Among his accomplishments is the work he performed on Joey Paulk, who nearly burned to death in Afghanistan in 2009. He removed scar tissue, raising his eyelid and lower lip. A second and third operation improved the former soldier’s eye alignment and lips by replacing scars with healthy tissue. With a fourth and final surgery, he added chin implants for definition.

“From a distance, you can’t tell I was injured,” Paulk said.

Read the rest of this article at the New York Times.

Arm liposuction is one of the simplest and most gratifying procedures in plastic surgery.  The great results have greatly decreased the number of skin excision surgeries necessary. The incision for liposuction is a tiny incision at the elbow that quickly gos away. Come for a consultation and simple surgery. I have done well over 1000 arm liposuctions. This is a really wonderful procedure.

2. When deciding on which route to go for a liposuction procedure, should I seek out the latest technology?

The skill of the surgeon is everything. The technology is irrelevant. 93% of the world’s liposuction is done by simply small instruments. Choose a surgeon boarded by the American Board of Plastic Surgery and a Fellow of the American College of Surgeons who is able to prove a track record of success in liposuction procedures, take good care of yourself after surgery, and you will likely be pleased with the results.

3. Where does a dissolving fat graft go?
The fat breaks down and the lipids and by products are removed by the blood stream. The fat metabolic fragments are then further altered and removed by kidneys and liver. This dissolution process will not be harmful to you. The fat that does not survive is that that gets too little blood supply.

4. How painful is liposuction?
The pain is at most moderate. Getting more areas hurt more, of course. The good news for patients considering liposuction is that the pain medication Percocet is highly efficient in providing comfort. Do I recommend multiple areas? Possibly. If multiple areas can be done at once there is the economy of cost and recovery time off from work to consider. How long off work? Minimum one week for bigger cases but many tummy lipos go back the next day. How long to full work out? Full blast in 5-10 days. It depends on the number of areas.

5. Can patients on coumadin and other blood thinners have plastic cosmetic elective surgery?
No. It is far too dangerous to remove coumadin therapy for elective cosmetic surgery. If you are taking coumadin because of heart irregularity and stop it electively you could have a stroke and die. Don’t risk it. If you need surgery other than cosmetic to save your life or maintain health, go ahead and do it. The risk is small and you have no real choice. But for cosmetic elective surgery such as a facelift or liposuction, the answer is no. Be safe and not sorry.

6. In a tummy tuck procedure, what muscles are repaired? How long does it last?
During the tummy tuck your midline muscles are repaired. They are called the rectus muscles. When we are born these muscles are side by side parallel.

As we age, get fat, or go through pregnancies, the muscles separate and become bowed out. This means the muscles are no longer joined in the middle. You cannot get a 6-pack. You cannot even exercise because the muscles are not parallel and exercise only further separates them. This is a true hernia. During a tummy tuck, the rectus muscles are sutured together in a very strong fashion.

Once done properly, this never needs to be repeated. You are returned to pre-pregnancy condition. This also works beautifully for people who have lost weight and are now thin but have a protruding stomach because of muscle separation. Once repaired, a hernia will not return.

7. Can flank-hip liposuction make the buttocks more attractive?
Liposuction of the area above the buttocks, the flank-hip area, suddenly seems to give the buttocks a better shape. This occurs for two reasons. The removal of the fat hiding the buttock curve allows the natural attractive curve to show.

Reason two is that the skin above the buttocks contracts and pulls up the buttocks. If a person is really flat and desires a more shapely, attractive posterior, fat removed from the flank hip zone and elsewhere can be added to the buttocks. About 50% of fat permanently survives so the trick is to use twice as much as you feel you need. This works great.

8. What kind of pain is involved with getting Juvederm lip injections?
There should be no pain if the treatment is done properly with TLC and expert kindness. I have all of my patients prep one hour ahead with a full tube or two of EMLA cream. The cream must be placed on the skin 60 minutes before and applied according to my simple formula. Next, I do a tiny injection of lidocaine and block the infraorbital nerve and the mental nerve. This allows a zero pain experience when you are treated with Juvederm to your lips.

9. What is the true test of a perfect nose job?
The best test is the naturalness factor. The post operative result must have a non operated appearance.

10. Do breast implants cause breast cancer or any form of cancer?
Breast implants cause no form of cancer whatsoever. This has long been established. From time to time there are sensational articles implying the opposite, but it is 100% untrue. No cancer has ever been linked to breast implants.

Dr George Commons has done over 3800 liposuction patient in the past 29 years. This is among the highest volume done by anyone in the United States and the largest volume in Northern California. Dr Commons was a pioneer in Ultrasonic Liposuction and one of the first 7 surgeons in the US to obtain the original liposuction equipment in 1996. Dr Commons has done over 2400 ultrasonic liposuction patients. Dr Commons has published the largest series of large volume liposuction patients in the world literature (632 cases). Dr Commons has served as a Vaser Ultrasonic Instructor for many teaching courses for other physicians. Dr Commons has served as a consultant and expert witness in legal issues regarding liposuction for 25 years. Dr Commons teaches Stanford Residents liposuction techniques. Dr Commons has offered state and national courses on liposuction safety. Dr Commons has written many liposuction articles, has liposuction chapters in 7 textbooks, taught liposuction techniques in Taiwan and other counteries, and delivered dozens of talks and lectures on liposuction. Dr Commons stresses Safety and Results. On the average each patients has 3.5 liposuction areas done per case, so Dr Commons has done 3.5 x 3800 areas equals 13,300 areas. Is there any doubt that Dr Commons is the Go To Guy for liposuction in Palo Alto? See Dr Commons. You will be glad you did. www.pacfps.com See many liposuction pre and post photos in this website. www.pacfps.com

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1. Your post-surgery adventure begins once you leave the operating room and enter the recovery room. You will be recovered from your anesthesia and your post-surgery recovery helper (either hired help or a trust friend/family member) will meet you.

2. Your post-surgery recovery helper will drive you to a safe, previously agreed-upon overnight care facility so that you may begin to recuperate. Per this discussion, I assume you are going to your home or equivalent with a family member.

3. Once home you ideally will go to your bed or inclined chair (lounge). Elevation decreases facial discomfort and decreases swelling. Elevation at all times is a good practice for 6 weeks. Elevation on two or three pillows is fine. Place the pillows vertical so your neck is not severely flexed and blood flow restricted.

4. Even if no eyelid or forehead surgery was performed, you may experience swelling about eyelids so cool compresses are useful. A wet washcloth and frozen peas work fine.

5. Activity on the evening of surgery day can be walking about your home. Short walks are encouraged and beneficial. You may get up with help. You may get up with help and go to the bathroom.

6. Diet is best if limited to ice chips and clear liquids for the first two hours at home and then progress to cold things such as ice cream or yogurt over the next two hours. Gradually advance to a light but normal diet in the morning and go slowly. A large amount of heavy food may cause nausea. Remember to keep salt, Na+ (sodium) to less than 2000 mg per day. Salt will cause swelling. Drink plenty of fluids. Read all labels. If you feel weak it is okay to occasionally break the rules and have a Gatoraid or similar drink that does contain Na+. If nausea is present stick to clear fluids and crackers and take the Zofran (ondansatron) prescribed sub lingual every 4 hours. Lying flat is okay if nausea persists, as it may help you feel better.

7. Post operative medications will be discussed one by one. Let’s start first with the antibiotic. The only antibiotic dose that has been scientifically proven to help is the one given to you prior to any incision in surgery. Generally one of the cephalosporins are used but I will select the one best for you and to which you are not allergic. We will discuss this.

In addition I may give you antibiotics that we will discuss for use after surgery. Generally I start these the day after and if cephalosporin is chosen, the antibiotic is cephalixin and the dose 500 mg every 12 hours. If these disagree with you stop and call me. Should you develop a rash and hives stop the antibiotic and call me. Generally the antibiotic is prescribed for 5 days but longer if breast implants have been done. Should you develop signs of infection after surgery, I will change the antibiotic. Call me if fever over 100, redness, swelling , and pain increases and seems one sided and unusual. If you just fell sick and increasingly ill call me.

8. Next we discuss pain medications. There are many pain medications and my preference is usually Percocet 5/325, or Vicodan 5/325, or Darvocet N 100 or at times simply Ambien 5 or 10 mg with 2 or 3 standard Tylenol tablets (acetaminophen). I am flexible on this issue. If Percocet5/325 is prescribed, it usually works well but so do the others.

Our anesthesiologists feel Percocet is more potent and less nauseating. All narcotics can nauseate in some cases. You may need to take Zofran with your pain medications and this is fine. Take the least amount that works to keep you comfortable. Pain medication is meant to control pain but it does not totally stop it. Usually I prescribe 1 or 1 and 1/2 or2 tablets every 3 to 4 hours as is needed.

Start low and add if you need. If your pain is not controlled call me. If you wish I can switch you to Vicodin or to Darvocet N 100, or to a very simple non-narcotic such as Tylenol and Ambien. There is no one answer. If you can’t get comfortable call me. It is fine to take Ambien and Percocet together but do separate by about one hour. You do not want to get over sedated. Some people choose to take nothing but Tylenol because they do not like the feel of narcotics or sedative drugs. This is fine also. Please remember that all narcotic pain medication constipates. On the second day start Milk of Magnesia 2 oz and continue as directed till results.

Remember that coolness or cold serves as a great pain medication so a cold water bottle, etc. is fine.

9. Zofran is a wonderful medication for nausea and I give it liberally. Zofran (ondansatron) sub lingual tablets are great (8mg) and take them at the slightest hint of nausea. Take it if you even think of nausea every 8 hours. I will give you a generous supply. You will also receive this medication in surgery. The medication Zofran that you take home is sub lingual so it can be absorbed even it you are vomiting. Hold it under your tongue. Remember also to take care of your stomach. Eat gentle food that is not spicy, take over the counter Prilosec as directed. Pepto Bismol helps some people. Do not drink alcohol. If nausea persists call me.

10. Ambien is given for sleep (5 or 10 mg) depending on weight and may be repeated in an hour. This substance may also be taken in the afternoon for a nap. Some prefer to combine Ambien with Tylenol for pain control. If this helps it may be taken every 6 to 8 hours. Ambien is not actually for control of pain but the sedative effects seem to help discomfort.

11. The day after you facelift you will come to my office and your small head dressing will be removed. After this you may shower in one hour using baby shampoo. Baby shampoo is wonderful and is called baby shampoo because if it gets in the baby’s eyes it does not hurt.

It is safe for incision lines and beautifully cleans your hair and face. We rarely use antibiotic grease about suture lines. Baby shampoo is just fantastic. Put it on generously and wash a little more each day or twice a day. Your hair will become clean and suture line perfect. No dressing is needed after the first 24 hours. If you also had eyelid surgery read my information on eyelids.

Continue to sleep with head elevated. Increase activity gently daily. Walk but don’t run. Gentle frequent walks are healthy and a goo prophylaxis against blood Clots which have never been a problem with any of my patients because we take all measures in surgery and get people moving. At two weeks after surgery you can do what you wish activity wise. Something may hurt to do but it will not hurt you. Put on sunscreen and wear a hat outdoors. Sun will hyper tan your bruised areas so be careful.

12. Sutures to be removed are far and few between because I use 95% subcutaneous sutures that will dissolve. Monocryl sutures are wonderful. You will have no suture marks and again only a very few suture need removing if any.

I will have you come to my office for check-ups on Day 1, Day 5, and Day 10. These will be made convenient for you. Thereafter I like to see you from time to time up to about a year. My door is always open for you. At your visits I do a would check, help your clean your incision and advise you about care.

13. At 10 days to 2 weeks you will look okay to return to work and play. Your appearance will continue to improve and at 3-4 weeks you will look even better. We say wound healing takes a year but by 3-4 months you are 90% there usually.

Some people take longer and I will work with you and advise you. Some numbness about the cheeks and neck may take up to 6-9 months to dissipate. Swelling varies but resolved substantially by 2-3 weeks. Swollen muscles move a little sluggish but at 2 weeks you will be okay. Certainly every day you look better until finally you will look great.

14. Once a patient you will have all of my phone numbers and contact information. You will have my home phone, my cell phone, and my office phone. I am easy to contact post operative and I find this calms patients and they do better. I do not mind getting calls about little things. These calls prevent big things from ever occurring.

15. Blurred vision occurs frequently after a facelift even if eyelids were not done. This goes as swelling dissipates.

16. Enjoy your post operative course and take great care of yourself. I will be there for you all the time. This is a wonderful experience and the results will be very worth the discomfort and inconvenience.
Remember that I want you to do well even more than you want you to do well. We will work together and you will do well.

It contains 7% hydroquinone, Retin A, and hydrocortisone to keep redness down.

We sell it for $120 normally but are currently discounting it to $70 through the end of February. CommonsMD skin care product and procedure is designed to get results at a reasonable cost. One bottle should last 3 months for use on the face and neck. It is also appropriate on the arms and hands.

Very small ultrasonic probes are used to gently melt the fat and then tiny 2 to 3 mm suction cannula are used to remove the emulsified fat. This procedure takes a bit longer than traditional liposuction using larger instruments. The extra time and a little extra expense are well rewarded. See Vaser Sound Surgical.