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Keith Denkler, M.D.


Contact Info


 CONTACT INFO



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


 ABOUT



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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





Abdominoplasty before and after

SURGERY OF THE ABDOMEN
ABDOMINOPLASTY

Abdominoplasty, known more commonly as a "tummy tuck," is a major surgical procedure to remove excess skin and fat from the middle and lower abdomen and to tighten the muscles of the abdominal wall. The procedure can dramatically reduce the appearance of protruding abdomen. But bear in mind, it does produce a permanent scar -- which, depending on the extent of the original problem and the surgery required to correct it, can extend from hip to hip. This procedure works the best for lax muscles over-stretched by pregnancy, or abdominal aprons after major skin loss. In young females, a mini-abdominoplasty is indicated as a lesser surgery for early abdominal problems.




Price: Price varies depending on the time required for your tuck



Upper Blepharoplasty Before and After

SURGERY OF THE EYELID
BLEPHAROPLASTY

Eyelid surgery, technically called blepharoplasty, is a procedure to remove fat, usually along with excess skin, from the upper and lower eyelids. Eyelid surgery can correct drooping upper lids and puffy bags below your eyes-- features that make you look older and more tired than you feel; in fact, these may even interfere with your vision. This procedure won't remove crow's feet or other wrinkles, eliminate dark circles under your eyes, or lift sagging eyebrows. While it can add an upper eyelid crease to Asian eyes, it will not erase evidence of your or your racial heritage. Blepharoplasty can be done alone, or in conjunction with other facial surgery procedures such as facelift or browlift. Blepharoplasty is popular in personÕs 35-65 years old. For those over 65 years of age, medicare sometimes covers this procedure if an opthalmologist documents visual obstruction from the upper lid overhanging the eyelid.


Price: Varies depending on the type of anesthesia and location of the surgery in the hospital or surgicenter



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.








BREAST LIFT
MASTOPEXY

The breast lift procedure, or mastopexy, is usually performed to correct the forces of gravity or aging or after pregnancy and nursing. As the skin loses elasticity, the breasts often lose their shape and firmness and begin to sag. This surgical procedure raises and reshapes sagging breasts. Mastopexy can also reduce the size of the areola, the darker skin surrounding the nipple. If your breasts are small or have lost volume, breast implants inserted in conjunction with mastopexy can increase both their firmness and size.







FACELIFT
RHYTIDECTOMY

As people age, the effects of gravity, exposure to the sun, and the stresses of daily life can be seen in their faces: deep creases from between the nose and mouth, the jawline grows slack, and jowls, folds and fat deposits appear around the neck. The facelift procedure (rhytidectomy) can't stop this aging process. What it can do is "set back the clock," improving the most visible signs of aging by removing excess fat, tightening underlying muscles, and redraping the skin of your face and neck. A facelift can be done alone, or in conjunction with other procedures such as a forehead lift, eyelid surgery, or nose reshaping. A mini-lift or necklift alone may be useful in certain patients.


Price: Varies depending on the type of lift required



BODY LIPOSUCTION
LIPOSUCTION

Suction-assisted lipectomy is a technique to remove unwanted fat deposits from specific areas of the body, including the chin, neck, and cheeks; the upper arms and above the breasts; the abdomen, buttocks, hips, and thighs; and the knees, calves, and ankles. Liposuction is not a substitute for weight reduction, but a method of removing localized fat that doesnÕt respond to dieting and exercises. Liposuction is an excellent technique for removing localized fat deposits i.e. Saddlebags, Love Handles, Knobby Knees, Turkey Neck, or Pear shaped Bodies.
TUMESCENT LIPOSUCTION
This is the most popular type of liposuction.  It works great for one or two areas.  It is limited by potential toxicity of the local anesthesia.  The technique was developed by Schleich in 1892 and has recently been popularized for liposuction since general anesthesia and its risks are avoided.  Large amounts, 1-3 liters, of dilute local anesthesia (lidocaine or Xylocaine) with a small amount of adrenalin or epinephrine are injected into the tissues.  The resulting swelling of the tissues combined with the constictive effects of the adrenalin minimizes blood loss and bruising.   For multiple areas or major liposuction, deep sedation or general anesthesia are used in addition to the infiltration techniuqe.
ULTRASONIC LIPOSUCTION is another technique to remove fatty tissue although it works best for large liposuciton or male breast reduction.  It is more expensive and can burn the local tissues including nerves or skin so Dr. Denkler prefers the safer micro-cannula liposuction.
RISKS
Risks are higher if multiple areas are done on the same day.  The media and the medical literature have reported on deaths from local anesthetic toxicity, pulmonary emboli, bowel perforation, and massive infections.
Bleeding and infection are the most severe risks although the risk is less than one percent.  They can be more effectively prevented through sterile technique and use of antibiotics.  The need for autologous blood donation before surgery is remote.  Serum collections (seroma) have a 2% risk. Cosmetic revisions may be necessary and occur in 10 to 15% of the cases.  There may be high or low spots and these are treated with further liposcution or lipoinjection.  There is no charge for revsions in the first year if weight is kept stable.
Dr. Denkler has performed hundred of liposucitons and has the ability to perform it in the hospital or an accredited surgicenter.
Single area liposuctions require about a week off work and in certain cases may only require  a long weekend to recover.




Safety: Liposuction is very safe, although it carries the risks of bleeding, infection, and anesthetic complications. All of these are rare, although cosmetic complications such are over or under-resection of fat are somewhat common and may require a revision.



Neck Liposuction with upper blepharoplasty


NECK LIPOSUCTION

Neck liposuction alone may sometimes give a dramatic improvement without a necklift or facelift. It can be a great alternative to a necklift or facelift. Certain people are canidates for this operation depending on the ability of the neck skin to re-drape without sagging. This patient had liposuction of the neck and an upper blepharoplasty.








NA FOR DUPUYTREN'S CONTRACTURE OF THE HAND AND FINGERS

Minor surgical release of Dupuytren's Contracture under local anesthesia as an office procedure. Uses small hypdermic needles to cut the affected tissues, a needle fasciotomy, as opposed to opening up and excising the diseased tissues which is called a limited fasciectomy. A fasciectomy is usually performed in a hospital or outpatient surgical center under regional or general anesthesia. This office is one of the few which can perform surgery for Dupuytren's under strictly local anesthesia. However, needle releases, (NA) are the first surgical procedure of choice. Safety The most common complications after NA are skin tears 15%. Other more uncommon complications include sensory nerve injury 1-2%, bleeding 1%, localized infection 1%. Rare and remote complications would inclued tendon ruputure 0.1%, NA does not cure Dupuytren's, and neither does surgical excision. Both are performed to straighten the fingers. Recurrence may occur after surgery or a NA procedure, but it would be more common after needle releases and more common after NA for PIP (middle) joint disease.

  • Insurance Coding: Diagnosis 728.6 (Dupuytren's)

  • Procedue coding: 26040 (Percutaneous Fasciotomy)

  • In longstanding contractures, needle releases of the joints of tendons may be necessary.

  • NA or needle aponeurotomy may be combined with Kenalog(cortisone) injections of Dupuytren's nodules.


Price: 895 for first digit then 395 for each subsequent digit. Severe disease may need additional tendon or joint release procedures






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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