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The You Re-Do

Cosmetic procedures from the neck down



 



A little nip here, a big tuck there. Make these smaller, and this straighter, please, and these much higher. As long as people are people, and certain body types trend, plastic and cosmetic surgeons will continue to help patients achieve their ideal bodies, look like themselves after illnesses or extreme weight loss, or get really large and round butt cheeks like Kim Kardashian’s.
 

“Butts are huge, no pun intended,” says Dr. Rouzbeh K. Kordestani. A well-credentialed plastic surgeon, Kordestani has recently moved back to Oklahoma City after a 14-year stint in Amarillo, Texas, where he served for a time as chief of the department of surgery for Northwest Texas Health Medical System.

“In my 14 years as a plastic surgeon, I have never had someone ask me for a smaller butt,” he says. “Contouring on the thighs, yes. Smaller butt, no.” As he begins to explain the two ways surgeons can make butts bigger, he becomes more animated. To be fair, he also becomes more animated when he is talking about other surgical procedures, taking care of his patients or the field of medicine in general. This guy loves what he does.

In fact, Kordestani tried to retire, but only made it about a year, and is now back doing what he does best: making his patients’ outsides more closely match how they feel inside. He is passionate about what he does, and precise when discussing it, his intense, step-by-step descriptions often accompanied by drawings, sound effects and the occasional quick tap on the wrist to underscore a point.

Kordestani himself has dabbled in Botox, and has had a rhinoplasty. The nose job was performed by Kordestani’s best friend and fellow plastic surgeon (who specializes in facial reconstruction), Dr. Ivan Wayne, whose Oklahoma City practice is now Kordestani’s home base, as well. “I broke my nose in a swimming pool, and Ivan fixed it for me,” he says.

“If people can tell that you’ve had surgery, I have failed you. There should be no trace afterward,” says Wayne. He, like Kordestani, is an intense person. In Wayne’s case, he’s a compact, fit-looking fellow with a tousled mop of hair, who almost vibrates when he’s sitting still.

On this day, he had just finished surgery and was moving himself out of the hyper-focused state you definitely want in a surgeon and into a still-intense-but-conversational version of himself. Although his practice is mostly above the neck, he does his fair share of neck lifts, and says you can spot a bad one right away.

“Men get neck lifts. No man wants a weak jawline,” Wayne says. In demonstrating how to do a proper neck lift – which, of course, many women get, too – Kordastani and Wayne each make a yanking motion and a “shhhhhrrrrrrttt” sound. “The neck is like a rubber band, you make two incisions and pull,” Kordestani says. But there has to be enough fat in the neck to hide the pull, and conversely, if you don’t pull enough or evenly, the patient is left with a lumpy neck. Or, to use the common vernacular, a turkey neck.

 

(left) Dr. Rouzbeh K. Kordestani (right) Dr. Ivan Wayne


 

“A good plastic surgeon won’t leave visible scars, and nobody should be able to tell you’ve had anything done. In the past, a facelift yielded a windblown look. Now, it’s a much more natural rejuvenation,” Wayne says.

Deana Alvarado had gastric sleeve surgery in 2014, which reduced the size of her stomach, and she lost 80 pounds over the course of the next year.  In 2015, she started looking for a surgeon to remove her excess skin. “I lived in east Texas at that time, so I started reading articles and looking at surgeons’ before and after photos. My experience was that most of the surgeons I talked to made me feel bad. They said that I wasn’t going to be able to look the way I wanted to look,” Alvarado says.

Alvarado’s son-in-law had a friend who was a plastic surgeon in Amarillo, who he suggested she meet. “I did my research, and talked with two people who knew him. I drove to Amarillo for my first meeting and as soon as he started to talk, I knew. He made me feel that something could be done. He was realistic about what could be done, but positive that I could look better,” she says. Who was he? Dr. Rouzbeh K. Kordestani.

Her transformation began on Dec. 1, 2015, with the first of three surgeries. “My first surgery was a 360 Fleur de Lis. It went all the way around, and there was a vertical incision, too. It was very intense. He removed 17 pounds of skin and repaired my abdominal muscles, which had separated,” Alvarado says.

Her surgery was performed in Amarillo; she stayed with family there for a month while she healed, headed home for a couple of weeks, and returned to Amarillo for her six-week check-up.

“He really went above and beyond. His scars are straight and perfect. Others’ scars have puckers, but his are beautiful,” Alvarado says.

She waited about two years to take the next step. In the interim, Alvarado and her husband moved to Oklahoma, and Kordestani decided to retire and moved to Las Vegas. His retirement lasted about a year; his dedication to improving patients’ lives wouldn’t allow any longer. “I was looking for a new doctor, and I just wasn’t happy with any of them,” Alvarado says. “I called Dr. K, and he called me back and said he was coming out of retirement and moving to Oklahoma, if I could wait. I said, ‘Of course.’”

Her inner and outer thighs got their makeover in January 2018: lipoplasty combined with the removal of excess skin. “The downtime was just three or four days. I wore a compression garment after that, but the recovery wasn’t bad at all.”

Compression garments after lipoplasty are crucial. “With lipoplasty, we find deep fat excesses, and flood them with a tumescent solution, which kills fat and liquefies it. Then we suction it out. After the procedure, the patient must wear a compression garment to eliminate the “lakes” that can form if fluids seep into the superficial layers,” Kordestani says.

 


 

Alvarado’s third and final surgery was in early March. Extra skin was removed from her arms. Her breasts were lifted, and evened out size-wise, with a reduction on one side followed by implants in both. About 10 days later, she was peppy. “I am feeling great. My energy level is good, and I’m driving. I get sore by the end of the day, but overall I feel great.”

Now that she’s shipshape, it’s her husband’s turn. He will undergo a tummy tuck with Kordestani soon. Alvarado’s daughter is also a member of the straight-scar society; Dr. K. augmented her breasts last month.

There are plastic surgeons, and there are cosmetic surgeons. They are not the same, and it’s important to know what each designation means, but it’s far more important to do your homework and learn as much as possible about any surgeon you are considering. Remember the old joke: What do you call the guy who graduated last in his medical class? Doctor.

A plastic surgeon completes a bachelor’s degree, and then attends medical school. That’s followed by five to six years of residency training, with the first half focused on general surgery and the second on plastic surgery. After residency, there are exams to pass before a student may finally work as a surgeon.

Many also go through fellowship training after residency, to gain expertise in a subfield of plastic surgery. This can all add up to 13-plus years. Plastic surgery can be used to enhance appearances (cosmetic surgery), or to reconstruct after illness or injury.

A cosmetic surgeon is not necessarily a plastic surgeon. Cosmetic surgery, whose purpose is to enhance a person’s aesthetic appeal, is performed by doctors from a variety of medical fields. To become certified by the American Board of Cosmetic Surgery, a doctor must complete a year-long fellowship training in cosmetic surgery, which happens after any residencies he or she may have completed in order to graduate. Many train far more than that.

All of this is to say, “Buyer beware,” whether your surgeon is of the plastic or cosmetic ilk. To directly quote the American Board of Cosmetic Surgery website, “Because any licensed physician can legally perform cosmetic surgery, regardless of how they received cosmetic surgery training, it is extremely important to do your research when choosing a cosmetic surgeon.”

Drs. Erik Nuveen and Courtney Caplin are cosmetic surgeons whose training, scholarship, research, experience and education are vast. Both are MDs and DMDs (doctors of dental medicine). Nuveen has had a total of nine years of surgical training, including craniofacial surgery, plastic surgery, micro vascular surgery, cosmetic and general surgery. Caplin was chief resident at the University of Florida, which she followed with a fellowship in general cosmetic surgery, which focused on facial and body procedures, specifically those of the face, breast and abdomen. Caplin and Nuveen are engaged to be married, taking their partnership from the operating room to the ever-after.

 

Dr. Erik Nuveen and Dr. Courtney Caplin


 

The two often operate as a pair, which makes surgeries efficient. “A body lift takes us about three hours,” Caplin says. That’s important – because the longer a surgery takes, the greater the risk. “About four hours is the bellwether for increased risk,” Nuveen says. “At that point you go from moderate to major risk.” With proper management, that four-hour window of low risk can be increased to up to seven, but as Nuveen said, he and Caplin see no reason to test that threshold.

Surgical efficiency isn’t the only advantage their partnership brings. “Being able to offer a male and female perspective is great for our patients,” Caplin says. Some patients prefer a female or male doctor, and each of the two brings a distinct approach to the process.

“We see many things differently,” Nuveen says, laughing the way men laugh when they say such things. “She is very social and outgoing, and I am an introvert. She views things from an artistic perspective, and I prefer objective data.” They are nicely balanced, and their dedication to their patients and to surgical education (theirs and others’) is ongoing. Nuveen is well-published, and has been first author in 15 articles for medical journals.

All of their surgeries are performed at their surgery center at the corner of Northwest 63rd and Penn, which runs with cheerful efficiency. Patients who’ve gone under the knife with Nuveen and Caplin now number around 1,300. The number of breast augmentations is high enough that their facility has a large storeroom filled with shelf after shelf of implants of all sizes, waiting for their forever homes.


Questions to Ask Your Potential Surgeon
 

Are you trained in plastic surgery?

Are you board certified?

How many of this specific procedure have you performed, and how long does it take you?

What are the possible complications?

What can I expect during recovery?

How uncomfortable will I be?

 

Operation Game
 

Whether caused by weight loss or the slow march of time, a turkey neck is something many of us would like to be rid of. How we go about doing that depends on one main thing: skin elasticity. If the neck skin is nice and stretchy, some careful lipoplasty might be just the ticket. If elasticity is low, a neck lift will yield better results.

 


 

Probably not a job for lipoplasty. Again, it’s about the stretchiness of the skin. Super stretchy skin? Lipoplasty is an option. For patients who have lost vast amounts of weight, and/or have less elasticity, an arm lift (brachioplasty), which means the surgeon will trim off the excess skin and fat, is the way to go.

 

Recontouring. This can involve a combination of removing excess skin, lipoplasty, removal of some glandular tissue and re-shaping it to make it look more masculine and nipple size reduction. Fun fact: The ideal average male areolar diameter is 22.5 millimeters.

 

The, um, centers of attention can be made bigger, smaller, tighter or perkier. Often, a breast lift and implants happen together.

 

A tummy tuck is slang for abdominoplasty. This is also referred to as a mommy makeover. You’ve lost weight, and have extra skin on your belly. How it got there is your business … but you’ve worked out and dieted, and there it still is. In this procedure, an incision is made from hip to hip, and the skin is pulled down and cut off. The belly button is then moved up.

 

Nobody wants a smaller booty these days. Maybe a little hip contouring, but large, round, peachy cheeks are currently in fashion. Implants can be used, or fat from other parts of your body can be suctioned out, cleaned in a centrifuge and injected right back in. This is the preferred method, because implants, which are made of really hard material, tend to move around or erode through the skin.

 

Lipoplasty. That’s it.

 

Lipoplasty plus skin incision, or skin incision alone. Non-medical translation: suck it out if it needs it and then chop off the extra, or just chop off the extra.

 

Not much, because you don’t want to do anything to change the structural dynamics of the body. So, maybe a little lipoplasty on the medial aspect, but that’s it.

 

Implants. These are custom-made and hard, not squishy. Calf implants are requested by men 70 percent of the time.

 

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May 2018

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