A Board Certified Plastic Surgeon in Scottsdale, AZ
AB Guerra, MD, FACS
Scottsdale Arizona plastic surgeon - Dr. Guerra, performs a broad range of cosmetic plastic surgery procedures including mommy makeovers, tummy tucks, breast augmentations, breast lifts, breast implant exchanges, liposuction, face lifts, eyelid surgery, rhinoplasty, plastic surgery after weight loss, body lifts, thigh lifts and more. He is known for having a graceful, gentle and meticulous touch in performing cosmetic enhancement procedures with great precision and elegance. Dr. Guerra prides himself in establishing long-term relationships with his patients and has a great bedside manner.
Homepage: http://www.myfaceandbody.com/?ref=wp
Posts by AB Guerra, MD, FACS
Fall Weather Plastic Surgery
Sep 3rd
Fall Weather Plastic Surgery
Scottsdale – We are finally turning the page on Summer and heading into the Fall Season. Plastic surgery is traditionally very popular in the Fall. For instance, over the past three years the trend is for cosmetic surgery patients to get breast augmentation around this time. We are not sure why, but the number of breast implants used in September, October, and November usually increases each month in the Fall and Winter.
Fall Uptrend in Breast Implants and Tummy Tucks
One theory is that may ladies went to the beach, and had some fun in the sun, this past Summer. They noticed their friends and acquaintances who did get plastic surgery of the breasts and mommy makeovers. These friends looked great and had a lot of confidence because of the way the looked after last year’s cosmetic surgery. Our clients during the Fall, often times, make reference to their friends, who by the way, are our number one source of referrals for future patients. After waiting for their turn, many new clients are ready for the breast surgery or tummy tuck by the beginning of November.
Fall Uptrend in Facelift and Eyelid Lift Surgery.
We also see an uptrend on the number of facial plastic surgery cases we perform. I have always said that facelift, eyelid surgery, and necklift are a lot easier on patients during cooler weather. The weather in Scottsdale, Arizona start getting really good during late October and many patients take advantage of this fact. To make it easy on patients looking into facial rejuvenation surgery, we are having a Facelift and Eyelid Lift Seminar on Wednesday the 22nd of September, in our office, at 6 PM sharp!
Plastic Surgery Success: First U.S. Face Transplant.
Sep 2nd
Scottsdale – It’s really impressive. The results of the first U.S facial transplant really impressed me! The initial operation was carried out by a team of dedicated plastic surgeons from the Cleveland Clinic nearly 2 years ago. The patient, Connie Culp, was disfigured by a shotgun blast 6 years ago. In 2004, her husband shot her in the face, tearing away her nose, upper jaw, teeth and all of her facial nerves and muscles. The injuries left her with the loss of smell and taste, unable to breathe through her nose and mouth, and nearly blind.
Now, the proud grandmother is recovering from her final facial plastic surgery, in which her doctors removed the extra skin around her jaw line. Over the past several months, Culp has regained sensation in her face as her nerves continue to regenerate. She no longer has an airway in her throat, can breathe through her nose, taste food, and importantly, smile and speak more clearly.
“As we planned, we have removed this extra skin, and essentially she received a facelift, and that really changed that extra skin look into a normal looking face,” said Dr. Maria Siemionow, who led the team of board certified plastic surgeons during the 22-hour procedure that replaced 80 percent of her face.
The first face transplant in the world was performed in France in 2005 on a woman mauled by her dog. Since then, a dozen or so more have been performed worldwide. In the U.S., a second face transplant has been performed by doctors at Harvard-affiliated Brigham and Women’s Hospital (Boston, MA) on a man who was disfigured in a freak accident.
“It feels great to go out and not have people gawk at me because I look strange, but it’s OK for people to go out that look different,” Culp said. “Don’t let nobody bring you down because you don’t look the same as somebody else.”
We have covered this story of success with face transplant on the blog previously. However, I continue to be impressed with the outcome and scope of this plastic surgery operation.
Primer on Buttock Shapes: Part II.
Sep 1st
Scottsdale – It is very important to understand the shape of the buttocks before performing buttock enhancement surgery. In fact, when planning a Brazilian butt lift, for instance, much of the fat in the back and hips is utilized for fat injections to the buttocks.
Brazilian Butt Lift and the V Shape Buttocks.
The goal with Brazilian butt lift is to improve the appearance of the back and butt. In many ways, the plan is to change the current shape of the buttocks from a V or square to a more attractive A and round shape.
The less-than-attractive V Shape.
The Square Butt Shape and Buttock Plastic Surgery.
In terms of overall results, it is the square shape that is the most challenging to change. The square buttock patient usually has extremely inelastic skin and little surrounding fat pockets. Additionally, the buttocks are pretty small and poorly defined. The buttocks are classically square and flat, on top of these other unfavorable characteristics.
The Square shape is a challenge.
The A Shape Butt: An Ideal Result for Plastic Surgery of the Buttocks.
The A Shape butt is the most attractive. If you consider that the top of the A is made up in the mid to lower back, then it is easy to see that removal of fat in this area will lead the way to achieving the most aesthetic result. The mid and lower sections of the A are achieved by adding volume and expanding the buttocks. People with A shapes have better buttocks when the bottom is very round.
The ideal, attractive A shape.
The Round Shape Butt and Liposuction.
Since the round shape is considered the second most attractive, the plastic surgeon makes the best effort possible to round-up the buttocks even more. How is this done? There is a two-step process which involves liposuction in the lower back and hips with fat injections to the buttocks. The round buttock patient is very close to ideal and the results of fat injection with lipo are excellent.
Round butt with hip liposuction is an A.
Buttock Fat Transfer Resorption.
In general, the closer you are to the A shape before surgery, the most likely it is that your results will look far more attractive when compared to someone who has a square or V shaped buttocks. This fact has to do with the amount of change that can be accomplished during one operation. When we perform fat transfer now, we place a lot more fat than in the past, and the technique has advanced even more in terms of better equipment and technique. Additionally, we know that about 70% of the fat injected will survive and an over correction of 30% is planned for all buttock augmentation cases.
Silicone Buttock Implants versus Buttock Fat Grafting.
If you have a plastic surgery consultation in Scottsdale, Arizona and decide, based on our recommendations, that 700 cc of fat per butt cheek is what you desire, then the operative plan will include fat harvest of several thousand cc of fat and, at least, 1000 cc of fat injection is made into the each buttocks. When the anticipated 30% reabsorbs, then you still achieve the results desired with the original 700 cc plan. Buttock augmentation with fat grafting, in my opinion, is far better than using silicone buttock implants. The buttock implants are limited in size and are associated with all the limitations encountered with all other implants. The fat tissue we would use for your cosmetic surgery, on the other hand, all comes from your body, and there is usually plenty of it. Some patients may be too thin for fat grafting, but we can discuss other options.
Composite Tummy Tuck for Moms: A Mommy Makeover.
For instance, I can recommend a composite abdominoplasty for moms who are not planning any more pregnancies, have loose skin with stretchmarks and plenty of fat in the tummy to donate. The composite tummy tuck, is a nice option for patients as it offers the ability to tighten the tummy with a modified tummy tuck, circumferential liposuction around the body, and then we top off the procedure with fat injections to the buttocks. When it comes to learning about your buttocks and buttock aesthetics, there is no substitute to having a consultation with an experienced board certified plastic surgeon. As you can see from the above diagrams, sorting out all the facts surrounding the gluteals is a complicated issue. Only a cosmetic surgeon, with formal training in plastic surgery, and with plenty of experience can help you to achieve the best results for your butt!
A Primer on Buttock Shapes: Part I.
Aug 31st
Buttock Shapes.
Scottsdale – It is true, at some point in our lives, we will all think about our butts!
Isn’t important to know what shape your buttock is? This article is for those who have a desire to better understand the aesthetics of the gluteal region and plastic surgery of the buttocks.
At this point in time, there is still a lot of work being done to document all the aesthetic points associated with the butt. No one, including myself, especially in a short blog, has been able to cover all the facts.
So, this is a primer that can help the plastic surgery patient who is looking for more information about buttock surgery. It is a beginning and will be updated on the blog with future articles on butt aesthetics and plastic surgery techniques developed specifically for the buttocks.
The most recent work on buttock aesthetics has been out of Miami, Florida, which has also served as the buttock surgery capitol for some time now. This body of work has helped tremendously to clarify some of the points I am going to discuss here today.
Common Buttock Shapes.
The 4 Basic Gluteal Shapes affecting Buttock Plastic Surgery.
There are four 4 basic shapes: The A shape (top left), the V shape (bottom right), the round (top right), and the square (bottom left). However, these general shapes may not classify every single buttock type seen in the world. The most attractive shapes visually appear to be the A and the round. Square butts and V shapes are the least attractive in that respective order.
Buttock Surgery at a Plastic Surgeon’s Office.
Other shapes, which are actually variations of the main four, are seen commonly in a board certified plastic surgeon office. Of course, we cannot simply talk about the buttocks without considering the surroundings. We must consider the relationship of the lower and upper back, the hips and outer thighs, and how these relate to the buttocks. In many cases, the surrounding fat pockets reduce the aesthetics of the buttocks and any cosmetic surgery for the buttocks should consider carefully reducing or removing these surrounding fat pads. To learn more about your buttock shape and how it affects the planning of buttock surgery, please stay tuned for tomorrow’s blog.
Breast Augmenation. Is there an App for that?
Aug 30th
Scottsdale – Have you always wanted to see what you might look like with bigger breasts without having plastic surgery or taking the time to consult with a plastic surgeon? Well, it turns out that such an App really does exist. It is available on the iPhone and iPod Touch. The creators tell us that consumers can get an instant virtual breast augmentation privately, easily, and inexpensively!
The breast augmentation application is called iAugment. The application allows you to take a photo of your breasts with your phone or using an existing photo. The breast implant size options available include sizes 210 cc to 690 cc. and choose one of the many implant options available to you! The application will do the rest.
• Recommended plastic surgeons in your area. • The ability to save your augmented photos on your photo library.
• The ability to publish your augmented photo on Facebook.
• Easy to follow instructions:
First: Take a photograph of your breasts.
Second: Highlight the augmented area, and adjust the slider to fully cover the breasts.
Lawnmower injuries still a serious concern.
Aug 29th
Summer Lawnmower Injuries
Scottsdale – Each summer there is a trend in the number of injuries experienced by adults and children from lawnmowers. The American Society of Plastic Surgeons (ASPS) reports that 247,000 people were treated for lawn mower-related injuries last year. A little more than 18,000 were children under age 19, the U.S. Consumer Product Safety Commission reports.
For this reason, the ASPS, the American Society for Reconstructive Microsurgery, the American Society of Maxillofacial Surgeons, the American Academy of Pediatrics, and the American Academy of Orthopaedic Surgeons are working together to prevent injuries and educate adults and children about the importance of lawn mower safety.
“Lawn mower injuries are not only among the most devastating I’ve seen in over 20 years of practice, they are also the most preventable,” said Peter Neligan, MD.
Typical lawn mower injuries are usually very complicated and require a team of doctors from various specialties, including, plastic surgery, microsurgery, pediatrics, and orthopedic surgery to properly repair.
“Lawn mower injuries often include deep cuts, loss of fingers and toes, limb amputations, broken and dislocated bones, burns, and eye injuries,” said Michael McGuire, MD.
Careless use of lawnmowers is a critical factor that often times leads to injuries. Several professional medical societies suggest some simple tips to prevent injuries and keep lawnmowers safe:
- Children should be at least 12 years old before operating a push-style lawnmower.
- You should not operate a ride-on lawnmower unless you are 16 years old.
- Children should never be passengers on ride-on mowers.
- Always wear sturdy shoes while mowing. Avoid sandals.
- Young children should be at a safe distance from the area you are mowing.
- Pick up stones, toys and debris from the lawn to prevent injuries from flying objects.
- Always wear eye and hearing protection.
- Use a mower with a control that stops it from moving forward if the handle is released.
- Never mow in reverse unless absolutely necessary. Carefully look for those behind you when you do.
Evidence-based Bodylift.
Aug 28th
Scottsdale – The lower bodylift operation is an extensive plastic surgery procedure which carries a significant amount of risk. It is performed with increasing popularity in America because more patients are finding out about this surgery each and every day. The lower body lift or belt lipectomy is the most popular plastic surgery after major weight loss available.
The bodylift has several variations, which we will review in this blog. Most of the variants have to do with the location and design of the incision. In some cases, the incision location can be placed quite low. This hides the incision better and allows for a very nice upward pull on the thighs and buttocks. This gives the patient an attractive outer thigh lift, buttock lift while simultaneously improving the figure.
Another popular version places the bodylift incision in a higher location, just above the pelvic bones. These incisions allow for the most amount of tissue to be removed at the waist and can create a beautiful hour-glass shape. The incision may be more noticeable in such cases.
The third variation is often used in patients with vertical scars from open gastric bypass surgery. The design of this operation can include either a low or high waist incision and a vertical component where the healed bariatric surgery scar is located. This creates a T-incision right at the bottom of your tummy.
We have to consider when and how to best use these three options. The decision about these incisions should be carefully considered by each and every patient. Once a patient decides on their best choice of incision, the pros and cons are discussed once more with their board certified plastic surgeon.
The vertical component is especially discussed with this type of cosmetic surgery. This incision, if it is opened and re-closed, at the same time as a bodylift, could increase the risks of wound separation, infection, and delayed in wound healing. We know that studies demonstrate about a 50 percent chance of wound breakdown because of the length of the incision and relatively poor nutritional status after bypass while using a circumferential incision. What happens if we add an extra incision to our bodylifts? Such as the T-incision?
The most likely scenario is the risk of incision breakdown would be even higher than 50%. This is, of course, is problematic for both surgeon and patient. We have already reviewed on this blog about T-incisions performed for surgery after major weight loss. Thankfully, most wounds delays in healing and separations are relatively minor and heal quite quickly. Therefore, the key to the T -incision with bodylift or tummy tuck, is going to be the identification of patients which will benefit the most from this incision while minimizing the risks.
What’s the bottom line? I recommend the extension to the T-incision with bodylift when the patient will get a big improvement in the contour of the body. When the patient is borderline, the judgment to proceed with the vertical incision may be made intra-operatively. The plastic surgeon reserves the right not to proceed depending on various factors which can occur during surgery. We always keep the patient’s safety in mind and ultimate outcome when making these decisions.
I use this incision when the patient will get a better cosmetic result with a tighter tummy and a smoother waistline. I also recommend that patients increase their nutrition with vitamin C and a high protein diet for 1 month before surgery to optimize their condition. It is my opinion that when the surgeon, patient, surgery center and technique are all optimized, then we can achieve very nice results with minimal risks.
Pocket Pharmacopia comes through – Again!
Aug 27th
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Scottsdale – As a physician you always need a handy medical prescription book that is readily available. Most of the time, the books available to plastic surgeons and medical doctors are way too large to carry around. Some programs are available on the iPhone, but I find these to be too complex to use on a regular basis.
For years, I have relied on a simple, small book that can be carried in the pocket of my white physician’s coat. I have used these little books, which are updated every year, and are easy to use with great reliability. These books are called Pocket Pharmacopia.
I used the Pocket Pharmacopia recently to create a blog on breast augmentation and postoperative medications. I am also using my little book to help me on future projects like my facelift and eyelid medication recommendations. The 2010 version which I currently use is 187 pages and it is full of useful information which any doctor can use.
The best thing about these little books is that they are always by my side and I can use them to clarify any issue with medications. As I mentioned earlier, the books are updated every year and they really do a great job at this. Even relatively new drugs I would normmaly not use in my practice can be referenced on the spot!
AB Guerra, MD, FACS. Surgery Training, 1997.
Aug 26th
Scottsdale – An unbelievable photograph taken at Harbor-UCLA Medical Center. This is during the my general surgery training years, before I was thinking about pursuing a career in plastic surgery. I was way too busy back then to care about photos, but I am glad an old friend had a camera handy! After so many years, I have learned to appreciate the value of old pics.
Breast Asymmetry: Causes and Treatments.
Aug 25th
Scottsdale – Breast development usually results in some unevenness of the breasts. Breast asymmetry, in fact, is normal and natural, but it is usually only acceptable to most patients when the difference is subtle. When examining the human shape, is is normal to visualize some differences in our bodies from side to side. Many patients request silicone breast implants to improve breast asymmetry.
The cause of breast asymmetry can be divided into two groups:
- Asymmetry may result from natural development, which includes pubescent growth, pregnancy, lactation and weight fluctuations.
- The second group of causes includes asymmetry caused by external factors such as disease, trauma, reconstructive or cosmetic surgery. During development, the female breasts increasing in size and projection, responding independently to hormonal and growth stimulation. For most women, the differences that exist at the end of this process are typically minor. Exceptions can occur when conditions such scoliosis and Poland’s syndrome.
The Developed Breast and Breast Implants:
The developed breasts have similar volumes with the infra-mammary folds in a similar position, nipple position is close to being at the same level, and the nipples are at the center of the breast and above the infra-mammary fold. Volume differences are very common and are often associated with differences in nipple position and diameter as well as differences in elevation of the IMF.
When the nipple position is below the ideal location the breast is said to be saggy. This is especially true when the nipples fall below the IMF. Breast augmentation and breast lift can improve the asymmetry in such cases. Perfection cannot be achieved. It is believed that breast should be like sisters but not identical twins.
Pregnancy and Weight Fluctuations and Breast Implants:
Pregnancy and weight fluctuations can lead to asymmetry. Pregnancy and lactation typically creates an increase in the size of the breasts. After the baby, there is a deflation and a loss of volume in the breasts. Usually, the breast shrink back to near pre-pregnancy size, although some experience an additional decrease in overall breast volume.
Similarly, significant weight changes can increase the saggy appearance and asymmetry. As weight increases, the fat portion of the breast increases and with the extra weight, the breast falls. This process can occur unevenly on each side leading to asymmetry which can also be compounded by the same stretching of the skin..
Breast augmentation may help those who are not very saggy, but a breast lift is better when the breasts are very saggy. As in cases involving other types of breast asymmetry, perfection cannot be achieved. Before and after plastic surgery, breasts are like sisters, not identical twins.
