Beautologie Cosmetic Surgery & Laser Center let The Californian observe a breast augmentation and liposuction surgery -- the two most popular cosmetic surgery procedures in the United States, according to the American Society for Aesthetic Plastic Surgery. We followed a patient through the hour-long surgery with Dr. Darshan Shah. Shah is a plastic surgeon who trained for five years in general surgery and two years in plastic surgery but is not board-certified, something he says he's working toward. Shah invited The Californian to observe the surgery to show that "it's a big deal," he said. "People think it's like a spa. When it's marketed as minimally invasive, people don't know what it means."

Breast augmentation:

After a nurse anesthetist put the patient under general anesthesia, Shah began the surgery. With the patient asleep and monitored, Shah said he could concentrate fully on the surgery. He made an inch-long incision below the patient's breast, creating a pocket for the implant. "You are so close to the lungs and heart that one false move and you can have a major problem," he said, lifting the skin and muscle to reveal the rib cage below.

With the implant placed under the muscle, he began to slowly inflate it with a sterile saline solution. "If you're in the right place, you don't get much bleeding," he said. "Creating the pocket is a form of art." Once the breasts were inflated to the right size, the sleeping patient was lifted up and Shah evaluated the breast size and shape. When satisfied, he removed the tube. The implant self-seals, he explained.

After squirting antibiotic around the scar and lidocaine to prevent pain, Shah began to close the incision with dissolvable sutures. Good suture technique is important for ensuring the smallest, flattest, narrowest scar possible, he added.

Liposuction:

While the patient was still asleep, Shah began preparation for inner and outer thigh liposuction. Shah said he won't do liposuction on places like calves, forearms or knees since the risk for problems is too significant. For patients who already have a lot of loose skin, lipo on the abdominal area can also be problematic since it can exacerbate slack skin.

"If you don't know the potential problems, you're going to do everything," he said, referring to performing liposuction on any area of the body.

To begin the procedure, he made a tiny incision in the thigh and inserted a mix of local anesthesia to reduce pain and bleeding. He used a small cannula, a wand about the diameter of a pen, which uses ultrasonic vibrations to melt the fat, and then vacuumed it out. (Other types of liposuction also exist, such as using a smaller wand with a laser that liquefies fat).

He inserted the wand below the skin and swept it across the fatty inside layer in regular, steady movements, using his other hand to guide the wand. "With experience, you know the feel of it, and when you've removed enough," he said. "This is like sculpting." The pinkish mix of fat and blood exited the body through a tube, collecting in a jar. Shah evaluated the volume to ensure consistency on both legs. He said inner thighs require especially careful work since they have loose skin to start with; improper technique can leave a wavy appearance.

"The worse problems are when you take too much out," he said.

Aftermath:

Several weeks after the surgery, the patient said "everything was great." She experienced pain for two to three days, especially on her legs. Within five days, though, she was back to work. The woman, 24, said she had planned the surgeries for a couple of years, and having a baby confirmed that choice. "I wanted my old look back," she explained. "So far, I am happy."

-- Staff writer Kellie Schmitt

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