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Keith Denkler, M.D.


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Kybella


Common Procedures


BOTOX® for Wrinkles


 Dupuytren's Disease



Dupuytren's and XIAFLEX Pictures


Dupuytren's Contracture (Maladie de Dupuytren)


Dupuytren's for Patients


FAQ/Needle Aponeurotomy


XIAFLEX for Distal Joint Dupuytren's Contracture


ASSH Hand Society Presentation of NA


AAPS Presentation on Needle Aponeurotomy for Severe Dupuytren's


Dupuytren's Boutonniere Deformity Treated with XIAFLEX


XIAFLEX Boutonniere Treatment


2011 ASSH Dupuytren's Needle Presentation


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 Needle Release for Beauty



Needle Release for Beauty

Keith Denkler M.D.  
415-924-6010  
275 Magnolia Ave.  
www.PlasticSurgerySF.com  
Larkspur, CA 94939  


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Common Procedures




Before and After Breast Augmentation.


BREAST ENHANCEMENT
BREAST AUGMENTATION
Breast augmentation or enlargement, also known as augmentation mammoplasty, typically is performed to enlarge small, underdeveloped breasts or breasts that have decreased in size after childbearing. The technique is performed through incisions around the nipple, in the breast or in the axilla. Saline implants are enclosed in a shell of soft silicone. Rarely is silicone gel used, so there is no migration of silicone if a rupture occurs. The implant would deflate but the saline solution would be excreted. The frequency of rupture of saline implants is unknown. It may occur up to 10-15% of patients over a lifetime. If a deflation occurred, another operation would be necessary to remove the old implant and insert a new one. All these problems may require further surgery and expenses. Complications of cosmetic surgery are not always or usually covered by insurance. Other possible problems of breast implants include hardening of scar tissue around the implant, infection, asymmetry of the breast or the position of the breast, hematoma or bleeding, and obscuring mammographic findings. Breast implants are not felt to cause cancer. Detection of cancer can be delayed due to the implants. Immune reactions can occur and the medical literature is researching this potential problem. Immune problems in general are more frequent in women and whether implants cause or potentiate autoimmune disorders is unknown.

LIMITATIONS of SURGERY: Surgery only places a saline implant under the breast tissues. It cannot stimulate normal breast tissue to increase in size. It cannot create younger skin or eliminate "stretch marks" If sagging severe, it cannot be eliminated with an implant alone. It will need a breastlift involving skin scars later. Cannot eliminate asymmetries such as differences in breast shape or position, rib cage irregularities, or nipple/areola size differences. In mammograms of women with implants, parts of the breast tissue can be difficult to visualize because of the implant. Some centers use special mammogram techniques. There is no evidence that the incidence of breast cancer is increased or decreased in women with implants.

SURGICAL TECHNIQUE/ANESTHESIA/FACILITY/RECOVERY: Office OR/ Surgical Center SF/Hospital OR (Marin General or Novato) Outpatient procedure Incisions – Below breast is best approach generally (armpit & @ nipple other options) Restrictions Stop all Aspirin, or anti-inflammatories, Vitamin E & Gingko 10 days prior to surgery. Anticipate 1-3 days of bed rest (up for meals, bathroom, sponge baths (or very shallow bath waist down, OK) Rest, light household activities next 5-7 days. Showers OK (once stitches removed) Return to work 1-2 weeks (1st week back half day preferable) No heavy lifting for 3 weeks No working-out until after 2 weeks (walks are OK after 1-2 weeks)

RISKS/COMPLICATIONS: Temporary: Permanent : Discomfort (pain/sensitivity) Scars somewhere in all patients Discoloration/Swelling Contracture or hardening Tightness/Relaxation Wrinkling/Irregularity Lumps/Irregularities Thinning of overlying tissue Bleeding/blood collection Inability to breast feed(rare) Infection Calcification in scar tissue(rare) Restricted activity Lymph node enlargement(rare) Sensory changes (numbness) Immune Response (rare) Sensory changes (numbness) Asymmetry early or late may occur Some complications can be surgically revised. Unfortunately complications may cause time off work, expense to you, and rarely hospitalization. Even though the risks and complications cited above occur infrequently, other complications and risks can occur but are even more uncommon. The risks of surgery are comparable to the risks you take everyday when driving in an automobile LIKELIHOOD OF SUCCESS: Usually very good. Perhaps 1% of patients have ever asked to have implants removed. Insurance usually does not cover this procedure; treatment of complications may or may not be covered by insurance depending on your plan. *On occasion, surgical revision may be indicated following the original surgery. If performed within one (1) year after the original surgery, there will be no charge by the surgeon but a facility fee or hospital fee, as well as anesthesia fee may be incurred. The practice of medicine and surgery is not an exact science; although good results are expected, there cannot be any guarantee.








Keith Denkler, M.D.  |  Contact Info  |  Kybella  |  Common Procedures  |  BOTOX® for Wrinkles  |  Dupuytren's and XIAFLEX Pictures  |  Dupuytren's Contracture (Maladie de Dupuytren)  |  Dupuytren's for Patients  |  FAQ/Needle Aponeurotomy  |  XIAFLEX for Distal Joint Dupuytren's Contracture  |  ASSH Hand Society Presentation of NA  |  AAPS Presentation on Needle Aponeurotomy for Severe Dupuytren's  |  Dupuytren's Boutonniere Deformity Treated with XIAFLEX  |  XIAFLEX Boutonniere Treatment  |  2011 ASSH Dupuytren's Needle Presentation  |  Credentials  |  Curriculum Vitae  |  Directions/Office Hours  |  Links  |  News Articles  |  Needle Release for Beauty

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