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Breast Augmentation
Increasing the volume or size of the breasts surgically is called augmentation mammaplasty. If breasts are excessively small in proportion to the torso or hips, a figure imbalance exists which may limit clothing options or detract from your feeling about your figure. Using our latest techniques, Dr. Shamoun can selectively fill all areas of your breast, meeting your desires for shape as well as size.
Who is a good candidate?
Women who wish to have larger breasts or have breast asymmetry
What will the results be?
Adds fullness to the breasts
Is it done at an office or hospital?
Hospital or office depending on surgeon
How long does it take?
1-2 hours, varying with surgeon
What kind of anesthetic is used?
Local or general anesthesia as desired
What are the risks?
Minor, moderate and some severe problems
How long is recovery?
Discoloration, hardness and swelling for 2-6 weeks, possible firmness
When can regular life style resume?
2-6 weeks
When can make-up be used again?
Doesn't apply
When can bath/shampoo begin again?
When released to do so by your surgeon
How lasting are results?
Long Term. May protect against future sagging
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Breast Reconstruction
If you're considering breast reconstruction...
Reconstruction of a breast that has been removed due to cancer or other disease is one of the most rewarding surgical procedures available today. New medical techniques and devices have made it possible for surgeons to create a breast that can come close in form and appearance to matching a natural breast. Frequently, reconstruction is possible immediately following breast removal (mastectomy), so the patient wakes up with a breast mound already in place, having been spared the experience of seeing herself with no breast at all.
But bear in mind, post-mastectomy breast reconstruction is not a simple procedure. There are often many options to consider as you and your doctor explore what's best for you.
This information will give you a basic understanding of the procedure -- when it's appropriate, how it's done, and what results you can expect. It can't answer all of your questions, since a lot depends on your individual circumstances. Please be sure to ask your surgeon if there is anything you don't understand about the procedure.
The best candidates for breast reconstruction
Most mastectomy patients are medically appropriate for reconstruction, many at the same time that the breast is removed. The best candidates, however, are women whose cancer, as far as can be determined, seems to have been eliminated by mastectomy.
Still, there are legitimate reasons to wait. Many women aren't comfortable weighing all the options while they're struggling to cope with a diagnosis of cancer. Others simply don't want to have any more surgery than is absolutely necessary. Some patients may be advised by their surgeons to wait, particularly if the breast is being rebuilt in a more complicated procedure using flaps of skin and underlying tissue. Women with other health conditions, such as obesity, high blood pressure, or smoking, may also be advised to wait.
In any case, being informed of your reconstruction options before surgery can help you prepare for a mastectomy with a more positive outlook for the future.
All surgery carries some uncertainty and risk
Virtually any woman who must lose her breast to cancer can have it rebuilt through reconstructive surgery. But there are risks associated with any surgery and specific complications associated with this procedure.
In general, the usual problems of surgery, such as bleeding, fluid collection, excessive scar tissue, or difficulties with anesthesia, can occur although they're relatively uncommon. And, as with any surgery, smokers should be advised that nicotine can delay healing, resulting in conspicuous scars and prolonged recovery. Occasionally, these complications are severe enough to require a second operation.
If an implant is used, there is a remote possibility that an infection will develop, usually within the first two weeks following surgery. In some of these cases, the implant may need to be removed for several months until the infection clears. A new implant can later be inserted.
The most common problem, capsular contracture, occurs if the scar or capsule around the implant begins to tighten. This squeezing of the soft implant can cause the breast to feel hard. Capsular contracture can be treated in several ways, and sometimes requires either removal or "scoring" of the scar tissue, or perhaps removal or replacement of the implant.
Reconstruction has no known effect on the recurrence of disease in the breast, nor does it generally interfere with chemotherapy or radiation treatment, should cancer recur. Your surgeon may recommend continuation of periodic mammograms on both the reconstructed and the remaining normal breast. If your reconstruction involves an implant, be sure to go to a radiology center where technicians are experienced in the special techniques required to get a reliable x-ray of a breast reconstructed with an implant.
Women who postpone reconstruction may go through a period of emotional readjustment. Just as it took time to get used to the loss of a breast, a woman may feel anxious and confused as she begins to think of the reconstructed breast as her own.
Planning your surgery
You can begin talking about reconstruction as soon as you're diagnosed with cancer. Ideally, you'll want your breast surgeon and your plastic surgeon to work together to develop a strategy that will put you in the best possible condition for reconstruction.
After evaluating your health, your surgeon will explain which reconstructive options are most appropriate for your age, health, anatomy, tissues, and goals. Be sure to discuss your expectations frankly with your surgeon. He or she should be equally frank with you, describing your options and the risks and limitations of each. Post-mastectomy reconstruction can improve your appearance and renew your self-confidence -- but keep in mind that the desired result is improvement, not perfection.
Your surgeon should also explain the anesthesia he or she will use, the facility where the surgery will be performed, and the costs. In most cases, health insurance policies will cover most or all of the cost of post-mastectomy reconstruction. Check your policy to make sure you're covered and to see if there are any limitations on what types of reconstruction are covered.
Preparing for your surgery
Your oncologist and your plastic surgeon will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications.
While making preparations, be sure to arrange for someone to drive you home after your surgery and to help you out for a few days, if needed.
Where your surgery will be performed
Breast reconstruction usually involves more than one operation. The first stage, whether done at the same time as the mastectomy or later on, is usually performed in a hospital.
Follow-up procedures may also be done in the hospital. Or, depending on the extent of surgery required, your surgeon may prefer an outpatient facility.
Types of anesthesia
The first stage of reconstruction, creation of the breast mound, is almost always performed using general anesthesia, so you'll sleep through the entire operation.
Follow-up procedures may require only a local anesthesia, combined with a sedative to make you drowsy. You'll be awake but relaxed, and may feel some discomfort.
Types of implants
If your surgeon recommends the use of an implant, you'll want to discuss what type of implant should be used. A breast implant is a silicone shell filled with either silicone gel or a salt-water solution known as saline.
Because of concerns that there is insufficient information demonstrating the safety of silicone gel-filled breast implants, the Food & Drug Administration (FDA) has determined that new gel-filled implants should be available only to women participating in approved studies. This currently includes women who already have tissue expanders (see below under Skin Expansion), who choose immediate reconstruction after mastectomy, or who already have a gel-filled implant and need it replaced for medical reasons. Eventually, all patients with appropriate medical indications may have similar access to silicone gel-filled implants.
The alternative saline-filled implant, a silicone shell filled with salt water, continues to be available on an unrestricted basis, pending further FDA review.
As more information becomes available, these FDA guidelines may change. Be sure to discuss current options with your surgeon. (Above guidelines are current as of July 1992.)
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Breast Reduction
Who is a good candidate?
Women of all ages with very large breasts causing discomfort or appearance problems
What will the results be?
Lifts and reduces breast size to improve contour
Is it done at an office or hospital?
Hospital or office depending on surgeon
How long does it take?
2-4 hours, varying with surgeons
What kind of anesthetic is used?
General anesthesia depending on size of reduciton
Whar are the risks?
Minor, moderate and some severe problems
How long is recovery?
Stitches removed in 1-3 weeks depending on surgeon
When can regular life style resume?
2-4 weeks
When can make-up be used again?
Doesn't apply
When can bath/shampoo begin again?
When released to do so by your surgeon
How lasting are results?
Long Term affected by significant weight gain or loss, birth control pills or pregnancy
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Breast Lift
If you're considering a breast lift...
Over the years, factors such as pregnancy, nursing, and the force of gravity take their toll on a woman's breasts. As the skin loses its elasticity, the breasts often lose their shape and firmness and begin to sag. Breastlift, or mastopexy, is a surgical procedure to raise and reshape sagging breasts--at least, for a time. (No surgery can permanently delay the effects of gravity.) Mastopexy can also reduce the size of the areola, the darker skin surrounding the nipple. If your breasts are small or have lost volume--for example, after pregnancy--breast implants inserted in conjunction with mastopexy can increase both their firmness and their size. If you're considering a breast lift, this brochure will give you a basic understanding of the procedure--when it can help, how it's performed, and what results you can expect. It can't answer all of your questions, since a lot depends on your individual circumstances. Please be sure to ask your doctor if there is anything about the procedure you don't understand.
The best candidates for breast lift
A breast lift can enhance your appearance and your self-confidence, but it won't necessarily change your looks to match your ideal, or cause other people to treat you differently. Before you decide to have surgery, think carefully about your expectations and discuss them with your surgeon. The best candidates for mastopexy are healthy, emotionally-stable women who are realistic about what the surgery can accomplish. The best results are usually achieved in women with small, sagging breasts. Breasts of any size can be lifted, but the results may not last as long in heavy breasts. Many women seek mastopexy because pregnancy and nursing have left them with stretched skin and less volume in their breasts. However, if you're planning to have more children, it may be a good idea to postpone your breast lift. While there are no special risks that affect future pregnancies (for example, mastopexy usually doesn't interfere with breast-feeding), pregnancy is likely to stretch your breasts again and offset the results of the procedure.
All surgery carries some uncertainty and risk
A breast lift is not a simple operation, but it's normally safe when performed by a qualified plastic surgeon. Nevertheless, as with any surgery, there is always a possibility of complications or a reaction to the anesthesia. Bleeding and infection following a breast lift are uncommon, but they can cause scars to widen. You can reduce your risks by closely following your physician's advice both before and after surgery.
Mastopexy does leave noticeable, permanent scars, although they'll be covered by your bra or bathing suit. (Poor healing and wider scars are more common in smokers.) The procedure can also leave you with unevenly positioned nipples, or a permanent loss of feeling in your nipples or breasts.
Planning your surgery
In your initial consultation, it's important to discuss your expectations frankly with your surgeon, and to listen to his or her opinion. Every patient--and every physician, as well--has a different view of what is a desirable size and shape for breasts.
The surgeon will examine your breasts and measure them while you're sitting or standing. He or she will discuss the variables that may affect the procedure--such as your age, the size and shape of your breasts, and the condition of your skin--and whether an implant is advisable. You should also discuss where the nipple and areola will be positioned; they'll be moved higher during the procedure, and should be approximately even with the crease beneath your breast.
Your surgeon should describe the procedure in detail, explaining its risks and limitations and making sure you understand the scarring that will result. He or she should also explain the anesthesia to be used, the type of facility where the surgery will be performed, and the costs involved.
Don't hesitate to ask your doctor any questions you may have, especially those regarding your expectations and concerns about the results.
Preparing for your surgery
Depending on your age and family history, your surgeon may require you to have a mammogram (breast x-ray) before surgery. You'll also get specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications.
While you're making preparations, be sure to arrange for someone to drive you home after your surgery and to help you out for a few days if needed.
Where your surgery will be performed
Your breast lift may be performed in a hospital, an outpatient surgery center, or a surgeon's office-based facility. It's usually done on an outpatient basis, for cost containment and convenience. If you're admitted to the hospital as an inpatient, you can expect to stay one or two days.
Types of anesthesia
Breast lifts are usually performed under general anesthesia, which means you'll sleep through the operation. In selected patients--particularly when a smaller incision is being made--the surgeon may use local anesthesia, combined with a sedative to make you drowsy. You'll be awake but relaxed, and will feel minimal discomfort.
The surgery
Mastopexy usually takes one and a half to three and a half hours. Techniques vary, but the most common procedure involves an anchor-shaped incision following the natural contour of the breast. The incision outlines the area from which breast skin will be removed and defines the new location for the nipple. When the excess skin has been removed, the nipple and areola are moved to the higher position. The skin surrounding the areola is then brought down and together to reshape the breast. Stitches are usually located around the areola, in a vertical line extending downwards from the nipple area, and along the lower crease of the breast.
Some patients, especially those with relatively small breasts and minimal sagging, may be candidates for modified procedures requiring less extensive incisions. One such procedure is the "doughnut (or concentric) mastopexy," in which circular incisions are made around the areola, and a doughnut-shaped area of skin is removed.
If you're having an implant inserted along with your breast lift, it will be placed in a pocket directly under the breast tissue, or deeper, under the muscle of the chest wall.
After your surgery
After surgery, you'll wear an elastic bandage or a surgical bra over gauze dressings. Your breasts will be bruised, swollen, and uncomfortable for a day or two, but the pain shouldn't be severe. Any discomfort you do feel can be relieved with medications prescribed by your surgeon.
Within a few days, the bandages or surgical bra will be replaced by a soft support bra. You'll need to wear this bra around the clock for three to four weeks, over a layer of gauze. The stitches will be removed after a week or two.
If your breast skin is very dry following surgery, you can apply a moisturizer several times a day. Be careful not to tug at your skin in the process, and keep the moisturizer away from the suture areas.
You can expect some loss of feeling in your nipples and breast skin, caused by the swelling after surgery. This numbness usually fades as the swelling subsides over the next six weeks or so. In some patients, however, it may last a year or more, and occasionally it may be permanent.
Getting back to normal
Healing is a gradual process. Although you may be up and about in a day or two, don't plan on returning to work for a week or more, depending on how you feel. And avoid lifting anything over your head for three to four weeks. If you have any unusual symptoms, don't hesitate to call your surgeon.
Your surgeon will give you detailed instructions for resuming your normal activities. You may be instructed to avoid sex for a week or more, and to avoid strenuous sports for about a month. After that, you can resume these activities slowly. If you become pregnant, the operation should not affect your ability to breast-feed, since your milk ducts and nipples will be left intact.
Your new look
Your surgeon will make every effort to make your scars as inconspicuous as possible. Still, it's important to remember that mastopexy scars are extensive and permanent. They often remain lumpy and red for months, then gradually become less obvious, sometimes eventually fading to thin white lines. Fortunately, the scars can usually be placed so that you can wear even low-cut tops.
You should also keep in mind that a breast lift won't keep you firm forever--the effects of gravity, pregnancy, aging, and weight fluctuations will eventually take their toll again. Women who have implants along with their breast lift may find the results last longer.
Your satisfaction with a breast lift is likely to be greater if you understand the procedure thoroughly and if your expectations are realistic.
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Liposuction
Who is a good candidate?
20s and up with local collections of excess fat not reduced by exercise
What will the results be?
Removes pockets of fat from thighs, knees, stomach, hips, legs or chin and neck
Is it done at an office or hospital?
Office for small volumes, hospitalization for greater volumes
How long does it take?
1-2 hours, varying with surgeons
What kind of anesthetic is used?
Local or general anesthesia as desired
Whar are the risks?
Minor, moderate and rarely severe problems
How long is recovery?
Swelling and numbness for 6–8 weeks
When can regular life style resume?
Often within 7–10 days
When can make-up be used again?
Doesn't apply
When can bath/shampoo begin again?
When released to do so by your surgeon
How lasting are results?
Long Term provided no major weight gain
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Tummy Tuck
Who is a good candidate?
20s and up with redundant skin of abdomen especially after pregnancy or weight loss
What will the results be?
Tightens abdomen and reduces hanging skin folds
Is it done at an office or hospital?
Either
How long does it take?
2-4 hours, varying with surgeons
What kind of anesthetic is used?
General anesthesia
Whar are the risks?
Minor, moderate and some severe problems
How long is recovery?
Restricted activity for 4-6 weeks
When can regular life style resume?
Usually 2-6 weeks
When can make-up be used again?
Doesn't apply
When can bath/shampoo begin again?
When released to do so by your surgeon
How lasting are results?
Long Term provided no major weight gain
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Facelift
Who is a good candidate?
Usually over age 40 with sagging skin
What will the results be?
Shapes face & neck; muscles may be tightened and fat removed
Is it done at an office or hospital?
Office or hospital depending on surgeon
How long does it take?
2-5 hours, varying with surgeon
What kind of anesthetic is used?
Local or general anesthesia as desired
Whar are the risks?
Minor, moderate and some severe problems
How long is recovery?
Most of swelling and discoloring gone in 2-3 weeks
When can regular life style resume?
2-3 weeks
When can make-up be used again?
10-14 days
When can bath/shampoo begin again?
When released to do so by your surgeon
How lasting are results?
3-15 years
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Necklift
Who is a good candidate?
Usually over age 40 with sagging skin
What will the results be?
Shapes face & neck; muscles may be tightened and fat removed
Is it done at an office or hospital?
Office or hospital depending on surgeon
How long does it take?
2-5 hours, varying with surgeon
What kind of anesthetic is used?
Local or general anesthesia as desired
Whar are the risks?
Minor, moderate and some severe problems
How long is recovery?
Most of swelling and discoloring gone in 2-3 weeks
When can regular life style resume?
2-3 weeks
When can make-up be used again?
10-14 days
When can bath/shampoo begin again?
When released to do so by your surgeon
How lasting are results?
3-15 years
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Eyelid Surgery
Who is a good candidate?
Anyone with bags of sagging eyelid skin not caused by heavy brows
What will the results be?
Eyes look fresher, less tired, removes drooping tissue and bags but not sagging eyebrows
Is it done at an office or hospital?
Office or hospital depending on surgeon
How long does it take?
1-2 hours, varying with surgeons
What kind of anesthetic is used?
Local or general anesthesia as desired
Whar are the risks?
Minor, moderate and some severe problems
How long is recovery?
Swelling and bruising for 2-3 weeks
When can regular life style resume?
3 days - 3 weeks
When can make-up be used again?
6-10 days
When can bath/shampoo begin again?
When released to do so by your surgeon, but usually not before sutures are removed
How lasting are results?
5-10 years
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Brow Lift
Background:
A forehead lift, also called a brow lift, corrects the sagging or low position of the eyebrows that can cause a tired or sad look. The procedure softens horizontal creases across the forehead. It is often performed to treat conditions associated with aging, and is also appropriate for treatment of certain inherited traits.
Technique:
The surgical technique recommended will depend on the position of the eyebrows, the amount of excess upper eyelid skin, and the height of the hairline. In many instances, an incision is made across the top of the scalp, beginning above the ears and hidden within the hair. Sometimes the incision may be placed at the front of the hairline or, in some cases, toward the middle of the scalp. Through the forehead lift incision, the plastic surgeon can modify or remove parts of the muscles that cause wrinkling and frown lines, remove excess skin, and lift the eyebrows. Another forehead lift technique uses an endoscope, a long, thin tube with a light on the end, attached to a video camera. The endoscope is inserted through several tiny incisions in the scalp and allows the plastic surgeon to see and work on the various internal structures of the forehead. The endoscopic technique requires minimal incisions, but in some instances, alternate methods may be preferable, or a combination of endoscopic and other techniques may be used.
Benefits:
• Although the aging process continues, patient satisfaction remains high.
• Incisions are designed to be inconspicuous when healed.
• Usually performed on an outpatient basis.
• Patient can typically resume most normal activities within 10 days.
Other Considerations:
• If there is significant skin overhang in the upper eyelids, or puffy bags beneath the eyes, eyelid surgery may be recommended in addition to a forehead lift.
• Temporary puffiness and discoloration may involve the eyelid and cheek areas.
• Temporary numbness and possibly some itching of the scalp can be expected.
• Recovery time varies greatly.
• Every surgery carries some risk. Potential complications could include reaction to anesthesia, hematoma (an accumulation of blood under the skin that might require removal), and infection.
• Patient should temporarily avoid exposure to direct sunlight and, for the long term, be conscientious about use of a sun block.
Provided by The American Society for Aesthetic Plastic Surgery (ASAPS)
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Nose Surgery
Who is a good candidate?
All ages, after full growth and those with appearance or airway problems
What will the results be?
Modest to great change of external nasal appearance and improved airway
Is it done at an office or hospital?
Office or hospital depending on surgeon
How long does it take?
1-3 hours, varying with surgeons
What kind of anesthetic is used?
Local or general anesthesia as desired
What are the risks?
Minor, moderate and rarely severe problems
How long is recovery?
Final splints removed in 3-14 days depending on surgeon, Minimal to No pain
When can regular life style resume?
10-30 days
When can make-up be used again?
After splints are off 3-10 days
When can bath/shampoo begin again?
When released to do so by your surgeon
How lasting are results?
Long Term
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Ear Surgery
If you're considering ear surgery...
Ear surgery, or otoplasty, is usually done to set prominent ears back closer to the head or to reduce the size of large ears.
For the most part, the operation is done on children between the ages of four and 14. Ears are almost fully grown by age four, and the earlier the surgery, the less teasing and ridicule the child will have to endure. Ear surgery on adults is also possible, and there are generally no additional risks associated with ear surgery on an older patient.
If you're considering ear surgery for yourself or your child, this information will give you a basic understanding of the procedure-when it can help, how it's performed, and what results you can expect. It can't answer all of your questions, since a lot depends on your individual circumstances. Please be sure to ask your doctor if there is anything you don't understand about the procedure.
All surgery carries some uncertainty and risk
When ear surgery is performed by a qualified, experienced surgeon, complications are infrequent and usually minor. Nevertheless, as with any operation, there are risks associated with surgery and specific complications associated with this procedure.
A small percentage of patients may develop a blood clot on the ear. It may dissolve naturally or can be drawn out with a needle.
Occasionally, patients develop an infection in the cartilage, which can cause scar tissue to form. Such infections are usually treated with antibiotics; rarely, surgery may be required to drain the infected area.
Planning for surgery
Most surgeons recommend that parents stay alert to their child's feelings about protruding ears; don't insist on the surgery until your child wants the change. Children who feel uncomfortable about their ears and want the surgery are generally more cooperative during the process and happier with the outcome.
In the initial meeting, your surgeon will evaluate your child's condition, or yours if you are considering surgery for yourself, and recommend the most effective technique. He or she will also give you specific instructions on how to prepare for surgery.
Where the surgery will be performed
Ear surgery is usually performed as an outpatient procedure in a hospital, a doctor's office-based surgical facility, or a freestanding surgery center. Occasionally, your doctor may recommend that the procedure be done as an inpatient procedure, in which case you can plan on staying overnight in the hospital.
Types of anesthesia
If your child is young, your surgeon may recommend general anesthesia, so the child will sleep through the operation. For older children or adults, the surgeon may prefer to use local anesthesia, combined with a sedative, so you or your child will be awake but relaxed.
The surgery
Ear surgery usually takes about two to three hours, although complicated procedures may take longer. The technique will depend on the problem.
With one of the more common techniques, the surgeon makes a small incision in the back of the ear to expose the ear cartilage. He or she will then sculpt the cartilage and bend it back toward the head. Non-removable stitches may be used to help maintain the new shape. Occasionally, the surgeon will remove a larger piece of cartilage to provide a more natural-looking fold when the surgery is complete.
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Laser Skin Resurfacing
If you're considering laser resurfacing ...
In laser resurfacing, sometimes called "laser peel," a carbon dioxide (CO2) laser is used to remove areas of damaged or wrinkled skin, layer by layer. The procedure is most commonly used to minimize the appearance of fine lines, especially around the mouth and the eyes. However, it is also effective in treating facial scars or areas of uneven pigmentation.
Laser resurfacing may be performed on the whole face or in specific regions. Often, the procedure is done in conjunction with another cosmetic operation, such as a facelift or eyelid surgery. Laser resurfacing is still a very new procedure. However, it has been shown that in some cases, this surgical method produces less bleeding, bruising and post-operative discomfort than is typically seen with other resurfacing methods.
This brochure will give you a basic understanding of the laser resurfacing procedure - when it can help, how it's performed and what results you can expect. It cannot, however, provide all the details which may be relevant to your particular needs. Please ask your plastic surgeon if there is anything about the procedure you don't understand.
A word about the laser
Laser resurfacing is performed using a beam of laser energy which vaporizes the upper layers of damaged skin at specific and controlled levels of penetration.
It's clear that laser resurfacing may offer a number of advantages over other resurfacing methods: precision, little (if any) bleeding and less post-operative discomfort. However, laser resurfacing isn't for everyone. In some cases, an alternative skin resurfacing treatment, such as dermabrasion or chemical peel, may still be a better choice.
All resurfacing treatments work essentially the same way. First, the outer layers of damaged skin are stripped away. Then, as new cells form during the healing process, a smoother, tighter, younger-looking skin surface appears. Laser resurfacing is a new method being used by plastic surgeons to remove damaged skin. Because it is new, there are no long-term data on this technique. However, a number of studies using microscopic examination have shown that the physical changes that occur to laser-treated skin are essentially identical to those that occur with either dermabrasion or chemical peel. Ask your plastic surgeon about the latest facts concerning long-term follow-up.
For superficial or medium resurfacing, the laser can be limited to the epidermis and papillary dermis. For deeper resurfacing, the upper levels of the reticulas dermis can also be removed. Varied penetration allows treatment of specific spots or wrinkles.
It's also important to consider the length of recovery when choosing among the skin-resurfacing alternatives. In general, the more aggressive the resurfacing procedure is, the more prolonged the recovery is likely to be. "Light" resurfacing procedures, such as superficial chemical peels or superficial laser resurfacing, offer shorter recovery times. However, these lighter procedures may need to be repeated multiple times to achieve results comparable to those achieved with more aggressive techniques.
The best candidates for laser resurfacing
In many cases, facial wrinkles form in localized areas, such as near the eyes or around the mouth. The laser can be precisely controlled so that only these specific areas are targeted.
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Endoscopic Surgery
If your doctor has recommended endoscopy . . .
Endoscopy is a surgical technique that involves the use of an endoscope, a special viewing instrument that allows a surgeon to see images of the body's internal structures through very small incisions.
Endoscopic surgery has been used for decades in a number of different procedures, including gallbladder removal, tubal ligation, and knee surgery. However, in the world of plastic surgery, endoscopic instruments have recently been introduced. Plastic surgeons believe the technique holds great promise, but further study is needed to establish its effectiveness, especially over the long-term. As important research continues, endoscopy is being used on a limited basis for both cosmetic and reconstructive procedures.
This brochure will give you a basic understanding of endoscopy in plastic surgery--how it's performed, what risks are involved, and the type of surgical training to look for in a surgeon. Please ask your doctor if there is anything you don't understand about the specific procedure you're planning to have.
The endoscope
An endoscope consists of two basic parts: A tubular probe fitted with a tiny camera and bright light, which is inserted through a small incision; and a viewing screen, which magnifies the transmitted images of the body's internal structures. During surgery, the surgeon watches the screen while moving the tube of the endoscope through the surgical area.
It's important to understand that the endoscope functions as a viewing device only. To perform the surgery, a separate surgical instrument--such as a scalpel, scissors, or forceps--must be inserted through a different point of entry and manipulated within the tissue.
Advantages of endoscopy
All surgery carries risks and every incision leaves a scar. However, with endoscopic surgery, your scars are likely to be hidden, much smaller and some of the after effects of surgery may be minimized.
In a typical endoscopic procedure, only a few small incisions, each less than one inch long, are needed to insert the endoscope probe and other instruments. For some procedures, such as breast augmentation, only two incisions may be necessary. For others, such as a forehead lift, three or more short incisions may be needed. The tiny "eye" of the endoscope's camera allows a surgeon to view the surgical site almost clearly as if the skin were opened from a long incision.
Because the incisions are shorter with endoscopy, the risk of sensory loss from nerve damage is decreased. Also, bleeding, bruising and swelling may be significantly reduced. With the endoscopic approach, you may recover more quickly and return to work earlier than if you had undergone open surgery.
Endoscopic surgery may also allow you to avoid an overnight hospital stay. Many endoscopic procedures can be performed on an outpatient basis under local anesthesia with sedation. Be sure to discuss this possibility with your doctor.
In endoscopic surgery, a probe with a tiny camera transmits images inside the body to a video monitor.
Uses in plastic surgery
As research continues, it's expected that many new uses for endoscopy will be developed. In the meantime, some plastic surgeons are using the technique on carefully selected patients. Some procedures that may be assisted by endoscopy are:
Cosmetic surgery
Abdominoplasty (tummy tuck) -- Endoscopy is sometimes used as an adjunct for selected patients who have lost abdominal muscle tone. Guided by the endoscope, the muscles that run vertically down the length of the abdomen may be tightened through several short incisions. Endoscopy is generally not used in patients who have a significant amount of loose abdominal skin.
Breast augmentation -- Inserted through a small incision in the underarm or the navel, an endoscope can assist the surgeon in positioning breast implants within the chest wall. Endoscopy may also assist in the correction of capsular contracture (scar tissue that sometimes forms around an implant, causing it to feel firm), and in the evaluation of existing implants.
Facelift -- Although the traditional facelift operation is still the best choice for most patients -- especially those with a significant amount of excess skin -- certain selected individuals may benefit from an endoscopically assisted procedure. When an endoscope is used, the customary incision along, or in the hairline is usually eliminated. Instead, small incisions may be strategically placed in areas where the most correction is needed. If the muscles and skin of the mid-face need to be smoothed and tightened, incisions may be hidden in the lower eyelid and in the upper gumline. To tighten the loose muscles of the neck, incisions may be concealed beneath the chin and behind the ears. The endoscope may also assist in the positioning of cheek and chin implants.
Forehead lift -- Of all the cosmetic procedures that use endoscopy, forehead lift is the one which plastic surgeons more commonly perform. Instead of the usual ear-to-ear incision, three or more "puncture-type" incisions are made just at the hairline. The endoscope helps guide the surgeon, who removes the muscles that produce frown lines, and repositions the eyebrows at a higher level.
Reconstructive surgery:
Flap surgery -- Endoscopy can assist in repairing body parts that are damaged from injury or illness. Often, healthy tissue is "borrowed" from one part of the body to help repair another. Using an endoscope, the tissue or flaps can be removed from the donor site with only two or three small incisions.
Placement of tissue expanders -- Used frequently in reconstructive surgery, tissue expanders are silicone "balloons" that are temporarily implanted to help stretch areas of healthy skin. The newly expanded skin is then used to cover body areas where skin has been lost due to injury (such as a burn) or disease. Using an endoscope, a surgeon can help ensure that a tissue expander is precisely positioned beneath the surface to bring the greatest benefit to the patient.
Sinus surgery -- An endoscope can assist a surgeon in pinpointing and correcting sinus-drainage problems. It can also help locate nasal polyps (growths) or other problems within the sinus cavity, and assist in full rhino-septal surgery.
Carpal tunnel release -- After the endoscope is inserted through a small incision in the wrist area, the surgeon locates the median nerve, which runs down the center of the wrist. A separate incision may be made in the palm to insert scissors or scalpel to cut the ligament putting pressure on the nerve.
Finding a well-trained surgeon
Because endoscopy is a relatively new technique in plastic surgery, it's extremely important that you select a board-certified plastic surgeon who has adequate training and experience.
Many endoscopic procedures do not require a hospital stay and are performed in a surgeon's office or an out-patient surgery center. If you're planning to have out-patient surgery, be sure that the surgeon you've selected has privileges to perform your particular endoscopic procedure at an accredited hospital. This assures you that your surgeon has been evaluated by the hospital's quality-assurance review committee and is generally considered to have the needed training.
Be sure to find out if the surgeon's hospital privileges cover both the endoscopic and the open version of the procedure you plan to have, since your doctor may have to switch to a traditional open procedure if a complication occurs during surgery.
Keep in mind that many plastic surgeons in practice today received endoscopy training as part of their plastic surgery or general surgery residency training. And, all board-certified plastic surgeons are continually being trained in new procedures.
Special consideration and risks
It's important to keep in mind that the endoscopic approach has only recently been applied to plastic surgery procedures. There are some known risks, which vary in severity depending on the procedure being performed. These include infection, fluid accumulation beneath the skin (which must be drained), blood vessel damage, nerve damage or loss of feeling, internal perforation injury, and skin injury.
And, keep in mind that if a complication occurs at any time during the operation your surgeon may have to switch to an open procedure, which will result in a more extensive scar and a longer recovery period. However, to date, such complications are rare--estimated to occur in less that 5 percent of all endoscopy procedures.
Deciding if endoscopic surgery is right for you
Although much is still unknown about endoscopic plastic surgery, you may want to focus on what is known as you make your decision. Considering the following:
For decades, endoscopy has been used successfully in orthopedic, urologic, and gynecologic procedures. Improved technology now permits endoscopy to be used by plastic surgeons.
If performed by an experienced, well-trained plastic surgeon, endoscopic procedures may provide the same results as open-method procedures, but with less scarring. In some cases, endoscopic surgery may require less recovery time than is usually required for open procedures.
Patients who tend to be the best candidates for cosmetic endoscopic procedures are those who don't have large amounts of loose hanging skin. Patients with loose facial or abdominal skin may benefit from a combination of classic and endoscopic techniques, in face or forehead lift, or abdominoplasty.
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Chin Augmentation
Who is a good candidate?
Teens and up with concern about "weak" chin
What will the results be?
Adds balance to profile, overall attractive look
Is it done at an office or hospital?
Usually office
How long does it take?
1/2 - 2 hours, varying with surgeons
What kind of anesthetic is used?
Local or general anesthesia as desired
Whar are the risks?
Minimal risks
How long is recovery?
Sutures removed 4-14 days depending on surgeon
When can regular life style resume?
3-30 days
When can make-up be used again?
7 days
When can bath/shampoo begin again?
When released to do so by your surgeon
How lasting are results?
Long Term
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