Liposuction and Your Weight: Clearing up Common Misconceptions

Woman taking body measurements around the hips.

In 2018, more than a quarter million liposuction procedures were performed in the United States. That makes it the second most common type of plastic surgery, after breast enhancement. Combine this with the fact that more than two-thirds of all Americans are classified as overweight or obese, and it’s easy to imagine that liposuction is a tool for weight loss.

It is true that the goal of liposuction is fat removal, and whenever any part of the body is removed, there is a small amount of weight lost. But liposuction is used for shaping or contouring the body, not for weight loss. In fact, the ideal candidate for liposuction is near or at their ideal weight.

According to Dr. Slack, “A good candidate for liposuction has one or more deposits of fat that are out of proportion with the rest of the body and can’t be eliminated with diet and exercise.” This includes “love handles” or stubborn areas of fat on the thighs, hips, belly, arms, chin, neck, and cheeks (face and buttocks).

Liposuction is best done in areas with good skin elasticity, and it does not address loose or sagging skin. For this reason, liposuction is often used in conjunction with other body contouring procedures like breast reductions, tummy tucks, arm and thigh lifts, and mommy makeovers.

During a liposuction procedure, a thin, hollow needle, called a cannula, is inserted through a small incision in the skin. For larger areas, several incisions may be made. The inserted cannula is connected to a vacuum pump which sucks out deposits of fat underneath the skin. Liposuction cannot be used to remove visceral fat, that is fat around the organs in the abdomen, common in people who are overweight or obese.

There is also a limit on how much fat can be removed at one time. “Large volumes of liposuction can cause significant fluid shifts inside the body. In certain circumstances this can be dangerous,” says Dr. Slack. “The American Society of Plastic surgeons recommends anyone having liposuction over 5 liters stay overnight in a hospital or ambulatory care center for observation and fluid management.”

With liposuction, fat cells are permanently removed, but that does not mean you can’t still gain weight. The more weight gained, the less effective the liposuction results.

According to the American Association of Plastic Surgeons:

“If the patient gains a small amount of weight after their procedure, say 5 pounds, fat cells throughout the body will get a little bigger. While this slight weight gain can diminish results, the overall improved body shape provided by a liposuction procedure will still be visible as treated body areas have less fat cells (and thus experience a lower enlargement rate) compared to surrounding areas.”

If someone gains more than about 10 percent of their body weight after liposuction, in addition to the remaining fat cells in the body getting even bigger, new fat cells can develop. This can happen even in the area that was treated. However, because there are still fewer fat cells there, the body contouring effect of the liposuction may still be visible. In other words, you may still have the body shape you desire, even if you are heavier.

Issues of body weight are complex, entangled with issues of health and body image, and they are not always easy to solve. There are tools that can help like building self-esteem, diet, exercise, and even bariatric surgery, but liposuction shouldn’t be considered one of them. If you are thinking about having liposuction, make sure you see a plastic surgeon who understands this.

If you want to learn more about liposuction and whether you are a good candidate, contact our office today and set up a consultation with Dr. Charles Slack. He can help clear up any misconceptions you may have.

Plastic Surgery and Diabetes

Syringe of insulin - plastic surgery and diabetes must be carefully considered.More than 30 million Americans have diabetes, and about three million of them live in Texas –that’s nearly 15 percent of the Texas population. What that means for us is that of all the people in Texas who are considering plastic surgery, at least some of them will also happen to be diabetic. Why is this a big deal? Diabetes can have a big impact on how well the body heals, so it is an important consideration when it comes to plastic surgery. Let’s look at what diabetes is.

Diabetes is a condition where blood sugar is too high. Normally, blood sugar is regulated by insulin, a hormone made by and released from the pancreas. In people with diabetes, either there isn’t enough insulin produced or the insulin isn’t used well. There are three main types of diabetes:

Type 1 Diabetes

Previously known as juvenile diabetes, this form of the disease can actually develop at any age. It occurs when the immune system destroys the ability of the pancreas to adequately produce insulin. People with type 1 diabetes have to take insulin every day.

Type 2 Diabetes

This was previously called adult-onset diabetes and is the most common form of diabetes. Although it more often develops in later life, today many children also have the disease, so we don’t call it “adult-onset” anymore. Here, the body is unable to use insulin properly. This is usually managed with medication to boost the production or use of the body’s own insulin. However, over time the pancreas may also lose its ability to make insulin so that insulin injections become necessary.

Gestational Diabetes

As the name suggests, this form of diabetes develops in women when they are pregnant. It usually goes away after pregnancy but puts you at greater risk of developing type 2 diabetes later in life.


No cure for diabetes has yet been found, but blood sugars can be managed using a variety of lifestyle changes, medications, and/or insulin. Type 2 diabetes can be prevented and sometimes reversed through diet and exercise. You can learn about diabetes, its types, symptoms, risk factors, and more from the American Diabetes Association.

But what does this have to do with plastic surgery?

A condition like diabetes makes medical care more complicated, as it is associated with complications in a variety of other body systems, and can result in conditions such as heart disease, kidney disease, nerve damage, and stroke. This complexity has to be taken into consideration for any medical procedure, especially surgery. Plastic surgery is no exception.

The authors of this 2017 research reviewed the case histories of nearly 40,000 plastic surgery patients, 3,000 of whom also had a diagnosis of type 2 diabetes. Diabetes was associated with an increase in a variety of postoperative medical and surgical complications as well as longer hospital stays. Patients taking insulin were even more at risk.

According to the National Institutes of Health, diabetes may also increase your risk for surgical site infection and slow wound healing after surgery. This is because a blood sugar level that is too high increases inflammation, suppresses the immune system, and prevents oxygen and nutrients from helping the would heal. Not only is this a health risk, poor wound healing may result in a more unsightly scarring and less than optimal plastic surgery results.

This does not mean that all patients with a diagnosis of diabetes will have complications or should be barred from having any kind of plastic surgery. It just introduces more risk and that needs to be weighed against the benefits of any procedure.

As Dr. Slack explains, “For the most part they do fine despite their increased risk for healing problems or infections. I worry a little more about my type 1 diabetic patients since they have usually been dealing with diabetes for a longer period of time. As a consequence, they may have more vascular issues than a type 2 diabetic patient.”

Dr. Slack typically has his patients with diabetes see their primary care physician to make sure their blood sugar levels are properly controlled, and they are healthy enough for surgery. All patients have a fasting glucose checked before surgery as part of standard pre-op labs. Dr. Slack will usually add a hemoglobin A1C test to the pre-op work-up as a measure of how well they are controlling their diabetes.

If you have diabetes and are considering plastic surgery, it is important to speak with your doctor about this. Make sure your medical doctor is involved in your decision and that you choose a plastic surgeon who understands the disease and will take appropriate precautions. 

The Trouble With Snapchat Filters and Selfies

Woman observing a selfie - selfie dysmorphia can lead inappropriate plastic surgeriesIf you’ve been watching social media at all lately, you’ve no doubt seen the rampant use of FaceApp by people hoping to see what they will look like as they age. As you might imagine, this is not the typical request of those who visit Dr. Slack’s office! But that doesn’t mean social media isn’t an influence on what happens in the plastic surgeon’s office.

Snapchat or Selfie Dysmorphia 

We’ve addressed a psychological condition called body dysmorphic disorder (BDD) here in the past. Individuals with BDD can suffer severe emotional distress over real and perceived problems with their appearance. When someone with realistic expectations undergoes plastic surgery, they are typically pleased with the outcome. Individuals with BDD, on the other hand, rarely find satisfaction after plastic surgery because they are conditioned to see only their flaws.

While BDD is not a new issue, it has been amplified by the rise of social media. In fact, a new term, Selfie dysmorphia or Snapchat dysmorphia, has been coined to describe the impact of social media on body image. Snapchat is the popular social media app that allows you to share pictures and short videos with your followers. One of its more popular features is its selection of filters that allows users to tweak their appearance toward some imagined ideal. Frequent Snapchat users become accustomed to their filtered appearance, and the “flaws” that are an inevitable part of reality become unacceptable. But this issue is not limited to Snapchat users – anyone who spends significant time scrutinizing their selfies is vulnerable. 

Dr. Slack explains it like this, “Part of the problem, as I see it, is the prevalence and ease of being able to take a picture of yourself. So much more to look at and scrutinize than 20 years ago. My dad was an avid photographer when I was growing up, and I remember him saying it usually took two rolls of film (64 shots) to get one or two good pictures of a person. Variables such as light and expression can conspire to make us all look worse than we really are.”

Is Selfie Dysmorphia Really Such a Big Deal?

It might seem harmless enough for people to play with selfies and add bunny ears and big eyes, but a recent survey of 7th grade girls shows that “girls who regularly shared self-images on social media, relative to those who did not, reported significantly higher overvaluation of shape and weight, body dissatisfaction, dietary restraint, and internalization of the thin ideal.” In addition, the same survey showed that a higher investment in manipulating images for social media correlated with body image issues and eating concerns, while excess media exposure did not. This is significant, as traditional media usually gets the blame for creating this unattainable ideal. Turns out it’s got nothing on social media.

Dr. Slack points out the need to understand that selfies aren’t reality. We don’t live in a ‘selfie’ world where we are viewed under the microscope of a milli-second of a shutter opening and closing. We live and are viewed in a world of constant motion and animation. No matter how good a surgery turns out you can make it look better or worse by altering camera angle, lighting or expression. We are living entities, not selfies!” 

That’s Great for Plastic Surgeons, Right?

From a financial standpoint, it might seem that selfie dysmorphia is a windfall for plastic surgeons. However, this is not how ethical plastic surgeons work. A good plastic surgeon is already skilled at recognizing BDD, and by extension the effects of social media on self-image, and how it can lead to unnecessary plastic surgery. Members of the American Society of Plastic Surgeons (ASPS) follow ethical guidelines to educate patients and guide them toward procedures that are best for them. In many cases this means no procedure. As an example, one-third of patients choosing rhinoplasty have body dysmorphic symptoms. This means a qualified plastic surgeon should have to say no somewhat regularly. Like other physicians, plastic surgeons took the Hippocratic oath and agreed to do no harm. Their goal should be the best outcome for their patient, and surgery doesn’t always yield that result.

Choose a Trusted Plastic Surgeon

For the best results from plastic surgery, the key is to find a skilled and ethical plastic surgeon you can communicate with comfortably. If you are at ease being honest about your desires, your surgeon can provide a realistic idea of whether they are possible or even desirable (what looks good on someone on social media might come off in a completely different way on you).

Be sure that your surgeon is a member of the ASPS so you know that he has agreed to certain ethical standards that will protect you as a patient. After your initial consultation, don’t rush your decision. It’s okay to mull over your options and make sure your health, finances, and mind are in the right place to take the next step. And it couldn’t hurt to take a break from selfies while you do that.

How Breasts Change With Age

“Women across generations agree that age does not define beauty,” AARP Survey of Women’s Reflections on Beauty, Age, and Media.

Thanks to the passage of time, hormonal changes—and gravity—most women begin to see a change in their breasts around age 40. It is normal at this point for breasts to appear smaller, less firm, more droopy, and further apart. Exactly when and how quickly changes like these occur depends a lot on genetics, body type, breast density and things like diet, exercise, and being a smoker.

For these reasons, no two women (and no two breasts) will age in the same way. That said, nature tends to follow certain patterns when it comes to aging tissues in and around the breast. Understanding how age affects bone, muscle, and other breast tissue can help explain the changes that each woman sees in the mirror, and what, if anything she might want to do about it.


No, breasts are not made up of bone, however, aging of the bones in the rib cage can have a visual impact on the breasts. With age, bone tends to shrink and lose density, providing less support and forward projection of the overlying breasts. This together with changes in posture can decrease the appearance of breast fullness.


Between the rib cage and breast tissue lies a layer of muscle that can greatly affect the appearance of the breasts. The tone and thickness of this muscle tends to diminish with age, resulting in flatter and lower placed breast. Some of this can be mitigated by exercise to keep these muscles toned.

Fat/Glandular Tissue

Breasts are mostly made up of a combination of fat and glandular tissue, including the milk ducts. With age and hormonal changes, breast tissue becomes less glandular and the ratio of fat becomes higher. Though the ratio of may be higher, the total amount of fat overall may still be reduced. The remaining fat is also usually less well distributed or smooth. This can result in less volume, especially in the upper part of the breast, and more sagging.

Some women, of course, gain weight with age (particularly after menopause) and for them fatty tissue increases, and their breasts do get bigger. “I have seen many women over the years who in their early 20’s underwent breast augmentation. Now in their late 50’s or early 60’s their breasts have increased in size due to this, and they feel too big and heavy,” says Dr. Slack. “Often they will choose to have their implants removed, which can be done without a significant increase in droopiness. This gets them back down to a size that they are happier with.”


The skin that covers the breast acts like a container for the rest of the breast tissue. Connective tissues like collagen, elastin and glycosaminoglycans (GAGs) keep the skin tight, elastic, and hydrated. With age, the body produces fewer GAGs, giving skin a dryer, less plump, and saggier appearance.


Technically speaking, what we call the nipple is the nipple-areolar complex (NAC). The center most raised part of the NAC is the actual nipple and it is where the milk ducts exit the breast. The circle of pigmented skin surrounding the nipple is the areola and it contains small bumps called Montgomery glands. With age, the areola can shrink and in some cases disappear. The nipple can sometimes become more inverted.

Among women there is huge variability in the way all these components come together to form a pair of breasts. There is even more variability on how these breasts then change with age. This means that for those women (and men) considering plastic surgery, a nuanced and highly individualized approach is necessary. It’s important to have a surgeon who can help you achieve the best results possible, even though not all the components can (or should) be changed surgically.

Dr. Slack, who has specialized training in plastic surgery of the breast, operates with one simple guiding principle – the patient comes first. With him, each patient gets the time, attention, and information they need to make the decision that is best for them. Make an appointment for a consultation today.

Plastic Surgery and Weight Loss: How do They Work Together?

After weight loss, use plastic surgery to achieve the body you want.The CDC tells us that nearly 35 percent of Americans are classified as obese, meaning they have a body mass index, or BMI, of 30 or more. Another one-third of us are considered overweight but not obese. It’s no wonder that weight loss concerns are on the minds of Americans, including plastic surgery patients.

But what is the role of plastic surgery in weight loss?

Weight Loss Surgery is Not Plastic Surgery

Weight loss surgery, also called bariatric surgery, includes procedures such as lap band, gastric sleeve, and gastric bypass surgeries. These are performed by general surgeons with specialized training in such procedures. They are designed to decrease the patient’s stomach capacity, and therefore his or her appetite. As you would expect, this helps the patient drop those stubborn pounds. 

These surgeries have been shown to be quite effective for those who have a significant amount of weight to lose. This can be life-changing – reducing the risk of chronic disease, lessening the strain on joints, improving appearance, and boosting confidence in those who achieve the weight loss.

But these surgeries don’t address the concerns that follow significant weight loss. Often, when someone has carried a large amount of excess weight for many years, the skin doesn’t bounce back after weight loss. These patients may be left with a new lighter body, but with sagging skin they don’t necessarily appreciate. Plus, it is a rare bariatric surgeon who has the training to address these concerns.

Plastic Surgery is Not Weight Loss Surgery

On the other hand, plastic surgery includes “body contouring” procedures such as tummy tucks, liposuction, thigh and breast lifts, and even body lifts.

These procedures do a great job in improving the appearance of individuals who have been at or near their ideal weight for at least six months. They can allow patients to wear clothes that fit well and participate freely in desired activities without the pain and even embarrassment caused by excess skin. But they are not weight loss procedures themselves. Even liposuction, which removes fat from under the skin, doesn’t result in many pounds lost. It is meant to target trouble spots that diet and exercise can’t seem to budge. So don’t expect to see the needle on the scale move much after liposuction or other body contouring procedures. They aren’t a substitute for bariatric surgery or diet and exercise.

Plastic Surgery and Weight Loss Go Hand-in-Hand

If you have lost a significant amount of weight – whether through surgery or lifestyle changes, plastic surgery can play an important role in helping you achieve your goals for your body.

Thigh lifts and tummy tucks can be used to remove and tighten up excess skin that remains after weight loss. Liposuction can target trouble spots where stubborn fat doesn’t respond to your best efforts at diet and exercise. A breast lift can restore a more youthful, perky appearance if breasts lose fullness and sag more after weight loss. After all, weight loss doesn’t discriminate among body parts.

Truly, plastic surgery after losing a significant amount of weight is a custom affair. Each body will respond differently, revealing different “problem” areas. And each individual will be bothered by different issues. One person may not mind sagging breasts but can’t live with excess tummy skin. Another may want a more youthful profile for her breasts, but not have much concern over the stubborn “love handles” that remain even after the excess weight is gone.

This is why it’s important to work with a board-certified plastic surgeon if you want to make changes after you lose weight. He will listen to your concerns and help you fine-tune your goals based on what is healthy and achievable for you. Do you have questions about plastic surgery after weight loss? Contact Dr. Slack for a consultation in his Allen, TX office.

Is There an Age Limit for Breast Reconstruction After Cancer?

“Seventy is the new fifty.” That’s not just a saying, it’s an actual statistic from a recent survey on age perception, conducted by TD Ameritrade. They found more than 70 percent of women believe this age adjustment is true. Times have certainly changed, considering that a child born in 1900 was only expected to live to be about 50-years old. Today women are not only living longer, they are living with more vitality, throwing out old edicts to dress and act “their age.”

Much of this is thanks to incredible advances in medicine, and breast cancer survival is a germane example. A once deadly killer now has survival rates upward of 90 percent. This leaves more women than ever before deciding how they want to live their lives following mastectomy. For many this means choosing breast reconstruction. According to this government report, in the last decade breast reconstruction has increased among all age groups but “disproportionately so for women aged 65 years and older.”

All this has led researchers (and many women) to ask the question: Is breast reconstruction more dangerous for older women than it is for those who are younger? An analysis published this month (June 2019) in the journal Breast Cancer Research and Treatment specifically asked the question “Is immediate breast reconstruction safe in women over 70?”

The researchers reviewed data collected between 2005 and 2016 in the United States on how women in this age group fared in the 30 days after breast reconstruction and compared that to those 18-69 years old. All women (older and younger) in the study had been diagnosed either with breast cancer that was in situ (contained within the breast) or invasive (also spread to another part of the body).

Most of the women in the study (28,000 of them) had undergone an implant-based reconstruction, while others (9,000 of them) underwent autologous reconstruction. Here is the difference between these two types of breast reconstruction, commonly performed following mastectomy of one or both breasts:

Implant-based breast reconstruction
A breast mound is constructed using breast implants. These may be filled with silicone gel, saline, or a combination of the two. Implants may allow for larger breasts, but they may not look and feel as much like a woman’s natural breasts.

Autologous breast reconstruction
A breast mound is constructed using tissue taken from the patient’s own body. Tissue may be taken from the patient’s thigh, back, buttocks, or abdomen. Autologous reconstruction may result in softer more natural looking breasts, but a second surgical site is needed for harvesting the graft tissue.

Dr. Slack performs both of these types of procedures and while more women choose implant-based reconstruction (as they did in the research study), the choice is personal and should be made with the help of a qualified plastic surgeon experienced with breast reconstruction.

In total, nearly 40,000 women were included in the study, nearly 2,500 of those were women 70-years and older. In other words, significantly more younger women underwent reconstruction than did older women (not surprising since this surgical option has only recently been open to older women). Nonetheless, the scientists were able to compare complication and death rates between the two groups during the 30 days following their procedures.

Their analysis took into account the fact that the older women in the study were more likely to have what are called co-morbidities. These include age-related and other health issues like high blood pressure, diabetes, or heart disease, that are not due to a diagnosis of breast cancer. After accounting for these issues, the researchers found complications were more or less equal between groups, and death within 30 days of breast surgery was rare in either group.

Here is the take-away: Any increased risk for a woman age 70 and above has more to do with her health than her age.

If you have read our blog much, you will likely know that Dr. Slack puts a big priority on health screening before any kind of plastic surgery. He encourages all his patients to do as much as they can to boost their health through diet and lifestyle, smoking cessation, and weight management before and after surgery. This helps ensure fewer complications and a better outcome— this goes for women (and men) of any age.

If you are considering breast reconstruction following mastectomy and have concerns about your age, make an appointment today to talk to Dr. Slack. He will give you an honest and carefully considered answer.

I ❤️ My New Breasts: The Role of Tattooing in Breast Reconstruction

It used to be tattoos brought to mind far away cultures or sailors on shore leave. Not so much anymore. From rock stars to soccer moms, tattoos are everywhere now, and in terms of their sophistication and artistry… well, they’ve come a long way since “I ❤️mom.” In the past decade, tattooing for some women has even become integral to their recovery from breast cancer. We’re talking about nipple tattoos, some of which are remarkable in their anatomical detail, color matching, and 3D shading.

For years Dr. Slack has believed that tattooing is a viable option for women after breast reconstruction (as long as they have fully healed). It can be done instead of nipple reconstruction or in addition to the procedure. For women who are undergoing breast reconstruction following mastectomy, the cost of nipple tattooing is often covered by insurance.

To understand where tattooing and breast reconstruction come together, you first need a little background on how breast reconstruction is typically done.

It is sometimes possible to spare a woman’s nipple when performing a mastectomy, however, most of the time the darker, sensitive skin of the nipple and areola is removed entirely. When the breast is then reconstructed, the first stage is to create a breast mound (without nipple), using grafted tissue from her own body or a breast implant. Depending on the extent of the cancer and the degree of tissue removed during the mastectomy, this may require more than one surgical procedure.

Once the breast mound is complete and fully healed, the question of the nipple can be addressed. There are several options here: no nipple, surgically reconstructed nipple with or without tattooing, or 3D nipple tattooing.

Some women choose to go without a nipple (reconstructed or otherwise), being most concerned with their breast appearance under clothes. You can see some before and after images of this in our breast reconstruction gallery. Prosthetic (or stick-on) nipples are an option for these women.

A nipple and areola can also be recreated surgically, using grafted tissue from the woman’s own body. Typically with reconstruction, the new nipple does not have the same color characteristics that the woman had before. For those who want a more natural looking nipple, Dr. Slack offers tattooing in his office. He has a specially trained cosmetic tattooist who can ink in the missing color, usually darker for the nipple and lighter for the areola. This is typically done about six weeks after surgery, to ensure all incisions are well healed.

For women who want the appearance of nipples, but don’t want surgery, 3D nipple/areola tattooing is a good option. For this, Dr. Slack refers his patients out to medical tattoo artists. He has several in the Dallas area that he trusts who do remarkable work. You can also find a listing or artists online at Pink Ink Project, 3D Nipple Areola Tattooing. They recommend taking a look at the tattooist’s before and after photos before making a choice.

Even though 3D tattooed nipples are actually flat and lack dimension, many women say they look as good as the real thing. According to a study published in the journal Plastic and Reconstructive Surgery, professional nipple tattooing can result “in a more realistic and three-dimensional reconstruction that can appear better than surgical methods. The application of three-dimensional techniques or ‘realism’ in tattoo artistry has significant potential to improve the aesthetic outcomes of reconstructive surgery.”

If you want to learn more about breast reconstruction and whether tattooing may play a role for you, schedule a consultation with Dr. Slack today.

Dr. Slack’s Patient Discusses Neograft® Hair Restoration

“To be perfectly honest with you, I wasn’t having a mid-life crisis, so I wasn’t really looking for this.” For David D., it wasn’t a mid-life crisis, but mid-night tv watching that triggered the decision to have a hair transplant via Neograft® hair restoration.

With a young son who is often up at night, David occasionally finds himself channel-surfing when infomercials rule the airwaves. And aside from a small George Foreman Grill problem and a few groggy mornings, this turned out pretty well for David, because it’s where he first learned about follicular unit extraction (FUE), the newest method of hair transplant.

David had never liked the look of other transplant methods, so it wasn’t something he had ever considered. But this method made sense to him, and it put the idea of a transplant on his radar. Shortly after the infomercials, David started seeing billboards with some of his favorite athletes advertising FUE. That really sparked his interest, particularly when he saw the transformation in Brian Urlacher of the Chicago Bears. After extensively researching the procedure himself, David decided to take the next step.

This is when he reached out to Dr. Slack, who uses the Neograft® hair restoration system for FUE. “Dr. Slack was able to answer all of my questions and really pretty much brought everything to light before I even had a chance to ask any questions.” Dr. Slack then put David in touch with a previous Neograft® patient to answer his questions about the experience.

At this point, David knew the procedure was what he wanted, and he was convinced that Dr. Slack was the surgeon to do it. “He pretty much was the reason why I did this. I’d probably still be thinking about it if it wasn’t for just how comfortable he made the whole thing for me from the very first time I stepped foot in his office and the way he conducts himself. There was no pressure or any of that stuff.”

On the day of his procedure, Dr. Slack prescribed David a single dose of valium to help him relax. Then he had injections to numb the areas of the scalp where the procedure would be performed. David explains, “If there was any part of the procedure that had any kind of pain level to it… when he was injecting back in that area in my head, it smarted a little bit. On a scale of one to 10, it was probably a five.”

Next they cropped David’s hair a little shorter in the donor area on the back of his head. Then they went to the room where the Neograft® machine was and David got comfortable face-down on a massage-style table with his favorite music playing on his earbuds. During the extraction of the follicles from the back of his head, David says there was no pain, just some occasional pressure.

At this point they bandaged the donor area and David turned around face-up. Dr. Slack used a marker to draw the new hairline and made sure that David liked the proposed look, and then began implanting the follicles according to that guide. This part was important to David who had done so much research ahead of time, “There’s an artistry to it. This is one of the things I talked to him [Dr. Slack] about when I did my research… I think this is where, if you don’t get the right people… if you don’t get the hairs put in properly and aligned the right way… there’s a lot to it. It’s just not pulling hair out and poking a hair back in your head.”

David’s procedure went a little more quickly than expected. It started first thing in the morning and wrapped up at about 2 pm, even though they anticipated it would take the full day. Then he was bandaged up and sent home.

The recovery went more smoothly than David expected. This can be credited to the fact that he carefully followed Dr. Slack’s instructions during the days and weeks following the hair transplant. These instructions include

  • keeping the bandage in place for 24 hours;
  • removing the bandage after 24 hours and applying antibiotic ointment to the donor site two or three times per day for a few days;
  • no rubbing, scratching, or lying on the grafted area to avoid dislodging the grafts during the first week;
  • washing only after 24 hours by pouring a mixture of shampoo and water over the scalp and rinsing in the same manner – no massaging of the shampoo into the new grafts!

By day ten, David returned to work. David explains that his results are so natural, no one outside of his family even realizes he had anything done.

David on Day 1 following Neograft® hair restoration

David on Day 1 following Neograft® hair restoration

David on Day 7 following Neograft® hair restoration

David on Day 7 following Neograft® hair restoration

Dr. Slack points out that taking off from work is more to maintain privacy about having a hair transplant. Most patients can go back to work in two or three days if they don’t feel self-conscious about coworkers noticing they had the procedure.

Dr. Slack emphasizes that one of the giveaways that a patient has had hair restoration is that the back of the head is shaved. For this reason, he recommends patients have a close crop hair cut (with a 0 or 1 guard) a week or two ahead of time. That way people will have had a chance to get used to the new short look, and it won’t draw so much attention after the procedure.

This process is not for those looking for immediate gratification, as it will be full year before the final results are evident. The following pictures aren’t of David, but they give a sense of the typical one-year progression following Neograft hair restoration:

Progression of Neograft® hair restoration


David is still early in the process, but now that four months have passed, he is pleased with the result. “Ask me again at the 12-month mark and I would hope to be that much more excited than I am now. My wife’s like, ‘Yeah, I can tell a big difference.’ So honestly I’m pretty excited about the results so far.”

“I would highly recommend Dr. Slack. He’s a great guy. I can just speak for myself obviously, but the whole experience was fantastic. The healing process was a lot faster than I thought it was going to be. The whole thing was just really good. I still feel great about it and I’m not even at the halfway mark.”

Are you researching your options for hair restoration? Dr. Slack would love to sit down with you and help you understand the Neograft® procedure and answer any questions you have. Just contact our office to schedule a consultation.

It’s Not Just the Surgeon That Matters. Is Your Surgical Facility Accredited?

Surgical facility accreditation matters for patient safetyHave you ever found out a friend was having surgery, only to have them reassure you that “It’s outpatient surgery so it’s not that serious.”?

While it’s true that surgeries at outpatient facilities generally carry less risk than those that require an overnight stay at the hospital, the idea that it isn’t that serious is faulty. The reality is that all surgery presents certain risks, which is why barbers no longer remove a ruptured appendix, but board-certified surgeons do. We expect a certain level of training and a promise that certain standards of surgical care will be followed.

But surgeons only control a certain amount of the risk. Much of the risk attached to surgery is a determined by how the facility that hosts the surgery is run. What licensing is the staff required to have? What procedures for preventing infection are followed? How is hazardous waste handled? The answers to these questions can raise or lower the risk of surgery, even one performed by the most skilled of surgeons.

What is Accreditation?

Those are important questions, but how is the typical patient supposed to know about all these things when scheduling a surgery?

This is where surgical facility accreditation comes in. Reputable ambulatory surgery centers (aka, outpatient surgery centers or same day surgery centers) adhere to certain minimum standards for personnel, equipment, operating room procedures, and surgeon credentials. Independent agencies then certify that they do indeed meet these standards and accredit the facility.

In short, the independent accrediting agencies do the legwork for you, making sure the facility operates in a safe manner. Accredited outpatient surgery facilities have very low complication rates among their patients and provide a significant cost savings over hospital surgery.

How Does Surgical Facility Accreditation Influence Where Plastic Surgeons Operate?

Remember that the starting point for finding a good plastic surgeon is The American Society of Plastic Surgeons (ASPS). This organization has very specific requirements for their member surgeons.

One important requirement is that their members only perform outpatient procedures in accredited facilities (unless the procedure needs only mild local anesthesia). So if your surgeon wants to perform your surgery at a non-accredited facility, this should ring two warning bells – not only do you have no way to know if the facility meets minimum standards, you know the surgeon is not adhering to ASPS guidelines.

In short: If your surgeon wants to perform your surgery at a non-accredited facility, find a different surgeon.

Who Accredits Outpatient Facilities

A number of organizations accredit outpatient surgery centers, but only a handful meet the standards set by the ASPS. ASPS recognizes accreditation by:

In addition, the following designations are sufficient for a facility to meet ASPS standards.

  • Certified to participate in the Medicare program under title XVIII
  • Licensed by the state in which the facility operates.

Dr. Slack, a board-certified plastic surgeon and member of ASPS, performs his outpatient procedures at McKinney’s Texas Health Surgery Center at Craig Ranch, which is accredited by the Joint Commission on Accreditation of Health Care Organizations. These choices reflect Dr. Slack’s philosophy that all surgery is serious and requires the highest standard of care. If you have questions about plastic surgery, it’s safety, and what’s right for you, Dr. Slack would like to meet you. He will help you find a solution that is both appropriate for your goals, and provided in the safest manner possible.