Dr. Quigley enjoys plastic surgery because it allows her to solve a wide variety of problems with innovative and often technically challenging procedures. Through the years her practice has evolved to include all types of breast surgery, as well as body contouring including procedures such as abdominoplasty, arm and thigh lifts, and liposuction. She also has a special interest in all types of facial rejuvenation surgery and rhinoplasty.
Dr. Quigley stays current in her techniques by attending meetings and taking courses. A patient's needs are her number one priority. Dr. Quigley's consultations are times for her and the patient to get to know one another. In her opinion, as this is the starting block for a successful doctor-patient relationship.
Arm Lift (Brachioplasty)
An “arm lift” refers to a procedure where the skin and fat that hang on the upper arm is cut off. This procedure leaves a visible scar so the skin really needs to be excessive for you to feel the scar is a reasonable trade. Most of the time this occurs in the weight loss population. If the problem is more of a “thick” upper arm, liposuction is an option. Downtime is 1-2 weeks.
There is a lot of information out there regarding breast augmentation so instead of explaining my philosophy on this I want to define some terms so that hopefully you can have a better consultation.
Submuscular: Implants are under the muscle and under the breast. This position is chosen more often because it has a lower incidence of capsular contracture, rippling, and makes it easier to see breast tissue during a mammogram. The muscle also holds the implant up and minimizes problems in the breast from the weight of the implant.
Subglandular: this means the implant is only under the breast. This position is useful in patients who do a lot of upper body, especially pectoralis muscle, work. Also useful in patients with very widely spaced breasts. When implants are submuscular there is sometimes upward displacement of implants during exercise. This does not occur with subglandular placement. The downside of subglandular is that there is a higher incidence of capsular contracture, rippling, and visible implant edges.
Saline: Saline implants are filled with liquid. Their advantages are that if they wear out it is obvious to the naked eye, and they were felt to have a lower incidence of capsular contracture. They are also less expensive than silicone. Their disadvantage is that they look a little less natural and are more likely than silicone to show rippling.
Silicone: These implants are filled with a silicone gel. The latest silicone gel implants contain a gel called “cohesive gel’. This looks like the inside of a gummy bear. These are not the true “gummy implant”. Those are the anatomic implants which contain a firmer gel. Silicone implants are more expensive than saline and the anatomic implant is the most expensive.
Both types of implants now have lifetime warranties. There is no need to get a new implant every 10 years.
Capsule/ Capsular Contracture
All implants are “foreign’ to your body. Anytime something is placed in your body that is not you, the body’s response is to form a layer of scar tissue around that object to wall it off from the rest of the body. There is nothing wrong with this unless the scar tissue becomes firm. This can make the breast feel hard and can sometimes be painful. This is capsular contracture. It is one of the risks of breast augmentation.
This is meant to help you understand what you might read online or hear from your friends. As with all procedures, a consult with a plastic surgeon is the only way to truly know your options.
Breast Lift (Mastopexy)
Breast lifts or Mastopexy tighten the skin of the breast without removing breast tissue. The breasts may enlarge with pregnancy and go away after breastfeeding leaving stretched out skin. Or the breasts may shrink with weight loss, leaving stretch out skin. The point of a Mastopexy, besides tightening the skin, is to move the nipple up on the breast.
There are three types of Mastopexy
Periareolar – scar is only around the areola. This can only move the nipple up about an inch and is often combined with implants.
Lollipop – So named because the position of the scar looks like a lollipop.
Full Mastopexy – This is necessary when there is a great deal of droop. The scar looks like an “anchor” or “inverted T”.
An implant can be added with any of the lifts. Downtime is around a week. Risks include loss of feeling in the nipple and noticeable scars.
Most patients, when given a diagnosis of breast cancer, are referred to a plastic surgeon for a consultation, but with all the new & often unexpected facts running through your mind it easy to get confused. I would like to begin by clarifying some terms.
Lumpectomy – only the cancerous portion of the breast is removed. If you have a lumpectomy you will have radiation after surgery. Once your breast has been radiated it makes future surgery more difficult. If you are considering a lumpectomy, I am always glad to tell you what kind of aesthetic result you will get from this procedure.
Mastectomy – In a mastectomy the entire breast is removed. Whether or not you need radiation depends on your tumor. Most patients do not need radiation. A nipple sparing mastectomy means the breast surgeon keeps the nipple & areola. Whether or not you are a candidate for this depends on your tumor & the amount of droop or ptosis your breast has. The decision on unilateral or bilateral mastectomies should be made between you and your breast surgeon. We can always make your remaining breast match the reconstructed side (yes insurance covers this).
Types of Reconstruction
Tissue expanders: These are a stiffer version of saline implants that can be put in at the time of a mastectomy or years later. They stretch the skin and muscle until we have the size we want & then they are exchanged for a permanent implant at a second surgery. This is the most common way to do breast reconstruction, and is the procedure of choice in nearly 100% of bilateral reconstructions.
Flaps: this means some of your own tissue is brought in from somewhere else on your body to reconstruct a breast. There are 3 different types
Free Flap: Tissue is totally removed from one area & transferred to the chest where the blood vessels are sewn to vessels on the chest wall. The surgery is lengthy, only certain doctors do it & the risks are higher.
TRAM Flap: In this operation a portion of your abdomen, along with a muscle to give the tissue blood supply, is tunneled under the abdomen into the chest. Not everyone has enough tissue here to make a breast, taking the muscle weakens the abdominal wall & the operation takes longer & isn’t always successful. I no longer do this for bilateral reconstructions as this weakens the abdomen too much.
Latissimus Flap: In this surgery skin and muscle from the back are passed under the arm & into the front part of the chest. You still need an implant with this surgery. If you need to have radiation it may be necessary to use this flap to bring in soft, pliable skin and to cover an implant. It is also useful to make a breast that is a little lower & more natural looking to match an opposite breast.
Which of these types of reconstruction is best for you is a decision made between you, your breast surgeon, & your plastic surgeon.
This procedure makes the breasts smaller but it also lifts them. Insurance may cover the procedure, depending on how much breast tissue is removed.
Downtime is 1-3 weeks depending on the size of your breasts and your age and general health.
Brow lifts can be done endoscopically or through an incision in the hair. Since so many people achieve some correction in forehead lines with Botox, this procedure is not done as often as blepharoplasty or face lift, but when it is indicated the results are quite good. It not only raises the brow position, which makes you look happier, if your brows are horizontal but can raise a low hairline and remove forehead lines. I do not do the endoscopic brow lift because I don’t feel it is long lasting. Downtime is a few days. Click here to learn more.
Eyelid Rejuvenation (Blepharoplasty)
This surgical procedure counteracts the effects of aging on the eyes. The procedure can be done on the upper eyelids, the lower eyelids or both. Eyelid skin usually starts to sag in the 40s. These procedures remove excess skin and fat, if present, to tighten the eyes and reduce puffiness. Upper lids can easily be done in the office under local anesthesia. Discomfort and downtime are minimal.
A facelift treats the part of the face from the cheekbone to the base of the throat. The scars are hidden in front of and behind the ears. What is done during surgery is tailored to the specific need of your face and neck, and can involve some liposuction and muscle tightening, as well as skin excision.
Day lifts are advertised to have little down time but are not as involved as a full facelift, usually just cutting out some skin in front of the ear. In a full facelift the skin is lifted off the muscles of the face so it can be repositioned and the pull of these muscles changed which help define the neck and jawline as well as lift the cheeks.
A full facelift is a major undertaking with a down time proportionate to the amount of work done, but in the neighborhood of 10 days.
I do this procedure under general anesthesia because I think this is less stressful for both of us.
Most patients don’t want to publicize the fact that they have had a facelift and that is why I don’t have before and after pictures online.
There are many options out there to remove unwanted fat from your body, several offering office procedures with minimal down time, such as:
In this procedure a laser produces heat that in theory “melts” the fat and then your body absorbs the melted fat, eliminating the need for the suction part of liposuction. Fat is fragile and when traumatized forms dense scar tissue, which is extremely common after this procedure. The laser may also burn the overlying skin.
In this procedure warm fluid is injected to “melt” the fat and then it is suctioned out. This is similar to traditional liposuction using the tumescent technique. This procedure and laser liposuction have risks similar to liposuction but probably a little higher because they are performed by non-plastic surgeons.
this is the least invasive of the three procedures. Plates compress an area of skin and fat, using cold to kill fat cells. This then relies on the body to remove these cells. Down time is minimal but it may take months to see results which probably come from the trauma to the fat from the cold as well as the compression. This may require multiple treatments.
So what is the difference between these procedures and what we know as “liposuction”? Most plastic surgeons, including myself, use tumescent technique, which means that saline (a solution most like natural body fluids) is injected into the area to be suctioned. Usually the amount of saline injected equals the amount of fat suctioned out. Traditional liposuction uses probes connected to suctions to remove the fat which has been “loosened” so to speak by the saline.
In areas where the fat is denser, such as the abdomen, love handles, and buttocks, something more is needed to loosen the fat and in these instances we use ultrasonic liposuction to heat the fat gently with ultrasound so it can then be suctioned out easier.
It is obvious that the aqua lipo, laser lipo, and cool sculpt are easier and less invasive, however, they are not cheap, the results are highly variable, and most of the time these procedures are not done by plastic surgeons. The reason we use liposuction is that it can be used on any area of the body not just the abdomen. It removes the fat directly, instead of relying on your body to do it and you are not limited by local anesthesia with regard to how much you can do.
The next question, why a plastic surgeon? It takes a lot of training and experience to know who is a good candidate, how to avoid complications, and how to manage patient post-op to get optimal results. Plastic surgeons are the only group of doctors who have spent years learning to do this, not just a weekend course.
Nose Reshaping (Rhinoplasty)
This is a surgery to change the appearance of your nose. The nose has 3 distinct areas upper bony portion, middle cartilage, & tip cartilage. The nasal septum is cartilage & bone & runs up the center of your nose.
Depending on the appearance of your nose, one or all areas can be changed. Downtime varies with the extent of the surgery and can be from 3-10 days. If an “open” technique is used, it may take a year to lose all the swelling but you are usually quite presentable in 2-3 weeks.
You are a candidate for a thigh lift if the skin of your inner thigh is thin and loosely stretched. Liposuction is often combined with a thigh lift to remove the fat making the cylindrical shape of the leg smaller. Like and arm lift, you have to confirm whether you have enough extra skin to make a visible scar worth it, because if excess skin extends beyond the upper 1/3 of the leg, a scar will show down the inside of the thigh.
Skin and fat are removed from the inner aspect of the leg and the skin is closed leaving a scar up the inside of the leg.
This is the hardest of all body contouring procedures to recover from. Blood vessels are larger in the thigh than other body parts. As a result, recovery involves swelling and takes about 4-6 weeks. Risks such as bleeding or chronic swelling are higher with a thigh lift than other procedures. As with the other procedures, garments and occasionally drains are used to help with this.
Tummy Tuck (Abdominoplasty)
As discussed in liposuction, there are a lot of things out there that say they will help your abdomen. The problem here is that liposuction, Cool Sculpt, Aqua Lipo, etc. all need good skin to give a result you will be happy with. Abdominal skin doesn’t have the elasticity of back and thigh skin so if your skin has been stretched out by pregnancy or weight gain/loss, you probably need something that will tighten the skin.
Abdominoplasty or tummy tuck cuts out the extra skin and fat as well as tightening the abdominal muscle.
The procedure does leave scars, but they are fairly well hidden. The recovery is longer (probably 1-2 weeks), and the risks (bleeding, infection, blood clots) are higher than with liposuction.
You can spend almost as much money on these “non-invasive” procedures and be left with an abdomen that looks the same or sometimes worse.
In the end, it takes a consult with a plastic surgeon to truly know your options.
University of Missouri St. Louis
St. Louis, MO, January 1969-August 1972, B.A. Biology
University of Kentucky School of Engineering
Lexington, KY, 1973-1975
University of Kentucky School of Medicine
Lexington, KY, 1975-1979
University of Kentucky Medical Center
Lexington, KY, July 1979-June 1984
University of Kentucky Medical Center
Lexington, KY, July 1984-June 1985
University of Tennessee, Plastic Surgery Residency Program
Memphis, TN, July 1986-June 1988
American Board of Surgery, December 1987
American Board of Plastic Surgery, 1990
Tennessee and Mississippi
Memphis and Shelby County Medical Society
Tennessee Medical Association
American Society of Plastic Surgeons
Southeastern Society of Plastic & Reconstructive Surgeons
The American Society for Aesthetic Plastic Society
Nashville, TN, July 1985-June 1986
Nashville, TN, July 1985-June 1986