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Breast Augmentation
Breast Augmentation is a surgical procedure to enhance the size and shape of a woman's breast through the use of breast implants. Women choose this procedure for a variety of reasons including enhancing body contour, correcting a reduction in breast volume after pregnancy, balancing a difference in breast size, and reconstruction following breast surgery. The bust line can often be increased by one or more bra cup sizes.
For the past 14 years, the only choice for women interested in breast augmentation has been saline implants. We are excited to announce that on 11/17/06, the FDA approved the use of silicone breast implants for women who are at least 22 years of age. There are advantages to each type of implant that Dr. Peters will be happy to discuss with patients during their personalized consultation.
The surgery is usually performed using general anesthesia using an incision either around the areola or underneath the breast. A pocket is then created either just underneath the breast tissue or below the chest wall muscle into which the implants are placed. The skin is then closed using hidden, dissolvable stitches. Surgery generally lasts one to two hours.
Most women will feel tired and sore for several days following surgery and, depending on what type of work they do, will take up to a week off work.
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Breast Reduction
Many women with very large breasts may suffer from a variety of medical problems and physical discomforts. These problems range from back and neck pain, skin irritation, poor posture, and even breathing problems. In addition, bra straps may leave shoulder indentations. Many women are very self-conscious if they have unusually large breasts. Breast reduction removes fat, glandular tissue, and excessive skin, resulting in smaller, lighter, and firmer breasts that are better shaped in proportion to the rest of the body.
The surgery is performed under general anesthesia and can take up to four hours. Some patients spend one night in the hospital, but many go home the same day. Most women who have this procedure require an anchor-shaped incision that circles the areola, extends downward, and follows the crease under the breast. For some patients who require less tissue to be removed, sometimes the incision under the breast can be eliminated.
As with other breast surgery, most women with feel sore for several days and will take approximately one week off work to recover.
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Breast Lift
Over time, the effects of gravity, along with the loss of the skin's natural elasticity, begins to have an effect on the appearance of a woman's breasts. These factors, combined with pregnancies and nursing, will often cause the breasts to lose their youthful shape and firmness.
Breast lift is a surgical procedure to raise and reshape sagging breasts and can also reduce the size of the areola, if necessary. If your breasts are small or have lost volume following pregnancy or for other reasons, breast implants inserted in conjunction with a breast lift can increase both their firmness and size.
Breast lift surgery is performed under general anesthesia using a variety of techniques. In a patient who requires only a small amount of lift, incisions may be confined only to the area around the areola. For a patient who requires a moderate lift, the areola scar may be combined with a vertical scar to maximize reshaping. For a woman who requires a large amount of tightening of the breast, incisions are made around the areola, in a vertical line extending downward from the nipple, and along the lower crease of the breast.
Most women will feel tired and sore for several days following surgery and, depending on what type of work they do, will take about one week off work.
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Breast Reconstruction
There are a variety of techniques available to reconstruct a breast following mastectomy for cancer or other breast diseases. This can be performed at the same operation as the mastectomy, or in a delayed fashion up to years following the original surgery. In almost all cases, medical insurance will cover this procedure.
A TRAM flap is an operation where the excess skin and fat of the lower abdomen is used to reconstruct the breast. Because this is the same tissue that is normally removed in a tummy tuck, the result is usually a natural-appearing breast with flattening of the abdomen.
Some women prefer to have their breast reconstructed without borrowing tissue from other parts of the body and without creating additional scars. For this group of patients, a tissue expander can be placed in the breast pocket to gradually stretch out the overlying skin and muscle and, at a second operation, this expander is replaced with a saline or silicone breast implant.
In some women, the best option is a combination of the above 2 approaches where some tissue is borrowed from another part of the body and a breast implant is used to add volume to the reconstructed breast.
Regardless of the breast reconstruction technique used, most women can also have reconstruction of their nipple performed at a later operation.
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Tummy Tuck (Abdominoplasty)
A tummy tuck is an operation that is designed to remove excess skin and fat from the abdomen and, at the same time, tighten the abdominal muscles. The surgery is particularly helpful for men and women who, through episodes of weight gain and loss or pregnancy, have stretched their abdominal muscles and skin. A tummy tuck can dramatically reduce the appearance of a protruding abdomen and can narrow the waistline. It does, however, produce a permanent scar, which, depending on the extent of the original problem and the surgery required to correct it, can extend from hip to hip. In some patients with excess skin and fat of the buttocks and back, this operation can be combined with a buttock lift in a procedure called a belt abdominoplasty or lower body lift.
Prior to an abdominoplasty, the amount of skin that is to be removed is carefully marked. The operation is usually carried out under general anesthesia and takes about 3 hours.
Following surgery, the patient is fitted in a snug abdominal binder to minimize bruising and swelling and to help support the area during healing. Drainage tubes are left in place for 1-2 weeks to help prevent fluid from accumulating under the skin. Many patients go home the same day of surgery, but some prefer to spend a night or two in the hospital. Patients usually take 1-2 weeks off work to recover from surgery. The scar fades over the 12 months following surgery and, although it will not disappear completely, it will be covered by most clothing and bathing suits.
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Liposuction
Liposuction has become one of the most popular procedures in plastic surgery today. During liposuction, a surgeon removes fat is areas that have not responded to diet and exercise. Common areas treated include the hips, thighs, abdomen, knees, ankles, face, and neck. Liposuction is most successful in people with good skin tone who have localized problem areas. It is not a treatment for obesity. To maintain the safety of the procedure, there is a limit on how much can be done at one time.
The time required to perform liposuction varies depending on a number of factors including the size of the area, the amount of fat being removed, and the type of anesthesia. The procedure is done through several, less than 1 cm incisions and is usually performed on an outpatient basis. Following the procedure, the patient is fitted with a snug elastic garment to minimize the bruising and swelling and provide support while healing. Most people describe the discomfort associated with the procedure as a "soreness," rather than pain and take up to a week off work.
Results are visible immediately, although they will also improve as the swelling subsides. Most of the swelling dissipates within the first month, although there is a small amount of swelling up to 6 months following surgery.
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Arm Lift
Brachioplasty is a surgical procedure that removes excess skin and fat from the upper arms. This surgery is particularly helpful for patients that have lost a significant amount of weight and have hanging skin with stretch marks that will not improve with further weight loss or exercise.
The procedure is usually done under general anesthesia. In most patients, an incision from the armpit to the elbow is required on the inner part of the arm. Although some scarring will always be visible, most patients are willing to trade improved contour of the arms for the scar that results from surgery.
Most patients go home the same day of surgery and, like the other body contouring procedures described, the patient is required to wear a snug elastic garment to assist in healing.
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Thigh Lift
A thigh lift is performed to tighten the loose skin of the inner thigh that can occur after weight loss or as part of the aging process. In the procedure, incisions are usually placed around the upper thigh and buttock and hidden in natural creases.
The operation is done under general anesthesia and patients usually go home the same day. The patient is fitted with a snug elastic garment which is worn for several weeks following the procedure.
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Body Contouring After Weight Loss
Excess hanging skin can be a troubling problem for patients who have lost a significant amount of weight. Whether after bariatric surgery (gastric bypass or lap band surgery) or following a successful diet and exercise program, the loose skin of the abdomen, arms, buttocks, thighs, and breasts can detract from the overall result of the weight loss. Some patients report that they still feel "fat" despite reaching their goal weight and a few even feel that they looked better when they were overweight. Using procedures such as abdominoplasty (tummy tuck), arm lift, lower body lift, thigh lift, and breast lift, Dr. Peters can remove excess skin to reshape the patient's body and allow the thin person underneath to shine through. These procedures are typically performed when the patient is at or near their goal weight and their weight has been stable for several months.
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Facelift
Gravity, sun exposure, stress, and genetics contribute to creases formed between the nose and mouth, a slack jaw line, and loose skin around the neck. At some point in your life, you may look in the mirror, or see a photograph of yourself and decide that the face that you see does not reflect the way you feel.
A facelift will not stop the aging process, but it will slow it down by removing excess fat, tightening underlying muscles, and redraping facial and neck skin. A facelift can be done alone, or combined with other procedures like blepheroplasty or brow lift. As a result, your face will appear refreshed and rejuvenated.
Most facelift patients are in their forties to sixties, but facelifts can be done successfully on people in their 70s or 80s as well. Good candidates for facelift are healthy individuals with loose skin, wrinkles, or excess fatty tissue in the neck, loss of a previously well-defined jaw line, deep wrinkles in the cheeks, or sagging skin the jowl area.
The operation is usually performed with IV sedation or general anesthesia. Depending on the extent of surgery required, it can take up to 5 hours to perform. The incisions usually begin above the hairline at the temples, extend in a line hidden in the natural contour of the ear, and continue behind the earlobe to the lower scalp. If neck work is needed, a small incision may also be made under the chin. The lining of the underlying muscle is then tightened or repositioned, the skin is pulled back, and the excess tissue is removed.
The discomfort associated with a facelift is not usually severe, and the recovery is determined by bruising and swelling. Most patients will feel comfortable being seen socially in 10-14 days.
Mini-Facelift
There are many names for this type of procedure, including the S-type facelift. This procedure is best suited for patients with some of the symptoms noted above in the "Facelift" section, such as sagging skin of the lower face, jowls, and upper neck, but whose symptoms are minor and don't warrant a full facelift or in patients that would prefer a smaller procedure. The results are a natural-looking smoothing of the skin of the lower face and neck.
In a mini-facelift, incisions are similarly placed to the full facelift, but the work done under the skin is less extensive. Stitches are still used to tighten the lining of the facial muscles and excess skin is still removed. Because the amount of work done under the skin is less extensive, however, the procedure generally takes about an hour, can be performed under only local anesthesia, and the recovery is faster. Although some patients even go back to work within a couple of days, there is still some bruising and swelling with this procedure and most people take about a week off work.
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Nose Surgery (Rhinoplasty)
Nose surgery is a procedure that reshapes the nose. This surgery can change the size of your nose, change the shape of the tip or the bridge, change the angle between your nose and your upper lip, or narrow the span of the nostrils. It can also correct birth defects or injuries and help relieve some breathing problems.
The surgery can take between 1-4 hours to perform, depending on the complexity of the problems being treated. Incisions are hidden inside the nostrils, with the exception of a small, inconspicuous scar on the skin between the nostrils. An external splint is frequently used immediately after surgery to help the nose maintain its new shape. In addition, nasal packs may also be placed in the nostrils.
After surgery, your face may feel puffy, your nose may ache, and there may be some bruising around the eyes. Most of the swelling and bruising should resolve in 1-2 weeks.
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Forehead/Brow Lift
A forehead lift is a procedure to restore a more youthful look above the eyes. This procedure corrects drooping brows and improves the horizontal lines across the forehead that can make people appear angry, sad, or tired. Muscles and tissues causing a drooping appearance are removed or changed, which smoothes the forehead, raises the eyebrows, and minimizes frown lines. The outcome is a more relaxed, refreshed appearance.
The operation is usually done under general anesthesia. In a conventional brow lift, the incision is placed across the scalp behind the hairline. In an endoscopic brow lift, 3 smaller incisions are used which are also hidden within the hair of the scalp. The best choice for an individual patient is discussed with them at the time of consultation. This operation is frequently combined with eyelid surgery.
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Eyelid Surgery (Blepharoplasty)
Blepharoplasty is a very common procedure that removes fat along with excess skin and muscle from the upper and lower eyelids. Eyelid surgery can correct drooping upper lids and the puffy bags under the eyes - features that make you look older and more tired than you feel. The effect is to give the eyes a more rested, youthful look with a brighter appearance. Eyelid surgery is sometimes combined with a forehead lift to correct sagging eyebrows or skin resurfacing to reduce crow's feet and other wrinkles around the eyes. Botox injections are also excellent adjuncts to blepheroplasty.
Eyelid surgery usually takes 1-2 hours and can be performed under local or general anesthesia. Incisions are made following the natural lines of your eyelids: in the creases of your upper lids and just below the lashes in the lower lids. When these incisions heal, the scars are usually barely visible, even in men.
Sutures are removed 3-5 days after surgery and most patients are surprised at how little discomfort they feel. There can be bruising associated with the procedure that may last 7-10 days. Makeup can be worn 2 days after suture removal.
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Facial Implants
Much of the external appearance of our face is dependent on bony structure. For people with a "weak" chin or cheekbones, augmenting the bony structure with implants may improve the balance of the facial features and lead to a more aesthetically appealing appearance.
Facial implant surgery is usually done on an outpatient basis and can be combined with other facial surgery.
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Botox
Botox injections will temporarily remove frown and forehead lines as well as wrinkle lines around the eyes known as crow's feet. Botox is a safe, FDA-approved toxin which can be used to paralyze specific facial muscles that are responsible for unsightly wrinkles. The effects of Botox typically last three to six months. Injections may be repeated when lines reappear.
The procedure involves injections using a tiny needle only in the treatment area. Patients may return to work immediately, as there is virtually no redness or swelling associated with Botox injections. The injection gradually takes effect over the 3-5 days following treatment.
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Collagen
Collagen is an FDA-approved substance that has been safely used for decades. It is a protein like those in our own skin and is injected below wrinkles to lift them up and smooth the contour of the face. Collagen can also be used to augment the lips, creating a fuller and more youthful shape.
There are 2 basic kinds of collagen. The older product was made from cow proteins and required skin testing to assure the patient was not allergic to the product before therapeutic injections were performed. The newer collagen products are not made from cows and there have been no allergic reactions reported, so skin testing is not necessary.
Collagen injections usually last 3-4 months and may be repeated as necessary. Following injection, there is some minor swelling and redness that lasts about a day.
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Restylane
Restylane is a new injectable filler, similar to collagen, that is primarily used to fill in wrinkles in the lower face and to augment the lips. It is made of hyaluronic acid, a naturally-occurring substance in normal skin, and is FDA approved. There are no reported allergic reactions to Restylane, so skin testing is not required.
The injections are performed in the office and there is only minor swelling and redness following the procedure. The results of Restylane usually last 6 to 9 months.
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Radiesse
Radiesse is one of the latest injectable fillers to receive FDA approval for treating facial wrinkles. It is typically used to treat lines in the lower face and can also be used to enhance the shape of the jaw line, chin, and cheeks.
Injections are done in the office and there is typically only minor swelling, redness, or bruising following the procedure. Most patients will return to work the following day. The results of Radiesse usually last 12-18 months.
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Chemical Peels and Laser Skin Resurfacing
As we age, the effects of genetics, sun exposure, and smoking are seen in the fine lines and wrinkles that occur on the face. These are best treated with a skin resurfacing procedure which creates a superficial burn of the skin. As this burn heals, the skin grows back healthier and smoother than it was before the procedure, smoothing out the fine lines and wrinkles.
There are several techniques available to resurface the skin. Chemicals, such as TCA and phenol, can be used as can lasers to achieve this result. The type of chemical or laser used depends on the severity of the problem and the thickness of the skin to be treated.
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