intimate activity may be safely resumed at 4 weeks and light exercise between 3-4 weeks. The Labiae start to look kinda freakish. This resolves but can worry some patients in the short term.

I ask my patients to stay in bed for two days after the labia minora reduction procedure with ice on the area. Most patients are able to return to work 3 to 4 days after surgery (not strenuous). Some swelling and spotting after the procedure is common and I asked my patients not to be concerned about the appearance of the area for the first month given that the swelling may cause unnecessary anxiety.
I also ask my patients to avoid horseback riding, bicycle riding, prolonged sitting, and sexual intercourse for approximately one month after surgery. This timeline may change depending on how the patient is doing during the postoperative visits.
What to expect after Labiaplasty Surgery?



1. swelling for about 4 weeks, with the majority of improvement seen by the second week . you will
generally need 3-4 days at home to recover.
2. back to work within 3-4 days, if not physical in nature
3. pain is well tolerated with Tylenol and decreases significantly by the end of the first week . DO NOT take aspirin or ibuprofen because they can increase bruising and bleeding.
4. showering is permitted the following day after surgery
5. sexual activity may be resumed 4 weeks post Labiaplasty
6. sutures used are mostly resorbable a will fall off on their own by the 4th to 6th week
7. Swelling and tenderness should disappear within 6 weeks.
8. It will take between 6 months to a year before you will see the absolute final results.

Labioplasty, How Do I Know if I Need Labiaplasty?

Hi
How Do I Know if I Need Labiaplasty?

Answer:




The demands for labiaplasy (any procedure to alter the size and shape of the labia) seem to have increased in the recent past. Labiaplasty procedures have gained significant popularity over the past 5 years due to changes in fashion and grooming as well as due to further education and media exposure. With grooming trends limiting amount of genital hair, a woman's long or asymmetric labia (or inner lips) are more apparent.
The typical patient that presents desiring labiaplasty has a very similar combination of signs and symptoms. Essentially all patients have relatively large inner labia that hang out past the outer labia and therefore are always visible whether sitting, standing, or laying down - this is the most common aesthetic concern. Some have functional problem from this such as drying, chafing, frequent infections, and/or uncomfortable in activities such as bicycle riding, running, and during sexual intercourse. The pain could be described as pinching, rubbing or irritation of the excess skin and to have discomfort with certain tight fitting clothes and pinching of the “excess” tissue in tight fitting clothing.
Labiaplasty is a surgical technique to reduce the amount of skin and mucosal tissue in the labia of a female patient.This is performed to rejuvenate the appearance of the labia and to improve the patient's comfort. Surgery typically takes approximately 1 hour and performed under local anesthesia approximately 80% of the time.

Best Laser for Depilation

The clinics near me offer a number of different laser machines. names like Light Sheer, IPL, Yag, Duet, Cool Glide. What do the medical expert here think works best in laser hair removal? --Julie


Answer:Older generation lasers were slow, very painful and worked only on individuals with very dark hair and very light skin. Today, lasers can work on all skin colors and some lasers are even safe for treating tanned skinned. Lasers for hair removal can be performed on any (yes, any) area of the body
There are several lasers for hair removal available differing in wavelength used to target the hair follicle as well as the manufacturer. No one laser is ideal for every individual. Depending on your skin color and hair color, some lasers will be more effective than others. The effectiveness of any laser hair removal treatment depends on the patient's skin color, hair color and on the abilities of the person providing the treatment. Choose a practitioner with a lot of experience. Know that hair must have pigment to be well treated, grey and blond hair is not sensitive to the laser. Electrolysis may be your best bet for permanent hair reduction in this case. Darker skin is more safely treated with an ndYag laser

The Ruby Laser: This is the "original " hair removal laser. Its deep red color at 694nm is very well absorbed by the melanin pigment in hair, making it an excellent choice for fine and light hair. However, because melanin is present in the skin as well, the Ruby laser cannot be used on patients with skin that is not very light, including tanned skin. Because of this limitation, slow repetition rate, and relatively small spot size, Ruby lasers have become less popular for laser hair removal in recent years.

The Alexandrite Laser:This laser produces reddish light. With its large (up to 18mm) spot size and high repetition rate, the Alexandrite laser is the fastest hair removal laser, and is suitable for rapid treatment of large body areas in patient with light to olive complexion. An entire back can be treated in less than 30 minutes. The absorption of light by melanin (which is the pigment found in hair) is closest to the wavelength of the Alexandrite laser. This laser is by far the best for people with fair skin. since it has the greatest pigment absorption with sufficient depth of penetration to treat hair. Because of its excellent absorption by pigment, darker skin types should be treated more cautiously and I do not treat darker Hispanic, Middle-Eastern, or Asian, or any African-American skin with this laser The NdYag laser is better for darker skin individuals and is also the deepest penetrating laser. since it has the greatest pigment absorption with sufficient depth of penetration to treat hair.

The Diode Laser: This laser, consists of a high power laser diode emitting infrared (invisible) light at ~800-808nm. The longer wavelength allows deep penetration into the skin and safety for darker skin types, but with less efficacy for lighter and finer hair. A smaller spot size means a longer treatment. That may mean a more expensive treatment. A longer treatment may also increase discomfort and a need for topical numbing. The Diode laser doesn't penetrate deep enough to kill all of the hair follicles and may just damage them causing them to fall out, but they will probably grow back again


The long pulse Nd:YAG: This laser can be used on all skin types, including tanned skin. Large spot sizes and fast repetition rates allow large areas to be treated quickly. Then disadvantage is less effective clearance for fine and light hairs than some other hair removal lasers. For darker skin types, the safest, most effective laser is the Long-Pulsed Nd:Yag laser. As it does not pick up pigment as well-- finer hairs may not respond as well as the Alexandrite, but it is very safe in all skin types. The Nd:YAG laser delivers laser in the 1064 wavelength which is absorbed by the pigment in the hair follicle. The other major categories of hair removal lasers are either of the 800nm wavelength (diode) or 755nm wavelengths However, they are not safe for use in darker or tanned skin tones. An attempt to treat darker toned skins by reducing the energy would lead to less effectiveness. Conversely, increasing the energy levels would cause burns.GentleYAG laser hair removal is used for any area of the skin which has unwanted hair, including the face, neck, chest, back, bikini area, underarms, arms and legs.

IPL devices are not lasers, because they emit non-coherent light of many different wavelengths. However, because most of the light energy is in the shorter wavelengths, treatment of darker skin types is less effective than with the appropriate laser. The light based technologies are not as specific as their laser counterparts however. They generally have broad applications (eg facial rejuvenation, leg vein treatment and hair removal) without being particularly great in any one specific indication
A larger spot size offers not only the advantage of faster treatment, but also additional safety and efficacy. As spot size increases, a lower percentage of the delivered light energy scatters outside of the treatment area, increasing the depth of pentration, and allowing a lower energy setting to be used for treatment.
It is important that a laser have consistent cooling in order to ensure patient safety and comfort. Although complications with new lasers for hair removal are rare, in the event of a complication, you need to know who will provide medical attention.
Because every person will respond at a slightly different rate, and some individuals will require more treatments than others for complete clearance


Final: Light sheer laser Not only is it five times faster but the comfort level is significantly better. Not a single patient has complained of pain or discomfort with this laser. The results have been excellent on all skin types and many patients who were reluctant to treat large areas, such as the legs, chest and back, have gone ahead with this laser mainly because it is so tolerable and fast. Like other lasers, however, it does not work on blonde or white hair. it is the fastest and most comfortable way of getting rid of unwanted hair.
Cutera CoolGlide Yag Laser uses a sophisticated light energy source for permanent hair reduction. The light is absorbed by the pigment in your hair, which effectively disables the hair follicle. The CoolGlide technology is considered the gold standard in the laser industry because of its long history of safety and effectiveness on all skin types—even on tanned skin, which is a nice benefit to patients in the summer months. It can treat not only coarse hair but fine hair as well. It is permanent, safe and effective. The CoolGlide can remove hair from the face or body; for example, the arms, underarms, legs, backs, and even particularly sensitive areas like the upper lip.
It is sometimes hard to tell how many treatments you might need in advance. Hair develops in phases and we can only treat hair in its active, visible stage. Therefore, the number of treatments depends on how quickly the untreated hairs appear. For significant clearance, most patients require a course of four to six treatments, which are spaced at least six to eight weeks apart.
Patients will feel a series of short snaps, somewhat like a rubber band snapping, but no local anesthesia or pain medication is necessary. Sensitivity varies from person to person, and we have a topical blocker that works quite well. Treatment times vary depending, of course, on the size of the area, but it typically takes 60 minutes to treat the upper and lower legs and 45 minutes for a man’s back. Underarms for women are fast. it effectively destroys the hair itself without harming the surrounding skin. You may be a little red afterward, but that typically goes away in a matter of hours. Unlike with waxing, you should shave beforehand since the treatment is targeting the hair follicle itself – not just hair.
No laser or light-based system can treat blonde, white, red or gray hair since there is no melanin in it to absorb the light, but with our CoolGlide system people with any other color hair, any skin type, and even tanned skin can receive treatment.

Capsular Contracture in Breast Aumentation & it´s Signs

Question:


There are 10 years after my breast aumentation surgery with prothesis and stick out more. They feel somewhat harder, but is this the implant or capsular contracture? How does a doctor determine if a patient has this problem?


Answer:
Increased firmness 10 years after breast implant surgery is certainly a capsular contracture. The implants themselves do not get firm. Capsular contracture is when the tissue surrounding the implant gets more dense and tightens arounds the implant squeezing it. If it tightens enough, the implant will get very firm and become shaped like a ball. Remember that the smallest space an object can occupy is a perfect sphere, and if the scar tightens enough, the implant will become a sphere. And, further tightening can even become painful.
There are four grades of breast capsular contracture - The grading is as follows ( according to the Baker system ) :
• Grade I the breast is normally soft and looks natural
• Grade II the breast is a little firm but looks normal
• Grade III the breast is firm and looks abnormal
• Grade IV the breast is hard, painful, and looks abnormal
If you are a Grade 2, I would do nothing. Grade 3, but only mildly distorted and you may need replacement of the implant and removal of the surrounding scar capsule(called a capsulectomy). Capsule contracture is the most common complication of an augmentation mammoplasty.
Some patients have had some softening of the encapsulation using the medication Singular, which is an anti-leucotriene. Add an anti-prostaglandin to that, such as Aleve, and you may have some relief natural Vitamin E complex
The following techniques have been employed to fight capsular contracture:
1. submuscular breast implant placement
2. using textured implants
3. limiting handling of the implants and skin contact prior to insertion
4. irrigation with triple-antibiotic solutions
the study examined saline vs. silicone capsular contracture rates , actually found silicone to be higher but this was likely secondary to the fact that a RUPTURED silicone implant causes much more of an immune response and is likely to cause capsular contracture. However the most reliable and common way to treat capular contracture is to remove the capsule and replace the implant
The causes have not conclusively been determined although some things that increase capsular contracture are: 1) Infection, 2) Hematoma (collection of blood around the implant), 3) History of breast radiation, and 4) History of previous capsular contracture .It is believed that capsular contracture is primarily a response to the presence of low-virulence or non-virulent bacteria (i.e. not the kind that generally produce an actual infection, with redness/tenderness/fever etc) that adhere to the implant surface on the day of surgery, and which over weeks and months following surgery stimulate the cells that make collagen (called fibroblasts) to make more collagen - thickening the capsule and stimulating it to contract and tighten around the implant. It is not an actual infection; there are no symptoms that this is going on, and taking antibiotics will not prevent the process or reverse it. The source of these non-virulent bacteria is thought to be the patient's skin, or the ductal systems of the breast that lead to the nipple, as both are normally colonized with bacteria.
The older implants are known to have greater gel bleed which allows smaller particle size silicone molecules to bleed out from the implant shell over time. This is though to incite a low grade inflammatory reaction and potentially contribute to capsular contracture.
A capsular contracture is diagnosed by physical exam and symptoms – . If the implant is firm and does not move around or starts to ride up on the chest more so on one side than the other, then more than likely you have it. imaging can show scar but not contracture . Encapsulated implants will feel very distinct from the surrounding breast tissue, are usually firmly attached to the chest wall, and the breast tissue will sometimes hang off the implants. Often times they may feel painful to the touch as well, which can occur in more advanced forms of this condition. You can try to massage the implants to relieve some of these signs/symptoms
Capsular contracture can occur on one or both sides, and while it can develop early (weeks) or late (years) after a breast augmentation surgery, in the vast majority of cases it is evident fairly early following the procedure. So the good news is that once you are six to 12 months out from your surgery, if your augmented breasts are soft and supple then they are likely to stay that way for the long term.
The more difficult decision is what to do. If the contracture does not bother you, it may be best to adopt a wait and see. Surgical options typically involve replacing the implants and either removing the capsule itself, or changing the position of the implant.
1. If it doesn't bother you, capsular contracture is not medically worrisome, and you could consider doing nothing if the process is stable.
2. If it is mild and early but bothers you, certain medications (Singulair, Accolate, Vitamin E) show promise in reducing or at least preventing progression of capsular contracture.
3. If it is moderate to severe, you may wish to consider surgery to loosen or remove part or all of the capsule (capsulectomy or capsulotomy) with implant replacement.
I would encourage you to perform breast implant excercises to prevent or minimize ongoing contracture.

Recovery , Breast Aumentation

Breast augmentation recovery. How much time off work does breast implant recovery require? Will I be able to take care of my 2 children afterwards? When do scars really begin to fade? The more you can tell me the better

Answer:




Initially, you can expect to feel tightness and pressure if the implants are placed under the muscle. Pain medication and muscle relaxants can ease this. Only use as much as you need to reach a point of "tolerable discomfort." Trying to become pain free with medications is not possible and will only lead to taking too much of the drugs prescribed to you. Recovery from breast surgery depends on many factors including implant size and placement, patients pain tolerance to name a few.

For the first couple days, you will have tight discomfort around your chest, like you had engorgement from breast feeding.This tightness eases significantly over the first week and most patients are off medications by then. Returning to activities that elevate your heart rate and blood pressure is possible at the 6 week point after surgery.
After surgery you will have swelling in the upper pole of your breast.The swelling should be largely gone by 6 weeks and usually there is no bruising at all. The final size and appearance should be seen by 3 months
.Breast Augmentation has consistently been the most popular cosmetic surgery operation for multiple reasons; It is affordable, makes a great change in your appearance, boosts your attractiveness and self-confidence and does NOT have a prolonged down-time


Recovery in general for breast augmentation is a fairly carefree operation done as an outpatient procedure with general anesthesia. The patient can usually go home following the procedure and short recovery period. Most normal activity can be resumed in three to five days following surgery. I recommend my patients to refrain from exercise and getting their heart rate above 100 for at least six weeks following surgery. The patient can expect to be off work for three to five days immediately following the procedure. Indeed time away from work depends upon the physical activity requirements of your job
.If your implants are placed submuscular (under the muscle) then I suggest no gym for 6 weeks. Let the kids get up on your lap then take them from a sitting position. Don't lift them from a standing position because it's a little too much force on the pectoralis itself . If you have small children you probably want someone to be around to help you during the first few days.Don't plan to drive during 10 days ,especialy while you're taking the prescribed pain pills .
.Most patients who undergo breast augmentation are actually surprised to find that they recovery is smoother than anticipated. Younger clients in the 20-30 group tend to bounce back faster but still need to limit their aerobic exercise and heavy lifting for a four weeks after surgery. At 6 days at your follow-up appointment incisions are healed and you learn how to massage them for softnes

Conclusion
These are general observations and by no means exhaustive nor completely exclusive.
Home the same day of surgery. You may experience some nipple sensitivity for the first few weeks Any bruising typically resolves in the first 2 weeks
Days 1-4: Inflammatory period: Swelling, pain, discomfort. Early risk for bleeding in first 24 hours.This is the period that requires the vast majority of medication. Move arms (if allowed by surgeon to minimize spasm pain). Bruising may appear. Fluid retention is common .
Days 4-10: Generally OK to shower and get wounds briefly wet if permitted by surgeon. Belly may be swollen as the swellng moves down your body. Possible constipation due to pain meds. Pain tends to diminish during the day with less need for meds. However, pain tends to occur at night from 3-6am and is worse with submusclular placement. Bruising stable. Begin implant displacement exercises(massage) if permited by surgeon. Between 7-10 days be aware of signs of bleeding or infection
Days 10-21: lowered risk of infection and bleeding. Increased physcial activity such as low impact exercises avoiding upper extremity resistance excersises. Vast majority of initial capsule formation occurs during this period. Vast majority of swelling begins to subside. Occasional pain at night.
Nerves begin to wake up (resolving dysesthesias) and may cause "pins and needles" sensation to nipple area. Normal to have some areas of skin numbness. More aggressive implant displacement exercises are begun.
Days 21-42: Generally a plateau period in terms of wound healing. Not alot of changes as the remaining 20% of the capsule tends to be formed during this period. Rare to require any pain meds.
May begin transition from low implact activities to higher impact aerobic activites and begin a slow but gradually progressive course of upper extremity resistance exercises. Many surgeons disagree at which point you may be unrestricted *(anywhere from 6 wks to 3 months).
Days 42-9 months: Progressive relaxation of scar tissues and softening of the initially firm result with descent of the implant and resolution of the remaining 5-10% of swelling. It is at this points that the breasts generally become softer and movil.
During this time most patients take "ownership" of the implants and they become part of their body image but this varies tremendously among patients. This is also a common time period where patients may feel that they didn't go big enough.
Although the breasts become stable in their appearance, it is important to realize that they are never stable and always changing with the greatest amount of change occuring with pregnancy, weight gain, and menopause. Everyone heals differently and not all surgeons would agree with this summary