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Breast Augmentation
What are the benefits of breast augmentation with implants?
This operation is performed to enhance or restore the size and shape of a of lack of development or changes following pregnancy, weight loss or congenital abnormalities. Sometimes a woman's breasts are very asymmetric. This operation can improve a woman's self esteem and quality of life.
Studies have shown over 90% of women are satisfied with their results. Currently, saline implants (silastic bags filled with salt water) are placed either behind the pectoral muscle and breast tissue or in front of the muscle. This is done through an incision 1-1/2" - 2" long placed either under the breast, around the areola, or in the armpit.
What do breasts look like after augmentation mammaplasty?
Saline-filled prostheses are the best means now available to enlarge the breast by surgery However, the prospective patient should know that the final appearance, shape and texture are not exactly the same as normal breasts. They tend to be more firm. The contours are usually somewhat different than in normal breasts. In some patients these discrepancies may be rather noticeable. Although every effort is made to place the implants symmetrically, complete symmetry is rarely achieved. Immediately after surgery the breasts may appear swollen and firmer. The final shape and size is seen after several weeks. Please note that silicone gel implants are no longer available for elective new breast augmentations because of FDA restrictions.
Are the prostheses safe? Can they cause cancer? To the best of our present knowledge, these prostheses are made of nonreactive, safe material. No one has had them in place for more than about 25 years at this time. Thus, there is no way to say positively that they won't cause trouble 20 years from now, but it is unlikely. The incidence of cancer in augmented breasts is the same as that in normal breasts.
What kind of anesthetic is used? A general anesthetic is most common when the implant is placed under the pectoral muscle. A local anesthetic with sedation can be used if the implant goes in front of the muscle.
What are my limitations in activity postoperatively? You should plan to avoid activities which require much raising of the arms above the level of the head for 10 days after surgery. With great care, you can drive a day or two after surgery. Patients can usually return to work in a few days unless their occupation requires particularly strenuous movements and lifting. In such a case, 2-3 weeks should be allowed.
What are the risk of surgery?
General Risks of surgery include infection, pain, delayed wound healing, hematoma (a collection of blood at the surgical site), bleeding, reactions to anesthetic.
Cosmetic Complications: You may not be satisfied with appearance of your implants(s). Incorrect implant size, inappropriate scar location or appearance and misplacement of implants may interfere with a satisfactory appearance. Asymmetry (unequal breast size or shape) may occur. The implanted breast may sag or droop (ptosis) over time, much like a natural breast. Very rarely the implant may change position or break through the skin, particularly if you have very thin breast tissue covering it. This is more common with saline implant(s).
Bleeding: When blood collects beneath the skin it causes excessive discoloration. Sometimes lumps which last many months may occur. If blood collection id discovered, it is usually removed by taking out a few stitches and squeezing the clot out, or inserting a needle and aspirating it. If bleeding continues it is sometimes necessary to return to the operating room to stitch the bleeding vessels. The risk is increased in people who take aspirin or who bruise easily. Let your doctor know if this is the case. Do not use aspirin or aspirin-containing products for two weeks before and two weeks after surgery. (See list of medications which may increase bleeding.)
Wrinkling and Rippling: Some wrinkling of the implant shell is normal and expected. If your breast tissue is very thin, these wrinkles can show up as visible ripples, especially when you lean forward without wearing a brassiere. The wrinkling can also produce little corners on the implants that can sometimes be felt with your finger if the breast tissue is very thin.
Capsular Contracture: The scar tissue that forms around the implant can tighten and squeeze the implant as a natural response to foreign object implanted in the body. This firmness can range from slight to very firm. The firmest ones can cause varying degrees of discomfort or pain. Capsular contracture can occur on one breast or both. Implants under the muscle may result in less contracture.
Rupture/Deflation: Breast implants may not last a lifetime. The silastic shell can break due to normal wear over time, injury valve malfunction, breast manipulation (Mammograms), or unknown reasons. The usual sign is loss of breast size over days or weeks. The saline (salt water) will be absorbed by the body without any harm. Surgical replacement will be needed to restore the breast size. Replacement will involve additional costs.
Numbness: Sensory changes are expected to some degree immediately after surgery but loss of nipple and breast sensation my be permanent. Increased sensitivity is less common but does occur. These changes can interfere with comfort, sexuality and nursing (lactation).
Pain: Can be related to the surgery itself or a later response to problems such as tight capsule formation.
Infection: When severe may require removal of the implant if it is not controlled with antibiotics. Rarely this can occur any time after surgery. Consideration should be given to taking prophylactic antibiotics with dental work or other surgeries. If an implant is removed, replacement may be delayed for three months.
Hematoma: May require surgery to remove the collection of blood. Sudden swelling of the breast after surgery should be immediately reported to the doctor.
Scars: Generally do well with all breast incisions. However, healing is unpredictable and occasionally patients may form thickened or red hypertrophic/keloid scars. Additional surgery may be required.
Interference with Mammography: An implant can interfere with the detection of early breast cancer because it may "hide" suspicious lesions in the breast during an X-ray exam. It is especially important for women who at high risk of developing breast cancer to consider this before having implants. Additional views are required for routine mammography in patients with implants. Mammographyis more effective with implants under the muscle.
Calcium Deposits Can develop in the breast tissue at any time after surgery. These are benign but may be confused on an X-ray with breast cancer calcium deposits and require a biopsy.
Alteration in Breast Feeding: For women who have not had children, this may alter your ability to nurture children. Spontaneous lactation may occur after this surgery but is usually self-limited.
Lifetime of Implant: Implants will not last forever. The FDA currently estimates implants will last about 10 years. This is an estimate. The FDA has not reviewed all data about saline implants. (1994)
Unknown Risks: In addition to these know risks, there are unanswered questions about saline-filled breast implants. For example, questions have been raised about whether these devices might cause autoimmune diseases such as lupus, scleroderma and rheumatoid arthritis in some women, or whether they might increase the risk of cancer. There is not scientific evidence at present that women with either silicone gel-filled or saline-filled breast implants have increased risk of these disease, but the possibility cannot be ruled out.
Photography: Photographing, filming or videotaping of the treatment or procedure for educational or diagnostic use is a standard and required part of patient care.
No Guarantee: The practice of medicine and surgery is not an exact science. Although good results are expected, there cannot be any guarantee, nor warranty, expressed or implied, by anyone as to the results that may be obtained.
Complications and Additional Surgery: Any of these problems or disorders noted above may require additional surgery, hospitalization, and time away from work. If this occurs. there will be additional costs for surgical fees, supplies, anesthesia, etc. depending upon the required operation. Complications of cosmetic surgery generally will not be covered by medical insurance.
The better known complications are discussed above. Please ask your surgeon if you want to know about remote complications, or if you have any other questions.
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Breast Lift
WHO IS A CANDIDATE?
If you have sagging breasts due to past pregnancies, genetics, or aging.
If the sagging is too great to be treated with an implant alone.
If your nipple-areolar complexes (pigmented areas around nipples) are enlarged.
INTENDED RESULT
A mastopexy or breast-lift operation is designed to improve the shape and position of the breasts without reducing their size. It is used for breasts which sag but are not large. Sagging of the breasts may occur with normal development for some women, or as part of aging. Pregnancy, breastfeeding, and weight loss are other conditions which increase breast ptosis (sagging). Some patients will have a better shape to their breast if an implant is used at the time of mastopexy.
An elevated, more youthful breast contour.
Nipple-areolar complexes of the desired size and at the correct height.
PROCEDURE DESCRIPTION
The procedure is done on an outpatient basis under sedation and local or general anesthesia.
There are a variety of techniques for these operations. Most commonly there is an incision around the areola, another between the areola and breast crease, and a third within the crease under the breast. This is an "anchor-shape" or inverted "T" incision. On occasion, especially with mastopexy, these incisions may be modified and more limited. Some operations may require only the incision around the areola.
The nipple-areolar complex is repositioned higher, the excess skin is removed, and the breast is reshaped in a pleasing contour and in a more normal position.
The insertion of an implant as well, may be advisable.
RECUPERATION AND HEALING
You will go home in a bra, or with only light dressings over the incision lines.
Sutures are usually completely removed within 1-2 weeks.
Initial discomfort is easily controlled with oral medication. Light activities may be started in 7-10 days.
OTHER OPTIONS
Additional procedures which may enhance the result are a small breast reduction or breast enlargement.
INSURANCE GUIDELINES
This procedure is considered cosmetic and therefore is not covered by insurance. You are responsible for payment.
NOTE
Gravity continues to have its effect, and there is a tendency for the skin of the breast to stretch over a long period of time. Women vary a great deal in this respect. In general, the smaller the breasts the less tendency for sagging to recur. If the breasts sag again, further excision of the skin on an outpatient basis can be used to correct the problem. If we try to lift heavy breasts without making them smaller at the same time, sagging will return soon. One key to a satisfying result is realistic expectations.
The specific risks and the suitability of this procedure for a given individual can be determined only at the time of consultation. All surgical procedures have some degree of risk. Minor complications that do not affect the outcome occur occasionally. Major complications are rare.
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Breast Reduction
WHO IS A CANDIDATE?
Also known as reduction mamoplasty, it is an operation intended to reduce the size of a woman's breasts and improve their shape and position. Frequently, the areola (dark skin around the nipple) is also made smaller, Functional symptoms (medical disorders) caused by excessive breast weight may be relieved or improved by this operation.
Women who have large, heavy breasts which may be the cause of breathing difficulties, back, shoulder and neck pain, poor posture, bra-strap indentations and chafing under the breasts will benefit from reduction. Women with excessive breast size, which may decrease a sense of attractiveness and self-confidence are candidates.
Large breasts that interfere with normal daily activities or with exercise will be more comfortable when reduced.
INTENDED RESULT
More attractive contour and smaller breast size.
Freedom from health problems associated with excessively large breasts.
Improved self image.
PROCEDURE DESCRIPTION
Minimal incision surgery using a "vertical" technique is the most common method of breasts reduction used by our doctors, This method has been used in Brazil and France for many years but is performed by only a few Plastic Surgeons in his country. The benefits include: fifty percent less scar, a more narrow breast, better forward projection, longer lasting improvement, shorter surgery time and less complications. We have stopped using the "anchor" or inverted "T" incisions as these provide inferior results.
The procedure is done under general anesthesia on an out-patient basis or in the hospital.
Generally, two board certified plastic surgeons will perform the operation. Physician assistant, nurses and medical students may act as assistants. There will be a separate bill for the assistants fee.
Liposuction may be used to reduce the size of the breast in selected patients. This method has the least number and size of scars but has the greatest limitations in shaping and reducing the breast.
Liposuction may be combined with the vertical method.
There are a variety of techniques for these operations. Occasionally in patients with very large breasts, there is an incision around the areola. Another between the areola and breast crease, and the third within the crease under the breast. This is an "anchor-shape" or inverted "T" incision. When possible, these incisions may be modified and more limited. Some operations may require only the incision around the areola.
In extraordinarily large or bulky breasts. For technical reasons, we sometimes remove the nipples completely and put them back as "free grafts". The sensory nerves are all cut, and even though a certain amount of sensation returns after healing, it will never be normal and erotic sensation is lost completely. The milk ducts are interrupted in this operation, so nursing would be impossible. You will be amply informed in advance if your breasts are in this category.
RECUPERATION AND HEALING
The incisions are covered with light dressings, and you will be place in a bra, which you should bring to the surgery center with you. The bra holds the breasts symmetrically during the initial healing.
Initial discomfort subsides daily and can be controlled with oral medication.
Discomfort, swelling and discoloration of the breasts are to be expected for several weeks. Usually, our patients return to almost normal activity within two weeks. The scars at the incision lines typically become reddish. Raised and firm a few weeks after surgery, but after many months they become pale and soft. After 8-12 months, the scars are relatively inconspicuous. The nipples and some areas of the skin may be numb or sensitive after surgery. Sensation may return within a few weeks or months, but may be diminished or overly sensitive.
Surgery will probably reduce and possibly eliminate the ability to breast feed.
Gravity continues to have its effect, and there is a tendency for the skin of the breasts to stretch over a long period of time. Women very a great deal in this respect In general, the smaller the breasts the less the tendency for sagging to recur. If the breasts sag again, further excision of the skin on an outpatient basis can be used to correct the problem. If we try to lift heavy breasts without making them smaller at the same time, sagging will return soon. One key to satisfying result is realistic expectations.
OTHER OPTIONS
An additional procedure that would enhance the result is Liposuction of the axillary area to reduce excess fat deposits. Occasionally patients respond to weight loss.
INSURANCE GUIDELINES
Large breasts (macromastia) or breast hypertrophy can occur in a variety of conditions (family trait, post pregnancy, excessive adolescent growth). When the excessive causes functional problems, insurance will generally pay for the operation. These problems may include neck pain, back or shoulder pain, hygiene difficulty, and breast pain. Other problems which are less likely to be covered by insurance include skin irritation, skeletal deformity, breathing problems, psychological/emotional problems, and interference with normal daily activities. Pre-authorization by the insurance company is required prior to surgery, and the process takes approximately one month. Each insurance policy has different guidelines and exclusions.
This procedure is commonly covered by insurance though insurance criteria are becoming more and more restrictive. Our staff will assist you in obtaining pre-authorization.
NOTE
The specific risks and suitability of this procedure for a given individual can be determined only at the time of consultation. All surgical procedures have some degree of risk. Minor complications that do not affect the outcome occur occasionally. Major complications are rare.
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Liposuction
WHO IS A CANDIDATE?
If you have excess subcutaneous fat, which is resistant to diet and exercise.
If you wish to change the contours of your body. Commonly involved areas are the anterior part of the neck (under the chin), upper arms and armpits, male chest/breasts, trunk, abdomen, waist, hips, thighs, inner knees, calves, and ankles.
Most patients are near normal weight and desire permanent contour changes. Patients with average weight, localized fat collections, and healthy elastic skin are the best candidates for liposuction. Obesity, cellulite, or loose, sagging, inelastic skin are several problems which would tend toward poor results. In face, these problems may be worsened by liposuction. Unfortunately, many individuals performing liposuction are not trained in other techniques of body contouring and may not have the experience to recognize that a different procedure (such as a tummy tuck) may provide a better result for the patient. Suction Assisted Lipectomy (SAL) may be used in conjunction with other body contouring procedures, such as breast reduction, tummy tuck, thigh lift, or face lift.
Improved techniques now allow larger amounts of fat removal. Liposculpture can be useful to heavier persons as well.
Suction Assisted Lipectomy (SAL) or liposuction is a surgical technique in which the removal of fat deposits reshapes a specific part of the body, such as the face, neck, arms, abdomen, hips, or thighs. Liposuction, which was actively practiced in Europe during the mid 1970's, was not popularized in the United States until the early 1980's. Since then, ft has become the most requested aesthetic surgical procedure. The popularity of this operation is based on its relative simplicity, which requires only a small incision, usually well-hidden in a normal fold of skin.
Frequently, patients seek liposuction to reduce their weight and general obesity. Unfortunately, liposuction is not indicated to treat these problems. Standard methods of weight reduction are required for these patients. Liposuction is intended to resculpt isolated collections of body fat that would not generally respond to diet and exercise; ft is a method of body contouring to reduce inches, not pounds. The good news is that the suctioned fat cells are permanently removed. If the patient gains weight later on, the new fat will be distributed in a more proportioned manner.
INTENDED RESULTS
A permanent improvement in the contour and proportion of the treated areas.
A more flattering figure or physique, in or out of clothing.
PROCEDURE DESCRIPTION
Liposuction can be performed in an outpatient setting, such as the surgeon's office or Surgicenter; less frequently a short hospitalization will be required. The procedure can last from 30 minutes to several hours, depending on how many body areas are being operated upon. The type of anesthesia will also vary. Local anesthetic with sedation can be used for small areas; however, more extensive procedures usually require general anesthesia. Through a small incision, usually less than one-half inch, a blunt-tipped instrument called a cannula is passed back and forth, essentially vacuuming out the fat. The cannula is connected to rubber tubing which in turn attaches to a machine which generates high vacuum pressure. Following surgery, a firm elasticized garment is used to provide compression and reduce swelling and discoloration at the surgical site.
During surgery, IV fluids are usually required to replace losses which occur with the procedure. Infrequently, a transfusion is required, but this can be anticipated prior to surgery so that the patient can receive his/her own blood (autologous donation).
If very large volumes of fat are to be removed, we will probably ask you to donate one or two units of blood and take supplemental iron before surgery. Your own blood will be used as a transfusion at the end of surgery.
RECUPERATION AND HEALING
As with all operations, pain and discomfort varies greatly from patient to patient. Generally, one should expect that pain medication will be required for the first several days. Continuing discomfort can last varying amounts of time. Much of the swelling and bruising will be improved by two weeks; however, some will persist for six to eight weeks. It is often difficult to see significant changes in the body shape before this time. It is frequently useful to wear an elastic garment for four to six weeks, to help with skin shrinkage. Your doctor will tell you how long you should wear your elastic garment. Normal activity may be resumed at 1-2 weeks, and exercise at 3-4 weeks. Your doctor will give you specific time periods during a post-operative visit. Persistent swelling and irregularities may be present for several months. If antibiotics are prescribed, they should be taken as directed.
OTHER OPTIONS
Additional procedures that may enhance the result are Tummy Tuck (Abdominoplasty), Breast Reduction, Breast Lift, Breast Augmentation, Thigh Lift, or Buttock Lift.
INSURANCE GUIDELINES
This procedure is considered cosmetic and therefore is not covered by insurance. The patient is responsible for payment.
NOTE
IS HOSPITALIZATION NECESSARY?
Usually, hospitalization is not necessary. Many of these operations are performed under general anesthesia and may be done at a surgicenter as outpatient surgery.
IS THERE AN AGE LIMIT FOR THIS OPERATION?
People under 40 years of age usually get the very best results, because their skin is tighter. However, the state of the skin remains the determining factor.
ARE BANDAGES APPLIED?
As discussed earlier, compression garments are worn after the operation to assist in the retraction of the skin and to prevent swelling. Light massage is started on the 10th day. After the operation, exercises are recommended beginning on the 14th day, in order to minimize the adhesions between the skin and the deeper tissues. Early results are seen 10-14 days after surgery, but improvement continues for 4-6 months.
WHEN CAN YOU RETURN TO WORK?
In general, 3-5 days after the operation for office work, and 14 days for more active employment.
WHEN CAN YOU DO EXERCISES?
Usually, 2 weeks after the operation you may exercise, in order to modify and diminish the adhesions between the skin and the tissue. Walking, swimming, or a stationary bicycle can usually begin in a few days after surgery.
SHOULD YOU FOLLOW A SPECIAL DIET?
In order to have the best results, it is good to have a well-balanced diet, including carbohydrates, fruits, vegetables, and proteins, and not to overeat.
WHEN CAN YOU GET OUT IN THE SUN AGAIN?
When all the bruises have disappeared. This takes about 2-3 weeks. Use a sunscreen with a SPF of at least 15. Decreased sensation in the first few weeks or months after surgery may result in an accidental sunburn. Be careful.
ARE THE RESULTS PERMANENT?
In general, yes. If you gain a large amount of weight, however, the operated area will also increase but not as much as would have occurred before the operation. Rippling may also occur with large weight gain.
CAN THE OPERATION BE REPEATED?
Yes, in certain cases. It is preferable to operate in stages on heavier people.
WHAT ABOUT SCARS?
Following surgery, your surgical scars will go through a maturation process. For the first few months they will be red and possibly raised, firm or unsightly. As the scar matures, after 6-12 months, ft becomes soft, pale, and flat, and much less noticeable. You may experience numbness, tingling, burning, "crawling", or other peculiar sensations around the surgical area. This is a result of the healing of tiny fibers which are trapped in the scar. These symptoms will disappear. Some people are prone to keloids, which is an abnormal scar that becomes prominent and unsightly with time. If you or a blood relative have a tendency to keloid formation, please inform me.
WHAT HAPPENS TO THE EXCESS SKIN?
Depending upon the age of the patient, the skin (because of its elasticity and retraction) will shrink over the reduced area of the body. Older or excess skin may require subsequent surgery to obtain the desired result.
WHY IS IT IMPORTANT TO HAVE PRE-OPERATIVE PICTURES TAKEN?
Pictures help in the analysis of the problem in pre-operative planning, as a guide during surgery, and in evaluating results. Consequently, they are necessary prior to all plastic surgery procedures.
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Ear Pinning
WHO IS A CANDIDATE?
If you have ears that stick out too far from the side of the head.
If the ears have an unusual or undesirable shape.
INTENDED RESULT
Ears that have normal folds and shape with normal protrusion from the side of the head.
PROCEDURE DESCRIPTION
The operation is usually performed on an outpatient basis under sedation and local or general anesthesia.
The ears are usually bandaged with a dressing that wraps around the head in a turban-like fashion for several days.
Initial mild postoperative discomfort is easily controlled with oral medication.
The procedure is appropriate beginning at age 5 or 6 or at any time thereafter.
RECUPERATION AND HEALING
The ears usually look "normal" within 10-20 days.
Usually, a thin stocking cap or head band is worn at night for 3 weeks after the first dressing is removed to protect the ears.
Contact sports should be avoided for about a month.
OTHER OPTIONS
Any facial procedure that is desired or appropriate would enhance the result.
INSURANCE GUIDELINES
When performed in children or youths, insurance frequently pays. Our staff can assist you in making that determination.
NOTE
The specific risks and the suitability of this procedure for a given individual can be determined only at the time of consultation. All surgical procedures have some degree of risk. Minor complications that do not affect the outcome occur occasionally. Major complications are unusual.
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Facelift
Aging is unavoidable; unfortunately the outward signs usually appear while you still feel young and have productive years ahead. The appearance of an aging face can interfere with a happy, full life in these valuable years. The outward manifestations of aging need not be accepted as a matter of course. Facial rejuvenating procedures are highly rewarding and satisfying procedures for appropriate patients.
Face lift or rhytidectomy is operative procedure designed to remove the major folds or wrinkles of the skin on the face and neck which naturally occur with aging. It frequently is done in conjunction with a similar procedure for the eyelids called blepharoplasty since the aging process is usually present in this region also. A forehead lift may be recommended to elevate the eyebrows and remove deep creases.
Contrary to some articles in popular newspapers and lay journals, a face lift is not as simple as having a hairdo. The procedure is accomplished by an operation and as in all operations there is risk involved. Cosmetic surgery is an art and not a science; consequently no assurance or guarantee of results can be given. All surgeries have a possibility of complications and poor results; cosmetic surgery is no exception. Fortunately, complications in this field of surgery are uncommon. The procedure is designed to produce a maximum benefit in the appearance of the face by removing major wrinkles and sagging of the skin. It is impossible to remove every wrinkle regardless of the treatment and too much surgery would result in a pulled or plastic look. Fine wrinkles, particularly those about the mouth, may require additional treatment, such as dermabrasion, chemical peeling or fat injection.
The face lift can be done in combination with removal of fat from beneath the chin (submental lipectomy) and/or rearrangement of the platysma muscle of the neck to give a more youthful chin line.
Where are the incisions? These vary to some degree depending upon whether the patient is male or female, the hairstyles, hairline, age, previous surgery, etc. Generally the incision starts in the temple, in front or within the hairline. It continues in front of the ear, sometimes partially hidden with the ear (tragus). It then goes under the earlobe, behind the earfold and ends wither within the hairline or at the hairline behind the ear. Frequently another incision is made under the chin in a natural skin fold. This allows fat removal and tightening of the platysma muscle in the neck.
Where is the surgery performed? Face lifts and ancillary procedures are usually performed at outpatients in a surgicenter. A one night stay in post-operative care facility may be advisable in some cases. Local anesthetic combined with intravenous sedation is usually used. This will allow the patient to sleep through most of the procedure. General anesthesia is available upon request but usually is not necessary.
How will I look after surgery? You should expect swelling, discoloration, and bruising of the skin for several weeks after a face lift. Individuals vary a great deal in their response, but commonly the patient will be presentable within 3 weeks. Make-up can be applied shortly after surgery. The marks left by the incisions are often noticeable at first, but these gradually improve as the wounds mature. The scars are not usually mature for about 6-12 months. A face lift will reduce the sagging and loose skin and give a more youthful appearance to the face. The facial features themselves are generally not appreciably changed. The fine lines and wrinkles of the face are usually not much affected by a face lift. Dermabrasion or chemical peel of the skin are sometimes used to reduced fine lines during or after a face lift. Fat injections may also be recommended.
How long will it last? Because people vary so much, an exact time is difficult to give. An average figure given is 5 to 10 years. You may repeat the face lift procedure at that time if you wish. There is always an improvement compared to not having the procedure, even though the aging process continues in the future. In occasional patients with very loose skin, early sagging may be seen as soon as the first year and require a secondary procedure to tighten the loose skin.
What are the risks of surgery?
General Risks of surgery include infection, pain, delayed wound healing, hematoma (a collection of blood at the surgical site,) bleeding, reactions to anesthetic.
Bleeding. When blood collects beneath the skin it causes excessive discoloration. Sometimes lumps which last many months may occur. If blood collection is discovered, it is usually removed by taking out a few stitches and squeezing the clot out, or inserting a needle and aspirating it. If bleeding continues it is sometimes necessary to return to the operating room to stitch the bleeding vessels. This risk is increased in people who take aspirin or who bruise easily. Let your doctor know if this is the case. Do not use aspirin or aspirin-containing product for two weeks before and two weeks after surgery. (See list of medications which may increase bleeding.)
Loss of Skin: The skin may lose its blood supply. While uncommon when this happens, an area of skin will fail to survive and number of weeks are needed for healing. Rarely, a skin graft may be needed to obtain healing. This risk in increased in smokers; therefore, you must stop smoking a least 2 weeks before and 2 weeks following surgery.
Infection: Infection in facial surgery in uncommon but can occur. This requires antibiotics, possible hospitalization, and there is an increased risk toward skin loss as mentioned above.
Facial Nerve Injury: Permanent injury to the facial nerve is very rare. It is not uncommon for branches of the facial nerve to be bruised from the operation and for the muscles of the forehead or the corner of the mouth to lose some or even a great deal of their activity temporarily. Activity usually returns to normal within a few weeks. In extremely rare instances, it may take months or more.
Discoloration: Sometimes the skin remains discolored for many months. This may be related to the absorption of blood pigments during the healing process. Permanent discoloration is rare.
Asymmetry: Every effort is made to keep both sides even, but since no face is symmetrical to begin, mild asymmetry may remain after surgery. Some changes in the earlobe shape may occur as result of skin tension and scars.
Numbness: Parts of the face, forehead, eyes, ears and scalp may feel numb for weeks or months after surgery; this is normal and expected. On occasion, loss of sensation my be prolonged or permanent.
Scars: Every operation creates some type of scar. Facelift incisions are planned to hide and minimize visible scarring. Scars, however, are not predictable and infrequently patients will develop scars which are widened, thickened, raised, more red or generally more visible than anticipated (hypertrophic or keloid). Normally, scars go through a maturation process which takes months. This includes an expected period of thickness, redness and firmness, during the first 4-6 months. (More information on scars is available upon request.)
Hair loss: On occasion hair loss in the temple area or the hair behind the ear may occur. This is usually temporary and the hair regrows in several months. These situations are more the exception than the rule but they do occur.
Pain: Generally facial operations have surprisingly little pain. however, pain is very subjective. On occasion a patient will experience tightness and discomfort for a prolonged period of time. Scars may remain sensitive for months. These situations are more the exception than the rule but they do occur.
Depression: Some patients may experience an emotional let down after this surgery. This may be related to the normal chemical changes after extensive surgery or overly high expectations. It is usually self limited and does not require treatment
Alternatives: Other procedures which may improve an aging face but are less extensive include chemical peels, collagen or fat injections or liposuction technique.
Photography: Photographing, filming or videotaping of the treatment or procedure for education or diagnostic use is standard and required part of patient care.
No Guarantee: The practice of medicine and surgery is not an exact science. Although good results are expected, there cannot be any guarantee, nor warranty, expressed or implied, by anyone as to the results that may be obtained.
Complications and Additional Surgery: Any of these problems or disorders noted above may require additional surgery, hospitalization, and time away from work. If this occurs, there will be additional cost for surgical fees, supplies, anesthesia, etc. depending upon the required operation. Complications of cosmetic surgery generally will not be covered by medical insurance.
The better known complications are discussed above. Please ask your surgeon if you want to know about remote complications, or if you have any other questions.
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Forehead Lift
WHO IS A CANDIDATE?
This procedure, sometimes called a coronal lift or brow lift, lifts the forehead, eyebrows and skin around the eyes to give a rested, more youthful appearance. It is an uncomplicated procedure, which gives results that can last for 5 to 10 years or more. A forehead-lift is intended to soften the lines in the forehead and frown lines above and between the eyes. It may be used to improve drooping eyebrows or "hooding" of the upper eyelids. If you have deep furrows at the top of your nose (glabellar frown lines) a portion of the muscle between your eyebrows will be removed to correct this. The benefits of this operation can be very dramatic.
INTENDED RESULTS
A more youthful and rested appearance to the forehead and upper eyelids.
PROCEDURE DESCRIPTION
The procedure is done on an outpatient basis under general anesthesia.
The forehead skin is lifted and repositioned. The muscles that cause frown lines are weakened.
The standard forehead-lifts employ an incision across the top of your head, just an inch or so behind your hair line. If you have a high hair line or a receding hair line, the incision will be made at the hair line. This may result in a more visible scar and may require that you wear your hair in such a way as to camouflage the scar.
The operation is done using an endoscope (a narrow hollow instrument with a fiber optic light source and camera) and a small special instrument. Endoscopic forehead-lifts use several short incision placed in the hair line.
Staples or screws are used to hold the scalp in the new position for 10-14 days.
RECUPERATION AND HEALING
The patient may go home with dressings which are usually removed on the first or second day after surgery.
Initial discomfort is easily controlled with oral medication.
Sutures or staples are removed within 10 days.
Most swelling and bruising is gone in 7-10 days.
Smoking must be avoided for at least 2 weeks before and 2 weeks after surgery
OTHER OPTIONS
Additional procedures that may enhance the result are Lower and/or Upper Eyelid Lift, Face Lift, or other facial procedures or implants.
INSURANCE GUIDELINES
This procedure is considered cosmetic and therefore is not covered by insurance. The patient is responsible for payment.
NOTE
The specific risks and the suitability of this procedure for a given individual can be determined only at the time of consultation. All surgical procedures have some degree of risk. Minor complications that do not affect the outcome occur occasionally. Major complications are unusual.
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Butt Implants
Some plastic surgeons are calling buttock implants the new "it" surgery. Such a new development, the American Society for Aesthetic Plastic Surgery does not even have statistics for buttock implants prior to 2002. In 2003, the number of buttock implants increased 533 percent from the year before, with around 3,885 procedures performed compared to the 533 in 2002. Popular in South America, like breast implants have been to Americans, buttock implants have just started to make waves in the U.S.
Starting in South America in the 1960s, the popularity of buttock implants has finally reached the U.S. due in part to the quickly growing acceptance of cosmetic surgery procedures and the fashion trend shifts. The availability of buttock implants is believed to be just at its taking off point, with more surgeons learning how to perform the surgery and more awareness among patients increasing. Buttock implants are achieved by having a cosmetic surgeon place implants into the patient's gluteal area so that a fuller, more rounded behind can be enjoyed.
The procedure is very complicated and expensive, and surgeons caution patients not to jump into the surgery without first fully evaluating the risks and benefits. A reputable and qualified cosmetic surgeon will not perform buttock implants on a patient until full consideration has been weighed and the patient completely evaluated. The tremendous surge in cosmetic surgery has resulted in a high number of unqualified doctors trying to cash-in on the highly lucrative market. As always, if considering buttock implants, a patient should make sure he/she becomes educated about the procedure and about the surgeon chosen.
A cosmetic surgeon will usually create a vertical incision between the cheeks in order to insert the implant or the patient's own fat under or over the gluteal muscles and under the connective tissue. Silicone gel is not approved for use in the U.S., so semisolid implants are used in buttock implants, which has its drawbacks. The buttock implants do not have a soft, natural feeling to it, rather a harder, more muscular feel, though the look will be very pleasing to patients.
Buttock implants are very risky and require a lengthy recovery period. Since the incisions are made for the surgery in easily infected areas, potential complications can occur. Patients must understand that following buttock implants they will not be able to sit down for at least ten days and will not be able to resume most normal activities for a month. More rigorous activities will not be able to be enjoyed for about two months after the buttock implants. Still, for patients unhappy with their backside appearance, the growing availability of buttock implants has allowed them to achieve a more pleasing figure.
According to a prominent buttock implants surgeon, there appears to be two different groups of patients seeking the procedure. One group of patients is younger and has goals of transforming their bodies into more curvaceous figures like popular Hollywood stars J. Lo or Beyonce Knowles. The other group of patients is women that have aged and would like to restore a more youthful backside with buttock implants to replace now sagging areas. Men have also been requesting buttock implants as well.
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Blepharoplasty
WHO IS A CANDIDATE?
If you have excessive, sagging or wrinkled upper or lower eyelid skin.
If you have excess upper eyelid skin that interferes with vision.
If you have lost your natural upper eyelid crease.
If you have puffy pouches of fat in the upper or lower lids that create a tired or aged appearance.
A blepharoplasty is an operation designed to remove sagging skin and muscle from the eyelids, and to remove "bags", by trimming away excess fat bulges. In some cases the upper or lower lids can be treated alone. If indicated, all four lids may be treated at the same time. At times, a forehead-lift and/or a face-lift is done along with the eyelid surgery. Excess drooping of the eyebrows and corners of the upper eyelids may require a forehead lift to correct the area.
One of the first signs of early aging is bagginess or puffiness around the eyes, often associated with wrinkling of the eyelid skin. Blepharoplasty is designed to correct this condition and to restore the youthful, alert appearance of your eyes. This condition may be present in the upper eyelids, lower eyelids, or both. It also may be associated with looseness of the skin of the eyebrows or temple region.
Normally, everyone has a small amount of fat around the eyeball. If the quantity of fat increases, or the local tissues stretch and weaken, the fat begins to bulge producing "bags". Occasionally this bulging is seen in young patients and is an inherited family trait, and not a result of aging. The laxity and wrinkling of the eyelid skin may be seen alone or in conjunction with excess fat. These changes have a striking effect on one's appearance. An attractive face with these early signs of aging can affect a patient's self image, attitude and sense of well-being.
INTENDED RESULT
A more youthful and rested appearance of the eyes.
Widening of visual fields if excessive upper lid skin has partially blocked vision.
It will not remove or erase all wrinkle lines. It will soften wrinkle lines.
PROCEDURE DESCRIPTION
WHERE ARE THE INCISIONS?
The incision in the upper lid usually lies in the lid crease. The incision in the lower lid lies just below the eyelashes and parallel to the lid edge. Both incisions may extend for a short distance beyond the eyelids, toward the temple. In certain cases, lower lid incisions may be made inside the lid (transconjunctival incision). This is useful when only excess fat is removed and eliminates external skin incisions. Excellent healing is characteristic of eyelid skin, and once the wounds are mature they usually become quite inconspicuous. The outer part of the incision -- the part extending toward the temple -- is the slowest to mature, and is sometimes noticeably pink for some months after the operation. The stitches are removed in 3-7 days after surgery.
WHERE IS THE OPERATION DONE?
The operation is usually done in a surgicenter, on an outpatient basis. A friend or relative should be available to take you home and stay with you for at least 24 hours after surgery. Some patients may be done in a hospital operating room, if other medical conditions are present.
WHAT KIND OF ANESTHESIA IS USED?
A local anesthetic is used. The patient also receives sedation so that the operation will be a relaxed and comfortable experience. A general anesthetic may be indicated in some cases.
RECUPERATION AND HEALING
All sutures are usually removed within 3-5 days.
Initial mild discomfort is easily controlled with oral medication.
Eye makeup can be used shortly after sutures are removed.
Contact lenses can be worn when comfortable -- usually within 7-10 days.
Swelling, discoloration, and bruising is to be expected. It is not unusual to have some difficulty seeing during the first day or two after surgery because of the swelling. Patients vary a great deal in their recovery rate, but usually can resume normal light activity or work 3-4 days after surgery, using dark glasses and make-up to camouflage the swelling and discoloration. The patient will usually be presentable without dark glasses in 10 days. A small amount of residual swelling persists for many weeks, but gradually disappears.
OTHER OPTIONS
Additional procedures that would enhance the result are: Forehead Lift, Face Lift, Chemical Peel or Laser Skin Resurfacing.
INSURANCE GUIDELINES
Patients who have functional or visual problems caused by excessive upper eyelid skin may have coverage by their insurance policy. This usually requires documentation by an ophthalmologist regarding the medical necessity of surgery. Otherwise, these procedures are cosmetic and the patient is responsible for payment.
NOTE
Sagging skin or wrinkles may recur as the years go by, but it is unusual for "bags" to recur. The operation can be repeated as necessary. "Crows feet" (skin wrinkling at the corner of the eye, near the temple) is not greatly affected by this procedure; they may be helped with an ancillary procedure such as a dermabrasion or chemical peel.
The specific risks and the suitability of this procedure for a given individual can be determined only at the time of consultation. All surgical procedures have some degree of risk. Minor complications that do not affect the outcome occur occasionally. Major complications are rare.
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Rhinoplasty
WHO IS A CANDIDATE?
Nose that is cosmetically unattractive or does not "fit" with other facial features.
This is a surgical procedure which is done to improve the appearance of the nose and/or the ability to breathe through the nose. The operation, therefore, may be considered cosmetic, functional, or for some patients both. Nasal deformities may be present at birth or develop with aging and growth. Traumatic injuries (broken nose) or changes from previous surgeries may result in significant deformity. Chin augmentation with a small synthetic implant may help create better facial harmony and an improved profile when used.
Most often, patients request removal of a "hump" on the nose, refinement of a round nasal tip or elevation of a drooping tip. Noses which are crooked, too wide, long, pointy or flat may be improved. Realistically, there are limitations in achieving the final goal and the ultimate outcome will vary from patient to patient.
Frequently, the nasal septum (the cartilage separating the right and left nasal passages) is deviated and needs to be corrected. A crooked nose may worsen this disorder and, therefore, require correction at the same time. This operation is called a septo-rhinoplasty. Turbinates are parts of the nose which help to add moisture and filter inspired air. These structures can be enlarged for many reasons and contribute to airway blockage. When this occurs, the doctor will recommend their removal as part of the nasal surgery. Other problems, such as narrowed passages and airway "collapse", may require placement of cartilage grafts for structural support. On rare occasions, scar tissue within the nose from previous injury or surgery may block air flow and require correction.
INTENDED RESULT
More attractive nasal shape. Nose in better proportion to other facial features.
PROCEDURE DESCRIPTION
Cosmetic rhinoplasties are frequently done with local anesthesia and intravenous sedation in our surgery facility or other outpatient surgery centers. General anesthesia may be used upon patient request or physician recommendation. Functional surgeries with septal turbinate, scar correction or the need for grafts usually require general anesthesia. These operations most often are outpatient procedures, but on occasion an overnight hospital stay may be required for unusually long or difficult cases.
Cosmetic rhinoplasties have incisions hidden within the nostrils inside the nose. A small "nick" in the skin is sometimes placed at the upper nose near the corner of the eye. More complex nasal operations often require a small incision in the skin at the base of the nose (columella). This tiny scar is barely visible, yet it allows the surgeon to "lift" the nasal skin and directly view all of the cartilage and bone requiring correction. This is termed an "open rhinoplasty". To narrow the base of the nose, small incisions (Weir incisions) are placed in the groove where the nostril meets the cheek.
Cartilage and bone grafts are often taken from within the nose (septum). Ear cartilage, rib, hip, or outer portion of the skull are other possible grafts. Synthetic nasal implants may also be used to build-up portions of the nose.
RECUPERATION AND HEALING
You will go home with an external cast or splint in place. The nose may be packed for 24-48 hours. The cast or splint is usually removed in 7-10 days. Internal splints may be used for septoplasties and remain in place for 1-3 weeks.
Initial discomfort is easily controlled with oral medication.
Majority of swelling and bruising subsides progressively over 2-4 weeks.
External sutures (if any) are removed in 4-6 days. Internal sutures dissolve.
Seminal result is evident in 3 months. Final result is evident in 12-14 months which is the tune necessary for complete tissue softening.
Areas of sensitivity or numbness will slowly resolve; the tip of the nose will feel stiff or "woody" and this will improve over the first several months. Other temporary conditions may include some airway or sinus blockage, nasal drainage, lumps and irregularities.
OTHER OPTIONS
An additional procedure that may enhance the result is a chin enlargement.
If you need to improve breathing, correction of a deviated septum (Septoplasty) and enlarged turbinates may also be appropriate.
INSURANCE GUIDELINES
Changes necessary to correct functional breathing problems or deformity from an injury should be covered by insurance. The insurance carrier will not cover charges which they determine are cosmetic in nature. Often this will not be determined until the insurance company reads the operative report and compares pre-operative and post-operative photos. When possible, we will obtain pre-authorization from your insurance company.
Pre-authorization information can be obtained from your insurance company.
NOTE
The specific risks and the suitability of this procedure for you may be determined only at the time of consultation. All surgical procedures have some degree of risk. Minor complications that do not affect the outcome occur occasionally. Major complications are unusual.
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Tummy Tuck
WHO IS A CANDIDATE?
Patients who are healthy but have EXCESS SKIN OR FAT that does not respond to diet and exercise. Patients who have undergone SIGNIFICANT WEIGHT LOSS and have hanging skin. Women with loose skin and stretchmarks FOLLOWING PREGNANCY. Older patients with LOSS OF SKIN ELASTICITY. Patients who are unable to tighten the abdominal wall with exercise.
INTENDED RESULTS
A smoother, flatter abdomen.
PROCEDURE DESCRIPTION
This is an operation designed to improve the appearance of an abdomen which may be overly protruding, or may have excess loose skin and fat. There are variations of the standard operation, including "mini-tucks", which may be of benefit to patients who require only tightening of the abdominal muscles or removal of a small amount of skin. On the other hand, patients with massive weight loss may require a more extensive operation.
If you have loose or sagging abdominal wall skin; frequently associated with abnormal relaxation of the anterior abdominal wall muscles (frequently secondary to multiple pregnancies or prior to surgery).
Usually, under general anesthesia, an incision is made across the lower part of the abdomen. A circular incision is made around the navel which stays attached to the muscle. The skin is then separated from the muscle up toward the ribs, so that ft can be pulled down like a window shade. The tummy is then "tightened", (narrowing and flattening the abdomen) by stitching the muscles together. 'Mini1 tummy tucks can benefit patients who have a small amount of excess skin and fat or protruding of the lower abdomen. This operation may be done under local anesthesia with sedation, on an outpatient basis. Liposuction may be used alone or in conjunction with a tummy tuck to benefit selected patients.
Mini-abdominoplasty tightens the lower abdominal wall skin only (shortest scar).
Modified abdominoplasty addresses conditions where just the muscle wall or just the abdominal skin requires repair.
Standard abdominoplasty tightens all of the abdominal wall skin and muscles (standard scar).
Extended abdominoplasty tightens the abdomen and the flanks or sides (longest scar extending around the flanks onto lower back.)
A general anesthetic is most common, although mini-tucks may be done with local anesthetic and intravenous sedation. Standard abdominoplasties generally require a short hospitalization of 1-2 days.
RECUPERATION AND HEALING
After surgery, the bed will be positioned so that you are bent at the hips (waist) to keep tension off the newly tightened skin. Within 24 hours you will be walking in a bent-over position. Although strenuous activity, and lifting more than ten pounds, must be avoided for 6 weeks, some people can return to work and daily activities as soon as 2 weeks after surgery. Softening of the surgical scars, return of sensation, and loosening of the tight sensation may take several months. Abdominoplasty can be one of the more uncomfortable plastic surgery procedures and probably requires more time-consuming and limiting recovery.
1-3 days of hospitalization or skilled nursing care or assistance at home is usually indicated.
You will be encouraged to move and walk regularly within 1-2 days.
Light activity is comfortable in 10-20 days. Sports will not be comfortable for about 6 weeks.
OTHER OPTIONS
Additional procedures that may enhance the result are Liposuction, Breast Procedures, or Thigh Lift. Variations of the standard abdominoplasty, including "mini-tucks" may be possible.
INSURANCE GUIDELINES
In general, "tummy tucks" are considered cosmetic surgery. Several conditions, however, may be covered completely or in part by insurance. These include defects of the abdominal wall, such as hernias, diastasis (separation of the muscles), or trauma resulting in muscle loss, weakness or painful scar contracture. In addition, a large abdominal panniculus, frequently seen after massive weight loss, is removed for purely functional reasons and, therefore, should be a covered expense. Pre-authorization may be required from your insurance company; they will require photographs to document your condition.
NOTE
The specific risks and the suitability of this procedure for you may be determined only at the time of consultation. All surgical procedures have some degree of risk. Minor complications that do not affect the outcome occur occasionally. Major complications are rare.
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Vaginal Surgery
Pacific Center for Plastic Surgery offers “Vaginal Rejuvenation” or “Vaginoplasty” which refers to a surgical procedure that resurfaces and tightens the vaginal tissues to restore the youthful appearance and function of the vulvar and vaginal area. For some women, the effects of childbirth, aging, trauma, and/or genetics, causes their vaginal tissue and muscles to become stretched which results in loss of strength and tone in the vaginal area. This can lead to unsatisfying intimate contact and discomfort. The surgical procedure, vaginoplasty, can increase friction during intercourse, giving you more control of your vaginal muscles, increasing sexual satisfaction, while also creating a more attractive and appealing appearance to the vaginal area.
Labia Reduction Surgery (Labiaplasty)
Labial unevenness, and/or enlarged Labia Minora can result in discomfort with intimate contact, chronic rubbing, and/or an uncomfortable sensation as well as psychological discomfort, that leads to the inability to wear certain types of tight clothing. Most women live with these symptoms, and actually are not even aware that a certain surgical procedure exists to help to correct this problem and restore their femininity. Pacific Center for Plastic Surgery offers this surgical procedure called Labiaplasty. It is a procedure that basically trims the labia minora, carefully removing excess and unnecessary skin. In the majority of cases, the labiaplasty surgery is virtually undetectable and patients are extremely happy with their results. The outcome is a more youthful appearance, improved sensation, ability to wear all types of clothing without discomfort and/or embarrassment, and a more confident sex life.
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