Blepharoplasty

Blepharoplasty, or eyelid surgery, improves the appearance of the upper eyelids, lower eyelids, or both, and gives a rejuvenated appearance to the surrounding area of your eyes, making you look more rested and alert.

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Botox

BOTOX® Cosmetic is a prescription medicine that is injected into muscles and used to improve the look of moderate to severe frown lines between the eyebrows (glabellar lines) in people 18 to 65 years of age for a short period of time (temporary).

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Breast Augmentation

Also known as augmentation mammaplasty, breast augmentation involves using implants to fulfill your desire for fuller breasts or to restore breast volume lost after weight reduction or pregnancy.

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Breast Lift

Also known as mastopexy, a breast lift raises and firms the breasts by removing excess skin and tightening the surrounding tissue to reshape and support the new breast contour.

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Breast Reconstruction

Breast reconstruction is achieved through several plastic surgery techniques that attempt to restore a breast to near normal shape, appearance and size following mastectomy.

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Breast Reduction

Also known as reduction mammaplasty, breast reduction removes excess breast fat, glandular tissue and skin to achieve a breast size in proportion with your body and to alleviate the discomfort associated with overly large breasts.

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Facelift

Also known as rhytidectomy, a facelift is a surgical procedure to improve visible signs of aging in the face and neck.

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Gynecomastia

Gynecomastia, or breast reduction for men, is the surgical correction of over-developed or enlarged breasts in men.

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Liposuction

Also known as lipoplasty, liposuction slims and reshapes specific areas of the body by removing excess fat deposits, improving your body contours and proportion, and ultimately, enhancing your self-image.

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Tummy Tuck

Also known as abdominoplasty, a tummy tuck removes excess fat and skin, and in most cases restores weakened or separated muscles creating an abdominal profile that is smoother and firmer.

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Perforator (DIEP) Free Flap

Dr. Coleman's Comments:

The Tram flap has been a workhorse for plastic surgeons for nearly 20 years now. In the right conditions, nothing can make a more natural looking and feeling breast. The technical procedure is demanding. Even in the best hands there is a 24% incidence of complications, though most are minor. It has been established that the microsurgical method of transplant also provides the best blood supply for this flap. For years we have always taken a patch of the rectus abdominus muscle where all the blood vessels perforate through the muscle to nourish the fat and skin of the flap. This has caused minor problems with hernias in the area where the muscle was taken. In 1989 two adventurous microsurgeons, one in Japan, and one in America tried to trace a few of the small perforator vessels through the muscle in order to leave the muscle behind and lessen the chance for hernias. They found that the same large flaps can live with only one or two perforators entering the deep surface of the flap. This has made the procedure much less traumatic to the abdomen, and has made repair of the abdomen much easier.

However it is a very delicate operation, only possible in the most skillful of hands, so only a few surgeons offer this. In the State of Texas, I am only aware of two surgeons other than myself. I almost always attach the vessels to the internal mammary artery as the blood flow is so

strong in these vessels, and it leaves the circulation to the latisimus intact, should it need to be used as a salvage flap. I have had one patient who indeed did not have good perforators and I had to abandon the flap and use the latisimus (her photos are in the latisimus section of this website). I have also had one patient who lost a significant portion of the perforator flap and needed to have the latisimus as a source of additional tissue. However, in the successful cases, I have been very pleased with how much less pain the patients have, and how much more quickly they recover than with the Tram. Here are two examples of my best work.

- W.L. Coleman, M.D.

 

Upper Row: Pre-Op
Lower Row: Post-Op (six months)

The drawback of Tram Flaps is the need to harvest a part of the rectus muscle that contains the vessels. This lady had a wealth of skin and fat on her abdomen, but she had a weak abdominal wall, so a Tram Flap couldn't be offered. However we were able to trace the vessels through the muscle leaving it in place, using only the skin and fat and vessels for the reconstruction. She also had a nipple reconstruction.

 

This 44 year old had a mastectomy for her right breast seven years ago.  Despite the fact that she had radiation and chemotherapy, and was also a smoker, her breast and nipple reconstruction went smoothly and had a good result.

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8715 Village Drive, Ste. 504, San Antonio, TX 78217

Phone: (210) 251-4362   ||   Fax: (210) 251-3383