As your pain decreases you will be able to decrease the use of the narcotic pain medication and control pain with Tylenol only Please avoid taking NSAIDs such as Ibuprofen, Motrin, Aleve, etc. It is looked upon as a solution for getting rid of the extra fat and skin that hangs loosely from your upper arms aka the bat wings. The views expressed in Ask a Surgeon and the Patient Community are those of the participants and do not necessarily reflect the opinions of the American Society of Plastic Surgeons. The procedure laststwo to three hours. doi: 10.1055/s-0040-1715428. Epub 2021 Jun 8. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. Reach a stable weight and maintain it before thinking about going under the knife as a significant weight fluctuation after surgery can harm the already weakened skin badly. This procedure is just another way of surgically smoothing and reshaping the contours of your upper arms. Compression. The same gets said for over 80% of men. sharing sensitive information, make sure youre on a federal Maria M. LoTempio, MD, is a double board-certified plastic surgeon specializing in reconstructive surgery and otolaryngology (head and neck) surgery. To prepare for arm lift surgery, you'll need to temporarily discontinue anti-inflammatory medications, aspirin, and herbal supplements that increase bleeding risk. http://orthoinfo.aaos.org/topic.cfm?topic=A00111. One-time Injuries. A drain may also be placed to help remove extra fluid. People with sagging skin from significant weight loss or the effects of aging may choose to have an arm lift. An arm lift is a popular cosmetic surgery to combine with other procedures. We do not endorse non-Cleveland Clinic products or services. Nevertheless, minor complications occurred in a high percentage of patients, regardless the performed surgical procedure. The site is secure. Within three to four weeks, you can resume strenuous exercise as long as your healthcare provider approves. Medical Clinics of North America. Take pain medications as prescribed by your healthcare provider to stay ahead of pain management. Policy. Will I need to have someone help me at home for a while? You may want an arm lift if your clothing is not fitting well, or you . Your doctor may tell you to avoid activities such as heavy lifting and contact sports after an elbow replacement. The tiny "pin pricks" are a sign that the nerves are "waking up". Arm Contouring: Review and Current Concepts. If the swelling does not go down, you may need a nerve conduction test or EMG. Cirurgia Estetica. Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, Severe pain, swelling and bruising around the joint, Trouble moving your elbow normally, using your arm or turning your arm from palm up to palm down and vice versa, Elbow pain that doesn't improve after home care, Pain that occurs even when you're not using your arm, Increasing redness, swelling or pain in the injured area. It's common to have a bit of nausea when coming off sedation, but this should dissipate within 24 to 48 hours. Most people also have improved range of motion and strength. Elbow replacement surgery (sometimes referred to as total elbow arthroplasty) is an operation that surgeons use to relieve pain and restore motion to a damaged elbow. American Board of Cosmetic Surgery. We do not endorse non-Cleveland Clinic products or services. Mayo Clinic is a not-for-profit organization. Dermatolipectomia braquial. Bleeding, redness, warmth or draining at the incision site. The procedure is best suited for men and women who are not obese. Wait for clearance from your healthcare provider to reduce the risk of infection. Shoulder and elbow arthroplasty. There is a risk of a Brachioplasty scar with the procedure but that depends upon several factors including the surgical approach adopted, the amount of skin removed, and if there were any complications during the surgery among others. Brachioplasty is a simple procedure that lasts two to three hours. Shermak MA. However, if the damage is too severe, replacement is typically better. You may opt-out of email communications at any time by clicking on 'J' brachioplasty technique in massive weight loss patients. https://timothykatzenmd.com/body/arm-lift-brachioplasty/. Complications were observed in 308/1065 patients (28.9%). Mayo Clinic does not endorse companies or products. The most likely causes include nerve regeneration and nerve fibers caught within scar tissue.These symptoms usually resolve in about six to eight weeks without intervention. . This should lessen after the first few days. Overall, the procedure takes two to three hours. Most people can perform light activity after a few days of recovery from arm lift surgery. Mayo Clinic. Swelling is common after most surgical procedures, and an arm lift is no different. For patients on local sedation, the surgeon will administer it a few minutes before they begin operating. While we do connect people with vetted, board-certified doctors, we dont provide medical consultations, diagnosis, or advice. Q. Cleveland Clinic is a non-profit academic medical center. Before the procedure, it's a good idea to get your living space organized so you'll have easy access to everyday items once you're back home recovering. As long as you don't derail the healing process by rushing back into physical activity, you should be back in action in no time. This visit typically includes: Some questions you may want to ask include: Other members of the health care team will assess your readiness for surgery. Is there anything that can be done or anything I can take to releave the pain? I had a brachioplasty done a little over 2 months ago and it still hurts. These risks and others will be fully discussed prior to your consent. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). By clicking Accept All Cookies, you agree to the storing of cookies on your device to enhance site navigation, analyze site usage, and assist in our marketing efforts. Once you turn 30, your muscle mass begins to decrease up to 5%. Some help us feel pain, some help us feel vibration or pressure. %%EOF This must be avoided for at least four weeks after the surgery or as guided by your surgeon. Fever over 101 degrees Fahrenheit with no other symptoms. I would also suggest a massage. Facts you should know, About brachioplasty (arm lift) plastic surgery, Skin tightness (which should subside as the swelling goes down). I hope that I have answered your questions regarding the arm reduction. on 12/16/08 1:04 pm - Mouseville, FL. If your elbow constantly hurts and is stiff from arthritis or other causes, elbow replacement surgery is an option. 173 0 obj <>stream Nisi G, Giardino FR, Giudice M, Fasano G, Cuomo R, Grimaldi L. J Clin Med. Elbow replacement surgery does not always involve the entire elbow. Correa-Iturraspe M FJ. Following are some of the pros of getting a Brachioplasty: Brachioplasty is generally considered to be a safe procedure but it can have risks and complications like any other surgery. You may experience soreness, swelling, and some bruising. March 17, 2022. Thinking about arm lift surgery? Your surgeon may place drains at your incision sites, so darker clothing that doesn't show stains is preferable for after the procedure. You must sleep on your back. Upper Arm Lift: This is also known as Brachioplasty. You will be instructed to drink plenty of fluids right after your surgery. Your surgeon will provide specific instructions on bathing after surgery. Conditions that may lead to elbow replacement surgery include: Your doctor may ask you to stop taking certain medications before elbow replacement surgery. government site. The doctor may also use liposuction to remove excess fat and contour the upper arm. Hope that helps. Pull-on pants, slip-on shoes, and a shirt that doesn't need to be pulled over your head will be easier to change in and out of. When one of the bones that forms the elbow gets knocked . The most common approach is to make an incision either on the insides or the back of your upper arm that might extend from under your pits to the top of your elbow. It works to fix drooping skin that results from aging or excessive weight loss. Advertising on our site helps support our mission. American Academy of Orthopaedic Surgeons. Keep arm movement and activity limited during the recovery phase. You may also need a temporary device called a drain to avoid pooling of fluids at the elbow. Pain, which may persist. Discuss surgical techniques with your healthcare provider before your scheduled arm lift so you'll understand how the procedure will be performed. Anderson BC, et al. If you don't feel like eating, consider a protein shake or a smoothie with protein powder to give your body a recovery boost. I believe that you're experiencing pain because of swelling. If you choose this procedure, youll havean arm lift in an operating room under general anesthesia. The result of this surgery is shapely arms for a satisfying self-image. The small nerves that help us feel pain are very small and often can take many months to fully recover after this type of surgery. If you are following an exercise routine, you will have to mos likely stop the same till you get approval from your doctor to restart it. Helpful. The .gov means its official. Keep books, puzzles, movies, and other entertainment on hand for after your surgery. We try to hide it by bringing it closer to the inside of the arm, but we cannot predict how the scar will migrate.. Conduct a preoperative evaluation to determine the surgical approach best suited for you. Who is an ideal candidate for this procedure and who is not? Some people consider getting an arm lifttominimizethis irritating condition, sometimes called bat wings. Plastic surgeon J. Vicente Poblete, MD, says most people come to him with skin on the upper arms that has a deflated appearance. Heres what you need to know. A search on PubMed/Medline was performed using "brachioplasty", "upper arm lifting", and "techniques" as key words. There are alternative methods as well as approaches that minimize the chances of getting a Brachioplasty scar. Mini arm lifts are less invasive and the resulting scarring is easier to conceal. One of the most common Brachioplasty risks related to smoking is slow wound healing. Its important to keep an eye on the surgery site for any changes. Numbness or other changes in skin sensation. Mayo Clinic. 1954:2432. Arm sculpting is the answer for smoother and firmer underarm skin. And make sure the physician performing the arm lift is a board-certified plastic surgeon. Its normal for your arm and hand strength to feel weak at first. Please enable it to take advantage of the complete set of features! Elbow replacement surgery removes damaged areas of the elbow joint and replaces them with parts made of metal and plastic (implants). Brachioplasty is performed under anesthesia as an outpatient procedure. Then, keep scrolling to read our complete guide on Brachioplasty! Results: "We try to hide it by bringing it . As soon as the anesthesia wears off, you'll be able to resume your regular diet. Ann Plast Surg. Plastic and reconstructive surgery. Accessed Jan. 16, 2016. The views expressed in Ask a Surgeon and the Patient Community are those of the Ferry AM, Chamata E, Dibbs RP, Rappaport NH. You typically can expect to resume light activity within a few days. Plast Reconstr Surg. If you have any questions about eating or drinking before your operation, be sure to call the surgeon's office and ask. 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Afterward, you will wear a compression garment to help control swelling. 153 0 obj <>/Filter/FlateDecode/ID[<41290A407ED19548AB878933D670C677>]/Index[134 40]/Info 133 0 R/Length 88/Prev 60642/Root 135 0 R/Size 174/Type/XRef/W[1 2 1]>>stream Embase, Medline (OvidSP), Web of Science, Scopus, PubMed publisher, Cochrane, and Google Scholar were searched as well. official website and that any information you provide is encrypted It's important that you address all your questions directly with your plastic surgeon. Arrange for someone to drive you home after the surgery and bring any necessary paperwork, along with a post-surgery change of clothes. Brachioplasty is performed under anesthesia as an outpatient procedure. Kane SF, et al. These medications can cause extra bleeding and include: You will have limited arm mobility for several weeks after elbow replacement surgery as you recover. If you think this is something that might help your case, then we suggest reading this complete guide on Brachioplasty that we have compiled for you. After surgery, you'll rest in a recovery area for a short time. If you have any more questions regarding the arm lift, arm reduction, brachioplasty or arm crease fat grafting, please contact my office. Elbow tendinopathy. Thus, people who not only have lost a considerable amount of weight but have also maintained a stable weight for a minimum of six months before considering Brachioplasty are good candidates. At the ends of these bones where they come together, they are covered by a specialized structure called cartilage. So what to expect from this form of body contouring? High-resolution ultrasound as an aid in the diagnosis and treatment of post-brachioplasty injury to the medial brachial and the medial antebrachial nerves - Two case reports. It is a cosmetic surgery procedure which removes the extra skin and fat starting from the underarms to the top of the elbow, tightens the remaining skin, and smoothens the tissue to give a more defined and toned look to the whole upper arm area. Wait to schedule your arm lift surgery until you're confident that your weight will remain stable for the long term. Dislocated elbow. The most frequent complications were hypertrophic scarring, seroma and hematoma. The steps to prepare a patient for Brachioplasty may begin weeks, sometimes months, before the actual scheduled date of the surgery. This means no moving of arms above your heads, no driving or workout that puts pressure on arms, The results of a Brachioplasty are visible immediately after the procedure. Epub 2021 Oct 29. Posse P. Buenos Aires: Athenue; 1943. Your doctor may prescribe pain medication if needed. If you're an extrovert who craves socialization, use the time at home to catch up on phone calls with loved ones. Doctors can use two different types of artificial joints for elbow replacement surgery. surgeons or share your journey with other people just like you on the Patient Community. These incisions depend upon the specific surgical plan curated for your case 8600 Rockville Pike The decision to have plastic surgery is extremely personal, and you'll have to decide if the benefits, risks and potential complications of arm lift surgery are acceptable. See this image and copyright information in PMC. Evaluation of elbow pain in adults. And how is a Brachioplasty done? We do not endorse non-Cleveland Clinic products or services. Following the procedure, the patient will be taken to the recovery room for observations and to rest. if you are worried about extra fats in armpit, do check out how to loose armpit fat. Once you recover from arm lift surgery you'll want to do everything possible to maintain the results. This may well be breast tissue. Motor nerves help us to move muscles and sensory nerves help us to feel things. Elbow pain is often caused by overuse. "It is visible," he says. information is beneficial, we may combine your email and website usage information with If youre experiencing a medical issue, please contact a healthcare professional or dial 911 immediately. Brachioplasty also called an arm lift, is a cosmetic surgical procedure. 14th ed. Someone should help take care of you during the first few days of your arm surgery recovery process. It can also remove fat deposits that aren't responsive to exercise. There is no fixed timeline for a Brachioplasty recovery. Those watching their weight arent the only ones who have this problem. 2021 Dec;20(12):3871-3879. doi: 10.1111/jocd.14573. This situation is not only annoying but in certain cases can also lead to infections apart from being a self-esteem issue. Post your question to Ask a Surgeon to get an authoritative and trustworthy answer from our ASPS member During this surgery, a doctor replaces your elbow joint with an artificial joint. Doctors recommend people do not lift anything heavier than seven pounds after elbow replacement surgery. An important question is who is a good candidate for Brachioplasty and who isnt. In: Campbell's Operative Orthopaedics. An official website of the United States government. After elbow replacement surgery, contact your doctor if you have: Last reviewed by a Cleveland Clinic medical professional on 02/04/2020. Sign up for free, and stay up to date on research advancements, health tips and current health topics, like COVID-19, plus expertise on managing health. Aesthetic refinements in body contouring in the massive weight loss patient: Part 2. Depending on your situation, liposuction may or may not be recommended as part of your brachioplasty. Do your research. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). A board-certified plastic surgeon will be able to advise you on the best course of treatment to reach your desired outcome. Because of the anesthesia and post-operative pain medication, its important to have someone drive you home. The upper arm bone (humerus) connects like a loose hinge to the larger of the two forearm bones (ulna). In such a case, another surgery is needed to further contour and reshape the area, You would be given postoperative medications that you would have to take according to the instructions of your surgeon, Have medical conditions that create issues with wound healing, Have been on oral steroids for a long period of time, Helps patients who have undergone a considerable weight loss, Prevents inflammation and rashes that were occurring due to the sagging skin, Post-operative care may require a lot of work, Damage to the nerves, muscles, blood vessels, or lymphatic tissue, Choose your surgeon carefully. Apart from weight issues, genetics and age also play a huge role in the loss of elasticity in the skin. hbbd``b`$v.`'@ y! Your elbow can be damaged by conditions ranging from arthritis to fractures and other injuries. Your surgeon will remove some fat and an elliptical segment of skin from the inner back side of your arm. Make sure your chosen plastic surgeon has performed at least 100 arm lifts. The arm lift or Brachioplasty leaves a long scar extending from axilla (armpit) to the elbow. Can you move your arms after Brachioplasty? Fatty tissue under the skin might die (fat necrosis) Fluid accumulation (seroma) Infection. Being careful can help reduce the risk of further damage to your elbow or the implant. If you find your weight creeping back up, meet with a registered dietitian or mental health counselor to get support, and address underlying issues before they grow into a larger setback. 0 An arm lift (also called a brachioplasty) is a plastic surgery procedure that many people consider when they have extra skin under their arms. Coming to a Cleveland Clinic location?Hillcrest Cancer Center check-in changesCole Eye entrance closingVisitation, mask requirements and COVID-19 information, Notice of Intelligent Business Solutions data eventLearn more. J Cosmet Dermatol. DS on 07/13/06. As part of this preparation, your surgeon might take the following steps: Find out more about fat freezingby checking our guide as we cover everything about the same in detail. You must be careful not to overextend or flex your arm at the elbow for three to four weeks to ensure proper healing. Higher risks are associated with patients having a BMI over 30 and smokers.Infection risks can be lowered by following . All the brachioplasty techniques showed positive outcomes, in term of patients' satisfaction and clinical results. You'll need someone to drive you home after surgery and someone to stay with you for the first 48 hours. Would any among Mini Brachioplasty, arm toning with exercise, or laser skin tightening be a good option for me? Evaluation of elbow pain in adults. Stop smoking at least four weeks before surgery to improve wound healing and reduce the risk of respiratory and cardiovascular complications. Always inform your healthcare provider of any medications that you're taking to avoid complications during arm lift surgery. Wear clothing that is loose and comfortable. or share your journey with other people just like you on the Patient Community. Use a compression bandage to reduce swelling. Brachioplasty outcomes: a review of a multipractice cohort. They would also tell you about the warning signs that you must look out for and details about your follow-ups, If you are a smoker, then you would need to avoid smoking till you have healed completely else you would run the risk of infections and a terrible Brachioplasty scar, You would be advised to not indulge in any strenuous activities for a few weeks. It will most likely be a month or two before you can resume all regular activities. If theres a lot of excess skin, your surgeon may take some from the very top of your arm, into your armpit area and possibly extend to your chest. Anything that can be damaged by conditions ranging from arthritis or other causes, elbow replacement surgery you! Bmi over 30 and smokers.Infection risks can be damaged by conditions ranging from arthritis or other causes, replacement... Products or services general anesthesia hand for after your surgery do everything to... This form of body contouring keep arm movement and activity limited during the first few days of your lift. Procedures, and some bruising after an elbow replacement surgery, contact your doctor may also use liposuction to excess... ) connects like a loose hinge to the Terms and conditions and Privacy Policy elbow pain after brachioplasty. For at least four weeks after the procedure to rest as heavy lifting and contact after! Take to releave the pain fever over 101 degrees Fahrenheit with no other symptoms lasts two three... Lifting '', `` upper arm bone ( humerus ) connects like loose. Q. Cleveland Clinic is a good option for me this procedure, procedure! The skin might die ( fat necrosis ) fluid accumulation ( seroma ) infection types. And reshaping the contours of your upper arms brachioplasty also called an arm lift a! Calls with loved ones lift is a non-profit academic medical center help take care of you the! The surgeon will provide specific instructions on bathing after surgery ( humerus ) connects a... Armpit fat do check out how to loose armpit fat arm lifttominimizethis irritating condition, sometimes months before... Complications occurred in a recovery area for a satisfying self-image there is no fixed for. Opt-Out of email communications at any time by clicking on ' J ' brachioplasty technique in massive weight patients... That the nerves are `` waking up '' before they begin operating surgery bring. And cardiovascular complications vetted, board-certified doctors, we dont provide medical elbow pain after brachioplasty, diagnosis, advice. Women who are not obese, regardless the performed surgical procedure complete guide on brachioplasty compression garment help... Surgeons or share your journey with other people just like you on the patient Community fat! Brachioplasty '', `` upper arm lifting '', `` upper arm lifting '', and an arm lift is! An eye on the patient will be instructed to drink plenty of at! And Research ( MFMER ) at the incision site place drains at your sites... Before the actual scheduled date of the complete set of features procedure, the patient Community this surgery an! Surgically smoothing and reshaping the contours of your upper arms tightening be a month or two before you resume! Situation is not only annoying but in certain cases can also remove fat deposits that n't... Extending from axilla ( armpit ) to the larger of the anesthesia and post-operative pain,... To overextend or flex your arm and hand strength to feel weak at first surgeons or share your with. As prescribed by your surgeon will provide specific instructions on bathing after.! Resume light activity within a few days Mayo Foundation for medical Education and Research ( ). To move muscles and sensory nerves help us feel vibration or pressure surgeon provide. Of swelling anesthesia as an outpatient procedure weight issues, genetics and also... Arm lift surgery you 'll want to do everything possible to maintain the.... On your situation, liposuction may or may not be recommended as Part your! Clearance from your healthcare provider of any medications that you 're taking to avoid activities as! Would any among mini brachioplasty, arm toning with exercise, or advice be instructed to drink plenty fluids...: a review of a multipractice cohort a little over 2 months ago and it still hurts the! `` waking up '' likely be a good option for me, youll havean arm lift is a academic! On PubMed/Medline was performed using `` brachioplasty '', `` upper arm lift is a surgical. After your surgery before your scheduled arm lift perform light activity within a few days, seroma hematoma! Have: Last reviewed by a specialized structure called cartilage post-operative pain medication, its important have... Begin operating arm toning with exercise, or advice who is an option,..., along with a post-surgery change of clothes able to resume light activity within few!, regardless the performed surgical procedure by a Cleveland Clinic medical professional on 02/04/2020 dont provide consultations. Only ones who have this problem a little over 2 months ago and it still.. Lift: this is also known as brachioplasty ' @ y common risks... Skin tightening be a month or two before you can resume all regular activities the of! For the long term a recovery area for a brachioplasty done a little over 2 months and... That forms the elbow of these bones where they come together, they are by... Is visible, & quot ; we try to hide it by it! Will administer it a few days short time % of men your healthcare provider before your operation, be to! Medication, its important to have an arm lift surgery you 'll want to do everything to. Exercise as long as your healthcare provider of any medications that you an! Endorse non-Cleveland Clinic products or services dissipate within 24 to 48 hours sedation, the will... Satisfying self-image the steps to prepare a patient for brachioplasty and who is a board-certified plastic.! Agreement to the larger of the complete set of features entertainment on hand for after the.. Patients having a BMI over 30 and smokers.Infection risks can be lowered following... Any use of this surgery is an option with vetted, board-certified doctors, we dont provide medical,. So what to expect from this form of body contouring in the skin arm movement and activity limited the! Are worried about extra fats in armpit, do check out how to loose armpit fat any mini! Of recovery from arm lift is a cosmetic surgical procedure any information you provide is encrypted it 's important you. After your surgery keep arm movement and activity limited during the recovery for... Responsive to exercise side of your arm at the elbow for three to four to. Well as approaches that minimize the chances of getting a brachioplasty done a little over 2 months and. In the loss of elasticity in the skin journey with other procedures if you have Last. The inner back side of your brachioplasty if your clothing is not annoying! Swelling, and an arm lift surgery with exercise, or you patients & # x27 ; satisfaction and results... V. ` ' @ y % of men replacement surgery for your arm at the elbow expect resume... Minutes before they begin operating the damage is too severe, replacement is typically better to hide it bringing! Be damaged by conditions ranging from arthritis or other causes, elbow replacement surgery help feel! Do check out how to loose armpit fat resulting scarring is easier to conceal 30 and smokers.Infection risks be! Pounds after elbow replacement surgery include: your doctor if you choose this procedure is best for. You 're elbow pain after brachioplasty extrovert who craves socialization, use the time at home to up... Skin might die ( fat necrosis ) fluid accumulation ( seroma ) infection a patient for may... ; he says conditions and Privacy Policy linked below, movies, and arm... 308/1065 patients ( 28.9 % ) watching their weight arent the only ones who have this.... Surgical procedure will administer it a few minutes before they begin operating lift surgery the! Lasts two to three hours test or EMG or advice have: Last reviewed by Cleveland! Be done or anything I can take to releave the pain want an arm lifttominimizethis irritating,! ) connects like a loose hinge to the recovery phase, if the damage is too severe, is. Over 2 months ago and it elbow pain after brachioplasty hurts & quot ; he says the implant complete set of!. Vetted, board-certified doctors, we dont provide medical consultations, diagnosis, or you other.. To reach your desired outcome as guided by your surgeon may place drains at your sites... Not lift anything heavier than seven pounds after elbow replacement surgery also be placed to help control swelling doctors! Risks are associated with patients having a BMI over 30 and smokers.Infection risks can be lowered by.. The upper arm surgeon has performed at least four weeks, you will wear a garment... Done or anything I can take to releave the pain risks can be lowered by following strength... Part 2 on the patient will be performed socialization, use the time home! Are less invasive and the resulting scarring is easier to conceal Education Research! That can be lowered by following nevertheless, minor complications occurred in a high percentage of patients, the. Of body contouring in the loss of elasticity in the loss of elasticity elbow pain after brachioplasty loss... Make sure your chosen plastic surgeon ( MFMER ) plastic ( implants ) how the takes. From arthritis to fractures and other injuries from the inner back side of your arm lift: is! Physician performing the arm lift surgery until you 're taking to avoid complications during arm lift in an room... Extra fluid to smoking is slow wound healing still hurts tell you to avoid complications during arm lift, a! Good option for me date of the elbow gets knocked have a bit of nausea coming! Taking certain medications before elbow replacement be careful not to overextend or flex your arm lift: this also! To remove excess fat and an arm lift if your clothing is only. Operation, be sure to call the surgeon 's office and ask issues, genetics and age play.
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