While Much Of Dr. Kunkel's Practice Focuses On Cosmetic Surgery, He Believes That Even The Patient With The Most Challenging Reconstructive Problem Should Have The Best Possible Cosmetic Result.
Keywords rhinoplasty, facelift, brow lift, blepharoplasty, chin impalnts, otoplasty, breast augmentation, breast lift, breast reconstruction, breast reduction, male breast reduction, liposuction, tummy tuck, mommy makeover, body lift, arm lift, thigh lift, back lift, dermal fillers, kybella, botox, microneedling, microdermabrasion, facials.
Dr. Kunkel grew up in Fort Worth. He attended the University of Notre Dame, graduating with honors. Dr. Kunkel received his Doctor of Medicine degree from the University of Texas Medical Branch. He recognized early during his medical school years that he wanted to become a plastic surgeon. During his fourth year of medical school Dr. Kunkel went to Basel, Switzerland to study with one of the pioneers of facial reconstructive surgery techniques. Dr. Kunkel completed a residency in surgery at the University of Texas Medical Branch hospitals (where he also won an award as the Outstanding Surgery Intern), then moved to Seattle to study burn surgery at the University of Washington. He then completed his plastic surgery training at the Oregon Health Sciences University in Portland, Oregon, where the program director was one of the innovators in bone growth and regeneration. Dr. Kunkel moved back to Fort Worth in 1994 to begin his private practice of plastic surgery. He is currently certified by the American Board of Plastic Surgery. Dr. Kunkel was recognized by Fort Worth, Texas Magazine as one of the area’s best plastic surgeons for 18 consecutive years and has also been listed by Texas Monthly Magazine in its Texas Super Doctors for 15 consecutive years. He was recognized as a Top Doctor by 360 West Magazine for 3 years. He was also named a HealthCare Hero by the Fort Worth Business Press. Dr. Kunkel is a member of many professional societies, including the American Society of Plastic Surgeons, American Society of Aesthetic Plastic Surgeons, Texas Society of Plastic Surgeons, Fort Worth Plastic Surgery Society, American Medical Association, and the Tarrant County Medical Association. In addition to his plastic surgery practice, Dr. Kunkel believes in service to the community. He has served on the Board of Directors of the Tarrant County Medical Society, Women's Haven of Tarrant County, Southwest Branch YMCA, and Leadership Fort Worth. He has served on numerous hospital committees, ensuring quality health care for people living in North Central Texas. Dr. Kunkel has also represented local plastic surgeons as an officer in the Fort Worth Plastic Surgery Society and North Texas Specialty Physicians. Hospital Affiliations: Andrews Women's Hospital Baylor All Saints Medical Center Harris Methodist Southwest Hospital Plaza Day Surgery USMD Hospital at Fort Worth
Nose Surgery | Rhinoplasty | Forth Worth TXRhinoplasty, or nasal surgery, is one of the most commonly performed plastic surgery procedures. By reshaping, reducing, or augmenting a person's nose it may be possible to achieve improved facial balance and harmony as well as improved self-confidence. While rhinoplasty may be performed as a cosmetic procedure to enhance a person’s appearance, it may also be done as reconstructive procedure to correct a birth defect or an injury like a broken nose. Both functional and cosmetic concerns may be addressed by rhinoplasty surgery. Combining nose reshaping with septoplasty (changing the cartilage between the nostrils internally) can effectively treat certain types of breathing problems, including those caused by a deviated septum. What types of changes can be made during rhinoplasty surgery? Rhinoplasty is an excellent procedure to: Balance the size of the nose with the other facial features Modify the width of the nose at the bridge Improve the nasal profile, including removing humps or depressions Contour a nasal tip that is too large, "boxy," drooping or upturned Change the angle between the nose and the mouth Narrow and reshape the nostrils Correct asymmetry or deviation Am I a good candidate for rhinoplasty? The best candidates for rhinoplasty: Are at least 13 years old; Have finished facial growth; Are generally healthy; Do not smoke or use e-cigarettes; Are seeking rhinoplasty for personal reasons, not pressure from others; and Have realistic goals for the procedure. How is rhinoplasty performed? Dr. Kunkel performs rhinoplasty surgery in an outpatient surgery center with the patient under general anesthesia. It usually takes about 3 hours to complete the nasal surgery. An open approach is used in which a small incision is made across the columella, the area between the nostrils. This allows direct sculpting of the underlying bone and cartilage to help achieve an optimal nasal shape. If the patient has a deviated septum, Dr. Kunkel adjusts the septum and often some of the other internal structures of the nose to help improve breathing. The tissues are re-draped over the bone and cartilage and the rhinoplasty incision is sutured closed. What is the recovery from nose surgery like? After rhinoplasty surgery patients may experience swelling and bruising, nose ache, a dull headache, bleeding, and stuffiness. Rather than having substantial pain, many patients feel like they have a “head cold” for three or four days. Most patients feel like themselves within a few days and many return to work in about a one or two weeks. Sutures are usually removed between 5 to 7 days after surgery, and a splint is worn on the nose for about 10 days. Any bruising that is present will last about 3 weeks. Contact lenses may be worn immediately, but glasses may need to be taped to the forehead for a while rather than having them rest on the nose. The results of rhinoplasty become gradually apparent as the days pass after surgery and swelling recedes. Patients often feel swollen for a few months, but other people looking at them usually do not see much swelling after about three weeks. The final result of rhinoplasty surgery may not be apparent for several months, perhaps even until a year, after surgery. Most people, however, have a pretty good idea of what their result will be after three or four months. Will I like the results of my nose surgery? Patients with realistic goals for rhinoplasty are generally very happy with the new shape and appearance of their nose. The final surgical result is influenced by the patient’s pre-existing nasal bone and cartilage structure, facial shape, and skin thickness. What are the risks of rhinoplasty? All surgery has risks, like bleeding, infection, and scars. Risks that are more specific to rhinoplasty include possibly having difficulty breathing through the nose after surgery, small bumps that may be felt through the skin, and visible contour irregularities. It is possible that a person may not end up with the nose that she or he wanted. That’s where communication is important. Before surgery ever takes place Dr. Kunkel spends a lot of time with each patient, learning what that person hopes to achieve with rhinoplasty surgery. Clear communication provides better understanding for both the patient and Dr. Kunkel. Does insurance cover rhinoplasty? Insurance may cover a rhinoplasty when breathing problems exist or if there has been significant trauma in the past. Rhinoplasties performed for cosmetic reasons are not covered by insurance.
Over time, gravity, sun exposure, and the stresses of daily life take their toll on our faces and necks. If you were to compare photographs of yourself from 10 or 15 years ago to photographs of today you would find several differences. You may have deeper and more noticeable creases and wrinkles. Jowls (ugh!) may be present. You may have lost some of the youthful contour of your neck. Also, the once oval shape of your youthful face may have assumed a more squared appearance as the skin loses its elasticity and loosens. Facelift surgery can alter and minimize these telltale signs of aging, resulting in a refreshed and rejuvenated appearance. In contrast to some of the "wind tunnel" appearance of facelifts so common in the past, a facelift performed by Dr. Kunkel tends to give a more natural, harmonious appearance. What can a facelift do for me? Facelifts (technically known as rhytidectomies) revitalize the mid- to lower face and neck. Facelifts are most effective for patients who want to correct: Midface sagging Deep creases under the eyes Deep creases between the nose and mouth (nasolabial folds) Jowls Sagging areas of skin and fat around the cheeks, jaw line, and neck What won't a facelift correct? Facelifts can produce a dramatic improvement in appearance for patients with the problems mentioned above. However, facelifts do not stop the aging process; in time, signs of aging will gradually appear once again. Facelifts alone will not rejuvenate the brow, eyelids, nose, and some of the midface. Patients who want to improve these areas may consider combining a facelift with a brow lift or eyelid surgery (blepharoplasty). Facelifts also will not affect deep lines around the mouth. Injectable soft-tissue fillers, facial implants, and skin resurfacing may significantly enhance the effects of a facelift in this area. Am I a good candidate for a facelift? The best candidates for rhytidectomy: Wish to improve one or more of the signs of aging indicated above Are women and men who have lost some of the tone of their facial skin Are generally healthy Do not smoke Have realistic expectations Are reasonably close to their ideal body weight Are considering a facelift for personal reasons, not because someone else is pressuring them to do so How is a rhytidectomy performed? Dr. Kunkel typically performs facelift procedures in a surgery center or hospital. The procedure is accomplished with the patient under general anesthesia and takes about three to four hours. While some patients go home the same day as their surgery, many find it more reassuring and comforting to spend the first night in the surgical facility. While each facelift is designed with a patient's unique goals in mind, a 'typical' facelift performed by Dr. Kunkel begins with an incision placed just behind the hairline in the temple. This incision curves down just in front of the ear, and sometimes ends at the base of the ear. For patients with more laxity of the facial tissues, the incision may extend into the hairline behind the ear. The 'work' of a facelift is accomplished by lifting and tightening the tissues deep to the skin. The deep tissues are repositioned in an upward and sometimes slightly lateral direction, and this allows some of the redundant skin to be removed. An incision may also be placed beneath the chin to help achieve optimal improvement in the neck. The facelift incisions are closed with sutures and these are removed in about 5 to 7 days. Scars are hidden in the hairline and the natural contours of the face, and they fade over time. It is not unusual for women to wear their hair pulled back within just weeks of the facelift procedure. What is the recovery from a facelift like? One or two drain tubes may be placed beneath the skin to help minimize fluid collections and bruising after the facelift procedure. A gauze dressing is applied. The drains are usually removed in one or two days. Hair may be washed beginning one or two days after facelift surgery (but there is at least one bad hair day after surgery!). The facial skin feels tight and numb for a few weeks after the facelift. The face is swollen and may have some bruising. Any bruising that occurs resolves in about 3 weeks. The face feels swollen for several weeks but friends and other people usually don’t notice the swelling after about 3 weeks. Many patients return to work in 2 or 3 weeks. Make-up may be worn beginning 10 to 14 days after the facelift procedure. How long do the effects of a facelift last? The skin and tissues that remain after a facelift retain the same physiological characteristics they had before the surgery. Because of this, some stretching will occur over time. It is possible that a person may want to have another procedure in five or ten years, but this is not common.
A browlift may be an ideal procedure for women or men who are frequently told that they look angry or tired because their eyebrows are low, they have very noticeable forehead wrinkles, and the upper eyelid skin is loose or droopy. The procedure lifts the eyebrows to a more aesthetically appealing position while at the same time helping to reduce the horizontal forehead lines and the furrows between the eyebrows. This creates a refreshed appearance in the upper part of the face. The procedure may be done alone but is also commonly combined with other facial rejuvenation procedures like facelifts and blepharoplasties (eyelid surgery). There are several techniques that may be used to perform a browlift, as described below. The technique chosen is based on the patient’s physical characteristics and desires. Dr. Kunkel thoroughly examines patients during their consultations and listens to their specific concerns. This allows him to tailor the browlift technique to address each patient's unique attributes. Hairline browlift: With this type of browlift an incision is made immediately behind the hairline. The forehead skin is elevated off of the underlying muscle and pulled tight. The extra skin is removed, resulting in a precise, tailored elevation of the specific areas of the eyebrows. The hairline browlift approach is becoming more popular today. The incisions are much smaller than with a coronal browlift (described below) and the elevation of the eyebrows is more tailored. The incisions are made in such a way as to allow growth of hair through the scar over several months, making the scar difficult to detect. Endoscopic browlift: In an endoscopic browlift, three to five short incisions are made just behind the hairline. An instrument called an endoscope is then placed beneath the skin. The endoscope allows elevation of the forehead skin off of the underlying tissue. The muscles between the eyebrows are thinned, then the eyebrows are lifted to their new positions. This type of browlift may work best in women whose eyebrows are low but do not have significant looseness of the forehead skin. Women who do best with this procedure are often in their 30’s and 40’s, although some women in their 50’s and 60’s may also be candidates. Coronal browlift: This is the "classic" browlift, very popular in the 1970's and 1980's but less commonly performed today. With a coronal browlift an incision is made behind the hairline, stretching across the top of the head from one ear to the other. The forehead skin is elevated off of the underlying tissue. This allows direct visualization and treatment of the muscles between the eyebrows. These muscles are thinned and modified to help minimize and prevent wrinkles in this area after surgery. The eyebrows are then lifted to their new positions. Excess skin is trimmed and the incision is closed with sutures. This type of browlift may work best in women who have significant looseness of the forehead skin and numerous deep wrinkles. Typically women who undergo this browlift are in their 60’s or 70’s. With any type of browlift some swelling takes place after surgery. Bruising may also be present; it usually goes away in two or three weeks. The forehead skin may be numb temporarily. Most patients should expect to take 7 to 10 days away from their usual daily activities. Complications are rare and usually minor but may include numbness, nerve injury, hair loss near the incision sites, visible scars, asymmetry of the results, infection, and bleeding.
A common concern among people seeking improvement in the appearance of their eyelids is that friends and acquaintances tell them they look tired or sad. Laxity of skin and deeper tissues in the lower eyelid results in protrusion of fatty tissue, leading to that "tired" or "allergy" look. Extra skin and fat of the upper eyelids contributes as well. Cosmetic eyelid surgery (blepharoplasty) can help create dramatic yet refined changes around the eyes, often resulting in a natural, refreshed look. Surgeons performing blepharoplasty surgery in the 1990's and before typically removed substantial amounts of fat. Over time, however, this created a hollow look around the eyes. With cosmetic eyelid surgery today there is much more focus on re-positioning eyelid fat than just removing it. Saving and re-positioning fat helps create nice shapes of the eyelids and the fat can help blend the lower eyelid with the cheek, creating a smooth transition there. During upper eyelid blepharoplasty, an incision is made near the natural crease of the eyelid. Once the incision is made fatty tissue is re-positioned and removed. Excess skin is also removed. The incision is then closed with sutures. During lower eyelid blepharoplasty surgery Dr. Kunkel typically manages the fatty fullness through an incision inside the lower eyelid. Some of the fat is removed, and some of the fat is re-positioned so it drapes over the bony rim of the eye down into the upper cheek. This helps blend the upper cheek and lower eyelid, creating a smooth transition. Once this part of the procedure is complete, the loose skin is then addressed. Typically an incision is made just beneath the eyelashes and a small amount of skin is removed. Candidates for Blepharoplasty The best candidates for blepharoplasty are women and men who are in good overall health, do not smoke, and do not have any serious eye conditions. For those who have loose, sagging skin or puffy bags around the eyes, blepharoplasty can help reduce these unwanted effects and leave the eyes looking relaxed. Procedure Dr. Kunkel performs blepharoplasty at a surgery center or hospital with the patient under general anesthesia. Patients may choose to have this procedure on their upper eyelids alone, their lower eyelids alone, or both the upper and the lower eyelids. Some patients undergo blepharoplasty combined with a browlift. Depending on these choices, the procedure can take anywhere from one to three hours. Recovery after Blepharoplasty Surgery Most blepharoplasty patients have very little pain. The eyelids are mildly swollen for a few weeks. If bruising occurs it will be present for about 3 weeks. Make-up may be worn beginning about a week after surgery. Contact lenses should not be worn for 7-10 days after blepharoplasty surgery. Some patients return to work in just a few days, but that depends on a person’s comfort level with others seeing the swelling and sutures. Most people take about 10 days off from work. If there is a special occasion coming up, like a wedding or a reunion, it is probably best to undergo the blepharoplasty about three months before the event, leaving time for the swelling to dissipate and the scars to be less noticeable. Risks All surgical procedures, from breast biopsy to hysterectomy to cosmetic eyelid surgery, have some risks. Risks common to all procedures include infection, bleeding, and visible scars. Each specific surgical procedure has more unique risks as well. Risks that are more unique to blepharoplasty include dry eyes, inability to fully close the eyes, and an irregular downward pulling of the lower eyelids (ectropion). During initial and subsequent consultations, Dr. Kunkel carefully discusses the procedure, the recovery, and the risks with each patient.
Although many people do not notice it, a weak chin may significantly affect facial appearance, causing the nose to look larger or the neck skin to appear loose. Chin augmentation is often performed to provide a more balanced facial appearance and create a chin that is stronger, wider or longer, depending on each patient's individual goals. Also known as mentoplasty, chin augmentation may also be performed in conjunction with rhinoplasty or facelift surgery in order to achieve more harmonious results. Dr. Kunkel performs chin augmentation surgery with the patient under general anesthesia in an outpatient surgery center. During the mentoplasty procedure a small incision is made beneath the chin and a pocket is created for the implant. The chin implant is typically made of silicone or another soft, flexible material. The implant is placed into the pocket and may be secured using sutures or possibly small screws. The procedure usually takes about 45 minutes to complete. After chin augmentation surgery some swelling and bruising are present. The lower lip may be numb for a few days. In most cases tape is placed on the skin around the chin implant and left in place for a few days. There typically is not very much pain after chin augmentation surgery. Patients may return to work within a few days but should avoid strenuous activities for a few weeks. Chin augmentation surgery may help restore balance and harmony to a face. While all surgery entails some risk, chin augmentation may provide subtly dramatic changes in a relatively low risk procedure. Visit with Dr. Kunkel and learn more about mentoplasty surgery!
Otoplasty, or ear pinback surgery, is an operation that corrects prominent, protruding ears. The ears are set back closer to the head, making them look much more normal and less conspicuous. The ears are almost fully grown by age 4, so children as young as ages 4 or 5 may be treated early in life. More commonly, children and young adults with prominent ears who are between the ages of 10 and 18 become more self-aware and begin concealing their ears. Boys grow their hair long, and girls stop pulling their hair back into pony tails. This trend may continue into adulthood. Otoplasty surgery is a great way to correct the problem. In people who have prominent ears the cartilage that gives the ears their shape does not form correctly. A normal ear has a fold in the cartilage just in front of the rim of the ear (see the picture of the ear above). This is called the anti-helix. Quite often in people with prominent ears the anti-helix does not form correctly, or there is a rudimentary fold. Another area of cartilage that may contribute to prominent ears is in what is called the conchal bowl. That's the "bowl" of the ear the gives entrance to the ear canal. Excessive conchal bowl cartilage may make the ear stand out away from the head. During a visit with Dr. Kunkel he identifies the cartilage deformities and formulates a plan with the patient (and the patient's parents if the patient is under the age of 18). The operation itself is typically not very painful. Dr. Kunkel performs otoplasty surgery with the patient under general anesthesia in an outpatient surgical facility, and the surgery typically takes about 2.5 hours to complete. An incision is placed on the back of the ear, exposing the cartilage. The cartilage is sculpted into a new shape, in most cases creating a more natural-appearing anti-helix. Sutures are placed internally to help create and maintain the new shape of the anti-helix. In some patients with prominent ears part of the conchal bowl cartilage is also removed. Additional sutures may be placed to pull the entire ear cartilage complex closer to the skull. Sutures are then placed to close the incision, and these dissolve over a few weeks. A protective plastic cup dressing is placed to protect the ears for the first few days. The changes from otoplasty surgery are usually fairly dramatic and may be seen immediately. Initially the ears appear swollen and purplish and the skin of the ears may be numb. The swelling and bruising diminish over three to four weeks. Usually after about 4 weeks other people who see the ears do not notice that they are swollen, but the patient may feel like they are swollen because normal sensitivity may take longer to return. Dr. Kunkel typically has his otoplasty patients wear a headband during the day and night for the first month to protect the ears. After the first month the headband may be worn at night only for another few weeks. Sporting activities should be avoided during the first month after surgery, particularly contact sports like basketball, soccer, lacrosse, field hockey, football, and volleyball. People involved in dance may become active after about two weeks, but the ears will be noticeably swollen at that time. Patients begin shampooing their hair on the second or third day after surgery. One of the most fun things about this surgery is seeing patients come to the office with their hair pulled back within a week or two after the surgery. Confidence often soars after this procedure, and many patients quickly begin wearing the hairstyles that they want, not having to conceal what were once very prominent ears. Dr. Kunkel actually makes a point of telling his adolescent patients to thank their parents for providing this surgery for them. Otoplasty surgery may be a profoundly rewarding experience!
Breast augmentation is one of the most frequently performed cosmetic surgery procedures in the U.S. and is also one of our most popular services. Breast augmentation (breast implant surgery) can provide women who have modest or unevenly sized breasts a fuller, firmer, more balanced look. Women choose to undergo breast augmentation for many reasons. Some lose volume and fullness after pregnancy, breast feeding, and weight loss. Others have breasts that did not develop proportionally with their hips, shoulders, and frame. Some women have congenital breast issues including significant asymmetries. Breast augmentation creates breasts that are more shapely and full, often promoting a tremendous increase in self-confidence. Customized Breast Enhancement Each woman has unique physical attributes and unique goals and expectations regarding breast implant surgery. We recognize this and take time to ask questions and listen to what it is our patients hope to achieve. Dr. Kunkel was the first surgeon in Fort Worth and Tarrant County to use Vectra XT three-dimensional imaging. This system uses 6 cameras to take photographs of a woman's torso. The computer software reconstructs those photographs into a three dimensional image. This image may be rotated in all directions, helping identify specific areas that may be addressed. The Vectra Breast Sculptor software contains information about almost every breast implant available in the U.S. With a few clicks of the mouse, the software alters the 3-d image to show what the woman may look like with a specific set of implants. Want something bigger or smaller? Just a few more mouse clicks. No longer is it necessary to put rice in baggies and wear that inside a bra to get an idea of what you might look like. A study published in 2014 showed the system is up to 90% accurate. The 3-d imaging system has transformed the consultation process in Dr. Kunkel's office. He uses the Vectra system not to show a woman exactly what she will look like, but rather as a way to make sure that he and the patient are seeing and talking about the same things. It is a very interactive session. When a woman comes in to learn about breast augmentation or breast lift surgery, the visit typically lasts about 1.5 to 2 hours. The extended back-and-forth interaction between the woman and Dr. Kunkel, while viewing and altering the 3-d image according to what the patient wants to learn about and see, allows for a finely tailored approach in choosing which implants may provide her most ideal result. Dr. Kunkel does not decide for his patients, he decides with them. Different Types of Breast Implants Breast implants are silicone rubber shells filled with either saline (salt water) or silicone gel. Numerous clinical studies have demonstrated the safety of both types of implants. The implants may be round or they may have a shape (other terms used for shaped implants include "teardrop" and "gummy bear"). Round breast implants also come in different 'profiles': moderate, moderate-plus (or midrange), and high. The profile refers to the combination of width and projection (front-to-back dimension) of the implant. Think of it as having three differently shaped glasses of water, each glass holding the exact same amount of water. Maybe one glass is short and wide, another is tall and thin, and the third is in between those two, but all three contain the same amount of water. A moderate profile 300 cc breast implant is wider and has less projection than a high profile implant, and a moderate-plus implant is in between those two. All three may contain 300 cc's of saline or silicone, but the shapes are different. It's pretty hard to look at pictures on websites, trying to determine what volume and profile implant might work best for you. That's where the Vectra 3-d system adds real value to the consultation, helping see potential outcomes with specific implants. It adds clarity to an otherwise confusing topic. The different implants have specific advantages and disadvantages, and these are addressed with our patients during the initial (and any subsequent) consultations. We offer all types of breast implants (saline and silicone, round and shaped, textured and smooth) to our patients and thoroughly explain the differences to help them decide which type may be best for their individual needs. Breast Augmentation Surgery - Incision Techniques The breast augmentation procedure typically lasts one to two hours and is performed under general anesthesia. Incisions are made in inconspicuous areas to help minimize scar visibility. These may be located: in the crease beneath the breast (inframammary) in the armpit (transaxillary) along the lower edge of the areola, the darker skin around the nipple (periareolar) The breast is then elevated off of the underlying tissue, creating a pocket into which the implant is inserted.
Saline-filled breast implants were introduced by a French company (Laboratoires Arion) in 1964. Over the years different companies have changed the implant shell composition as well as the sizes and shapes of saline implants. In 1992 the US Food and Drug Administration (FDA) placed a moratorium on the use of silicone gel breast implants for cosmetic breast augmentation due to safety concerns. Saline implants were not included in that decision, allowing them to continue to be used for both breast augmentation as well as breast reconstruction after mastectomies. The popularity of breast augmentation soared during the 1990's, during the time that silicone breast implants were not even available. Today there are two companies, Allergan (through their Natrelle brand) and Mentor, that make FDA-approved saline breast implants for use in the United States. Shapes and sizes Saline breast implants may either be round or shaped like a "tear drop". Round saline implants are used more commonly for breast augmentation than shaped ("tear drop") saline implants, but both types are available for use by women age 18 and older. There are different "profiles" of round saline breast implants. The two companies have slightly different names for their profiles, but basically the profile names are 'moderate', 'moderate plus' or 'midrange', and 'high'. (There are additional profiles but they are used primarily for breast cancer reconstruction.) The profiles refer to a combination of width and projection (front-to-back dimension) of the implant. A moderate profile implant is wider and flatter than a high profile implant of the same volume, and the midrange implant is in between those two. To make this a little more understandable, imagine that you have three vases into which you want to place some flowers. Suppose that the volume of water each vase can hold is the same (a quart, for instance), but the vases are shaped differently. One vase is tall and thin (comparable to a high profile implant), one vase is short and wide (comparable to a moderate profile implant), and one vase is in between those two. Each vase holds the same amount of water, but they look different. That is what profiles of breast implants are like. Having so many profiles of implants available allows a more individually customized approach to breast augmentation and breast reconstruction surgery. Shaped, or 'teardrop' saline implants are different. Instead of being round, these have more of an oblong shape and are thinner at the top and wider at the bottom. These 'anatomical' breast implants were developed in the 1990's in an effort to create a more gentle shape to the breast. Some women and some surgeons think these implants are a bit firmer than round implants and there is debate as to whether or not they actually create breasts that are shaped differently than breasts with round breast implants. There are more sizes of saline implants available than silicone implants. The largest saline breast implant available for use in the U.S. is 960 cc's. That is an extremely large implant, used essentially only in breast reconstruction cases and not for breast augmentation. These types of issues may be more thoroughly discussed during a visit with Dr. Kunkel. Technique of placement compared to silicone breast implants Silicone breast implants are pre-filled. Saline implants are empty initially. Because of this, smaller incisions may be used when placing saline breast implants compared to silicone implants. After the incision is made and the pocket into which the saline implant will be inserted is created, the edges of the saline breast implant are rolled toward the center into a shape that looks something like a thin burrito. This allows an empty, narrow implant to be inserted into the pocket, then unrolled once inside. Sterile saline is then added to the implant, filling it to its final volume. Benefits of saline breast implants compared to silicone implants The incisions and resulting scars are usually smaller when saline implants are used than when similar-volume silicone breast implants are used. Saline breast implants allow more fine adjustment of size compared to silicone implants because saline may be added or removed during the surgery to optimize the result. This is particularly beneficial for a woman who has one breast that is larger than the other. Saline implants also cost less than silicone implants. Who are the best candidates for saline breast implants? Saline and silicone breast implants wrinkle around the edges. With saline-filled breast implants, it may be possible to feel those wrinkles under the skin more easily than with silicone implants. For that reason, saline implants tend to work best in women who have a little more existing breast volume than women who have almost no shape or volume before undergoing breast augmentation.
Shaped silicone breast implants are also commonly known as "form stable implants", "gummy bear implants", "highly cohesive gel implants", and "teardrop" implants. Three companies make form stable silicone gel breast implants that are FDA-approved for use in the United States: Allergan, Mentor, and Sientra. Early silicone gel breast implants from the 1970's were made of silicone gel that was very thin, surrounded by very thin implant shells. The combination of thin, 'runny' silicone and thin shells created some concerns about the safety of those implants. Thicker silicone gel filler material was created in the 1990's as a response to this concern. The round silicone breast implants available for use in this country today have thick ('cohesive') silicone gel in them. Shaped silicone breast implants, however, are different. The silicone in these types of implants is bonded together in a way that is different than in the typical round silicone breast implant. This bonding process creates silicone that is very thick and, in essence, like a gummy bear. An Allergan form stable implant is shown on the top right side of this page. Note that the implant is thinner in one area and tapers to being wider in another. The thinner area is the top of the implant, and the wider area is the bottom. One of the ideas behind this type of breast implant is that it maintains this shape when placed in an upright position behind the breast tissue. This may create a little more subtle transition from the top of the breast to the most projecting area of the breast than may be achieved with some round breast implants. Another potential benefit of form stable silicone breast implants is that, if a defect develops in the implant shell, the silicone is so thick and bonded that it does not leak. If scissors are used to cut completely across this type of breast implant, no silicone liquid leaks out. In that sense it is very much like a gummy bear. Textured surface Shaped silicone gel breast implants have textured surfaces. 'Texturing' is a process that makes the surfaces of these types of breast implants a little rough. It has been found that placing a textured surface on a breast implant allows some of the breast tissue to attach to the implant. Tissues do not attach to smooth implants, and most silicone implants used in the US today are round and have smooth surfaces. Texturing is very important for shaped breast implants, however. Shaped implants need to maintain their position in the breast. If a shaped implant were to rotate 90 degrees to the right, for instance, now the top thin area and the bottom wide area would be oriented incorrectly, resulting in an unusual shape to the breast. Rotation rarely happens, though, due to the texturing. Once a shaped implant is placed in the breast tissue, the textured surfaces promote tissue ingrowth into the surface of the implant, helping maintain correct orientation of the implant and minimizing the chance for rotation. Profiles of form stable implants There are different shapes, or profiles, of form stable silicone gel breast implants. Some of the shaped silicone breast implants are taller than others, and some have more projection (front-to-back) dimension than others. A taller woman with a longer torso may have a better result with a taller shaped silicone breast implant than a shorter implant. A woman with a short distance between her collar bone and the bottom of her breasts may have a better result using a shorter and more projecting implant. Dr. Kunkel and his staff will go over all of this with you when you visit. You will have an opportunity to look at round and shaped silicone and saline breast implants to help you understand the differences. If the silicone is so thick, are the implants hard? When you hold a form stable silicone gel breast implant in one hand and a round silicone implant in the other, the round implant may feel a little softer. When the implants are in the body, however, this difference is not very noticeable at all. Form stable breast implants typically result in very soft, shapely breasts. Who is a candidate? Almost any woman who is a candidate for breast augmentation is a candidate for form stable silicone gel implants. An FDA regulation is that silicone implants may only be used for breast augmentation in women who are at least 22 years-old. Shaped silicone breast implants probably work best in women who have some shape to their breasts. Women with almost no natural shape or volume may obtain a better result with round implants. Dr. Kunkel and his staff will discuss all of this in detail with you when you visit.
Three companies (Mentor, Allergan, and Sientra) make breast implants that are available for use in the United States. The Vectra Breast Sculptor software contains information about almost every breast implant from these companies. Once an image of a woman's breasts/chest is created using the Vectra system, it is possible to alter the 3-d image to show what she may look like with specific implants. 350 cc round silicone implants? A couple clicks of the mouse. Want to see shaped 375 cc silicone implants instead? A few more mouse clicks. Instead of placing implants inside a bra, or filling baggies with rice and trying that on, the Vectra three dimensional system gives a woman a reasonable idea of what she may look like with specific breast implants (saline or silicone, round or shaped). All of this is done in a way that allows her to see herself even from angles that are next to impossible to see in a mirror. The 3-d imaging system has transformed the consultation process in Dr. Kunkel's office. While the Vectra system does not show a woman exactly what she will look like, this system helps make the consultation process more complete. The patient and Dr. Kunkel are looking at the images and modifying them during this interactive session. The extended back-and-forth interaction between the woman and Dr. Kunkel, while viewing and altering the 3-d image according to what she wants to learn about and see, allows for a finely tailored approach in choosing which implants may provide her most ideal result. Dr. Kunkel does not decide for his patients, he decides with them.
Large breasts frequently cause pain in the back, neck, and shoulders, as well as rashes beneath the breasts, indentations in the shoulders from bra straps, and low self-esteem. A woman may think about reducing the size of her breasts related to these symptoms, or maybe because she is uncomfortable with the unwanted attention created by her large breasts. Breast reduction surgery can help a woman regain her self-confidence and positive self-image, while creating shapely, proportional breasts. After breast reduction surgery many women find they are able to participate in physical activities that may have been just too painful to do before, like running or soccer. Breast reduction surgery, also known as reduction mammaplasty, is usually done to provide relief from these types of symptoms and issues. Initial Consultation The initial consultation with Dr. Kunkel takes about an hour. During that time Dr. Kunkel and his staff listen to you as you talk about your concerns and what you hope to achieve. Your breasts are evaluated, then a thorough discussion takes place to help you understand the things you need to kow about breast reduction surgery. There are a few options for techniques that may be used to reduce your breast size and these, as well as potential advantages and disadvantages of the options, are discussed during your visit. Dr. Kunkel and the staff also go over what to anticipate in the time around the surgery. Dr. Kunkel performs breast reduction surgery in a hospital or outpatient surgery center. Different insurance companies often require one facility or another to be used, and Dr. Kunkel's staff help you in planning where the operation will take place. The procedure usually takes three to four hours and is performed with the woman under general anesthesia. Typically the patient goes home on the afternoon of the surgery. An overnight stay is not usually required unless the breast reduction is combined with another operation like a tummy tuck. Incision Techniques The size and shape of the breasts, as well as the desired amount of reduction, helps determine which type of incision and surgical technique is best for each woman. The different types of incisions for a breast reduction include: Breast Reduction | Fort Worth TXTraditional Breast Reduction Surgery - The “traditional” approach to breast reduction surgery is a very effective method for alleviating discomfort caused by large, heavy breasts. The traditional method, also called an inverted-T pattern, anchor pattern, or Wise pattern reduction, is often the best choice for women requiring a large amount of tissue removal. In the traditional breast reduction surgery technique, incisions are made horizontally under the breast in the crease and extend vertically up to and around the nipple. Because traditional breast reduction surgery allows for excess skin removal both vertically and horizontally, it is typically the best method for women with extremely large breasts. This type of reduction may allow Dr. Kunkel to remove more tissue than other methods, maximizing breast reduction results. Although the inverted-T pattern method can be useful in reducing excessively large breasts, it leads to more scarring than other breast reduction surgery techniques. These scars can almost always be hidden by bathing suits and even low cut tops. Vertical Incision Breast Reduction Surgery - The vertical incision technique, also known as the short scar breast reduction, may result in less scarring than traditional breast reduction surgery. Vertical incision breast reductions are a popular alternative to the traditional method, especially for women who do not require extensive tissue removal. Incisions using this technique extend around the areola and vertically down to the breast crease, making a “lollipop” pattern. Vertical incision breast reductions eliminate the need for the horizontal incision along the breast crease that is used in traditional breast reduction surgery, resulting in no scarring in the crease beneath the breast. Women with moderately large breasts are the best candidates for vertical incision breast reductions. Vertical incision breast reduction surgery may not be a good choice for women requiring the removal of significant amounts of fat and breast tissue. Liposuction Breast Reduction Surgery - This type of breast reduction employs liposuction techniques to reduce the size of the breasts with minimal visible scarring. Because liposuction can only reduce the amount of fatty tissue in the breast, ideal candidates for liposuction breast reduction are women whose breasts have more fatty tissue than glandular tissue. Breast reduction using only liposuction is often not the best option for more slender women with large breasts, women with extensive droopiness of the breasts, or women with excessively large breasts. This technique removes much of the weight of the breast but typically does not result in a lifted or tightened appearance.
Over time, the effects of gravity and the loss of the skin's natural elasticity begin to have an effect on the appearance of a woman's breasts. These factors, combined with pregnancies and nursing, may cause the breasts to lose their youthful shape and firmness. A breast lift, or mastopexy, is a surgical procedure to elevate, tighten, and reshape breasts that have a droopy or bottom-heavy appearance. The procedure can also reduce the size of the areolas (the darker skin surrounding the nipples). Breast lift surgery may be performed either with or without having breast implants placed at the same time. Many women with fuller breasts like how they look in a bra and do not want more fullness. For them, mastopexy surgery by itself may provide a great result. Other women want to have more fullness in the upper part of their breasts. They notice that their breasts look low in general and they have a gap at the top of their bra when they lean forward. For these women breast implants may enhance the result of breast lift surgery. There are different types of mastopexies. One of the most important factors in helping a woman achieve the best result is matching the right woman with the right type of breast lift. Dr. Kunkel uses the Vectra XT 3-dimensional photography system to help with this. Each of the three major types of mastopexies has been programmed into the Vectra system software. With a few mouse clicks, the 3-d image of the woman's torso is altered to show how a specific type of breast lift may affect the appearance of her breasts. The various options, with the potential advantages and disadvantages, are thoroughly discussed with each patient. Dr. Kunkel performs breast lift surgery in a hospital or an outpatient surgery center, with the woman being put to sleep (general anesthesia) for the procedure. The surgery typically takes between 2 to 3½ hours and the woman is able to go home the same day. At the end of mastopexy surgery the breasts are wrapped with gauze dressings. After about two days the dressings are removed and a soft bra may be all that is required after that. Typically some bruising is present for a couple of weeks. Immediately after breast lift surgery there is often quite a bit of fullness in the upper breasts and the bottom of the breasts may appear a bit tight. Over two or three months after mastopexy surgery the weight of the tissues, and the weight of the breast implants if implants were placed, creates some stretching of the tissues in the lower part of the breasts. As these tissues stretch the lower part of the breast rounds out and appears more natural. Some of the upper breast fullness that was present initially shifts more toward the central part of the breasts. Most women may return to work in 1 or 2 weeks. For women who may want to have one or two more children, it's probably best to wait to have breast lift surgery. Pregnancy and breast-feeding result in substantial changes to the breasts, and breast lift surgery does not alter those normal physiologic responses. As with any surgery, complications are possible. For mastopexy these may include numbness, uneven positioning of nipples, asymmetry of the results, and widening of scars. Other less common risks include infection, bleeding, long-term pain, and loss of a nipple.
Many women require surgical removal of the breast (mastectomy) for a variety of conditions (cancer, severe fibrocystic disease). With modern techniques, reconstructing the breast is often an appealing option. Using either a woman's own tissues or implants, Dr. Kunkel is able to create a breast that may be very natural in appearance. Breast reconstruction is almost always covered by insurance and can make an enormous difference is a woman's self-image. A consultation will provide you with information on the many options available for breast reconstruction. Procedures Techniques for surgery to treat breast cancer continue to evolve. In some situations the breast cancer surgeon may recommend removal of an entire breast. In other situations the breast cancer surgeon may recommend removal only of the part of the breast that has the cancer. What technique is chosen to reconstruct the breast depends on many factors, including the type and location of the cancer, the size and shape of the breasts, what the woman ultimately wants to achieve with her reconstruction, as well as her overall health history. The different types of reconstruction techniques are discussed below. Tissue expander - This is the most common technique used for breast reconstruction. At the first operation, Dr. Kunkel inserts a temporary device called a tissue expander beneath the skin at the mastectomy site. Saline (salt water) is injected into the tissue expander at the time of the surgery. The amount of saline added during surgery varies depending on how loose the tissues are, the quality of circulation to the tissues, and the patient's expectations. As the woman is seen in the office over the next several months saline is gradually added to the tissue expander. This is easily accomplished through a device called a port that is built into the expander. The woman comes into the office every two or three weeks for this and it takes just a few minutes to do. Over time the tissue expander is filled to a size and shape that she thinks fits her overall frame. Once the final size of the expander has been reached, the woman undergoes a second operation to replace the tissue expander with a longer-term implant, either saline or silicone. This operation usually takes about an hour or two and the woman goes home the same day. Direct-to-Implant - Some women are candidates to skip the tissue expander entirely and just have the final implant placed at the time of the mastectomy. The best candidates for this are women who have slightly large but not very droopy breasts who would not mind being a little smaller after the mastectomy than before. Women who have extremely large or extremely droopy breasts may not be good candidates. Oncoplastic reduction/mastopexy - This technique often provides terrific results for a woman who has large breasts and chooses to have just the tissue containing the cancer removed instead of the entire breast. She may have already had a lifetime of pain in her back and neck and shoulders due to the weight of her breasts. She might have grooves in her shoulders from her bra straps. Women who choose this procedure undergo removal of only the tissue containing the cancer and the tissue immediately around that. Sometimes the defect that remains may be filled with nearby breast tissue as the breast tissue is rearranged and often made smaller. Typically the woman's nipple is elevated to a more pleasing position and the breast is re-shaped. This procedure may be completed as an outpatient. Most women who choose this type of cancer care also require radiation. Latissimus flap - This procedure may be a good option for a woman who has breasts that are somewhat droopy (“ptotic”) and who is only going to have one breast removed. Skin, fat, and muscle are transferred from the woman’s back to the mastectomy site. This tissue is draped over a tissue expander or an implant that has been placed in the mastectomy site. Latissimus flap technique allows for more shaping and sculpting of the breast than just using a tissue expander or an implant alone. The skin, muscle, and fat create a more natural look and feel to the breast. In most cases the tissue expander is later replaced with a long-term implant. Breast Reconstruction Forth Worth TXTRAM flap - TRAM flap breast reconstruction is a less common technique today, but remains a good option for the right candidate. This operation uses abdominal skin, fat, and muscle to create a breast; usually there are no breast implants or tissue expanders involved. In most cases there is enough skin, fat, and muscle to be transferred from the abdomen to the mastectomy site to create a breast that looks very similar to the other breast. However, women who have had several abdominal operations, are overweight, have other medical conditions, or smoke are not good candidates for TRAM flap breast reconstruction.
The over-development of male breasts, also known as gynecomastia, affects an estimated 40 to 60 percent of men. This condition may be caused by a hormonal imbalance, side effects from certain medications, or may occur for no particular reason at all. Regardless of the cause, the condition is significant and may pose a serious problem in a man's life. Men with large or sagging breasts can be both physically and emotionally uncomfortable, often restricting themselves from certain activities because they feel self-conscious about their breast size. Male breast reduction is an excellent way to decrease the size of a man's breast, helping him feel more comfortable and confident. Candidate for Male Breast Reduction Any man who has excess breast tissue and is bothered by this tissue is a candidate for male breast reduction surgery. The procedure can be performed on men of all ages who are in good health, both physically and emotionally. The best candidates for male breast reduction surgery have firm, elastic skin that will reshape well to their body's new contours. Male Breast Reduction Procedure Male breast reduction surgery is usually performed in a surgical facility with the patient under general anesthesia. The surgery typically takes one to three hours to complete and the patient goes home the day of the surgery (an "outpatient procedure"). Several techniques can be utilized in male breast reduction, depending on the physical findings and the desires of the patient. If the enlarged breasts are primarily caused by excessive fatty tissue, liposuction may be performed through tiny incisions to remove the excess fat. The incisions may be made around the edge of the areola (the area around the nipple) or in the underarm region. If excess glandular tissue is the primary cause of the enlarged breast, this thicker tissue may need to be excised ("cut out") in addition to liposuction. In more extreme instances when large amounts of fat or glandular tissue have been removed, excess skin may have remained that has not reshaped well to the new contour of the breast. In these cases, the excess skin may have to be removed as well. The incisions are then closed using sutures and are usually covered with a dressing. The chest may be wrapped to keep the skin firmly in place. Recovery after Male Breast Reduction Surgery Following male breast reduction surgery, patients will experience some bruising, swelling, and discomfort. This discomfort usually dissipates after a few days and can be reduced with prescribed medication. To help reduce swelling, an elastic pressure garment should be worn day and night for about two weeks, and at night for several weeks after that. Swelling and any skin discoloration will partially subside after a week or two. You will be encouraged to walk around on the day of your breast reduction surgery and can expect to return to work in approximately one week. You may also begin light aerobic exercise after a week, but you should avoid strenuous activities for about three to four weeks following the surgery. Risks and Complications of Male Breast Reduction As with all surgical procedures, male breast reduction surgery contains a possibility of complication. Although rare, these complications include: Skin injury Infection Excessive bleeding Excessive fluid accumulation or loss Loss of nipple sensation Discoloration Scarring Asymmetrical breasts or nipples
Among the most popular cosmetic surgery procedures, liposuction (also known as "suction lipectomy") sculpts the body by removing undesirable fat from areas around the abdomen, waist, hips, thighs, knees, buttocks, neck, and arms, depending on the patient’s desires. Liposuction is not a substitute for a healthy diet and exercise, but the procedure can eliminate areas of fatty fullness that are unresponsive to typical weight-loss methods. Ultrasound-assisted liposuction (UAL), power-assisted liposuction (PAL), tumescent technique and the super-wet technique are among the various techniques used to provide precise results in liposuction surgery. Personalized Care We recognize that all patients are different. Dr. Kunkel takes as much time as necessary during your consultation to learn what each you want to achieve with liposuction. By listening to your desires and discussing what is (and what is not) possible with liposuction, Dr. Kunkel formulates a treatment plan with your unique attributes and goals in mind. Liposuction Techniques Liposuction | Forth Worth TXThe liposuction procedure begins with the injection of a solution composed of saline (salt water), a local anesthetic called lidocaine, and a small amount of adrenaline (epinephrine) to decrease bruising and bleeding. This is known as either the tumescent or super-wet technique, depending on the ratio of the fluid to the fatty tissue being removed. Once the solution has been introduced into the area planned for liposuction treatment, Dr. Kunkel proceeds using either “traditional” suction-assisted lipectomy (SAL), power-assisted lipectomy (PAL), or ultrasound-assisted lipectomy (UAL). The exact technique used is discussed and decided upon during your preoperative visits. Tiny incisions are made and a small suctioning instrument (a "cannula") is inserted and moved back and forth beneath the skin, breaking up the fat layer and suctioning it out. In UAL, ultrasonic energy is used to liquefy the fat before it is suctioned out with a cannula. Dr. Kunkel typically performs liposuction in a surgery center with the patient under general anesthesia. The procedure may last from one to three hours, depending on the amount of fat being removed and the number of areas being treated. Recovery Most patients wear compression garments for at least 3 weeks after liposuction. Patients are encouraged to walk and move around quite a bit on the same day, and many return to work within a few days. Strenuous activity should be avoided for about a month. Results of Liposuction Some of the results are visible immediately, and improvement often continues as swelling subsides during the first three months. Risks of Liposuction As with any surgery there are some risks. While uncommonly encountered, these include: Asymmetry of the results Irregular contours Numbness of the skin Pigmentation changes of the skin Infection Delay in healing Fat clots or blood clots Shock Fluid accumulation under the skin Burns Perforation injury Lidocaine toxicity
Abdominoplasty, often called a "tummy tuck," is a popular procedure that shapes and tightens the abdomen. Loose skin and excess fat are removed and muscles that have been stretched through pregnancy and weight changes are often pulled together, creating exciting new shapes and contours. Dr. Kunkel calls tummy tuck surgery "the return of the belly button" because many of the patients who have not been able to see their umbilicus for years absolutely love the "new" belly button that results. Tighter, flatter abdomens, new belly buttons, beautiful new shapes and contours...these are operations that can produce "Wow!" types of results. Tummy tucks help provide a fabulous look in a bathing suit during those hot Fort Worth/North Texas summers. That loose, sometimes bulging skin and fat no longer hang over the jeans and shorts..."Wow"! Candidates for a Tummy Tuck While often thought of as an operation for younger patients, Dr. Kunkel has performed abdominoplasty on patients ranging from age 22 to 64. As long as the person's health is good, age by itself should not deter someone from looking fantastic! Most patients are from the Fort Worth and North Texas area, but Dr. Kunkel has also performed tummy tucks on women from states as far away as Colorado and Illinois. The best candidates for tummy tuck surgery are in good physical condition and have loose skin in the lower or central abdomen. They may have some 'pooches' of fat in the lower abdomen or flanks or have the appearance of having "a lap in my lap" when they sit down. Pregnancy can create some pretty dramatic changes of an abdomen...wrinkles, stretch marks, loosening of the muscles with accompanying central bulges. Whether a woman has had one child or she is a mother of multiples (twins, triplets, quadruplets!), tummy tuck surgery can help guide her back to that flatter and tighter abdomen of years ago. Another group of people who may achieve stunning results with tummy tuck surgery are those who have lost a lot of weight. Tummy tucks can help complete a transformation and provide a wonderful increase in self-confidence for weight loss patients. Customized Treatment An abdominoplasty consultation in Dr. Kunkel's Fort Worth office usually takes about 2 hours. The Vectra 3-dimensional photography system is used as part of the consultation. Photographs are taken of the person's abdomen and back. The Vectra software reconstructs those photographs into three-dimensional images, allowing the person to see herself/himself from angles that are next to impossible to see in a mirror. This 3-d system is a very powerful educational tool and helps ensure that the patient and Dr. Kunkel are seeing and talking about the areas of the body that are most important to the patient. Dr. Kunkel and staff listen to the patient, learning what she hopes to achieve, and then customize a treatment plan. The patient is involved in every step of the process. A tummy tuck consultation is not a quick "in-and-out" visit with the doctor. The patient has substantial interaction directly with Dr. Kunkel. Using this approach Dr. Kunkel believes the patients understand their own physical findings and the options available better than with a quick 5 or 10 minute visit. The patient is also given a booklet to take home, written by Dr. Kunkel, containing essential information to know about how to prepare in the days leading up to the abdominoplasty surgery, what to expect after the procedure, and photographs of actual patients. The Tummy Tuck Procedure Dr. Kunkel performs tummy tuck surgery with the patient under general anesthesia in a hospital or surgery center in Fort Worth, usually completing the procedure in about three hours. Patients often spend the night in the facility but this is not mandatory and is carefully discussed during the consultation. There are a few variations to abdominoplasty surgery. With the most common procedure, an incision is made beginning within the pubic hairline, extending toward the hip on each side. The loose skin and fat are then separated from the underlying muscles. The rectus muscles ("six pack" muscles) are then frequently pulled together, creating what some people have described as an "internal girdle". The loose skin is removed next. The umbilicus (belly button) remains physically attached to the underlying tissues in its normal position. When the loose skin is pulled tight and removed, a new hole must be made for the belly button. The belly button is pulled through the new hole and sutured into place at the level where it had always been, but now it has a new appearance! The tummy tuck incisions are closed with dissolving sutures and dressings are applied.
A mommy makeover may include any combination of procedures, but in most cases it refers to surgical procedures that enhance the appearance of the breasts and the abdomen, performed at the same time. Many women really liked the volume and shape their breasts had when they were breast feeding. They liked how the filled out their clothing and they want to get back to that look. These women have nicely shaped but smallish breasts. For this group, breast augmentation may just be perfect. Placing an implant to increase breast volume and shape takes about an hour; the increase in self-confidence lasts a lifetime. Some women develop substantial looseness of the skin, resulting in a major change to the look of their breasts. Maybe the breasts develop a bottom-heavy appearance, with much of the fullness of the breasts sagging down below the bra-line level. Maybe the nipples point down. Women with these types of changes may benefit from a breast lift (mastopexy) to tighten the breast tissues and re-position the nipples more centrally on the breasts, possibly combined with placement of breast implants to enhance the shape and volume. A final group of women always had large breasts and found that having children made their breasts way too big and heavy. These women may benefit from breast reduction surgery. Mommy makeover surgery may include breast augmentation, breast lift, or even breast reduction surgery depending on the woman's features and desires. Dr. Kunkel discusses this carefully during the initial mommy makeover consultation. The abdomen, of course, also changes as a result of pregnancy. Some women have amazingly few long-term changes (sometimes life just isn't fair that way!). Some women remain thin but find that when they lean forward their skin is so loose it also falls way forward. Other women develop a muffin top or maybe a pooch of skin/tissue in the lower central abdomen that hangs over a fold or cesarean section scar. Stretch marks are common. Often the belly button changes, with skin draping over and concealing it. Tummy tuck (abdominoplasty) surgery may work wonders for women with these types of findings. Liposuction of the flanks may be performed at the same time for women who have fullness in that area. Women whose loose skin extends all the way around to their back may benefit from a more circumferential approach, possibly a lower body lift that also lifts and tightens the lateral thighs and the buttocks. Mommy makeover surgery is not one specific operation. It is a combination of procedures, typically involving the breasts and the abdomen, performed to help reclaim the body lost due to the 'ravages' of pregnancy and breast feeding. Mommy Makeover: How to Decide Which Procedures Will Work Best Dr. Kunkel and his staff spend a lot of time with the patient during the initial mommy makeover consultation. The visit typically lasts about 2 hours. Vectra XT 3-dimensional imaging is used during the consultation. Six cameras take photographs of the woman's breasts, abdomen, and back. The Vectra software then combines the digital information in the six photographs of each of those areas into three dimensional images. These images may be rotated in almost every conceivable direction, allowing visualization of the body in ways that are almost impossible to do with mirrors. Dr. Kunkel uses 'marking pens' in the software to draw on and highlight specific areas of the images, helping the patient understand the types of changes that may be possible for each of her areas of concern during mommy makeover surgery. The three dimensional imaging is used as an educational tool to help increase knowledge and understanding rather than as a tool to show exact results. The Vectra software includes information about almost every saline and silicone breast implant available in the United States. For women considering breast augmentation, it is possible for the software to show what a woman may look like with a specific pair of breast implants. Want to see a different look? Just a few more mouse clicks. While the simulated result from the software is not exact, it does help provide important information in helping women choose the type of mommy makeover surgery outcome that may work best for them. Where does Dr. Kunkel Perform Mommy Makeover Surgery? Mommy makeover surgery is performed in a hospital with the patient under general anesthesia. Facilities that Dr. Kunkel uses include Andrews Women's Hospital at Baylor All Saints, USMD Fort Worth Hospital, Texas Health Harris Southwest Hospital, and Baylor Surgical Hospital. Recovery after Mommy Makeover Surgery Most of Dr. Kunkel's mommy makeover patients spend the night in the surgical facility. Why spend the night? Primarily as a safety issue. One of the most important things a person should do after a mommy makeover is get out of bed and move around. Some patients have a great helper at home who will help/make them get out of bed.
Genetics and lifestyle choices combine to create our body shapes. Over time some people develop significant laxity of the tissues of their abdomen, sides, lower backs, and thighs. This may happen to someone who lost a lot of weight, either through diet and exercise or as the result of weight-loss surgery. It also may happen to someone who has always been near her ideal weight but whose tissues are just naturally loose. At times this results in medical problems like rashes and infection. When loose, hanging tissue becomes undesirable it may be possible to have that tissue removed surgically. Circumferential Body Contouring Tummy tuck surgery addresses the front, and to a lesser degree the sides, of the abdomen. When loose tissue of the outer thighs, lower back, and buttocks are a concern, tummy tuck surgery may not be enough. In these situations, a more circumferential approach may be best. Lower body lift, belt lipectomy , and corset body lift are different operations that may be done to address the particular areas of concern a patient may have when loose tissue goes all the way around the central part of the body (the "trunk"). Lower Body Lift and Belt Lipectomy Surgery Lower body lift surgery and belt lipectomy surgery are similar procedures. They both address loose tissue all the way around the lower abdomen, sides, and back. The front of the abdomen is addressed in much the same way as an abdominoplasty ("tummy tuck"). An incision is made beginning within the pubic hairline and extending transversely across the lower abdomen. The dissection continues deeply along the muscle layer in an upward direction, elevating all of the loose tissue off of the muscle. One the rib cage is reached, all of the loose skin and fatty tissue have been mobilized and can now be pulled down toward the thighs. This allows a substantial amount of skin and fat to be removed. The rectus muscles of the abdomen (the "six pack" muscles) are often pulled together in the midline with sutures, creating something like an 'internal girdle'. Once the extra skin and fat have been removed and the muscles addressed, the tissues are sutured together. This completes the abdominoplasty part of the procedure. With a lower body lift or a belt lipectomy, however, the patient is now turned on her side or stomach, and the incisions are extended all the way around to the midline of the back just above the buttock crease. Loose areas of skin of the outer thighs and buttocks are removed, lifting the outer thighs and the buttocks. The biggest difference between a lower body lift and a belt lipectomy is where these incisions are made. In lower body lift surgery, the incisions along the side and back are typically made in a lower position than in belt lipectomy surgery. Lower body lift incisions work best for the woman or man who has bulges of loose skin and fat over the hips and upper thighs. Lower body lift surgery creates more substantial changes in the upper outer thigh than belt lipectomy surgery. Belt lipectomy incisions are made a bit higher on the sides and the back. Belt lipectomy operations work best for the person whose tissues are loose but there are not distinct bags of tissue on the hips. Making the incision higher on the side and back may help create a more tailored, sculpted waist than a lower body lift. Dr. Kunkel takes the time to go over all of this with the patient during the initial consultation, helping identify the areas of most concern to the patient. Corset Body Lift Corset body lift is different than lower body lift and belt lipectomy operations. A corset body lift addresses tissues that are loose all the way around the central trunk, but all of this is done through incisions on the front; there are no incisions on the back. In this procedure when the patient is lying flat on her (or his) back, the loose abdominal skin is pulled tightly together in the midline from between the breasts down to the pubic hairline. Pulling the tissue strongly together in the middle allows tissues that are on the back to be pulled forward too. The extra tissue is removed, creating tightness centrally in the front. Extra skin and fat are then removed from beneath the breasts on the upper abdomen extending to the side. Finally, extra tissue is also removed from the lower abdomen extending far to the side as well. This results in a "corset" look to the central trunk. The scar pattern is like a 'sideways H', with scars running along the breast creases, down the center of the abdomen, and transversely across the lower abdomen. A corset body lift provides dramatic changes in the look of the abdomen and trunk, all accomplished through incisions on the front. Customized Treatment for Optimal Results An consultation in the office to learn about body contouring operations usually takes about 2 hours. The Vectra 3-dimensional photography system is used as part of the consultation. Photographs are taken of the person's abdomen and back
Arm lift surgery (“brachioplasty”) is a procedure that removes excess skin and fat from the arms. It may be combined with liposuction of the arms to reduce arm fullness even further. This procedure is popular with people who have lost a lot of weight. However, even men and women who have not lost a lot of weight but have “bat wings” or loose, sagging skin of the upper arms are candidates for brachioplasty surgery. Dr. Kunkel performs brachioplasty in a hospital or surgery center with the patient under general anesthesia. The procedure takes about 3 hours to complete. Patients may go home that day, although some prefer to stay in the surgical facility overnight. In the most common type of brachioplasty an incision is made near the elbow and the extra skin and fat are then removed all the way to the armpit and even a short distance down the side of the upper part of the chest; this last part is very helpful in women in particular because it removes some of the skin that hangs over the top of the bra in that area. The scar that results is relatively inconspicuous on the upper inner arm and upper lateral chest. The arms are swollen and a bit tight for a few days, but typically there is not much actual pain. Most people take one or two weeks off from work and, as with any major operation, strenuous physical activities like upper body CrossFit training should be avoided for about six weeks. Most brachioplasty patients wear compression sleeves for about two months after surgery. For that reason many brachioplasty patients prefer to undergo the surgery in the fall or winter. Wearing long sleeves in Texas in the summer may be uncomfortable and is a good way to draw attention to one's self!
A thigh lift is performed to remove excess skin and fat from the upper legs. Candidates typically have loose, droopy skin after significant weight loss due to diet and exercise or bariatric surgery. Thigh lift surgery is often combined with other body contouring procedures like breast lift surgery or abdominoplasty, helping the person re-gain a sense of proportion and balance of the overall physique. Dr. Kunkel performs inner thigh lift surgery in a hospital or outpatient surgery center with the patient under general anesthesia. The operation typically takes about 3 hours to complete. In the type of inner thigh lift performed most frequently by Dr. Kunkel, skin and fatty tissue are removed from the inner aspects of the thighs. Incisions are made along the inner thigh extending from the groin crease to the knee, allowing excision of the excess tissue. The resulting scar is very pink for several months but fades. Ultimately the scar will be visible in shorts, but people who go through this operation are typically very willing to trade the scar for the significant enhancement in thigh shape and contour. The legs are swollen, bruised, and tight for several days after thigh lift surgery, but pain is not usually a major concern of this group of patients. Most people will want to take about two weeks off from work. Compression garments are recommended for several weeks to a few months after thigh lift surgery to help minimize swelling and accelerate the return to the skin's natural tone. It's best to wait about six weeks before resuming running and working out.
A back lift focuses on recontouring and tightening up the back by removing excess skin and fat. Due to aging, sun exposure or major weight loss, the skin of the back may begin to sag and bulge, creating unsightly lumps and rolls. This makes many people self-conscious even when dressed, as clothing often shows off every roll. A back lift procedure concentrates on the mid to upper back area and sides of the upper abdomen beneath the arms. This is a particularly difficult spot for women as these rolls of skin tend to surface above and below the bra line. An incision is made through which excess tissue is removed, smoothing the skin of the back for a much more toned appearance. The incision does form a thin scar, but this is easily concealed under a bra or bathing suit strap. Performed under general anesthesia, most back lifts are outpatient procedures completed in one to two hours. Back lift surgery is an effective form of treatment for both men and women, and may be combined with other body contouring procedures to help patients achieve their aesthetic goals all at once.
These are effective in softening fine lines, reducing hyperpigmentation, balancing oil production, controlling acne lesions, as well as refining pores and overall skin texture. Cell renewal and collagen activity are stimulated. We use Rhonda Allison Alpha Hydroxy Acids, Beta Acids, TCA, Salicylic Acid, and Retinol. Our treatments are not limited to the facial area. We can help improve the appearance of the neck, décolleté, arms, and hands with a series of in-office peel treatments combined with a customized at-home peel regimen.
Our Derma Genesis Microdermabrasion system uses medical grade crystals to remove the dead, outermost layer of skin. The exfoliation process reveals new, living skin cells that are soft, smooth, and receptive to nutrients. Treatments minimize fine lines and wrinkles, acne, hyperpigmentation, and dull, sun-damaged skin without any downtime. This is a wonderful “lunch hour peel”. For optimal results it may be combined with careful extractions, and Microdermabrasion also works beautifully with many chemical exfoliations such as the Jessner Peel, TCA peels, and many fruit acid combinations.
Our corrective facials treat acne, hyperpigmented, dehydrated, sun-damaged, mature/aging, and rosacea skin conditions. We provide deep cleansing and exfoliation using acids and enzymes specific to your skin type. Careful extractions help clients see immediate improvement, and antioxidants accelerate cellular repair as well as enhancement in the rejuvenation of the skin. Therapeutic massage and mask aid the repair process. Waxing services and eyebrow shaping are also available.
Dermaplaning Dermaplaning, also known as Epidermal Leveling, is a resurfacing treatment that safely removes dead skin cells from the superficial layer of the skin (stratum corneum), along with fine facial hair. It is not meant to treat specific skin disorders like acne or other blemishes, but rather to enhance the overall appearance of the skin. This treatment helps reduce fine lines and uneven pigmentation and may aid the absorption of skin care products, increasing firmness and elasticity., also known as Epidermal Leveling, is a resurfacing treatment that safely removes dead skin cells from the superficial layer of the skin (stratum corneum), along with fine facial hair. It is not meant to treat specific skin disorders like acne or other blemishes, but rather to enhance the overall appearance of the skin. This treatment helps reduce fine lines and uneven pigmentation and may aid the absorption of skin care products, increasing firmness and elasticity.
KYBELLA® is a non-surgical chin contouring injection treatment option to redefine the chin and jawline in patients with mild skin laxity and moderate to severe submental fullness. What is "Submental Fullness"? Submental fullness, sometimes referred to as “double chin”, is the presence of noticeable fatty fullness directly beneath the chin. It is common in both men and women and is influenced by several factors including aging, genetics and weight gain. If you’re bothered by submental fullness, you’re not alone. According to a 2015 survey conducted by the American Society for Dermatologic Surgery (ASDS): 67% of people said they’re bothered by under-the-chin fullness, or double chin People are just as bothered by under-the-chin fullness as they are by lines and wrinkles around and under their eyes How KYBELLA Cosmetic Works® Cosmetic Works The active ingredient in KYBELLA® is deoxycholic acid, a naturally-occurring molecule in the body that aids in the breakdown and absorption of dietary fat. When injected into the fat beneath your chin, KYBELLA® causes the destruction of fat cells. Once destroyed, those cells cannot return. Most patients require two or more treatments, separated by 6 to 8 weeks. Once the desired aesthetic response is achieved with KYBELLA®, it is possible that additional treatments may never be required.
When you smile, laugh, frown, or look puzzled, you contract the muscles of your face. Over time, these contractions produce permanent furrows and deep wrinkles in the skin. These lines can make you look older, sad, angry or tired. BOTOX® Cosmetic helps prevent these lines from deepening while it softens or erases these marks of aging, leaving you looking younger and more refreshed. What can BOTOX® treatments do for me? BOTOX® Cosmetic is the most popular cosmetic procedure in the country and one of our most requested services. Quick, safe and effective, BOTOX® reduces or eliminates facial lines and wrinkles for up to six months with no downtime and little to no discomfort. Through a series of tiny injections, BOTOX® gives you a rejuvenated look and is often used to help smooth crow's feet beside the eyes, frown lines between the eyebrows, horizontal lines across the forehead, worry lines around the mouth, and lines on the neck. How BOTOX® Cosmetic Works BOTOX® is the brand name for onabotulinum toxin A, a therapeutic muscle-relaxing agent derived from the bacteria Clostridium Botulinum. Originally approved by the FDA for the treatment of eye muscle spasms, BOTOX® was quickly recognized for its cosmetic value. Physicians have been using BOTOX® Cosmetic for years as a treatment to correct visible signs of stress and aging. The medication relaxes the muscles in the face that cause wrinkles. When injected in small doses in specific areas, BOTOX® injections block nerve conduction to muscles responsible for the repetitive actions that cause fine lines and wrinkles. In this way, BOTOX® smoothes the lines in the skin that make you look tired or angry. Candidates for BOTOX® BOTOX Cosmetic | Fort Worth TXA good candidate for BOTOX® treatment may be anyone looking to enhance her or his appearance by getting rid of unwanted lines or wrinkles. It is also important that people seeking treatment with BOTOX® Cosmetic are in good physical health, are not pregnant or nursing, and do not have a neuromuscular disorder. While some people receive BOTOX® treatments two or three times a year, others are more selective in its use. Common “special” uses of BOTOX® include just before class or family reunions, weddings, or prominent social engagements. When used for these purposes it is usually best to receive the treatment about two weeks prior to the special occasion. The BOTOX® Procedure Through the use of a small, fine needle, BOTOX® Cosmetic is injected under the skin into specific muscles of the face that are causing lines and wrinkles. The treatment takes just a few minutes and recovery is immediate, allowing you to return to work and resume your normal daily activities that same day. The Importance of Choosing a Qualified Provider Even though BOTOX® is not a surgical procedure, it is important to choose an experienced, qualified provider when deciding to undergo BOTOX® treatments. Dr. Kunkel and his nurse injector Krista are intimately familiar with BOTOX® Cosmetic and have successfully treated hundreds of patients at our office. They take time to talk with each candidate before beginning the treatments. This helps them understand what each person wants to achieve and allows them to determine how to best correct the problem area(s). BOTOX® Cosmetic Results Immediately following the BOTOX® treatment some patients may experience mild bruising, which goes away shortly. The wrinkles begin to fade within 24-48 hours, with continued improvement over the next 5 days. The effects of BOTOX® Cosmetic typically last about four months. After several BOTOX® treatments, the results may be prolonged. Risks and Side Effects of BOTOX® Side effects of BOTOX® Cosmetic are rare and are usually mild and temporary. The most common side effects caused by BOTOX® are headaches and temporary redness or bruising of the skin at the site of injection. In rare cases, slight drooping of an eyelid or asymmetry of expression may occur.
When we are young our skin is smooth and elastic with a healthy glow. As we age, our ability to maintain that smoothness and elasticity diminishes, resulting in skin that becomes drier, thinner and less able to replenish itself. Our body’s natural collagen and hyaluronic acid levels decrease and our skin loses volume and becomes lax. This leads to skin wrinkling and appearing older than it should. Approved by the FDA, Juvéderm® is designed to replace volume lost by your skin. Replacing this volume results in smoothing of wrinkles, sculpting of the lips, or shaping of facial contours. With its ability to bind with water, results of Juvéderm® treatments may be seen for many months. The most common areas for a Juvéderm® treatment are the nasolabial folds (from the root of the nose to the angle of your mouth), and the wrinkles around the mouth and chin. It is also commonly used to add volume and shape to the lips and cheeks. Juvéderm® | Dermal Fillers | Fort Worth TXSince no pre-testing is required, a Juvéderm® treatment can be performed almost immediately. It usually takes about 30 minutes, depending on the amount of correction you want. Most people find the injections relatively painless, but a topical anesthetic may be applied to the area prior to your treatment. You will be able to see the results as soon as your treatment is completed. Juvéderm® is a clear transparent gel composed of hyaluronic acid, a natural substance that is found throughout your body. Hyaluronic acid gives volume to your skin and has been used as a lubricant for arthritic joints. It has even been used during eye surgery to protect the retina. The hyaluronic acid found in Juvéderm® is not of animal or human origin which means that there is no risk of disease transmittal or allergic reaction, which might be found in other cosmetic fillers. There is no need for skin testing and the risk of side effects is very low. How long do the effects of a Juvéderm® treatment last? The length of time the effect of a Juvéderm® treatment lasts depends on many factors, including the structure of the skin, lifestyle, age, the degree of correction and perfection desired, and the injection technique of the practitioner. Touch-ups and follow-up treatments will add to the duration. Most people who have treatment of facial folds and wrinkles choose to have another treatment within a year, while those who undergo lip enhancement often desire another treatment after about 6 months. What should I do after my Juvéderm® treatment? During the first 48 hours after your treatment, do not massage or rub the treated area. If you have had a lip enhancement, avoid puckering your lips for the first two days after the treatment. You should not expose the treated area to intense heat (e.g. in a solarium or by sunbathing) or extreme cold for the first few days after the treatment in order to minimize inflammation.
Microneedling is a revolutionary, skin rejuvenation treatment. Using Rejuvapen, the most powerful microneedling system available, invisible, micro-perforations are created at various depths into the epidermis. As a result, the skin shifts its natural repair mechanism into high gear and starts producing collagen and elastin to repair the micro-perforations. Skin becomes firmer and fine lines and wrinkles are visibly reduced. Rejuvapen can also treat acne scarring, surgical scars, stretch marks and can firm and tighten skin on most areas of the body. A series of 3 to 6 treatments is recommended.
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