• Breast augmentation. This is the surgical placement of breast implants to increase fullness and improve symmetry. It also helps restore breast volume after weight loss or pregnancy. 
• Breast lift or mastopexy. This procedure removes the excess skin from your breasts and reshapes them to make the breasts rounder and fuller. It also raises the position of the nipple. The breast size does not change. 
• Breast reduction or reduction mammoplasty. This procedure decreases the size of the breast as well as reshapes the breast to make it fuller and rounder. It also raises the position of the nipple. 
• Male breast reduction. Gynecomastia is the enlargement of a man’s breasts. Hormones are often why teenage boys develop enlarged breasts. In most cases the enlarged breast tissue will shrink after puberty. However, healthy adult men within their ideal body weight who are still affected by gynecomastia on one or both breasts may consider a breast reduction. 
• Breast reconstruction. Breast reconstruction uses various techniques to restore a breast’s shape, appearance and size. 

• Abdominoplasty (tummy tuck). This procedure removes excess fat and skin. In many cases, the procedure also tightens weakened or separated muscles, resulting in a smoother and firmer abdomen. 
• Liposuction. This procedure slims and reshapes specific areas by removing excess fat deposits, improving your body contours and proportion. 
• Thigh lift. A thigh lift removes skin and fat from the thighs to tighten the skin and improve the shape of the legs. 
• Arm lift. Also known as brachioplasty, it tightens up loose or sagging skin to improve the contour of the upper arms. 
• Mommy makeover. Pregnancy can cause loose skin and stretch marks on the breasts, stomach, arms and thighs. A mommy makeover can include a combination of procedures to help you get back your pre-baby body. 
• Hand surgery. This includes surgical treatment of: 
  • Nerve and tendon injuries
  • Tumors 
  • Hand fractures 
  • Carpel tunnel syndrome 
• Cancer surgery. The mainstay of most cancer treatment involves surgical excision. Many cancers of the skin and soft tissues can be treated by our plastic surgeon. 

• Blepharoplasty (eyelift), neck lift and facelift. These surgeries help lift and tighten loose skin around the eyes, face and neck to reduce wrinkles and sagging skin. 
• Liposuction of the neck. Liposuction in this area will remove a double chin and loose skin to restore a normal contour. 
• Otoplasty (ear pinning). Commonly performed on children prior to school age, this surgery brings ears closer to the head.  

To make the most of your visit, we offer the following in-office procedures: 

• Shave biopsies 
• Punch biopsies 
• Small excisions 
• Body skin examinations 

• Botox® cosmetic. Botox cosmetic is used to reduce facial wrinkles on the forehead and crow’s feet areas, as well as frown lines. With a simple 10-minute treatment, results can appear within a few days and last as long as four months.
• Juvederm® XC. Juvederm XC is a synthetic dermal filler that is injected into the deep layer of the skin to help reduce wrinkles and provide volume in areas of the lower face.
• Juvederm Voluma® XC. Juvederm Voluma XC is the first FDA-approved injectable gel to instantly add volume to your cheek area to correct age-related volume loss in adults over the age of 21. It can give added contour and a subtle lift for up to two years.
• Skin resurfacing. Using a chemical peel, skin resurfacing improves the appearance of your skin by reducing fine lines, uneven pigmentation, sun damage and age spots. 

Unfortunately, this is a part of the aging process that can make someone appear sleep deprived, even though they are not. The solution is a surgical procedure called a blepharoplasty, or eyelift. With this procedure, the loose and sagging skin, as well as the excess fat around the eyelids, are removed. The incisions heal so well that they are practically invisible. Blepharoplasty is the second most common cosmetic surgery performed in the U.S.

An otoplasty or ear pinning is an operation done to normalize overly protruding ears. It is done via incisions placed on the back of the ear that are very well hidden post-operatively.

During a facelift incisions are made along the hair line in the temple region extending down in front of the ear and then around the back of the ear into the hairline. Most plastic surgeons have been trained in more than one face lift technique, and they can determine which technique will work best for each specific patient. With all facelifts the skin of the face and neck is dissected into the cheeks and neck to allow it to be mobilized upward to produce a tightening and smoothing result. The surgeon will also tighten the underlying muscle layers. Years of highly specialized training are necessary to learn to safely perform this procedure.

This can only be determined after you are evaluated by a plastic surgeon. It is important to understand that to obtain the results that you want, the appropriate procedure should be performed.

The facelift is somewhat more expensive because more surgery is performed. A neck lift is a more limited procedure.

Juvederm is very effective in smoothing out and filling in bothersome wrinkles and lines, particularly in the lower part of the face. It has several advantages over other filler-type materials such as collagen; it lasts longer and causes very little adverse reaction.

Juvederm® and Botox® (botulinum toxin) often are used in a complementary fashion. While Juvederm is best for the lower face, Botox® is great for wrinkles that occur in the upper face – crow's feet or the vertical frown lines between the eyebrows – because it paralyzes muscles stopping the skin from wrinkling.

Botox® lasts about three to four months, and the treatment can be repeated as needed. When it wears off, you will begin to notice increased muscle action and some reformation of the wrinkles. It appears that with repeated use, the effect of Botox® becomes longer lasting.

Juvederm injections last for about 12 months, and can also be repeated as needed.

A newer Juvederm product, called Voluma is designed to be injected deeply over the cheek bones to provide fuller cheeks and give a lifting effect. This product may last up to two years.

Yes, the tumescent liposuction technique is the gold standard in liposuction. No other technique has been shown to be more effective.

Yes. During a tummy tuck, weakened abdominal muscles are tightened, and excess fat and skin are removed.

"Smart liposuction" uses a heated cannula to heat the fat prior to sucking the fat cells out. No study has ever shown that this technique is any better than traditional tumescent liposuction; however, there may be more complications with this technique.

This procedure should currently be considered experimental. Fat cells suctioned from other areas of the body and injected into the breasts will die because they no longer have a blood supply. The breasts may not maintain the initial increase in volume, as the dead fat cells are absorbed by the body. Newer technologies recently developed for processing the fat cells may make this a viable option in the near future. 

During the consultation, Dr. Fleming will ask what your goals are for the surgery. Then, depending on your current breast size and shape, he will suggest an implant to match those goals. “Trying on” sample implants is part of your consultation process. 

A breast lift, also known as a mastopexy, raises the breasts by removing the excess skin and tightening the surrounding tissue to reshape and support the new breast contour. 

Yes. Breast augmentation surgery is often combined with a breast lift, abdominoplasty or liposuction. 

Two of the leading breast implant manufacturers we recommend are Allergan and Mentor. There are different types of implants with different consistencies of gel, as well as saline implants. Overall, silicone gel implants give the best result. Advantages and disadvantages of both types will be discussed during your consultation. 

A breast reduction, also known as a reduction mammoplasty, is a procedure in which the breasts are reduced by removing breast tissue and skin. If the breasts are unusually large and causing neck or back pain, this procedure is typically covered by most insurance plans. 

This is a very common complaint. There are two ways to improve the breast shape to look more youthful. One way is to remove the excess skin from around the breast tissue through a procedure called a breast lift or mastopexy. The other, called breast augmentation, adds breast implants to increase the size of the breast, fill out the loose skin and improve the shape. 

You can start by verifying the physician’s credentials. Your surgeon should be board certified, which signifies that they have the knowledge, skill and experience required to provide quality patient care in a given specialty.

You can verify your surgeon’s credentials at Certificationmatters.org or abms.org. You can look up Dr. Fleming’s credentials at the American Board of Plastic Surgery website by searching for: Dr. Francis X. Fleming.

Ensure that the facility where the procedure takes place is fully accredited. Many cosmetic surgery procedures are done on an outpatient basis. It is important to verify that the facility meets the proper accreditation criteria to ensure your safety.

Ask the physician for photographs of their work.

Consider the surgeon’s experience. How long have they been performing this procedure? How many of these procedures have they performed?

You can verify your surgeon's credentials at Certificationmatters.org or the American Board of Plastic Surgery. You can look up Dr. Fleming’s credentials by typing in his full name: Dr. Francis X. Fleming.

Some doctors who do not have this certification will try to confuse the public by claiming they are certified by the “American Board of Cosmetic Surgery.” This is deceptive because this is simply a LLC, is not a member board of the American Board of Medical Specialties, and is not used to credential surgeons for hospital privileges.

If your doctor does not have admitting privileges at your local hospital, for your procedure, it may be an indication that they do not have the proper training and certification.

• Cosmetic surgery is performed to reshape normal structures of the body in order to improve appearance and self-esteem. Cosmetic surgery is not usually covered by health insurance because it is not medically necessary.
• Reconstructive surgery is performed on abnormal structures of the body caused by congenital defects, developmental abnormalities, trauma, infection, tumors or disease. In general, reconstructive surgery is performed to improve function, but may also be completed to approximate a normal appearance. Reconstructive surgery is typically covered by most health insurance policies.

Unfortunately, yes. Most state medical boards do not regulate procedures that are done in a doctor’s office. Therefore, it is not uncommon for inadequately trained providers to dabble in cosmetic surgical procedures. Unfortunately, if a surgical procedure is not performed correctly, it is typically extremely difficult to restore a patient to a normal contour or appearance.

Additionally, to try and save money, some patients go out of the country to have cosmetic surgery procedures done in Mexico or South America. Many times it is difficult to assess whether these surgeons or doctors have the proper training, and they are not available to help if there is a problem when these patients return home. I have seen many patients who have been injured because of this type of medical tourism.

One of the best ways you can decide if cosmetic surgery is right for you is by meeting with our Plastic Surgeon, Dr. Fleming, for a consultation. During your initial consultation, you and Dr. Fleming will discuss your goals and expectations. Dr. Fleming will also:

• Review your complete medical history, including reviewing past and current medications
• Evaluate the part of your body that you want treated
• Give recommendations
• Answer any questions you may have.

You should leave your visit with a clear idea of the surgical options available to you as well as the risks involved. If you and Dr. Fleming decide upon a procedure, our appointment staff will work with you to schedule your surgery. You will be given complete information regarding where and when to arrive, any eating/drinking restrictions prior to your surgery, what to bring with you and the length of your hospital stay. If any testing is required, you will be scheduled for an appointment prior to your surgery.

• What is the best procedure for me?
• Where will you perform the procedure?
• How long have you been doing this procedure?
• How many of these procedures have you performed?
• What are the risks involved?
• How long will recovery take?
• Do you have hospital privileges, and at which hospital?
• Are you board certified in plastic surgery?
• How much will the procedure cost?
• Are there financing options available?
• How are complications handled? 

Dr. Fleming performs his surgeries at Kadlec Regional Medical Center. Most elective surgeries are performed on an outpatient basis, and patients typically go home about an hour or two after the procedure is completed.

If you are contemplating having surgery, it is important to determine whether the facility where your procedure will be performed is certified as safe by one of the credentialing entities such as the Joint Commission, American Association for Accreditation of Ambulatory Surgery Facilities or the Accreditation Association for Ambulatory Health Care.

It's important to learn about the safety of a plastic surgery procedure, as well as the expected outcome. Although thousands of people have plastic surgery every year without complications, no surgical procedure is risk-free.

To maximize your safety, ensure the following:

• That your physician is certified by the American Board of Plastic Surgery (ABPS).
• That your physician has hospital privileges at a reputable hospital. Most cosmetic surgery procedures are performed on an out-patient basis, and can safely be performed at an outpatient surgery center. However, it is important verify that your surgeon has hospital privileges, because this means that he or she has had the proper training, and the correct certification.
• The surgical facility conforms to strict safety standards and is accredited by the Joint Commission, American Association for Accreditation of Ambulatory Surgery Facilities or the Accreditation Association for Ambulatory Health Care.
• The surgical facility uses the appropriately licensed personnel to administer your anesthesia and monitor your recovery immediately following the procedure.

Depending upon what is most appropriate for your particular procedure, Dr. Fleming will decide what type of anesthesia is appropriate. He will answer any questions that you may have.

• Breast: augmentation, lifts, reduction and reconstruction
• Abdominoplasty
• Liposuction
• Facial cosmetic surgery: face-lifts, eye-lifts and otoplasty
• Mommy makeovers

Common procedures performed on men include liposuction, male breast reduction and blepharoplasty.

Depending on the procedure, certain resting positions and ice may help with post-op swelling. Also avoiding medications that thin the blood for two weeks prior to surgery is important.

The length of time it takes to recover after plastic surgery varies depending on the procedure performed and the person operated on. Most patients will require assistance for the first two days following surgery.

Yes. Most Kadlec Clinic Plastic Surgery referrals come from happy and satisfied patients. It is common to have friends and family of our patients travel to the Tri-cities area to have procedures performed by Dr. Fleming.

As a rule, cosmetic plastic surgery is considered “elective surgery” and is not covered by most insurance plans. If the service is not covered by insurance, we work with Care Credit to offer financing options. We encourage you to ask early in the conversation if financing is needed.