Unbeknowst to me, one of our patients has been describing  her experience, both before and after surgery, on a major website, realself.com.  She is a 35 year-old woman who is 5’6” in height and weighs 203 lbs.  She previously weighed 339 lbs but lost 137 lbs following gastric bypass surgery.  She complained of extreme dissatisfaction with the appearance of her abdomen after massive weight loss.

She underwent full abdominoplasty (tummy tuck) in our West Plano Plastic Surgery Center on March 2, 2012.  Her before and two month postoperative results are below.  Final results are anticipated at approximately one year.

Full tummy tuck:

Before front                                                           After front

Before side                                                            After side

Click here for a complete description of her experience—in her own words.

For more information about tummy tucks, including more before/after photos, please click here.

Dr. Friedman is a board-certified plastic surgeon who specializes in breast and body contouring in Plano, Texas.  In practice for 17 years, his office at Presbyterian Hospital of Plano serves the Frisco, Allen, and McKinney, Texas areas.  He also has a Flower Mound office that serves the Lewisville, Denton, and Coppell areas.

For more information about Dr. Friedman, please visit www.plasticsurgerydallas.com.

Before  (actual patient)                                   After (actual patient)

Tummy Tuck with Liposuction of Hips, flanks and upper torso

Before (actual patient)                                 After (actual patient)

A full tummy tuck (abdominoplasty) improves the appearance of the abdomen following pregnancy or weight loss by addressing excessive skin, excessive fat, and abdominal wall laxity:

1. Excessive skin: all skin from the umbilicus (belly button) to the pubic area is removed.  The remaining upper abdominal skin is advanced downward and tightened.

2. Abdominal wall laxity: the entire abdominal wall is tightened (typically 4 to 5 inches) by permanent stitches into the fascia (fibrous tissues between the rectus abdominis muscles).

3. Excessive fat:  all fat below the navel is removed, corresponding to the area of skin removal.

The big question: What do you do with the excessive abdominal fat above the navel?  The answer is not as obvious as it seems.  Many plastic surgeons are reluctant to perform liposuction of the upper abdomen during a tummy tuck for fear of problems with reduced blood flow to the tissues.  Specifically, they are concerned that if you elevate and advance the tissues, suctioning them at the same time may create too much trauma.

The problem: If you don’t liposuction the upper abdominal tissues, your abdomen may still protrude excessively after surgery, potentially requiring a second surgery for abdominal liposuction at a later date.

The solution: I routinely perform liposuction of the abdominal wall during tummy tucks.  The key is to be conservative with the amount of suction performed, so that the procedures can be combined safely.  Fat removal must be done conservatively to preserve blood supply to the abdominal skin and remaining fat.  Even greater care must be taken with diabetics (who must be well-controlled) and smokers (who must be off cigarettes), as both of these groups are at greater risk for blood flow compromise.

Judicious liposuction during tummy tuck can improve the cosmetic surgical results while preserving patient safety.

Dr. Friedman is the Founder and Director of the West Plano Plastic Surgery Center on the campus of Presbyterian Hospital of Plano.  He also serves the Fairview, Lucas, and Wylie communities.

Botox is now available at a reduced cost of $275 for the first 25 unit syringe ($11 per unit) and $225 for the second 25 unit syringe ($9 per unit).  This promotion is supported by Allergan, the manufacturer of Botox, and is good through April 30.  Our usual charge is $325 for the first syringe, but we can now provide a $50 rebate for patients who enroll in the Botox Rewards Program.

Dysport, an FDA-approved competitor of Botox, if offering a similar $50 rebate on the first syringe.  A 75 unit syringe of Dysport (equivalent to 30 units of Botox) is now available for $275.

The best part: these offers can be combined. For example, if you have a syringe of Botox to the lines between your eyes and a syringe of Dysport for the crows feet during the same visit, your regular cost would be $325 (first syringe) plus $225 (second syringe) = $550.  With these combined offers, you can save $50 on each syringe, yielding a total savings of $100.

Two syringes (one Botox, one Dysport) for $450 is an excellent deal (equivalent to $8.20 per Botox unit).

Also consider that every injection is personally performed by board-certified plastic surgeon, Ronald M. Friedman, M.D., who has been in practice in Plano and Flower Mound for 16 years. We also have numbing cream and laughing gas available at no extra charge.

Botox to Glabella  Before                                           Botox to Glabella  After

Dysport to Crows feet  Before                               Dysport to Crows feet  After

Dr. Friedman has always prided himself on personally performing every Botox, Dysport, Restylane, and Juvederm injection.  Although ice is suitable for many patients, he believes that it is unfair to charge extra for patient comfort.  So he provides topical anesthetics and/or 70% nitrous oxide (laughing gas) at no additional charge.  Our practice also serves the Frisco, Richardson, and Garland communities.

Please visit our website for more before and after Botox photos of patients who have been injected by Dr. Friedman.

The most serious risk of any excisional body contouring procedure is blood clots.  Due to the immobility associated with any major surgery (especially one that temporarily makes it more difficult to walk), there is a risk of blood clots forming in leg veins (deep venous thrombosis).

If a clot “breaks off” and travels through the bloodstream to the lungs, it can suddenly and seriously impair oxygen exchange.  This life-threatening condition is called a pulmonary embolus.  It requires immediate treatment with blood thinners (to dissolve the clot) and oxygen.

Every plastic surgeon and plastic surgery patient should take these risks very seriously.  The question: what can we do to prevent blood clots following tummy tuck and circumferential body contouring (body lift)?  We have a protocol:

1. DO NOT smoke for at least one month before surgery and one month after surgery.  Smoking causes constriction of blood vessels, impairing blood flow and oxygenation.  Smoking greatly increases your risk of blood clots (even if you are not undergoing surgery).
2. DO NOT use contraceptives or hormone replacement therapy for at least one week before surgery and one week after surgery.  These substances can increase your risk of blood clots (even if you are not undergoing surgery).
3. DO walk regularly after surgery.  Every time you want to eat or use the restroom, you must have a family member or friend help you to the kitchen or the bathroom.  Regular meals in bed are just a bad idea.  Walking helps pump blood through your leg veins, preventing clots from forming.
4. DO use SCDs. Sequential compression devices (SCDs) are mechanical pumps that intermittently compress the leg veins, promoting circulation by simulating walking.  We place these on all patients undergoing surgery in our nationally-accredited surgical facility, the West Plano Plastic Surgery Center.  We send abdominoplasty (tummy tuck) and body lifting patients home with an SCD machine for the first few days to further reduce the risk of blood clots.  I do not know of any other surgeon or surgery center that does this routinely, and I sincerely believe that they should.
5. DO consider anticoagulants.  Anticoagulants (blood thinners) can significantly reduce the risk of blood clots.  Unlike #s 1 to 4 above, they do increase the risk of postoperative bleeding, so they must be used with caution.  For example, I will not use an anticoagulant in a patient who bleeds excessively during surgery.  However, in most patients undergoing excisional body contouring, I begin low dose Lovenox (low molecular weight heparin) in the first 24 hours after surgery and continue its use daily for a week.

With this protocol in place over the past five years, we have not experienced a single clotting—or bleeding—episode in a tummy tuck or body lift patient.

We want you to look great after surgery.  But first and foremost, we want you to be safe!

Dr. Friedman, the former Chief of Plastic Surgery at Parkland Memorial Hospital in Dallas, serves the Frisco, Allen, McKinney, and Fairview communities.

D Magazine has named Dr. Friedman a Best Plastic Surgeon for FIVE consecutive years.  He was also named a Texas SuperDoctor by Texas Monthly magazine for four consecutive years. While working on the full-time plastic surgery faculty at the University of Texas Southwestern Medical Center in Dallas,  Dr. Friedman served as the Chief of Plastic Surgery at Parkland Memorial.

Dr. Friedman has a unique background as a wood and marble sculptor for over 25 years.  He believes that his artistic background has helped him to become a better plastic surgeon.

For more information about Dr. Friedman, including before and after photos, please visit www.plasticsurgerydallas.com.

D Magazine has named Dr. Friedman a Best Plastic Surgeon for five consecutive years.  He was also named a Texas SuperDoctor by Texas Monthly magazine for four consecutive years. While working on the full-time plastic surgery faculty at the University of Texas Southwestern Medical Center in Dallas,  Dr. Friedman served as the Chief of Plastic Surgery at Parkland Memorial.

Dr. Friedman has a unique background as a wood and marble sculptor for over 25 years.  He believes that his artistic background has helped him to become a better plastic surgeon.

For more information about Dr. Friedman, including before and after photos, please visit www.plasticsurgerydallas.com.

D Magazine has named Dr. Friedman a Best Plastic Surgeon for five consecutive years.  He was also named a Texas SuperDoctor by Texas Monthly magazine for four consecutive years. While working on the full-time plastic surgery faculty at the University of Texas Southwestern Medical Center in Dallas,  Dr. Friedman served as the Chief of Plastic Surgery at Parkland Memorial.

Dr. Friedman has a unique background as a wood and marble sculptor for over 25 years.  He believes that his artistic background has helped him to become a better plastic surgeon.

For more information about Dr. Friedman, including before and after photos, please visit www.plasticsurgerydallas.com.

Ronald M. Friedman, M.D., a board-certified plastic surgeon, has been providing cosmetic and reconstructive surgery to the Melissa, Texas  and Anna, Texas communities since 1996.  Dr. Friedman serves as the Director of the West Plano Plastic Surgery Center, located on the campus of Texas Health Presbyterian Hospital of Plano–just a half hour drive from Melissa and Anna.  Known for his natural results, Dr. Friedman specializes in breast augmentation, breast lift, liposuction, tummy tuck, mommy makeovers, and Botox and Restylane injections.

D Magazine has named Dr. Friedman a Best Plastic Surgeon for five consecutive years.  He was also named a Texas SuperDoctor by Texas Monthly magazine for four consecutive years. While working on the full-time plastic surgery faculty at the University of Texas Southwestern Medical Center in Dallas,  Dr. Friedman served as the Chief of Plastic Surgery at Parkland Memorial.

Dr. Friedman has also been a wood and marble sculptor for over 25 years.  He believes that his artistic background has helped him to become a better plastic surgeon.

For more information about Dr. Friedman, including before and after photos, please visit www.plasticsurgerydallas.com.

D Magazine has named Dr. Friedman has been named a Best Plastic Surgeon for five consecutive years.  He was also named a Texas SuperDoctor by Texas Monthly magazine for four consecutive years. While working  on the full-time plastic surgery faculty at the University of Texas Southwestern Medical Center in Dallas,  Dr. Friedman served as the Chief of Plastic Surgery at Parkland Memorial.

Dr. Friedman has been a wood and marble sculptor for over 25 years.  He believes that his artistic background has helped him to become a better plastic surgeon.

For more information about Dr. Friedman, including before and after photos, please visit www.plasticsurgerydallas.com.

However, many of these sites have a small disclaimer in the bottom right-hand corner of each photo.  Perhaps you should take a closer look:

Yes, each of these photos clearly say “model.”  Translation: these photos do NOT represent the surgeon’s actual patients.  I find this quite distressing.  If you’re going to shell out thousands of dollars to undergo cosmetic surgery, shouldn’t the surgeon be confident enough in his results to show his ACTUAL patients?

My website has hundreds of color images.  Each and every one of these represents actual patients upon whom I have performed plastic surgery.

I do have a few models on my website at www.plasticsurgerydallas.com.  But there’s a big difference between my models and theirs:  mine are actual patients who had surgery performed by me.  They just happen to work as models.

Dr. Friedman is a board-certified plastic surgeon serving the Plano, Richardson, Carrollton, and Lewisville areas.

Ronald M. Friedman, M.D.

Certified, American Board of Plastic Surgery

Director, West Plano Plastic Surgery Center

Former Chief of Plastic Surgery, Parkland Memorial Hospital, Dallas, Texas

www.plasticsurgerydallas.com