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Breast Augmentation
Breast augmentation is a popular cosmetic surgery procedure designed to change the size and shape of a woman's breasts. This procedure can increase the cup size of your breasts and/or balance an asymmetrical appearance. Also known as "augmentation mammaplasty," breast augmentation can also restore fullness to saggy breasts.
Ideal Candidates
It is important to carefully evaluate your goals and expectations regarding breast augmentation surgery, and feel comfortable discussing them with your doctor. During your initial consultation with Dr. David Kim, you should have an even clearer understanding as to whether you are a good candidate for breast enhancement. Overall, ideal patients for breast surgery are women who are healthy, psychologically stable, and looking for improvement - versus perfection - in the way they look. In turn, you will learn about the possible risks and uncertainties associated with breast augmentation.
Your surgeon will also need to know if you smoke, and if you are currently taking any medications, vitamins, or other drugs.
What To Expect From This Procedure
Augmentation mammaplasty is expected to take approximately one hour, and will be performed under a general anesthetic (puts you to sleep). During this cosmetic surgery procedure, a small incision will be made. This is where the doctor will create a pocket in which the implant will be inserted.
Typically, a breast implant can be inserted either under the breast tissue (over the muscle) or under the breast muscle (further below the breast tissue). With the intention of minimizing scaring, incisions can be made in either the armpit (transaxillary incision), along the areola (the darker skin surrounding the nipple known as the periareolar incision), or under the breast at the crease. Depending on the implant and surgeon's preference, an incision can also be made in the belly button to insert the implant (transumbilical breast augmentation or TUBA). The exact location of the implant will depend on your anatomy, the look you want to achieve, and your doctor's recommendation.
Implant Decisions
Essential factors to consider include: size, fill, shape, and exterior cover.
The size of the implants are determined by the volume of liquid inside them. When referring to the size, many medical professionals will use the term "cc." This is short for cubic centimeters - a unit of measurement for volume. Basically, the more cc's in an implant, the bigger your size will be.
Implants can be filled with cc's of either saline or silicone gel (both are FDA approved in the United States), both of which are commonly favored by women seeking enhancement.
Saline is a sterilized solution of salt and water, silicone is composed of a synthetic material, and the newest implants are referred to as "gummy bear implants" - made of dense silicone gel that will not leak. The name "gummy bear" comes from the fact that when they are cut, they don't leak (similar to the candy).
There are two basic shapes of implant: round or anatomical ("teardrop-shaped"). The results you get with each shape greatly depends on your unique anatomy, the amount of breast tissue you have, and how Dr. Kim positions the implants.
The exterior cover to the implant can be either smooth or textured. In general, textured implants have a thicker shell than a smooth exterior cover. To learn the benefits of each, consult Dr. Kim for the details to consider before deciding which is best for you.
Possible Risks
As with all surgery, there are risks to undergoing breast augmentation. Immediate risks include infection and excessive bleeding, especially in the implant pocket. Other problems may develop after the surgery, such as implant deflation, calcification in the pocket, or asymmetry, which may be a result of implant slippage. Capsular contracture may also develop, in which the scar tissue that forms around the implant tightens within the pocket causing the breast to feel hard.
Recovery
It is expected that you will feel sore and tired for a couple of days following your surgery, but the medication Dr. Kim prescribes will help to control most of the discomfort. You should be up and about shortly - in 24 to 48 hours. At first, you will have a gauze dressing that will need to be changed, but eventually will be given a special bra. Swelling in your breasts may take three to five weeks to cease, and your stitches should come out in about a week and a half after your procedure.
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Breast Reduction
Technically called "reduction mammaplasty," breast reduction surgery can make a woman feel more confident by helping to relieve her back pain, neck pain, breathing problems, and skin irritation, which is caused by overly-large breasts. The goal of breast reduction is to create smaller breasts that are better proportioned to her body. This procedure can also reduce the size of the areola (the darker skin surrounding the nipple). Dr. David Kim will work with you to accomplish your beauty goals and relieve you from any unnecessary pain. This is done through the removal of fat, glandular tissue, and skin from the breasts.
Ideal Candidates
This procedure is intended for women who are mainly seeking relief from discomfort or pain versus strictly improving the appearance of their breasts. Teens who are still developing and women who intend to breastfeed may not be good candidates. As with all surgeries, it is important for patients to be free from mental and physical illness.
What to Expect From This Procedure
It is important to discuss your goals and expectations with Dr. Kim, so that you can come to a greater understanding of what breast reduction can do for you.
The most common technique used for breast reduction involves the anchor-shaped incision, in which the doctor makes the incision by circling the areola and extending downward; following the natural curve of the crease beneath the breast. To give the patient a beautiful new bust contour, he will remove breast tissue, fat, and skin. Once that is complete, the doctor will bring the breast flaps down and around the areola.
When repositioning the nipple and areola, the doctor will make every attempt to leave them attached to their original blood vessels and nerves; however for very large breasts, this may not be possible. Dr. Kim would then need to completely remove the nipple and areola and graft them into a higher position. With the crescent-shape incision, stitches are typically located around the areola in a vertical line extending downward, and then run along the lower crease of the breast. After surgery, the patient will be wrapped in bandages, gauze or a surgical bra.
For some women, liposuction used during breast reduction surgery may be necessary. Dr. Kim can help to determine if this option will create optimal results and decide on the best technique for your reduction.
Possible Risks
As with all surgeries, there are the potential risks of infection, bleeding, or reaction to the anesthesia. In particular to breast reduction, there may be a loss of sensation in the breasts, and small sores may form around the nipples. There is the chance that the breasts will result in mismatched size, shape or position (possibility that if reattached, the nipples may be uneven in position). Noticeable and permanent scars are nearly impossible to avoid following breast reduction surgery, but they will lessen over time.
Recovery
Following surgery, it is normal to feel sore (which can be controlled with medication). There may be swelling and bruising, and you may have a small tube inserted in the breast area to allow for drainage. The garments should remain on until to swelling subsides. If your breasts feel dry, it is important to follow the doctor's instructions, and moisturize if needed.
Although the stitches can be removed in a few days, it may take several weeks to return to normal.
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Breast Lift
A "mastopexy," or what is commonly called a breast lift, will return fullness and support to breasts that have grown "saggy" because of natural factors, such as aging, pregnancy, or nursing. This procedure can also reduce the size of the areola (the darker area surrounding the nipple).
The use of breast implants will help to increase firmness of the breasts as well as the size of the breasts.
Ideal Candidates
Patients who have realistic goals and expectations, are in good physical and mental health, and are open to discussion with the doctor are always ideal candidates for surgery. However, patients who plan to have more children are encouraged to postpone breast lift surgery.
What to Expect From This Procedure
During your initial consultation with Dr. David Kim, the two of you will discuss various factors that are involved with breast lift surgery. A patient will come to better understand how her age, the current shape of her breasts, and the elasticity of her skin will influence the plan for surgery and the potential outcome. The surgeon may also discuss the option of breast implants with the patient during this time.
The procedure can take up to three hours, depending on the extent of the surgery, and is done under general anesthesia. The most common procedure involves an anchor-shaped incision (similar to the breast reduction procedure) in which incisions will be made around the areola, in a vertical line stretching from the areola to the breast crease, and then along the breast crease. Once excess skin is removed from these areas, the nipple and areola are moved to a higher position, and the skin surrounding the areola is brought down together to reshape the breast into a more youthful appearance. Stitches are used to close the incisions.
Dr. Kim will help to determine if another technique is best for your condition, such as the "doughnut lift." This is where the scar is only around the areola.
Possible Risks
Some of the common complications associated with any plastic surgery procedure include bleeding, infection, an adverse reaction to the anesthetic. A breast lift will not stop the skin from stretching and the breasts from sagging as a woman continues to age (especially true if she has larger breasts). Potential risks associated with mastopexy include a loss of sensation in your breasts, unevenly positioned nipples, or a permanent loss of feeling in the nipples or breasts.
Recovery
Over the next couple of weeks, you will be given instructions that need to be followed carefully in order to avoid certain complications. Stitches will be removed in a week or two, and a special moisturizer can help to subside dry breast skin.
After surgery you will wear a surgical bra or gauze dressing, which in a few days, will be replaced with a soft support bra. You will probably experience discomfort, swelling, bruising in the initial day or two, and you may even feel a loss of sensation in your nipples or breasts (which should return over time). As prescribed by Dr. Kim, certain medications can help to relieve discomfort or pain.
Numbness and swelling should lessen over time; however, it could take a few weeks to a few months to return to your normal activities.
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Liposuction
Liposuction is a cosmetic procedure that suctions fat from specific areas of the body. Technically called "suction-assisted lipectomy" or "lipoplasty", or liposculpture it is not intended to be a form of weight loss. Rather, it is designed to remove fat from certain "problem" areas that do not respond to dieting or exercising. This may be your midsection, thighs, buttocks, arms, chin, or another small area. Liposuction is a versatile elective procedure that allows patients to reshape their body.
It can also be performed for the treatment of medical conditions such as benign fatty tumors (lipomas) or problems with metabolism of fat in the body (lipodystrophy). However, liposuction cannot treat obesity.
Ideal Candidates
The best patients are average or slightly above-average weight with firm, elastic skin. They are also physically healthy, psychologically stable, realistic in their expectations, and do not have a history of medical complications that resulted from surgery. Men and women who are seeking weight loss through liposuction are poor candidates, because excessive fat removal with plastic surgery can be dangerous. Dr. David Kim will help to determine if you are an ideal candidate for this cosmetic procedure.
What to Expect From This Procedure
In general, a thin round-tipped tube, called a cannula, will be inserted through tiny incisions in your skin. The cannula is attached to a vaccum in order to extract the fat, which will move rapidly under your skin to remove the fat.
The extent of your surgery is important in determining the type of anesthesia to be used; depending on the amount of fat being removed or the number of areas from which fat will be removed. Whether you are put to sleep (general anesthesia) or remain awake in a state of relaxation with a numbed area (sedated with a local anesthetic), the extent of your surgery will also determine the length of the surgery and recovery time.
Common Techniques
Since the development of traditional liposuction, newer techniques have been created for better efficiency:
- Tumescent liposuction: The area where fat will be removed is numbed (under local anesthetic) and flooded with medicine (lidocane and epinephren), causing two major effects. First, the fat expands and becomes firmer, which contributes to an easy fat extraction process. Second, the blood vessels in the area get smaller (constrict); this prevents excessive blood loss, bruising and swelling. This procedure can last from about one to two hours depending on the number of areas involved.
- Super-wet technique: As compared to the tumescent technique, lesser amounts of fluid are used for the super-wet technique. The amount of fat to be removed and the amount of medication injected to the specific site usually equals out. This liposuction technique takes a generally less amount of time than tumescent technique.
- Ultrasound-assisted liposuction: Sound waves, or ultrasonic energy, is used to liquefy the fat, which allows the fat to be smoothly removed. This technique is especially useful for areas where the fat is fibrous or firm, such as the upper back or for male breast reduction. Ultrasound-assisted liposuction typically takes longer to perform than traditional liposuction.
Possible Risks
All surgery carries the risk of unforeseen complications, and at the office of Dr. Kim, you will become familiar with any potential problems associated with the procedure you are considering. Following surgery, there is the possible risk that the skin may be loose. Although the fat has been removed, liposuction does not tighten the skin; however, this may not result for several weeks. Other possible risks include scarring, excessive swelling, infection, and skin discoloration.
Recovery
After treatment, you will probably feel sore, swollen, tender, and possible discomfort from being tightly wrapped. This wrapping is necessary to prevent excessive bruising and swelling. After a few days, you will need to wear compression garments; for example if you have liposuction on your mid-section, you will need to wear a fitting garment.
Returning to normal activity may take a few weeks, but you should be able to do limited activities within a few days. Some improvements to the body will be noticeable immediately after surgery, but the true effect will develop as the body heals and the swelling subsides.
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Abdominoplasty
A tummy tuck, or "abdominoplasty," is designed to produce a more flattering mid-section with the removal of excess skin and fat, and tightening of loose abdominal muscles. This procedure will trim down an unwanted "pouch," produce a flatter abdomen, and help to provide overall body sculpting. For optimal results (and depending on your condition), a tummy tuck can be performed in conjunction with liposuction.
A smaller version, which is called a "partial abdominoplasty" (or mini-tummy tuck), can be performed on a patient whose pouch is primarily in the lower abdomen.
Ideal Candidates
As with all cosmetic procedures, the best candidates for abdominoplasty are those who are in good health in both body and mind, and have realistic goals and expectations. The best patients for tummy tuck surgery are those who are of average or slightly-above average weight, but cannot reduce the excess skin or fat in the abdomen region by dieting and exercise. Patients who intend to lose more weight should postpone this surgery until they reach their desired weight. Also, women who intend to have more children should wait before they decide to undergo abdominoplasty.
What to Expect From This Procedure
A tummy tuck typically takes between two to three hours, depending on if the patient chooses to have another procedure performed in combination with his or her surgery. Abdominoplasty is typically performed under general anesthesia.
During a full tummy tuck, the surgeon will start by making a long incision from hip to hip, which will loosen the skin from the abdominal muscle. A second incision will also be made to free the naval from the surrounding tissue. Next, the doctor will separate the skin from the abdominal wall all the way up to the ribs and lift a large skin flap to reveal the vertical muscles in the abdomen. The muscles are then tightened, pulled close together, and stitched into their new position - providing a firmer abdominal wall and slimmer waistline.
The extra skin is then removed once the skin flap is stretched down. Dr. Kim will create a new hole for the navel, in which it will be stitched into place. Finally, the incisions will be stitched, the dressing will be applied over the abdominal region, and a temporary tube may be inserted to the surgical site in order to drain excess fluid.
During your initial consultation, Dr. Kim will help to determine if a partial abdominoplasty is most conducive to your body.
Possible Risks
Some of the potential complications that are associated with abdominoplasty include infection, blood clots, poor healing with conspicuous scarring or skin loss, fluid collection under the skin, and the need for a second operation.
Recovery
For the first few days following surgery, you will probably feel pain and discomfort (which can be controlled with medication).
Once you leave the hospital, it is imperative that you follow your surgeon's instructions during the initial recovery period, especially in terms of physical activity. These instructions will maximize healing and minimize the potential for complications. These instructions include how to shower, change clothing, and how your body should or shouldn't move.
It may take anywhere from two weeks to a month to return to normal activity, and although it might feel uncomfortable standing up straight initially, walking early on may be encouraged to aid the recovery process. It may take several weeks or months for your final results to appear, and your hip-to-hip scar should lessen over the next year.
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Facelift
A facelift ("rhytidectomy") will help to create a more youthful-looking facial appearance by removing fat deposits in the face and neck, tightening facial muscles, and removing excess skin. This procedure is not permanent because the face will continue to age; however, it is a long-lasting solution to looking younger and refreshed. Rhytidectomy can be performed in conjunction with other procedures, such as eyelid surgery, laser surgery or a brow lift.
Ideal Candidates
The best patients for a facelift are those who have excess, saggy skin with good bone structure, but whose skin still maintains some elasticity. Typically, patients receiving facelifts are between the ages of 40 and 60, but this procedure may also be performed on patients in their 70s and 80s. Individuals who are not good candidates for a facelift surgery are those who are in poor health, have serious medical conditions, and have poor mental health. Additionally, bad candidates are those who have false expectations.(It is important to keep in mind that a facelift cannot stop the process of aging.)
What to Expect From This Procedure
Typically during surgery, a long incision will be made behind the hair line at about the temple. It will stretch in front and around and then behind the ear and extend to the lower hair line. The skin of the face will then be separated from the facial muscles. The tissue overlying the muscles known as the SMAS layer will be tightened next. The skin will than be pulled to lay over the newly-tightened SMAS layer, and stitched or stapled into place. Any scars will be hidden within the scalp. Finally, your face will be wrapped and dressed. If necessary, a tube will be inserted for drainage. A few days later, the stitches or staples will be removed.
Board certified plastic surgeon Dr. David Kim can help to determine if a "mini-facelift," or "mid-facelift," is best for your condition.
Possible Risks
In general, potential problems that might follow include:
- Visible scarring
- Asymmetry between the sides of the face
- An irregular hair line
- The appearance of prominent blood vessels on the face
- Skin discoloration
- Irregularr neck contours
Numbness and loss of muscle control is possible after surgery, but will resolve if no nerve damage has occurred. Other cosmetic risks include the distortion of the earlobe and, specifically in men, the distortion of sideburns and the growth of hair behind their ears.
Although typical complications can occur, such as infection or excessive bleeding, other potential complications include a collection of blood under that skin that must be surgically removed (hematoma). Dr. Kim will help you understand any possible complications or uncertainties before you decide if plastic surgery is right for you.
Recovery
You will be swollen and bruised after surgery, but this can be lessened with the use of cold compresses. The pain around your ears as well as your face can be alleviated with medication.
During your first few days of recovery, you will need to sleep and rest with your head elevated, and you may not be able to shampoo for two to three days. Patients will also be required to limit their activity during this time. It will take about two to three weeks to return to normal, and may take longer for the total results to appear.
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Rhinoplasty
Often referred to as "nose surgery," rhinoplasty is designed to reshape a person's nose by reducing or increasing its size. This procedure can help to create better balance, improve facial contour, and enhance appearance by:
- Changing the shape of the tip or the bridge
- Narrowing the span of the nostrils
- Changing the angle between your nose and your upper lip
- Correcting a birth defect or injury
If you suffer from breathing problems, consult Dr. David Kim to learn if "septorhinoplasty" is an effective solution for your condition.
Ideal Candidates
Plastic surgery does not guarantee perfect results (even though your self-confidence may greatly improve after nose surgery). This is why it is important to evaluate your goals and expectations first. The best patients are those who are realistic in their expectations, physically and psychologically healthy, and willing to engage in discussion with their doctor.
Board certified plastic surgeon Dr. Kim can help you understand the benefits and possible risks associated with rhinoplasty. Teens may not be good candidates if they are still physically developing; emotional maturity and social adjustment are also important factors when considering rhinoplasty on teens.
During consultation, be sure to tell your surgeon if you've had any previous nose surgery or injury to your nose. He will also need to learn of any allergies or breathing difficulties in addition to the details of your medical history.
What to Expect From This Procedure
The main focus of rhinoplasty is to alter the bone and cartilage of your nose, because your skin and connective tissue essentially "hang" on a "frame" of cartilage and bone. During your surgery, small incisions are made on the inside of your nose, or in the columella (skin that separates the nostrils), before a selective amount of soft tissue is separated from the cartilage and bone. The surgeon will than alter the cartilage and/or bone to achieve your desired look; for example, bone may be removed or cartilage may be reshaped. During you consultation with Dr. Kim, you will learn which technique - "open" or "closed" rhinoplasty - is best to utilize for your surgery.
Rhinoplasty is typically performed while under general anesthesia or, depending on the type of nasal procedure, under local anesthesia with a sedative. The length of the surgery depends on the intricacy of the surgery. For instance, altering the size of the nostrils along with the nose can take about one to two hours, but surgery to correct a birth defect is known to last longer because it can be more complicated.
The final step of surgery is the reattachment of soft tissue. Your nose then will be held in place with a splint (similar in idea to splinting a broken arm); a plastic or metal splint will be taped to the outside of your nose, and smaller splints may be placed within your nostril to allow your new nose to heal properly.
Possible Risks
All surgery places you at risk for complications, which even the best surgeons cannot plan for. Bleeding and infection are possible risks that may immediately follow surgery, while some of the long-term complications include red spots (burst blood vessels), scarring, and chronic nasal problems such as excessive drainage, dryness, or sinus headaches. Some of the rare risks include damage to the inside of each eye, a perforated septum (holes in the tissue that separate the nostrils), loss of taste, and permanent numbness to the teeth or top of the mouth.
Rhinoplasty may not correct all breathing problems or produce the desired results, which means an additional surgery may be needed. A second surgery may also be required to correct post-surgical problems, such as collapsed cartilage, obstructions, or polyps.
Recovery
After the anesthetic wears off, it is normal for a patient's nose to ache and for the face to feel swollen. A headache and some bleeding may occur, but most of the pain can be controlled with medication as prescribed by Dr. Kim.
Over the next few days, bruises may form near your eyes. To help minimize this, you must keep your head elevated, even when lying in bed. A cold compress can also minimize the bruising. You will also be asked not to blow your nose, especially if smaller stints are placed in side of your nose.
Over the next few weeks, your splint is removed, although you might still have subtle bruising and a swollen nose. The actual amount of time required to completely recover depends on the extent of your surgery.
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Blepharoplasty
Eyelid surgery removes fat, excess skin, and muscle from around the eye. This can provide a younger-looking and "more awake" appearance. "Blepharoplasty" (eyelid surgery) will also reduce the puffiness that occurs as people get older. Bags that form underneath the eyes can be reduced with a related procedure in which only fat is removed, known as "transconjuctival blepharoplasty."
Eyelid surgery has become popular among many people of Asian descent. For those who wish to add a crease to their eyes, "double eyelid surgery" may be the right solution. This surgery is designed to make the eyes appear somewhat rounder and larger, exposing more of the eyelashes, and making it easier for women to apply eyeliner. Contrary to popular belief, the surgical addition of a crease and removal of puffiness is not intended to erase the ethnicity of your face. Dr. David Kim can help you understand your goals with plastic surgery during an initial consultation.
Ideal Candidates
Eyelid surgery can be successfully performed on adults who maintain realistic expectations and an overall healthy lifestyle, and especially those who do not have dry eyes, an eye infection, or glaucoma. Blepharoplasty may be also risky for people with medical conditions such as Graves' disease, circulatory disorders, cardiovascular disease or diabetes, among others.
What to Expect From This Procedure
All eyelid surgeries typically take approximately one to two hours, usually performed while the patient is awake and relaxed, while under local anesthesia with a sedative (no feeling in and around your eyes). However, if a surgery is done in conjunction with other cosmetic procedures, it may take longer, and a general anesthesia is typically used (putting the patient to sleep). Similarly, a more complicated blepharoplasty procedure might cause the need for a general anesthetic.
Blepharoplasty: An incision will be made in the crease of your upper lid (top eyelid usually worked on first) to separate the muscle from the fat and skin. Depending on the desired results, the fat will be removed and the skin and muscle will be removed and/or tightened. In the lower lid, an incision will be made along the lash line where, again, the skin and fat will be separated from the muscle. Depending on the desired results, fat will be removed and muscle and skin will be tightened and/or removed. Following each surgery, the incision will be closed with very thin sutures, which will need to be removed in two to seven days; however, in some instances, dissolvable stitches can be used.
Dr. Kim will help to determine if "upper eyelid surgery" or "lower eyelid surgery" is more conducive to your condition versus full blepharoplasty.
Transconjunctival blepharoplasty: An incision will be made inside the lower eyelid (instead of the lash line), through which fat will be removed. Dissolvable stitches will then be used to close the incision so that no further procedure is necessary.
Double eyelid surgery: An incision is made to create a crease, from which a crescent-shaped piece of skin will be removed along with some of the underlying fat. The height and depth of the crease depends on the desired results. Finally, the incision is closed with stitches, which will need to be removed in a few days. Tiny white heads may form upon removal of the stitches; however, Dr. Kim can provide a solution for this skin condition following surgery.
Possible Risks
Potential dangers include but are not limited to eye infections and swelling at the corners of the eyelids, as well as asymmetrical healing and scaring. In rare cases, there may be permanent problems closing your eyes or with drooping of the lower lids (ectropion).
Recovery
Your eyes may feel sore, dry, and tight after your procedure, but there are ways to alleviate some of this discomfort, such as with eye drops, ointments and certain medicines. Your eyes will be swollen and bruises might develop around your eye; this could persist for two weeks. Excessive tearing and sensitivity to light may develop over the subsequent days, which will eventually subside.
It is typical to have blurry vision and swelling around the eyes (making blinking, reading and watching television difficult) for a few days. Patients will not be able to wear eyeliner for at least 10 days, and should steer clear of contacts for at least two weeks. In general, it should take about 10 days to return to normal activities.
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Brow Lift
A brow lift, or a "forehead lift," can improve the appearance of deep forehead lines and drooping brows, which is generally due to age or heredity. The furrow lines that make a person look angry can also be diminished with this procedure. The results will be a smoother, more animated appearance to your forehead. A brow lift can also be combined with other procedures to give an overall rested and refreshed look.
It is important to remember that plastic surgery cannot stop the aging process, but with an effective procedure such as a brow lift, you can look forward to a more youthful appearance.
Ideal Candidates
To help minimize some of the most visible signs of aging, a brow lift is commonly performed on adults between 40 to 60 years old. They should be free from mental and physical illness, have realistic goals and expectations, and have pronounced lines and skin overhang on their foreheads. If a patient is bald or has a receding hairline, the doctor can make adjustments to alter the incision location or perform a more conservative operation.
What to Expect From This Procedure
Brow lift surgery may last a one to two hours; however, if combined with another procedure, it can take longer. The surgery is usually done while you are under general anesthesia (asleep), but can be done while the patient is under a local anesthetic with a sedative (very relaxed with a numbed area).
Classic Forehead Lift
For the classic or "open" forehead lift procedure, Dr. David Kim will make a long incision which will run from ear to ear (hair is tied back before surgery and the hair that is growing directly in front of the incision line may need to be trimmed). For bald patients or those with receding hairlines, this incision can be made in different areas.
In getting started, the surgeon will cut along your hairline, remove and tighten skin and muscles, and lift and smooth the eyebrows. Once the incision is made, the surgeon will separate the skin from the muscle on the forehead. Depending on the desired results, the surgeon will then alter the muscle and lay the skin, removing any excess, so that the brows are raised and the entire forehead is smoother and appears more youthful.
Endoscopic Forehead Lift
There is now a variation to the classic brow lift procedure; replacing the long incision with a few short scalp incisions, each less than an inch in length. This is called the "endoscopic brow lift." An endoscope is a small "pencil-like" camera, which is connected to a television monitor; this allows Dr. Kim to clearly view the muscles and tissues beneath the skin as he operates. Similar to the open method, hair is tied back and trimmed, if necessary, prior to surgery.
During the endoscopic brow lift, another instrument will also be inserted through a different incision. The forehead skin will be lifted and the muscles and underlying tissues will be removed or altered to produce a smoother and rejuvenated appearance. In turn, the eyebrows may also be lifted and secured into a higher position. This is done by using sutures beneath the skin's surface or by special, temporary screws placed behind the patient's hairline.
For both brow lift methods, the incisions will be closed with sutures or clips.
Possible Risks
As with any surgery, there is a potential risk for complications, such as infection, bleeding, or reactions to anesthetics. Some of the possible complications associated with brow lift surgery include nerve damage, loss of sensation, a broadened scar, and hair loss along the scar edges. Dr. Kim makes every effort to create incisions in inconspicuous areas, even though hair loss and receding hair lines may still make these once invisible scars visible.
Recovery
Immediate recovery for the classic forehead lift and endoscopic forehead lift may significantly differ.
Classic Forehead Lift
A patient may experience numbness and itching on top of his or her scalp as well as temporary discomfort around the incision, which can be controlled with certain medications. You may be instructed to keep your head elevated for two to three days following surgery to keep any swelling down.
Although permanent hair loss is rare, if hair around the incision has fallen out and temporarily appears a bit thinner, you can anticipate your normal growth to resume within a few weeks or months.
If bandages were used, they will be removed one to two days after surgery. Most stitches or clips will be removed within two weeks, which is sometimes separated into two stages.
Endoscopic Forehead Lift
Similar to recovering from the classic forehead lift, patients may experience some numbness, incision discomfort, and mild swelling.
Incision site pain is usually minimal, but can be controlled with medication. Patients who have undergone the endoscopic forehead lift typically experience less of the itching sensation that is more common among classic forehead lift patients.
The stitches or staples should be removed within a week and the temporary fixation screws within two weeks.
Dr. Kim will help to determine which type of brow lift will best meet your goals.
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Facial Implants
There are several implants that can be used to improve the symmetry of a person's face. By creating a more harmonious balance, facial implants can help a person feel better about his or her appearance. Typically these implants are placed in the jaw, cheeks, or chin. Facial implants can also be performed in conjunction with other procedures, such as facelift surgery, a forehead lift, or eyelid surgery.
Ideal Candidates
The best patients for plastic surgery are those with clear, realistic goals and expectations. Often, people bring pictures to their consultation, which can be helpful for the surgeon, but it must be remembered that there are several factors that must be taken into account to obtain a certain look. For example, the shape of the face must be considered when determining the new jaw line.
People with gum problems may not be ideal for facial implant surgery, because sometimes the incisions are made through the mouth. Also those who are in poor health or who are currently suffering from mental illness are poor candidates for surgery. Teens may be good candidates for this surgery if they have completed development.
What to Expect From This Procedure
An initial consultation with Dr. David Kim will help to determine if a facial implant is the best option for you. Whether you desire chin, jaw, or cheek implant, these procedures are usually performed under a local anesthetic with sedation, but when in conjunction with other surgeries, they may be performed under general anesthesia.
- Chin Implants
Surgery
A chin implant can improve the jaw line or profile of a person's face. To do this, the doctor will make an incision inside the mouth at the base of the lower teeth, along the lower lip. It might also be inserted in the skin just under the chin area. (The doctor will decide on the best size and shape of the implant.) He will then create a pocket in which the implant is inserted and sutured in place. Typically, when surgery is intra-oral (in the mouth) the sutures will dissolve; otherwise they will need to be removed in five to seven days.
Recovery
Surgery done in the mouth may result in difficulty smiling and talking. It is normal to have bruising along the chin and neck. Furthermore, you will need to follow Dr. Kim's specific instructions about how to care for your teeth, the kind of food to avoid, and which activities to restrain from during recovery.
- Jaw Implants
Surgery
During lower jaw augmentation, incisions will be made in the mouth on either side of the lower lip - near the back teeth. A pocket will be created for the implant to sit, and the incision will be closed with dissolvable sutures.
Recovery
Swelling may develop in the first 24 to 48 hours following surgery, and may persist for the next few weeks preventing the full benefits of the surgery from being apparent. Smiling, talking, or moving your mouth in a certain way may be limited several days after surgery. Patients will be given specific instructions for eating, activities, and oral care.
- Cheek Implants
Surgery
Cheek implants can improve the aesthetic quality of the face, and restore a youthful appearance. An incision is made, thorough which a pocket is made and the implant is inserted. If this surgery is being done in conjunction with other cosmetic procedures, the same incision will be used for all procedures. If only cheek implants are being added, than the incision will be made in either the upper jaw inside the upper lip or through the lower eyelid. Stitches will be used to close the incision.
Recovery
You may be swollen and bruised following surgery. There will be specific instructions on how to eat, and what activities should be avoided. If surgery occurs through the mouth you may have difficulty moving your mouth or lips for a short period of time.
Possible Risks
Implants are typically made of silicone, and although this has not been shown to be harmful, common complications such as infection may occur. If the infection does not heal, the implant may need to be temporarily removed and replaced at a later time. Facial implants can potentially shift out of place (additional surgery may need to replace it in its proper position).
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Collagen Injections
As we age, the natural chemicals that keep our faces appearing youthful begin producing at a slower rate; causing lines and wrinkles to form. Dr. David Kim can help you look years younger by injecting collagen into certain areas of your face for rejuvenation.
Collagen, which is a chemical derived from bovine collagen, keeps several parts of the body optimally functioning. It is one of the most popular soft tissue fillers available. This substance can be used to reduce the appearance of fine lines and wrinkles near the eyebrows and around the mouth (nasolabial folds). Collagen injections can also add volume to the lips and cheeks, redefine the shape of the nose, and even reduce the appearance of noticeable scars.
Ideal Candidates
The ideal patient for collagen injections is a patient who is in good health, has realistic goals and expectations, and would like to attain smoother and younger-looking skin. Patients who typically do not qualify for collagen injections are those who are pregnant, are allergic to beef or bovine products, suffer from autoimmune diseases, and/or are allergic to lidocaine (the anesthetic agent that is combined with the collagen material during injection).
What to Expect From This Procedure
To make sure you are not allergic to this substance, a test will be administered into a discrete location on the patient's body about a month prior to receiving this filler. Once the area is clear from any reaction, Dr. Kim will begin the procedure. He will use a fine needle to inject collagen into several places along the intended site. The procedure should only take a few minutes to an hour, depending on the number of areas treated.
Collagen injections are a temporary cosmetic solution, so in order to maintain beautiful results, additional visits may be required.
Possible Risks
The most predominant, possible risk associated with collagen injections is allergic reaction (but this can be avoided with a skin test given ahead of time). Although reports of these risks are rare, some of the complications associated with collagen injections include infection, open sores, skin peeling, scarring, and lumpiness.
Recovery
There is no downtime and bandages are not needed. Patients should be up and about following treatment. They should be able to eat, drink, and wear makeup (and sunblock protection) shortly thereafter.
Directly following treatment, there may be some minor discomfort, stinging or throbbing. Any bruising, swelling, or redness should dissipate within a day.
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Gynecomastia
Men who suffer from gynecomastia, which is the abnormal enlargement of breasts or "female-like breasts," can turn to Dr. David Kim for male breast reduction. This condition is due to the over-development of glandular tissue either because of excessive estrogen or moderate testosterone. It can also be indicative of other medical conditions such as an overactive thyroid, problems with the pituitary gland, adrenal gland or testes; certain medications; or additionally, alcohol, marijuana, methamphetamine and heroine.
Cosmetic surgery can help reduce the development of gynecomastia by removing fat and glandular tissue. In extreme cases, skin can be removed to aid in a flatter, firmer, and better contoured chest. Gynecomastia can occur in males of all ages.
Ideal Candidates
Patients should be in good physical and emotional health, and have a realistic outlook on surgery. Ideal patients should also be of normal weight and have firm, elastic skin. Poor candidates, on the other hand, are men who are overweight, consume excessive alcohol, and use recreational drugs. As with any surgery, smoking at least two weeks before surgery is crucial to the outcome of a patient's results.
What to Expect From This Procedure
An initial consultation may require blood to rule out other underlying medical conditions. The surgery to correct gynecomastia will consist of an incision made to the areola (the darker skin around the nipple). Through this incision, excessive glandular tissue and fat will be removed. The skin will then be sculpted to provide a better contoured appearance, and the incision will be closed with stitches. The chest will be wrapped and dressed with a small drain, which may be inserted to remove excessive fluids. After one to two weeks, the stitches should be removed.
If gynecomastia is due to excessive fat deposits, liposuction may be performed. Again an incision will be made in the areola or in the underarm area, in which a cannula (a slim hollow tube) attached to a vacuum will be inserted to remove the fat.
Possible Risks
Some of the potential complications associated with gynecomastia include infection, excessive bleeding, adverse reaction to anesthesia, and fluid retention in the surgical area. Scars and discoloration of the skin may form, and slight peck asymmetry is a possible risk (although an asymmetrical appearance can most likely be corrected with additional surgery). Some temporary effects include sensitivity or numbness.
Recovery
A patient may feel discomfort for a few days; however certain medication can help to alleviate any pain following surgery. Proper pressure garments will help to minimize any bruising and swelling. It is important to stay out of the sun the first six months, because sunlight can permanently affect the patient's skin by causing it to darken. The resulting scars need to be protected for proper healing.
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How do I find a qualified plastic surgeon?
The best thing is to find someone who is board certified by the American Board of Plastic Surgery. There are many different boards out there but this is the only plastic surgery board recognized by the American Board of Medical Specialties. The ABPS is located in Philadelphia and their contact number is ( 215 ) 587-9322. You can call there to see if your doctor is a board certified plastic surgeon.
Try to get a referral from a friend who's had a good experience. Hopefully their doctor is a board certified plastic surgeon. If you don't have any referrals you can go to www.plasticsurgery.org This is the website for the American Society of Plastic Surgeons. Only board certified plastic surgeons can be members of this organization. A listing of member plastic surgeons can be found on the website Once you find your surgeon go for a consultation and see what he has to say. Different surgeons will have different opinions, different personalities, and different surgical abilities. Therefore, it is wise to do some research and find a surgeon with whom you are comfortable. View some before and after photos. It is important to see if your surgeon's idea of what is aesthetically pleasing, is pleasing to you.
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Who is a good candidate for plastic surgery?
Anyone who is both physically and mentally healthy, who has a realistic expectation as to the outcome of the procedure can be a good candidate.
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How do I ensure a good result?
The honest answer is that there is no way to ensure a good result. The best you can do, is do your research and follow your surgeon's instructions for proper care after the surgery. Doing your research and finding someone to perform an excellent surgery is only half of the process. You must also take proper care of yourself before and afterwards to give yourself the best chance for proper healing. Even if all the instructions are followed on occasion a complication will occur. This is the nature of any surgical procedure. Anyone who tells you they never have complications has either just started practice or is lying. A competent and ethical surgeon will have no reason to lie to you. Therefore,in regards to complications they will most likely tell you, that although complications can occur, with proper planning and proper care they can be kept to a minimum.
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How long will my recovery be?
Recovery will vary from procedure to procedure and also from patient to patient. For example for liposuction recovery may be anywhere from a few days to a week. For a rhinoplasty the recovery time may be longer. The entire healing process can take anywhere from a few weeks to several months.
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What is the best way to do my procedure?
Every procedure has several different ways in which it can be performed. Your surgeon can guide you regarding the advantages and disadvantages of the various methods. Keep in mind that every surgeon will have their own preferences as to what they feel is the best method and what they are more comfortable performing. If you are unsure, get different opinions so that you can decide which method is best for you.
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