A nip and tuck here, a suction there. Although it sounds simple, cosmetic surgery is anything but. In many cases, these are invasive treatments and surgeries with permanent and profound results.

Years ago, many cosmetic procedures were tedious and painful and produced unpredictable outcomes. However, thanks to technical advancements, patients are experiencing greater success with decreased pain and downtime. Here are five cosmetic procedure game-changers.


Radio Frequency-Assisted Liposuction (BodyTite/FaceTite)

Radio frequency-assisted liposuction (RFAL) tightens the skin and reduces fatty tissue underneath.

Small, discreet incisions are made, and a solution is injected to tense up the fat and cause the blood vessels in it to shrink. Then fat is removed using a rod with holes in the end, sucking the fat into the rod and out of the body. Any area on the body can be treated, but the best results occur on the inner thighs, lower abdomen, back of the arm and the neck and lower face, according to Dr. Greg Ratliff of Plastic Surgery Center of Tulsa.

Unlike traditional liposuction, heat is generated at the tip of the probe, popping fat cells and shrinking the connective tissues to tighten the subcutaneous tissues and the skin.

Ratliff performs RFAL with the BodyTite and FaceTite system and says it can tighten skin up to 40 percent. The incision is so small, the procedure is classified as noninvasive with no stitches needed.

Why it’s a game-changer: Ratliff says that before BodyTite, the results of liposuction were hit and miss. "(RFAL is) proven to be good for 40- to 55-year-olds who are starting to get laxity in the neck," he says, adding that the procedure "tightens the neck without a face lift." "It does what (parent company Inmode) claims it does, and they’ve done it right," he says.

The Body/FaceTite system produces minimal swelling and bruising, according to Ratliff. Patients can resume normal activities within a few weeks.

Cost: Begins around $3,500, depending on the area.


Hyaluronic acid fillers (Vollure)

Although they have been around for many years, hyaluronic acid fillers have recently been improved upon in their ease of use and longevity, according to Dr. Stephen Paulsen of Plastic Surgery Associates of Tulsa.

"This filler is administered under sterile technique to prevent infection and can be done in the office in about 20 minutes," Paulsen says. Target areas recommended by the manufacturer are the nasolabial folds (laugh line area), corners of the mouth and marionette areas (lines that run from the corner of the mouth to the chin).

The product lasts up to 18 months, he adds, and since the face continues to age and tissues continue to thin and sag, a more permanent product might end up in the wrong place. "As with the older HA products, this new one is reversible, as well, adding an additional benefit."

Why it’s a game-changer: "The next generation of fillers such as Vollure now promises a longer lifespan, causes less swelling post-injection and provides a softer, less firm result," Paulsen says.

Cost: Begins around $700 per syringe.


Drainless tummy tuck

Tummy tucks eliminate excess belly fat and tighten muscles in the abdominal wall. Traditionally, the surgery requires drainage tubes for several days.

Introduced in 2012, drainless tummy tucks use a progressive tension suturing technique (like quilting) to join together the tissue that was separated during the tummy tuck, closing spaces where fluid can collect in the surgical area, thus eliminating the need for drains. 

Why it’s a game-changer: Recovery is faster and less painful immediately following surgery — it’s decreased from a nine or 10 to a six on the pain scale, Ratliff says. It also decreases the rate for infection since there’s no hole for bacteria to enter.

Cost: $5,900-$7,900.


Fat grafting

Fat grafting is nothing new, Ratliff says, but the  survival rate of transplanted fat until now was as low as 10 percent. Patients were subject to significant inflammation and scarring at the injection site, resulting in large surface defects and draining openings in the skin. "That is why survival percentage of the graft is so critical; how it is aspirated, processed and injected all are critical in getting maximum survivability," Ratliff says. With today’s advancements, a 90 percent transplanted fat survival rate can be expected. Fat is harvested by liposuction, processed and injected back into the area that needs more volume. The buttocks and face are two areas which have benefited the most from fat grafting.

"As your face ages, it loses volume," Ratliff says, "so adding volume is the obvious answer. It allows us to put in living tissue, which molds to the place you add it, as opposed to artificial filler, which is static." Downtime for fat grafting on the face is about one week.

Ratliff points out one important consideration since fat is living tissue: it will retain its original characteristics. Fat cells in different body areas have different efficiency at processing and storing fat. Abdominal fat cells transplanted to the face, for example, are still abdominal fat cells and can enlarge much faster than fat from most of the rest of the body, so your face will enlarge faster than the rest of you. "So if it came from your stomach, you may get chubby cheeks if you gain weight."

Why it’s a game-changer: With new equipment and technology, the transplanted fat survival rate is now close to 90 percent.

Cost: Ranges from $1,800-$4,000, depending on the area.


Cohesive silicone gel

Breast implants — inserted between breast tissue and chest muscles or between chest muscles and the chest wall — also are not a new product, but the cohesive silicone gel offers peace of mind in case of implant rupture. Although it is more expensive than standard silicone, cohesive silicone retains its shape — without seeping into the body’s tissue if ruptured — for a more realistic appearance. The level of cohesivity can determine its pliability. "Form stable" or "anatomic" implants hold their shape and force the breast to conform to them, perfect for a mastectomy patient or someone with little breast tissue. Less cohesive implants are more pliable but still don’t seep into the body if ruptured.

Why it’s a game-changer: "It’s a great benefit for mastectomy patients because it looks so much more natural," Ratliff says.

Cost: Starts around $4,900. 


The numbers are in

As technology advances, so does the popularity of cosmetic procedures. These are the most performed cosmetic procedures in the U.S., according to the American Society of Plastic Surgeons.


The surgeon removes pockets of fat through small incisions. Although there will be swelling, bruising and possible numbness, the patient may feel well enough to return to work a few days post-op. Cost varies across the country, starting around $3,000 in Oklahoma, and increasing with the number of areas treated.


Eyelid surgery (blepharoplasty)

The surgeon reshapes the eyelids by removing bagginess and tightens loose skin around the eyelid. However, this doesn’t remove fine wrinkle lines. Swelling can take two weeks to go down and bruising might take up to 10 days to subside. Post-op, the patient might experience blurry vision and teary or dry eyes for several days. Cost starts around $2,000 and can exceed $4,000, depending on the surgeon and amount of work needed.


Breast implants

The chosen implants are inserted between breast tissue and chest muscles or between chest muscles and the chest wall. Patients might feel well enough to return to work two or three days post-op, but exercise should be avoided for at least three weeks. Cost might start around $4,900 and varies by surgeon, implant material and office location.


Nose job (rhinoplasty)

A nose job can be performed for cosmetic or medical reasons. Skin is removed, and bone and cartilage are altered to the desired shape. Bruising should subside quickly, but swelling will take longer. Cost begins around $4,000 and varies by surgeon and location.



Skin is stretched up toward the scalp to tighten and smooth. Bruising might fade after two weeks, but swelling can last longer with possible numbness for several weeks. Cost begins around $5,000.


Botox injections

Used to smooth frown lines and wrinkles around the eyes, Botox paralyzes muscles in the forehead. Patients might experience swelling, bruising or numbness, but most people receive injections and continue on with business as usual. To maintain results, treatments are needed every three to four months. Cost usually begins at $300 to $400.


How does Oklahoma’s cosmetic surgery landscape compare? Dr. Greg Ratliff says U.S. statistics are close to Oklahoma’s with one notable difference he has observed from his own practice: liposuction. "Our obesity level means fewer Oklahomans are candidates for lipo," he says. "I do far more tummy tucks than lipo." Oklahoma’s obesity level ranks among the top 10 in the nation, according to a 2016 report.


Buyer beware

Dr. Stephen Paulsen of Plastic Surgery Associates of Tulsa advises patients to always do their homework on a procedure, including its risks, and always choose a board-certified plastic surgeon.


Anna Holton-Dean is a freelance writer and editor of TulsaPets, OKC Pets and OklahomaHorses Magazines. She’s a wife and boy mom, and when she isn’t working, she’s dodging Nerf bullets and planning her family’s next Disney vacation.

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