 Good morning everyone. Dr. Salkirin Beverly Hills. We're starting the week right with this nice beautiful young lady who has done a magnificent job of losing a lot of weight. So she's here for a little makeover. We're going to tighten some things up. She's beautiful. We're just going to enrich the beauty today. So one thing we're doing is brachioplasty. Brachioplasty is when we do the arms. You can see she's lost weight, very thin, but what we're going to do is take off the skin. What I'm going to do for her is a Jane Brachioplasty. It's going to tighten her sides too. As you can see, I'm going to take all this extra skin and it's going to come right in the crease here and do, I'm going to do perfect suture in for her so the scar is minimized. So we're going to do the same thing on the other side. The left is a little bit bigger, you could see, but everyone has a little bit asymmetrical. So that's why. So we're going to take all that out, coming here into the jade. That's number one. You can put your arms down. Number two is we're going to do some Michael at the Flansen Cubic. That's going to give her some shape here. Give her the hourglass look. Then number three is we're going to do a super extended tummy tuck, which is going to go almost to where her buttock is. What I'm going to do is my line is low and it comes high. So they'll pull up on the skin a little bit like this. We're going to take as much as we can. We're going to take all this out. This point is going to come down here and we're going to go all the way across, all the way there. It's going to look very nice. Everything's going to be low, but it's going to lift things up also. If she turns around, you can see, usually I don't come this far, but we make exceptions for everyone. For her, we're coming all the way back here to get her skin in the back is good. I think she's going to retract very nicely. So I'm going to limit my incision to not do extra scars if we don't need to. For the icing on the cake, the fat we take out here and here, we're going to put here on top of the breast. Her breast, she has large breasts, but the thing is that up in the superior pole, I can feel her ribs. So the prudent thing to do is just add the fat up here so it gives her more volume up top because down here, she has quite a lot of volume, but what's lacking volume is up here. You can see the green arrows and that's where the fat will go. So this is going to be a fantabulous case. Stay tuned until we fantabilize her. So we're getting started on the case. What I'm doing right now is just taking out all the fat because what we're going to do is we're going to take out the skin without disturbing the lymphatics and the arteries, the veins and everything. So we're trying to get this area as thin as possible. You can see I'm taking out all the fat in the area. So it's basically just going to be skin. And this is the fat we're going to also transfer to her breast. So you guys never see me get it this thin when I'm doing it in an area where we're not doing excision. Look at how thin it is. You could basically see my instrument. The only reason I'm doing this is because we're going to take this off and I want this to be as thin as possible. I want it to be just purely skin, which you could see I'm already pinching it together. You could see my marks, my hash marks going around, and that's what's going to happen. So here we go. We're cutting the skin. It's all, you know what we say? Measure twice, cut once. We already measured twice. So there we are. Ready? Ready? So here look at this. This is a superficial vein. This is the lymphatics. This is the muscle fascia. All the good contents, it's still in here. We didn't take any of it out. Let me have a pickup so we could put it together. But you could see all the major veins and stuff were not cut. The lymphatics were not cut. So she'll have less swelling and everything after surgery. So here's this side to our mark. Green to green right there. Here we go. Another blue. This was from her arm going to the lateral area. You could see how thin it is. It's not thick because we already lipoded out. Look at how thin it is, but it's just excess skin. And she's not going to sweat anymore because we got all her sweat glands. So here we are on the left side. Look at how thin it is. Again, we want this super thin because we're going to just take off the skin and leave the lymphatics and everything behind. You usually don't want to be this thin when you're doing lipos because it's not good form to get it so thin. But because we're taking all this off, we're just, I'm coming very superficial. Regularly, you don't want this, this much superficial lipos. You can see my instrument almost threw the skin. And it's all connected. Watch this. Let's see. All of this is connected. So you guys can see how thin she is. She's just skin. Look at how thin that is compared to here, how thick she is. So we're just going to go her and start. It should just peel off because we've already lipored good enough. So it should just be, you see all these lymphatics and stuff that need to stay back, they stay back. You see all those? These are lymphatic channels that stay back. Let's give me the, then we go our hash mark to hash mark. You can see it's just, it's just by the deep dermis that it's connected. You see all the, all that honeycomb that's from the lipo. You can see there's no fat. These are just lymphatics and veins and stuff that need to stay back. All the way from here we're going to isolate the belly button. So you go around. It stays in. Everyone is, everyone's favorite question is, do I get a new belly button? Technically no, because it's your old, old one. And we just pull it through a different hole in your abdomen. So it's, but it does look different because we do make the hole you desire. So it does look different, but it is your own belly button. Isolating it. It's on a stalk and it's attached to the abdominal wall. So it doesn't go any higher or lower. It stays at the same area where it's been. But you guys, here for you guys at home, we've isolated the belly button. There it is. This is the hole. It's already on a stalk ready. We're going to start going down here to the fascia. The fascia is what covers muscles. That white sheet, all muscle practically in the body, with some exceptions, have a fascia around them. There are only a few in the face that don't have a fascia, but most muscle in the body do have a fascia covering them. So here we are. You could see the abdominal muscle fascia right here. This white thing is what we call fascia. You can see how it's nice, how gently, if I even use my fingers, I could push it back. Gentle movement on my fingers. And once in a while, I use my bovi pen and then push it back. It's in a layer where there is no blood vessels. So it's a vascular. So you don't have to worry as much about bleeding when you're in the right level. So now that we've cleared all the way to the belly button, this is one of our favorite parts is when we split it in half down the middle, and we go all the way to belly button because we know we're going to be able to get that amount of skin off of it. So here we are. Here's the belly button. You can see that it's on a stalk. So it doesn't move. It's connected through the abdominal fascia, abdominal muscle. It goes to the inside. So we're here. We're just going up till we get to the xipoint. You can see we're right here. We're getting some fluid and that's all the numbing fluid I injected. Of course, you're going to get some bleeding. We're doing such a big surgery. It's not a big deal as long as it's controlled. And we have good anesthesia today. So we've dissected. You can see this. This is her six-pack muscle. She's actually a tiny girl. You can see her pelvic bone right here and right here. She has very little visceral fat. That means fat around her organs. You can see how tiny she is. I'm going to close up her her defect right here, although it's small. I want to give her that internal corset look. So we're going to start doing that. So once again, this is the belly button. It's on a stock. You see it goes through the muscle and it's connected to the internal abdomen. You can see what I've drawn up. What we're going to do is take this side of the muscle and approximate it to the other side, which is an internal corset. You can see as I'm going through, I like to do this multi-layer closure because I just like it to be reinforced. So I do two layers. Your surgeon might do one, two. I'm not sure. But here, we always do two, just in case you have a backup. If you pop a stitch, which is, you know, it's a suture. It could be popped. So we like to be cautious. So you could see here, it approximates it. So what we're going to do now is one, two, get a knot. So you can see the lines are together. If you remember, they were apart. They were about inch and a half to two inches apart. Now they're all in one line. Now for the second layer, we're going to do a running suture. A running suture, we tie up top and we just run it all the way and tie it at the bottom. This just reinforces the incision and reinforces the internal core set that we have. So here we are. We're done. You could see the abdominal wall is nice and tight. We fixated our belly button so it doesn't move around all over the place. And now it's time for the skin excision. So we measured both sides equal distance and now we're going to make the cut on the left side of the tummy tuck. And here we go. And one swing of the back. So here we are. This is it. This is the midline. There it goes. We got it all up. Celebration. Let's pop the champagne. Pop the champagne. Whoa. That's a great piece. So we measure out where the belly button is. I feel it from underneath. I see where it is. So what I do is I'm going to make her a nice classic incision for the belly button right here. And that's how a belly button is made. It's brought out through incision and it's your actual own belly button. So you could see I tunnel it all the way down the thickness of the whole abdomen. So there's a tunnel made between the anterior wall and where the belly button is so it could be pulled through. So everyone, our marathon case is over. We did bilateral J-brakeioplasty. You could see it started out here and the elbow comes in and really contours the chest. We did 600 cc's of fat to each breast. They look rejuvenated. And for the main course, this was pretty big. I want you to see how long this is actually. This was the old belly button. Look at how it goes from side to side and let's see how the new one looks. Whoa. Look at that beautiful thin scar. Everything stretched out. She has curves where she didn't have curves. Her incision is down low. She looks fantabulous.