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Breast Augmentation
Breast augmentation, technically known as augmentation mammoplasty, is a surgical procedure to enhance the size and shape of a woman's breast for a number of reasons:
- To enhance the body contour of a woman who, for personal reasons, feels her breast size is too small
- To correct a reduction in breast volume after pregnancy
- To balance a difference in breast size
- As a reconstructive technique following breast surgery
By inserting an implant behind each breast, surgeons are able to increase a woman's bust line by one or more bra cup sizes. If you're considering breast augmentation, this 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 ask Dr. Lesavoy if there is anything you don't understand about the procedure.
The Best Candidates for Breast Enlargement
Breast enlargement 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 Dr. Lesavoy.
The best candidates for breast enlargement are women who are looking for improvement, not perfection, in the way they look. If you're physically healthy and realistic in your expectations, you may be a good candidate.
Breast augmentation is usually done to balance a difference in breast size, to improve body contour, or as a reconstructive technique following surgery.
Types of Implants
Women now have more choices than ever before in breast implant surgery. Since the recent FDA approval of silicone gel implants, women over 21 may now chose between saline-filled and silicone gel-filled breast implants.
There are also a number of breast implant options in terms of size, shape, and texture. Dr. Lesavoy will discuss your breast implant options with you during your consultation.
All Surgery Carries Some Uncertainty and Risk
Breast enlargement is relatively straightforward. But as with any operation, there are risks associated with surgery and specific complications associated with breast implant surgery.
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.
As with any surgical procedure, excessive bleeding following the operation may cause some swelling and pain. If excessive bleeding continues, another operation may be needed to control the bleeding and remove the accumulated blood.
A small percentage of women develop an infection around an implant. This may occur at any time, but is most often seen within a week after surgery. In some cases, the breast implant may need to be removed for several months until the infection clears. A new implant can then be inserted.
Some women report that their nipples become oversensitive, under sensitive, or even numb. You may also notice small patches of numbness near your incisions. These symptoms usually disappear with time, but may be permanent in some patients.
There is no evidence that breast implants will affect fertility, pregnancy, or your ability to nurse. If, however, you have nursed a baby within the year before augmentation, you may produce milk for a few days after surgery. This may cause some discomfort, but can be treated with medication prescribed by Dr. Lesavoy.
Occasionally, breast implants may break or leak. Rupture can occur as a result of injury or even from the normal compression and movement of your breast and implant, causing the synthetic shell to leak. If a saline-filled implant breaks, the implant will deflate in a few hours and the salt water will be harmlessly absorbed by the body.
If a break occurs in a gel-filled implant, however, one of two things may occur. If the shell breaks but the scar capsule around the implant does not, you may not detect any change. If the scar also breaks or tears, especially following extreme pressure, silicone gel may move into surrounding tissue. The gel may collect in the breast and cause a new scar to form around it, or it may migrate to another area of the body. There may be a change in the shape or firmness of the breast. Both types of breaks may require a second operation and replacement of the leaking implant. In some cases, it may not be possible to remove all of the silicone gel in the breast tissue if a rupture should occur.
A few women with breast implants have reported symptoms similar to diseases of the immune system, such as scleroderma and other arthritis-like conditions. These symptoms may include joint pain or swelling, fever, fatigue, or breast pain. Research has found no clear link between silicone breast implants and the symptoms of what doctors refer to as "connective-tissue disorders," but the FDA has requested further study.
While there is no evidence that breast implants cause breast cancer, they may change the way mammography is done to detect cancer. When you request a routine mammogram, 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 with an implant. Additional views will be required. Ultrasound examinations may be of benefit in some women with implants to detect breast lumps or to evaluate the implant.
While the majority of women do not experience these complications, you should discuss each of them with Dr. Lesavoy to make sure you understand the risks and consequences of breast augmentation.
Planning Your Breast Enlargement Surgery
In your initial consultation, Dr. Lesavoy will evaluate your health and explain which surgical techniques are most appropriate for you, based on the condition of your breasts and skin tone. If your breasts are sagging, Dr. Lesavoy may also recommend a breast lift.
Be sure to discuss your expectations frankly with Dr. Lesavoy. He will be equally frank with you, describing your alternatives and the risks and limitations of each. You may want to ask Dr. Lesavoy for a copy of the manufacturer's insert that comes with the implant he will use - just so you are fully informed about it. And, be sure to tell Dr. Lesavoy if you smoke, and if you're taking any medications, vitamins, or other drugs.
Dr. Lesavoy will also explain the type of anesthesia to be used, the type of facility where the surgery will be performed, and the costs involved. Because most insurance companies do not consider breast augmentation to be medically necessary, carriers generally do not cover the cost of this procedure.
Preparing for Your Breast Enlargement Surgery
Dr. Lesavoy will give you instructions 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
The majority of Dr. Lesavoy's surgeries are performed in the privacy, safety, and comfort of the Encino Outpatient Surgery Center, which is located next door in Suite 580. This state-of-the-art facility contains two operating rooms and is Medicare-certified. Depending on the case, Dr. Lesavoy may also perform surgery in the office (for minor procedures) or at UCLA Medical Center. Our RN nursing staff is warm, supportive, and trained to respond to the needs of plastic surgery patients, and our anesthesiologists are all MDs.
Types of Anesthesia
Breast augmentation can be performed with a general anesthesia, so you'll sleep through the entire operation. Alternatively, Dr. Lesavoy may use a local anesthesia, combined with a sedative to make you drowsy, so you'll be relaxed but awake, and may feel some discomfort.
The Breast Enlargement Surgery
The method of inserting and positioning your implant will depend on your anatomy and Dr. Lesavoy's recommendation. The incision can be made either in the crease where the breast meets the chest, around the areola (the dark skin surrounding the nipple), or in the armpit. Every effort will be made to assure that the incision is placed so resulting scars will be as inconspicuous as possible.
Incisions are made to keep scars as inconspicuous as possible, in the breast crease, around the nipple, or in the armpit. Breast tissue and skin is lifted to create a pocket for each implant.
Working through the incision, Dr. Lesavoy will lift your breast tissue and skin to create a pocket, either directly behind the breast tissue or underneath your chest wall muscle (the pectoral muscle). The implants are then centered beneath your nipples.
In some cases, putting the implants behind your chest muscle may reduce the potential for capsular contracture. Drainage tubes may be used for several days following the surgery. This placement may also interfere less with breast examination by mammogram than if the implant is placed directly behind the breast tissue. Placement behind the muscle however, may be more painful for a few days after surgery than placement directly under the breast tissue.
The breast implant may be inserted directly under the breast tissue or beneath the chest wall muscle.
You'll want to discuss the pros and cons of these alternatives with Dr. Lesavoy before surgery to make sure you fully understand the implications of the procedure he recommends for you.
Breast implant surgery usually takes one to two hours to complete. Stitches are used to close the incisions, which may also be taped for greater support. A gauze bandage may be applied over your breasts to help with healing.
After surgery, breasts appear fuller and more natural in tone and contour. Scars will fade with time.
After Your Breast Enlargement Surgery
You're likely to feel tired and sore for a few days following your surgery, but you'll be up and around in 24 to 48 hours. Most of your discomfort can be controlled by medication prescribed by Dr. Lesavoy.
Within several days, the gauze dressings, if you have them, will be removed, and you may be given a surgical bra. You should wear it as directed by Dr. Lesavoy. You may also experience a burning sensation in your nipples for about two weeks, but this will subside as bruising fades.
Your stitches will come out in a week to 10 days, but the swelling in your breasts may take three to five weeks to disappear
Getting Back to Normal After Breast Enlargement Surgery
You should be able to return to work within a few days, depending on the level of activity required for your job.
Follow Dr. Lesavoy's advice on when to begin exercises and normal activities. Your breasts will probably be sensitive to direct stimulation for two to three weeks, so you should avoid much physical contact. After that, breast contact is fine once your breasts are no longer sore, usually three to four weeks after surgery.
Your scars will be firm and pink for at least six weeks. Then they may remain the same size for several months, or even appear to widen. After several months, your scars will begin to fade, although they will never disappear completely.
Routine mammograms should be continued after breast augmentation for women who are in the appropriate age group, although the mammographic technician should use a special technique to assure that you get a reliable reading, as discussed earlier.
Your New Look
For many women, the result of breast augmentation plastic surgery can be satisfying, even exhilarating, as they learn to appreciate their fuller appearance.
Regular examination by your Dr. Lesavoy and routine mammograms for those in the appropriate age groups at prescribed intervals will help assure that any complications, if they occur, can be detected early and treated.
Your decision to have breast augmentation is a highly personal one that not everyone will understand. The important thing is how you feel about it. If you've met your goals, then your surgery is a success.
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Breast Reduction
Women with very large, pendulous breasts may experience a variety of medical problems caused by the excessive weight - from back and neck pain and skin irritation to skeletal deformities and breathing problems. Bra straps may leave indentations in their shoulders. And unusually large breasts can make a woman - or a teenage girl - feel extremely self-conscious.
Breast reduction, technically known as reduction mammaplasty, is designed for such women. The breast reduction procedure removes fat, glandular tissue, and skin from the breasts, making them smaller, lighter, and firmer. Breast reduction plastic surgery can also reduce the size of the areola, the darker skin surrounding the nipple. The goal is to give the woman smaller, better-shaped breasts in proportion with the rest of her body.
If you're considering breast reduction plastic surgery, 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 Dr. Lesavoy if there is anything about the breast reduction procedure you don't understand.
The Best Candidates for Breast Reduction
Breast reduction is usually performed for physical relief rather than simply cosmetic improvement. Most women who have the surgery are troubled by very large, sagging breasts that restrict their activities and cause them physical discomfort.
In most cases, breast reduction isn't performed until a woman's breasts are fully developed; however, it can be done earlier if large breasts are causing serious physical discomfort. The best candidates are those who are mature enough to fully understand the procedure and have realistic expectations about the results. Breast reduction is not recommended for women who intend to breast-feed.
All Surgery Carries Some Uncertainty and Risk
Breast reduction 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, including bleeding, infection, or reaction to the anesthesia. Some patients develop small sores around their nipples after surgery; these can be treated with antibiotic creams. You can reduce your risks by closely following Dr. Lesavoy's advice both before and after surgery.
Breast reduction surgery 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 slightly mismatched breasts or unevenly positioned nipples. Future breast-feeding may not be possible, since the surgery removes many of the milk ducts leading to the nipples.
Some patients may experience a permanent loss of feeling in their nipples or breasts. Rarely, the nipple and areola may lose their blood supply and the tissue will die. (The nipple and areola can usually be rebuilt, however, using skin grafts from elsewhere on the body.)
Planning Your Breast Reduction Surgery
In your initial consultation, it's important to discuss your expectations frankly with Dr. Lesavoy, and to listen to his opinion. Every patient - and every physician, as well - has a different view of what is a desirable size and shape for breasts.
Heavy breasts can lead to physical discomfort, a variety of medical problems, shoulder indentations due to tight bra straps, and extreme self-consciousness.
Dr. Lesavoy will examine and measure your breasts, and will probably photograph them for reference during surgery and afterwards. (The photographs may also be used in the processing of your insurance coverage.) He 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. 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 breasts.
Dr. Lesavoy will describe the breast reduction procedure in detail, explaining its risks and limitations and making sure you understand the scarring that will result. Dr. Lesavoy will also explain the anesthesia he will use, the facility where the surgery will be performed, and the costs. (Some insurance companies will pay for breast reduction if it's medically necessary; however, they may require that a certain amount of breast tissue be removed. Check your policy, and have Dr. Lesavoy write a "predetermination letter" if required.)
Preparing for Your Breast Reduction Surgery
Dr. Lesavoy may require you to have a mammogram (breast x-ray) before breast reduction 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. Dr. Lesavoy may suggest that his patients diet before the operation.
Breast reduction doesn't usually require a blood transfusion. However, if a large amount of breast tissue will be removed, Dr. Lesavoy may advise you to have a unit of blood drawn ahead of time. That way, if a transfusion should be needed, your own blood can be used.
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
The majority of Dr. Lesavoy's surgeries are performed in the privacy, safety, and comfort of the Encino Outpatient Surgery Center, which is located next door in Suite 580. This state-of-the-art facility contains two operating rooms and is Medicare-certified. Depending on the case, Dr. Lesavoy may also perform surgery in the office (for minor procedures) or at UCLA Medical Center. Our RN nursing staff is warm, supportive, and trained to respond to the needs of plastic surgery patients, and our anesthesiologists are all MDs.
Type of Anesthesia
Breast reduction is nearly always performed under general anesthesia. You'll be asleep through the entire operation.
Breast Reduction Surgery Procedure
Techniques for breast reduction vary, but the most common procedure involves an anchor-shaped incision that circles the areola, extends downward, and follows the natural curve of the crease beneath the breast. Dr. Lesavoy removes excess glandular tissue, fat, and skin, and moves the nipple and areola into their new position. He then brings the skin from both sides of the breast down and around the areola, shaping the new contour of the breast. Liposuction may be used to remove excess fat from the armpit area.
Incisions outline the area of skin, breast tissue, and fat to be removed and the new position for the nipple.
In most cases, the nipples remain attached to their blood vessels and nerves. However, if the breasts are very large or pendulous, the nipples and areolas may have to be completely removed and grafted into a higher position. (This will result in a loss of sensation in the nipple and areolar tissue.)
Skin formerly located above the nipple is brought down and together to reshape the breast. Sutures close the incisions, giving the breast it's new contour.
Stitches are usually located around the areola, in a vertical line extending downward, and along the lower crease of the breast. In some cases, techniques can be used that eliminate the vertical part of the scar. And occasionally, when only fat needs to be removed, liposuction alone can be used to reduce breast size, leaving minimal scars.
Scars around the areola, below it, and in the crease under the breast are permanent, but ban be easily concealed by clothing.
After Your Breast Reduction Surgery
After surgery, you'll be wrapped in an elastic bandage or a surgical bra over gauze dressings. A small tube may be placed in each breast to drain off blood and fluids for the first day or two.
You may feel some pain for the first couple of days - especially when you move around or cough - and some discomfort for a week or more. Dr. Lesavoy will prescribe medication to lessen the pain.
The bandages will be removed a day or two after surgery, though you'll continue wearing the surgical bra around the clock for several weeks, until the swelling and bruising subside. Your stitches will be removed in one to three weeks.
If your breast skin is very dry following surgery, you can apply a moisturizer several times a day, but be sure to keep the suture area dry.
Your first menstruation following surgery may cause your breasts to swell and hurt. You may also experience random, shooting pains for a few months. You can expect some loss of feeling in your nipples and breast skin, caused by the swelling after surgery. This usually fades 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 After Breast Reduction Surgery
Although you may be up and about in a day or two, your breasts may still ache occasionally for a couple of weeks. You should avoid lifting or pushing anything heavy for three or four weeks.
Dr. Lesavoy will give you detailed instructions for resuming your normal activities. Most women can return to work (if it's not too strenuous) and social activities in about two weeks. But you'll have much less stamina for several weeks, and should limit your exercises to stretching, bending, and swimming until your energy level returns. You'll also need a good athletic bra for support.
You may be instructed to avoid sex for a week or more, since sexual arousal can cause your incisions to swell, and to avoid anything but gentle contact with your breasts for about six weeks.
A small amount of fluid draining from your surgical wound, or some crusting, is normal. If you have any unusual symptoms, such as bleeding or severe pain, don't hesitate to call Dr. Lesavoy.
Your New Look
Although much of the swelling and bruising will disappear in the first few weeks, it may be six months to a year before your breasts settle into their new shape. Even then, their shape may fluctuate in response to your hormonal shifts, weight changes, and pregnancy.
Dr. Lesavoy will make every effort to make your scars as inconspicuous as possible. Still, it's important to remember that breast reduction 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.
Of all plastic surgery procedures, breast reduction results in the quickest body-image changes. You'll be rid of the physical discomfort of large breasts, your body will look better proportioned, and clothes will fit you better.
However, as much as you may have desired these changes, you'll need time to adjust to your new image - as will your family and friends. Be patient with yourself, and with them. Keep in mind why you had this surgery, and chances are that, like most women, you'll be pleased with the results.
With smaller, better proportioned breasts, you'll feel more comfortable and your clothes will fit better.
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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. Breast lift, 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 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 Dr. Lesavoy 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 breast lift surgery, think carefully about your expectations and discuss them with Dr. Lesavoy.
The best candidates for mastopexy are healthy, emotionally-stable women who are realistic about what breast lift 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 breast lift procedure.
Over time, a woman's breasts begin to sag and the areolas become larger.
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 Dr. Lesavoy'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 breast lift procedure can also leave you with unevenly positioned nipples, or a permanent loss of feeling in your nipples or breasts.
Planning Your Breast Lift Surgery
In your initial consultation, it's important to discuss your expectations frankly with Dr. Lesavoy, and to listen to his opinion. Every patient - and every physician, as well - has a different view of what is a desirable size and shape for breasts.
Dr. Lesavoy will examine your breasts and measure them while you're sitting or standing. He 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.
Dr. Lesavoy should describe the breast lift procedure in detail, explaining its risks and limitations and making sure you understand the scarring that will result. Dr. Lesavoy will 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 Dr. Lesavoy any questions you may have, especially those regarding your expectations and concerns about the results.
Preparing for Your Breast Lift Surgery
Depending on your age and family history, Dr. Lesavoy 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 Breast Lift Surgery will be Performed
The majority of Dr. Lesavoy's surgeries are performed in the privacy, safety, and comfort of the Encino Outpatient Surgery Center, which is located next door in Suite 580. This state-of-the-art facility contains two operating rooms and is Medicare-certified. Depending on the case, Dr. Lesavoy may also perform surgery in the office (for minor procedures) or at UCLA Medical Center. Our RN nursing staff is warm, supportive, and trained to respond to the needs of plastic surgery patients, and our anesthesiologists are all MDs.
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 - Dr. Lesavoy may use local anesthesia, combined with a sedative to make you drowsy. You'll be awake but relaxed, and will feel minimal discomfort.
Breast Lift Surgery Procedure
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. Incisions outline the area of skin to be removed and the new position for the nipple.
Skin formerly located above the nipple is brought down and together to reshape the breast. Sutures close the incisions, giving the breast its new contour.
After surgery, the breasts are higher and firmer, with sutures usually located around the areola, below it, and in the crease under 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 Breast Lift 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 Dr. Lesavoy.
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 After Breast Lift Plastic Surgery
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 Dr. Lesavoy.
Dr. Lesavoy 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
Dr. Lesavoy 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 breast enlargement surgery 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.
If your expectations are realistic, chances are you'll be satisfied with your breast lift.
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Tummy Tuck
Abdominoplasty, known more commonly as a "Tummy Tuck," is a major surgical procedure to remove excess skin and fat from the middle and lower abdominal and to tighten the muscles of the abdomen wall. Abdominoplasty can dramatically reduce the appearance of a protruding abdomen. But bear in mind, it does 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.
If you're considering abdominoplasty "tummy tuck", the frequently asked questions below 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 the individual patient. Please ask Dr. Lesavoy about anything you don't understand.
The Best Candidates for Abdominoplasty
The best candidates for abdominoplasty are men or women who are in relatively good shape but are bothered by a large fat deposit or loose abdominal skin that won't respond to diet or exercise. Abdominoplasty surgery is particularly helpful to women who, through multiple pregnancies, have stretched their abdominal muscles and skin beyond the point where they can return to normal. Loss of skin elasticity in older patients, which frequently occurs with slight obesity, can also be improved.
Patients who intend to lose a lot of weight should postpone the surgery. Also, women who plan future pregnancies should wait, as vertical muscles in the abdomen that are tightened during surgery can separate again during pregnancy. If you have scarring from previous abdominal surgery, Dr. Lesavoy may recommend against abdominoplasty or may caution you that scars could be unusually prominent.Abdominoplasty 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 tummy tuck surgery, think carefully about your expectations and discuss them with Dr. Lesavoy.
All Surgery Carries Some Uncertainty and Risk
Thousands of abdominoplasties are performed successfully each year. When done by a qualified plastic surgeon who is trained in body contouring, the results are generally quite positive. Nevertheless, there are always risks associated with surgery and specific complications associated with tummy tuck surgery.
Post-operative complications such as infection and blood clots are rare, but can occur. Infection can be treated with drainage and antibiotics, but will prolong your hospital stay. You can minimize the risk of blood clots by moving around as soon after the surgery as possible.
Poor healing, which results in conspicuous scars, may necessitate a second operation. Smokers should be advised to stop smoking, as smoking may increase the risk of complications and delay healing.
You can reduce your risk of complications by closely following Dr. Lesavoy's instructions before and after the surgery, especially with regard to when and how you should resume physical activity.
Planning Your Tummy Tuck Surgery
In your initial consultation, Dr. Lesavoy will evaluate your health, determine the extent of fat deposits in your abdominal region, and carefully assess your skin tone. Be sure to tell Dr. Lesavoy if you smoke, and if you're taking any medications, vitamins, or other drugs.
Be frank in discussing your expectations with Dr. Lesavoy. He will be equally frank with you, describing your alternatives and the risks and limitations of each.
If, for example, your fat deposits are limited to the area below the navel, you may require a less complex procedure called a partial abdominoplasty, also know as a mini-tummy tuck, which can often be performed on an outpatient basis. You may, on the other hand, benefit more from partial or complete abdominoplasty done in conjunction with liposuction to remove fat deposits from the hips, for a better body contour. Or maybe liposuction alone would create the best result.
In any case, Dr. Lesavoy will work with you to recommend the procedure that is right for you and will come closest to producing the desired body contour.
During the consultation, Dr. Lesavoy will also explain the anesthesia he will use, the type of facility where the surgery will be performed, and the costs involved. In most cases, health insurance policies do not cover the cost of abdominoplasty, but you should check your policy to be sure.
Preparing for Your Tummy Tuck Surgery
Dr. Lesavoy 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.
If you smoke, plan to quit at least one to two weeks before your surgery and not to resume for at least two weeks after your surgery. Avoid overexposure to the sun before abdominoplasty surgery, especially to your abdomen, and do not go on a stringent diet, as both can inhibit your ability to heal. If you develop a cold or infection of any kind, your surgery will probably be postponed.
Whether your surgery is done on an outpatient or inpatient basis, you should arrange for someone to drive you home after your surgery, and to help you out for a day or two after you leave the hospital, if needed.
Where Your Tummy Tuck Surgery will be Performed
The majority of Dr. Lesavoy's surgeries are performed in the privacy, safety, and comfort of the Encino Outpatient Surgery Center, which is located next door in Suite 580. This state-of-the-art facility contains two operating rooms and is Medicare-certified. Depending on the case, Dr. Lesavoy may also perform surgery in the office (for minor procedures) or at UCLA Medical Center. Our RN nursing staff is warm, supportive, and trained to respond to the needs of plastic surgery patients, and our anesthesiologists are all MDs.
Types of Anesthesia for Tummy Tuck
Dr. Lesavoy may select general anesthesia, so you'll sleep through the operation.
Alternatively, Dr. Lesavoy may use local anesthesia, combined with a sedative to make you drowsy. You'll be awake but relaxed, and your abdominal region will be insensitive to pain. (However, you may feel some tugging or occasional discomfort.)
The Abdominoplasty Surgery Procedure
Complete abdominoplasty surgery usually takes two to five hours, depending on the extent of work required. Partial abdominoplasty may take an hour or two.
An incision just above the pubic area is used to remove excess skin and fat from the middle and lower abdomen.
Most commonly, Dr. Lesavoy will make a long incision from hipbone to hipbone, just above the pubic area. A second incision is made to free the navel from surrounding tissue. With partial abdominoplasty, the incision is much shorter and the navel may not be moved, although it may be pulled into an unnatural shape as the skin is tightened and stitched.
Skin is separated from the abdominal wall all the way up to the ribs.
Next, Dr. Lesavoy separates the skin from the abdominal wall all the way up to your ribs and lifts a large skin flap to reveal the vertical muscles in your abdomen. These muscles are tightened by pulling them close together and stitching them into their new position. This provides a firmer abdominal wall and narrows the waistline.
Dr. Lesavoy draws underlying muscle and tissue together and stitches them, thereby narrowing the waistline and strengthening the abdominal wall.
The skin flap is then stretched down and the extra skin is removed. A new hole is cut for your navel, which is then stitched in place. Finally, the incisions will be stitched, dressings will be applied, and a temporary tube may be inserted to drain excess fluid from the surgical site.
Abdominal skin is drawn down and excess is removed. With complete abdominoplasty, a new opening is cut for the navel. Both incisions are stitched closed.
In partial abdominoplasty, the skin is separated only between the incision line and the navel. This skin flap is stretched down, the excess is removed, and the flap is stitched back into place.
After Your Tummy Tuck Surgery
For the first few days, your abdomen will probably be swollen and you're likely to feel some pain and discomfort which can be controlled by medication. Depending on the extent of the surgery, you may be released within a few hours or you may have to remain hospitalized for two to three days.
Dr. Lesavoy will give you instructions for showering and changing your dressings. And though you may not be able to stand straight at first, you should start walking as soon as possible.
Surface stitches will be removed in five to seven days, and deeper sutures, with ends that protrude through the skin, will come out in two to three weeks. The dressing on your incision may be replaced by a support garment.
Getting Back to Normal After Tummy Tuck Plastic Surgery
It may take you weeks or months to feel like your old self again. If you start out in top physical condition with strong abdominal muscles, recovery from abdominoplasty will be much faster. Some people return to work after two weeks, while others take three or four weeks to rest and recuperate.
Exercise will help you heal better. Even people who have never exercised before should begin an exercise program to reduce swelling, lower the chance of blood clots, and tone muscles. Vigorous exercise, however, should be avoided until you can do it comfortably.
Your scars may actually appear to worsen during the first three to six months as they heal, but this is normal. Expect it to take nine months to a year before your scars flatten out and lighten in color. While they'll never disappear completely, abdominal scars will not show under most clothing, even under bathing suits.
Your New Look after Tummy Tuck Surgery
Tummy tuck, whether partial or complete, produces excellent results for patients with weakened abdominal muscles or excess skin. And in most cases, the results are long lasting, if you follow a balanced diet and exercise regularly.
After surgery, the patient has a flatter, trimmer abdomen. Scars are permanent, but will fade with time.
If you're realistic in your expectations and prepared for the consequences of a permanent scar and a lengthy recovery period, abdominoplasty may be just the answer for you.
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Liposuction
Liposuction is a procedure that can help sculpt the body by removing unwanted fat from specific areas, including the abdomen, hips, buttocks, thighs, knees, upper arms, chin, cheeks and neck. During the past decade, liposuction, which is also known as "lipoplasty" or "suction lipectomy," has benefited from several new refinements. Today, a number of new techniques, including ultrasound-assisted lipoplasty (UAL), the tumescent technique, and the super-wet technique, are helping many plastic surgeons to provide selected patients with more precise results and quicker recovery times. Although no type of liposuction is a substitute for dieting and exercise, liposuction can remove stubborn areas of fat that don't respond to traditional weight-loss methods.
If you're considering liposuction, this information will give you a basic understanding of the procedure - when it can help, how it is performed and how you might look and feel after surgery. It won't answer all of your questions, since much depends on your individual circumstances. Please ask Dr. Lesavoy if there is anything about the procedure you don't understand.
The Best Candidates for Liposuction
To be a good candidate for liposuction, you must have realistic expectations about what the procedure can do for you. It's important to understand that liposuction can enhance your appearance and 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 Dr. Lesavoy.
The best candidates for liposuction are normal-weight people with firm, elastic skin who have pockets of excess fat in certain areas. You should be physically healthy, psychologically stable and realistic in your expectations. Your age is not a major consideration; however, older patients may have diminished skin elasticity and may not achieve the same results as a younger patient with tighter skin.
Liposuction carries greater risk for individuals with medical problems such as diabetes, significant heart or lung disease, poor blood circulation, or those who have recently had surgery near the area to be contoured.
Women may have liposuction performed under the chin, on their hips, thighs, and stomach, and in the under arm and breast area.
Planning Your Liposuction Surgery
In your initial consultation, Dr. Lesavoy will evaluate your health, determine where your fat deposits lie and assess the condition of your skin. Dr. Lesavoy will explain the body-contouring methods that may be most appropriate for you. For example, if you believe you want liposuction in the abdominal area, you may learn that an abdominoplasty or "tummy tuck" may more effectively meet your goals; or that a combination of traditional liposuction and UAL would be the best choice for you.
Be frank in discussing your expectations with Dr. Lesavoy. He should be equally frank with you, describing the procedure in detail and explaining its risks and limitations.
Getting the Answers You Need About Liposuction
Individuals considering liposuction often feel a bit overwhelmed by the number of options and techniques being promoted today. However, Dr. Lesavoy can help. In deciding which is the right treatment approach for you, Dr. Lesavoy will consider effectiveness, safety, cost and appropriateness for your needs. This is called surgical judgment, a skill that is developed through surgical training and experience. Dr. Lesavoy also uses this judgement to prevent complications; to handle unexpected occurrences during surgery; and to treat complications when they occur.
For men, common sites include under the chin and around the waist. Liposuction may also be used in the reduction of enlarged male breasts, a condition known as gynecomastia.
Your plastic surgeon's education and training have helped to form his surgical judgement, so take the time to do some background checking. Patients are encouraged to consider a doctor certified by the American Board of Plastic Surgery ("ABPS"). By choosing a plastic surgeon who is certified by the ABPS, a patient can be assured that the doctor has graduated from an accredited medical school and completed at least five years of additional residency - usually three years of general surgery (or its equivalent) and two years of plastic surgery. To be certified by the ABPS, a doctor must also practice surgery for two years and pass comprehensive written and oral exams.
Preparing for Your Surgery
Dr. Lesavoy will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding vitamins, iron tablets and certain medications. If you develop a cold or an infection of any kind, especially a skin infection, your surgery may have to be postponed.
Though it is rarely necessary, Dr. Lesavoy may recommend that you have blood drawn ahead of time in case it is needed during surgery.
Also, while you are making preparations, be sure to arrange for someone to drive you home after the procedure and, if needed, to help you at home for a day or two.
Where Your Liposuction Surgery will be Performed
The majority of Dr. Lesavoy's surgeries are performed in the privacy, safety, and comfort of the Encino Outpatient Surgery Center, which is located next door in Suite 580. This state-of-the-art facility contains two operating rooms and is Medicare-certified. Depending on the case, Dr. Lesavoy may also perform surgery in the office (for minor procedures) or at UCLA Medical Center. Our RN nursing staff is warm, supportive, and trained to respond to the needs of plastic surgery patients, and our anesthesiologists are all MDs.
Anesthesia for Liposuction
Various types of anesthesia can be used for liposuction procedures. Together, you and Dr. Lesavoy will select the type of anesthesia that provides the most safe and effective level of comfort for your surgery.
If only a small amount of fat and a limited number of body sites are involved, liposuction can be performed under local anesthesia, which numbs only the affected areas. However, if you prefer, the local is usually used along with intravenous sedation to keep you more relaxed during the procedure. Regional anesthesia can be a good choice for more extensive procedures. One type of regional anesthesia is the epidural block, the same type of anesthesia commonly used in childbirth.
However, some patients prefer general anesthesia, particularly if a large volume of fat is being removed. If this is the case, a nurse anesthetist or anesthesiologist will be called in to make sure you are completely asleep during the procedure.
Healthy, normal-weight people with elastic skin and pockets of excess fat are good candidates for surgery.
The best candidates for liposuction are of normal weight with localized areas of excess fat for example, in the buttocks, hips, and thighs.
A snug compression garment worn after surgery helps reduce swelling.
Dr. Lesavoy inserts a cannula through small incisions in the skin. At the other end of the tube is a vacuum-pressure unit that suctions off the fat.
The Liposuction Surgery
The time required to perform liposuction may vary considerably, depending on the size of the area, the amount of fat being removed, the type of anesthesia and the technique used.
There are several liposuction techniques that can be used to improve the ease of the procedure and to enhance outcome.
Liposuction is a procedure in which localized deposits of fat are removed to recontour one or more areas of the body. Through a tiny incision, a narrow tube or cannula is inserted and used to vacuum the fat layer that lies deep beneath the skin. The cannula is pushed then pulled through the fat layer, breaking up the fat cells and suctioning them out. The suction action is provided by a vacuum pump or a large syringe, depending on Dr. Lesavoy's preference. If many sites are being treated, Dr. Lesavoy will then move on to the next area, working to keep the incisions as inconspicuous as possible.
Fluid is lost along with the fat, and it's crucial that this fluid be replaced during the procedure to prevent shock. For this reason, patients need to be carefully monitored and receive intravenous fluids during and immediately after surgery.
Liposuction Technique Variations
The basic technique of liposuction, as described above, is used in all patients undergoing this procedure. However, as the procedure has been developed and refined, several variations have been introduced.
Fluid Injection - a technique in which a medicated solution is injected into fatty areas before the fat is removed, commonly used by plastic surgeons today. The fluid - a mixture of intravenous salt solution, lidocaine (a local anesthetic) and epinephrine (a drug that contracts blood vessels) - helps the fat be removed more easily, reduces blood loss and provides anesthesia during and after surgery. Fluid injection also helps to reduce the amount of bruising after surgery.
The amount of fluid that is injected varies depending on the preference of the surgeon.
Tumescent Liposuction - large volumes of fluid - sometimes as much as three times the amount of fat to be removed - are injected in the tumescent technique. Tumescent liposuction, typically performed on patients who need only a local anesthetic, usually takes significantly longer than traditional liposuction (sometimes as long as 4 to 5 hours). However, because the injected fluid contains an adequate amount of anesthetic, additional anesthesia may not be necessary. The name of this technique refers to the swollen and firm or "tumesced" state of the fatty tissues when they are filled with solution.
The Super-Wet Technique is similar to the tumescent technique, except that lesser amounts of fluid are used. Usually the amount of fluid injected is equal to the amount of fat to be removed. This technique often requires IV sedation or general anesthesia and typically takes one to two hours of surgery time.
Ultrasound-Assisted Lipoplasty (UAL) - this technique requires the use of a special cannula that produces ultrasonic energy. As it passes through the areas of fat, the energy explodes the walls of the fat cells, liquefying the fat. The fat is then removed with the traditional liposuction technique.
UAL has been shown to improve the ease and effectiveness of liposuction in fibrous areas of the body, such as the upper back or the enlarged male breast. It is also commonly used in secondary procedures, when enhanced precision is needed. In general, UAL takes longer to perform than traditional liposuction.
All Surgery Carries Some Uncertainty and Risk
Liposuction is normally safe, as long as patients are carefully selected, the operating facility is properly equipped and the physician is adequately trained.
As a minimum, your plastic surgeon should have basic (core) accredited surgical training with special training in body contouring. Also, even though many body-contouring procedures are performed outside the hospital setting, be certain that your cosmetic surgeon has been granted privileges to perform liposuction at an accredited hospital.
Your plastic surgeon must have advanced surgical skills to perform procedures that involve the removal of a large amount of fat (more than 5 liters or 5,000 ccs); ask Dr. Lesavoy about his other patients who have had similar procedures and what their results were. Also, more extensive liposuction procedures require attentive after-care. Find out how Dr. Lesavoy plans to monitor your condition closely after the procedure.
However, it's important to keep in mind that even though a well-trained surgeon and a state-of-the art facility can improve your chance of having a good result, there are no guarantees. Though they are rare, complications can and do occur. Risks increase if a greater number of areas are treated at the same time, or if the operative sites are larger in size. Removal of a large amount of fat and fluid may require longer operating times than may be required for smaller operations.
The combination of these factors can create greater hazards for infection; delays in healing; the formation of fat clots or blood clots, which may migrate to the lungs and cause death; excessive fluid loss, which can lead to shock or fluid accumulation that must be drained; friction burns or other damage to the skin or nerves or perforation injury to the vital organs; and unfavorable drug reactions.
There are also points to consider with the newer techniques. For example, in UAL, the heat from the ultrasound device used to liquefy the fat cells may cause injury to the skin or deeper tissues. Also, you should be aware that even though UAL has been performed successfully on several thousand people worldwide, the long-term effects of ultrasound energy on the body are not yet known.
In the tumescent and super-wet techniques, the anesthetic fluid that is injected may cause lidocaine toxicity (if the solution's lidocaine content is too high), or the collection of fluid in the lungs (if too much fluid is administered).
The scars from liposuction are small and strategically placed to be hidden from view. However, imperfections in the final appearance are not uncommon after lipoplasty. The skin surface may be irregular, asymmetric or even "baggy," especially in the older patient. Numbness and pigmentation changes may occur. Sometimes, additional surgery may be recommended.
Improvement will become apparent after about six weeks, when most of the swelling has subsided.
After Your Liposuction Surgery
After surgery, you will likely experience some fluid drainage from the incisions. Occasionally, a small drainage tube may be inserted beneath the skin for a couple of days to prevent fluid build-up. To control swelling and to help your skin better fit its new contours, you may be fitted with a snug elastic garment to wear over the treated area for a few weeks. Dr. Lesavoy may also prescribe antibiotics to prevent infection.
Don't expect to look or feel great right after surgery. Even though the newer techniques are believed to reduce some post-operative discomforts, you may still experience some pain, burning, swelling, bleeding and temporary numbness. Pain can be controlled with medications prescribed by Dr. Lesavoy, though you may still feel stiff and sore for a few days.
It is normal to feel a bit anxious or depressed in the days or weeks following surgery. However, this feeling will subside as you begin to look and feel better.
Getting Back to Normal After Liposuction Cosmetic Surgery
Healing is a gradual process. Dr. Lesavoy will probably tell you to start walking around as soon as possible to reduce swelling and to help prevent blood clots from forming in your legs. You will begin to feel better after about a week or two and you should be back at work within a few days following your surgery. The stitches are removed or dissolve on their own within the first week to 10 days.
Activity that is more strenuous should be avoided for about a month as your body continues to heal. Although most of the bruising and swelling usually disappears within three weeks, some swelling may remain for six months or more.
Dr. Lesavoy will schedule follow-up visits to monitor your progress and to see if any additional procedures are needed.
If you have any unusual symptoms between visits - for example, heavy bleeding or a sudden increase in pain - or any questions about what you can and can't do, call Dr. Lesavoy.
Your New Look
You will see a noticeable difference in the shape of your body quite soon after surgery. However, improvement will become even more apparent after about four to six weeks, when most of the swelling has subsided. After about three months, any persistent mild swelling usually disappears and the final contour will be visible.
If your expectations are realistic, you will probably be very pleased with the results of your surgery. You may find that you are more comfortable in a wide variety of clothes and more at ease with your body. And, by eating a healthy diet and getting regular exercise, you can help to maintain your new shape.
As healing progresses, a more proportional look will emerge.
A slimmer body contour can help you feel more confident and comfortable.
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Facelift
As people age, the effects of gravity, exposure to the sun, and the stresses of daily life can be seen in their faces. Deep creases form between the nose and mouth; the jaw line grows slack and jowly; folds and fat deposits appear around the neck.
A facelift (technically known as rhytidectomy) can't stop this aging process. What it can do is "set back the clock," improving the most visible signs of aging by removing excess fat, tightening underlying muscles, and redraping the skin of your face and neck. A facelift can be done alone, or in conjunction with other procedures such as a forehead lift, eyelid surgery, or nose reshaping.
If you're considering a facelift, this information will give you a basic understanding of the facelift 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 the individual patient and the surgeon. Please ask Dr. Lesavoy about anything you don't understand.
The Best Candidates for a Facelift
The best candidate for a facelift is a man or woman whose face and neck have begun to sag, but whose skin still has some elasticity and whose bone structure is strong and well-defined. Most patients are in their forties to sixties, but facelifts can be done successfully on people in their seventies or eighties, as well.
A facelift can make you look younger and fresher, and it may enhance your self-confidence in the process. But it can't give you a totally different look, nor can it restore the health and vitality of your youth. Before you decide to have surgery, think carefully about your expectations and discuss them with Dr. Lesavoy.
A facelift can improve the deep cheek folds, jowls and loose, sagging skin around the neck that come with age.
All surgery carries some uncertainty and risk When a facelift is performed by a qualified plastic surgeon, complications are infrequent and usually minor. Still, individuals vary greatly in their anatomy, their physical reactions, and their healing abilities, and the outcome is never completely predictable.
Complications that can occur include hematoma (a collection of blood under the skin that must be removed by the surgeon), injury to the nerves that control facial muscles (usually temporary), infection, and reactions to the anesthesia. Poor healing of the skin is most likely to affect smokers.
You can reduce your risks by closely following Dr. Lesavoy's advice both before and after surgery.
Planning Your Facelift Surgery
Facelifts are very individualized procedures. In your initial consultation Dr. Lesavoy will evaluate your face, including the skin and underlying bone, and discuss your goals for the surgery.
Dr. Lesavoy will check for medical conditions that could cause problems during or after surgery, such as uncontrolled high blood pressure, blood clotting problems, or the tendency to form excessive scars. Be sure to tell Dr. Lesavoy if you smoke or are taking any drugs or medications, especially aspirin or other drugs that affect clotting.
If you decide to have a facelift, Dr. Lesavoy will explain the techniques and anesthesia he will use, the type of facility where the surgery will be performed, and the risks and costs involved. Don't hesitate to ask Dr. Lesavoy any questions you may have, especially those regarding your expectations and concerns about the results.
Preparing for Your Facelift Surgery
Dr. Lesavoy 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. Carefully following these instructions will help your surgery go more smoothly. If you smoke, it's especially important to stop at least a week or two before and after surgery; smoking inhibits blood flow to the skin, and can interfere with the healing of your incision areas.
If your hair is very short, you might want to let it grow out before surgery, so that it's long enough to hide the scars while they heal.
Whether your facelift is being done on an outpatient or inpatient basis, you should arrange for someone to drive you home after your surgery, and to help you out for a day or two if needed.
Where Your Facelift Surgery will be Performed
The majority of Dr. Lesavoy's surgeries are performed in the privacy, safety, and comfort of the Encino Outpatient Surgery Center, which is located next door in Suite 580. This state-of-the-art facility contains two operating rooms and is Medicare-certified. Depending on the case, Dr. Lesavoy may also perform surgery in the office (for minor procedures) or at UCLA Medical Center. Our RN nursing staff is warm, supportive, and trained to respond to the needs of plastic surgery patients, and our anesthesiologists are all MDs.
Types of Anesthesia
Most facelifts are performed under local anesthesia, combined with a sedative to make you drowsy. You'll be awake but relaxed, and your face will be insensitive to pain. (However, you may feel some tugging or occasional discomfort.)
Dr. Lesavoy may recommend a general anesthesia. In that case, you'll sleep through the operation.
The Facelift Surgery
A facelift usually takes several hours - or somewhat longer if you're having more than one procedure done. For extensive procedures, Dr. Lesavoy may schedule two separate sessions.
Every surgeon approaches the procedure in his or her own way. Some complete one side of the face at a time, and others move back and forth between the sides. The exact placement of incisions and the sequence of events depends on your facial structure and Dr. Lesavoy's technique.
Incisions usually begin above the hairline at the temples, follow the natural line in front of the ear, curve behind the earlobe into the crease behind the ear, and into or along the lower scalp.
Incisions usually begin above the hairline at the temples, extend in a natural line in front of the ear (or just inside the cartilage at the front of the ear), and continue behind the earlobe to the lower scalp. If the neck needs work, a small incision may also be made under the chin.
Facial, neck tissue and muscle may be separated; fat may be trimmed or suctioned and underlying muscle may be tightened.
In general, Dr. Lesavoy separates the skin from the fat and muscle below. Fat may be trimmed or suctioned from around the neck and chin to improve the contour. The surgeon then tightens the underlying muscle and membrane, pulls the skin back, and removes the excess. Stitches secure the layers of tissue and close the incisions; metal clips may be used on the scalp.
After deep tissues are tightened, the excess skin is pulled up and back, trimmed and sutured into place.
Following surgery, a small, thin tube may be temporarily placed under the skin behind your ear to drain any blood that might collect there. Dr. Lesavoy may also wrap your head loosely in bandages to minimize bruising and swelling.
After Your Facelift Surgery
There isn't usually significant discomfort after surgery; if there is, it can be lessened with the pain medication prescribed by Dr. Lesavoy. (Severe or persistent pain or a sudden swelling of your face should be reported to Dr. Lesavoy immediately.) Some numbness of the skin is quite normal; it will disappear in a few weeks or months.
Dr. Lesavoy may tell you to keep your head elevated and as still as possible for a couple of days after surgery, to keep the swelling down.
If you've had a drainage tube inserted, it will be removed one or two days after surgery. Bandages, when used, are usually removed after one to five days. Don't be surprised at the pale, bruised, and puffy face you see. Just keep in mind that in a few weeks you'll be looking normal.
Most of your stitches will be removed after about five days. Your scalp may take longer to heal, and the stitches or metal clips in your hairline could be left in a few days longer.
Most of the scars will be hidden within you hair and in the normal creases of your skin.
After Your Facelift Surgery
There isn't usually significant discomfort after surgery; if there is, it can be lessened with the pain medication prescribed by Dr. Lesavoy. (Severe or persistent pain or a sudden swelling of your face should be reported to Dr. Lesavoy immediately.) Some numbness of the skin is quite normal; it will disappear in a few weeks or months.
Dr. Lesavoy may tell you to keep your head elevated and as still as possible for a couple of days after surgery, to keep the swelling down.
If you've had a drainage tube inserted, it will be removed one or two days after surgery. Bandages, when used, are usually removed after one to five days. Don't be surprised at the pale, bruised, and puffy face you see. Just keep in mind that in a few weeks you'll be looking normal.
Most of your stitches will be removed after about five days. Your scalp may take longer to heal, and the stitches or metal clips in your hairline could be left in a few days longer.
Most of the scars will be hidden within you hair and in the normal creases of your skin.
Your New Look after Facelift Surgery
The chances are excellent that you'll be happy with your facelift - especially if you realize that the results may not be immediately apparent. Even after the swelling and bruises are gone, the hair around your temples may be thin and your skin may feel dry and rough for several months. Men may find they have to shave in new places - behind the neck and ears - where areas of beard-growing skin have been repositioned.
You'll have some scars from your facelift, but they're usually hidden by your hair or in the natural creases of your face and ears. In any case, they'll fade within time and should be scarcely visible.
After surgery, you'll present a fresher, more youthful face to the world.
Having a facelift doesn't stop the clock. Your face will continue to age with time, and you may want to repeat the procedure one or more times-perhaps five or ten years down the line. But in another sense, the effects of even one facelift are lasting; years later, you'll continue to look better than if you'd never had a facelift at all.
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Rhinoplasty
Rhinoplasty, or surgery to reshape the nose, is one of the most common of all plastic surgery procedures. Rhinoplasty can reduce or increase the size of your nose, change the shape of the tip or the bridge, narrow the span of the nostrils, or change the angle between your nose and your upper lip. It may also correct a birth defect or injury, or help relieve some breathing problems.
If you're considering rhinoplasty, 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 the individual patient and the surgeon. Please ask plastic surgeon Dr. Lesavoy about anything you don't understand.
The Best Candidates for Rhinoplasty
Rhinoplasty 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 Dr. Lesavoy.
The best candidates for rhinoplasty are people who are looking for improvement, not perfection, in the way they look. If you're physically healthy, psychologically stable, and realistic in your expectations, you may be a good candidate.
Before surgery, these rhinoplasty patients have large, slightly hanging noses, with a hump and an enlarged tip.
Rhinoplasty can be performed to meet aesthetic goals or for reconstructive purposes - to correct birth defects or breathing problems.
Age may also be a consideration. Many surgeons prefer not to operate on teenagers until after they've completed their growth spurt-around 14 or 15 for girls, a bit later for boys. It's important to consider teenagers' social and emotional adjustment, too, and to make sure it's what they, and not their parents, really want.
All Surgery Carries Some Uncertainty and Risk
When rhinoplasty is performed by a qualified plastic surgeon, complications are infrequent and usually minor. Nevertheless, there is always a possibility of complications, including infection, nosebleed, or a reaction to the anesthesia. You can reduce your risks by closely following Dr. Lesavoy's instructions both before and after surgery.
After nose reshaping plastic surgery, small burst blood vessels may appear as tiny red spots on the skin's surface; these are usually minor but may be permanent. As for scarring, when rhinoplasty is performed from inside the nose, there is no visible scarring at all; when an "open" technique is used, or when the procedure calls for the narrowing of flared nostrils, the small scars on the base of the nose are usually not visible.
In about one case out of ten, a second procedure may be required - for example, to correct a minor deformity. Such cases are unpredictable and happen even to patients of the most skilled surgeons. The corrective surgery is usually minor.
Planning Your Rhinoplasty Surgery
Good communication between you and Dr. Lesavoy is essential. In your initial consultation, Dr. Lesavoy will ask what you'd like your nose to look like, evaluate the structure of your nose and face, and discuss the possibilities with you. He will also explain the factors that can influence the procedure and the results. These factors include the structure of your nasal bones and cartilage, the shape of your face, the thickness of your skin, your age, and your expectations.
Dr. Lesavoy will also explain the techniques and anesthesia he will use, the type of facility where the surgery will be performed, the risks and costs involved, and any options you may have. Most insurance policies don't cover purely cosmetic surgery; however, if the procedure is performed for reconstructive purposes, to correct a breathing problem or a marked deformity, the procedure may be covered. Check with your insurer, and obtain pre-authorization for your nasla plastic surgery.
Be sure to tell Dr. Lesavoy if you've had any previous nose surgery or an injury to your nose, even if it was many years ago. You should also inform Dr. Lesavoy if you have any allergies or breathing difficulties; if you're taking any medications, vitamins, or recreational drugs; and if you smoke.
Don't hesitate to ask Dr. Lesavoy any questions you may have, especially those regarding your expectations and concerns about the results.
Preparing for Your Rhinoplasty Surgery
Dr. Lesavoy will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, taking or avoiding certain vitamins and medications, and washing your face. Carefully following these instructions will help your surgery go more smoothly.
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
The majority of Dr. Lesavoy's surgeries are performed in the privacy, safety, and comfort of the Encino Outpatient Surgery Center, which is located next door in Suite 580. This state-of-the-art facility contains two operating rooms and is Medicare-certified. Depending on the case, Dr. Lesavoy may also perform surgery in the office (for minor procedures) or at UCLA Medical Center. Our RN nursing staff is warm, supportive, and trained to respond to the needs of plastic surgery patients, and our anesthesiologists are all MDs.
Types of Anesthesia
Rhinoplasty can be performed under local or general anesthesia, depending on the extent of the procedure and on what you and Dr. Lesavoy prefer.
With local anesthesia, you'll usually be lightly sedated, and your nose and the surrounding area will be numbed; you'll be awake during the surgery, but relaxed and insensitive to pain. With general anesthesia, you'll sleep through the operation.
The Rhinoplasty Surgery
Rhinoplasty usually takes an hour or two, though complicated procedures may take longer. During surgery the skin of the nose is separated from its supporting framework of bone and cartilage, which is then sculpted to the desired shape. The nature of the sculpting will depend on your problem and Dr. Lesavoy's preferred technique. Finally, the skin is redraped over the new framework.
If your nostrils are too wide, the surgeon can remove small wedges of skin form their base, bringing them closer together.
Many plastic surgeons perform rhinoplasty from within the nose, making their incision inside the nostrils. Others prefer an "open" procedure, especially in more complicated cases; they make a small incision across the columella, the vertical strip of tissue separating the nostrils.
Incisions are made inside the nostrils or at the base of the nose, providing access to the cartilage and bone, which can then be sculpted into shape.
When the surgery is complete, a splint will be applied to help your nose maintain its new shape. Nasal packs or soft plastic splints also may be placed in your nostrils to stabilize the septum, the dividing wall between the air passages.
Dr. Lesavoy removes the hump using a chisel or a rasp, then brings the nasal bones together to form a narrower bridge. Cartilage is trimmed to reshape the tip of the nose.
Trimming the septum improves the angle between the nose and upper lip.
After Your Nasal Plastic Surgery
After surgery - particularly during the first twenty-four hours - your face will feel puffy, your nose may ache, and you may have a dull headache. You can control any discomfort with the pain medication prescribed by Dr. Lesavoy. Plan on staying in bed with your head elevated (except for going to the bathroom) for the first day.
You'll notice that the swelling and bruising around your eyes will increase at first, reaching a peak after two or three days. Applying cold compresses will reduce this swelling and make you feel a bit better. In any case, you'll feel a lot better than you look. Most of the swelling and bruising should disappear within two weeks or so. (Some subtle swelling - unnoticeable to anyone but you and Dr. Lesavoy - will remain for several months.)
A little bleeding is common during the first few days following surgery, and you may continue to feel some stuffiness for several weeks. Dr. Lesavoy will probably ask you not to blow your nose for a week or so, while the tissues heal.
If you have nasal packing, it will be removed after a few days and you'll feel much more comfortable. By the end of one or, occasionally, two weeks, all dressings, splints, and stitches should be removed.
A splint made of tape and an overlay of plastic, metal, or plaster is applied to help the bone and cartilage of the nose maintain their new shape.
Getting Back to Normal After Rhinoplasty Surgery
Most rhinoplasty patients are up and about within two days, and able to return to school or sedentary work a week or so following surgery. It will be several weeks, however, before you're entirely up to speed.
Dr. Lesavoy will give you more specific guidelines for gradually resuming your normal activities. He's likely to include these suggestions: avoid strenuous activity (jogging, swimming, bending, sexual relations-any activity that increases your blood pressure) for two to three weeks; avoid hitting or rubbing your nose, or getting it sunburned, for eight weeks; be gentle when washing your face and hair or using cosmetics.
You can wear contact lenses as soon as you feel like it, but glasses are another story. Once the splint is off, they'll have to be taped to your forehead or propped on your cheeks for another six to seven weeks, until your nose is completely healed.
Dr. Lesavoy will schedule frequent follow-up visits in the months after surgery, to check on the progress of your healing. If you have any unusual symptoms between visits, or any questions about what you can and can't do, don't hesitate to call Dr. Lesavoy.
Your New Look after Nasal Plastic Surgery
In the days following nasal plastic surgery, when your face is bruised and swollen, it's easy to forget that you will be looking better. In fact, many patients feel depressed for a while after plastic surgery - it's quite normal and understandable.
Rest assured that this stage will pass. Day by day, your nose will begin to look better and your spirits will improve. Within a week or two, you'll no longer look as if you've just had surgery.
Still, healing is a slow and gradual process. Some subtle swelling may be present for months, especially in the tip. The final results of rhinoplasty may not be apparent for a year or more.
After surgery, the patient has a smaller nose, a straighter bridge, a well defined nasal tip, and an improved angle between the nose and upper lip.
In the meantime, you might experience some unexpected reactions from family and friends. They may say they don't see a major difference in your nose. Or they may act resentful, especially if you've changed something they view as a family or ethnic trait. If that happens, try to keep in mind why you decided to have this surgery in the first place. If you've met your goals, then your nasal cosmetic surgery is a success.
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Scar Revision
Scars - whether they're caused by accidents or by surgery - are unpredictable. The way a scar develops depends as much on how your body heals as it does on the original injury or on the surgeon's skills.
Many variables can affect the severity of scarring, including the size and depth of the wound, the blood supply to the area, the thickness and color of your skin, and the direction of the scar. How much the appearance of a scar bothers you is, of course, a personal matter.
While no scar can be removed completely, plastic surgeons can often improve the appearance of a scar, making it less obvious through the injection or application of certain steroid medications or through surgical procedures known as scar revisions.
If you're considering scar revision, this information will give you a basic understanding of the most common types of scars, the procedures used to treat them, and the 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 Dr. Lesavoy if there is anything about the procedure you don't understand.
Making the Decision About Scar Revision Cosmetic Surgery
Many scars that appear large and unattractive at first may become less noticeable with time. Some can be treated with steroids to relieve symptoms such as tenderness and itching. For these reasons, many plastic surgeons recommend waiting as long as a year or more after an injury or surgery before you decide to have scar revision.
If you're bothered by a scar, your first step should be to consult a board-certified plastic surgeon. The surgeon will examine you and discuss the possible methods of treating your scar, the risks and benefits involved and the possible outcomes. Be frank in discussing your expectations with the surgeon, and make sure they're realistic. Don't hesitate to ask any questions or express any concerns you may have.
Insurance usually doesn't cover cosmetic procedures. However, if scar revision is performed to minimize scarring from an injury or to improve your ability to function, it may be at least partially covered. Check your policy or call your carrier to be sure.
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Botox
Botox Cosmetic is a very popular injectable for the treatment of frown lines between the eyebrows, creases in the forehead and neck, lip lines, and crow's feet. Botox works by temporarily paralyzing the underlying muscles that cause facial wrinkles and lines, creating a smooth facial appearance. Results from Botox typically work for three to six weeks and can repeated as needed.
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