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What is Plastic Surgery?
Taken from the Greek word "plastikos," meaning to mold or give form, plastic surgery is the specialty of medicine dedicated to restoring and reshaping the human body. It encompasses both reconstructive surgery, which is performed on abnormal structures of the body caused by birth defects, developmental problems, injuries, infection, tumors, or disease; and cosmetic surgery, which is performed to reshape or restore normal structures of the body to improve appearance and self-esteem.
History suggests that the practice of plastic surgery has ancient roots. However, plastic surgery as a defined specialty became fully recognized during World War I. Today, scientific advances in the field allow plastic surgeons to achieve improvements in form and function thought to be impossible 10 years ago.
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Is plastic surgery safe?
All surgery carries some uncertainty and risk. However, plastic surgery procedures are normally safe when they're performed by a qualified, experienced board-certified physician. It is important for patients to disclose all pertinent medical history to the surgeon, so that a true assessment of any surgical risks can be made.
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What factors impact the success of surgery?
A patient's age, skin type, general health, genetic background, and the nature of his or her condition can all affect any final result. Patients who smoke may not heal as quickly as non-smoking patients. Patients with sun-damaged skin may not achieve the same degree of improvement as those without sun-damaged skin. Though there is no way to exactly predict a surgical outcome, the surgeon will examine the known patient variables before surgery begins and can project an estimate of the surgical result. Patients can take comfort in knowing that most of the procedures performed today have been refined over several decades.
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Am I an appropriate candidate for plastic surgery?
If you are considering plastic surgery, you must be honest with yourself. Exactly why do you want surgery? And, what are your goals for surgery-what do you expect plastic surgery to do for you?
There are two categories of patients who are good candidates for surgery. The first includes patients with a h3 self-image, who are bothered by a physical characteristic that they'd like to improve or change. After surgery, these patients feel good about the results and maintain a positive image about themselves.
The second category includes patients who have a physical defect or cosmetic flaw that has diminished their self-esteem over time. These patients may adjust rather slowly after surgery, as rebuilding confidence takes time. However, as they adjust, these patients' self-image is strengthened, sometimes dramatically.
It's important to remember that plastic surgery can create both physical changes and and changes in self-esteem. If you are seeking surgery with the hope of influencing a change in someone other than yourself, you might end up disappointed. It's possible that friends and loved ones will respond positively to your change in appearance and self-confidence, however understand and accept that plastic surgery will not cause dramatic changes in people other than you.
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Will my surgery be covered by insurance?
Reconstructive surgery is covered by most health insurance policies, although the specifics of coverage may vary greatly. Some carriers may fully cover reconstructive procedures, others may pay only a portion of the cost.
Cosmetic surgery, however, is usually not covered by health insurance because it is elective and not considered a medical necessity. Some plastic surgeons accept major credit cards or offer financing programs that allow patients to make manageable monthly payments for cosmetic surgery.
Keep in mind that there are a number of "gray areas" in plastic surgery that sometimes require special consideration by an insurance carrier. For example, eyelid surgery -- a procedure normally performed to achieve cosmetic improvement -- may be covered if drooping eyelids obscure a patient's vision. In assessing whether the procedure will be covered, the carrier often looks at the primary reason the procedure is being performed: is it for relief of symptoms or for aesthetic improvement?
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What effect can plastic surgery have on my self-image after surgery?
Each of us has a "self-image," a perception of how we believe we look to others. People who are happy with their self-image are more likely to be self-confident, effective in work and social situations, and comfortable in their relationships. Those who are dissatisfied tend to be self-conscious, inhibited, and less effective in activities.
Plastic surgery -- whether cosmetic or reconstructive -- encourages and promotes a healthy, positive self-image. Even a small change on the outside can create an extraordinary change on the inside, allowing an individual's self-confidence to flourish.
*Information on this page provided by the American Society of Plastic Surgeons
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What Are Botox® Injections?
The cosmetic form of botulinum toxin, often referred to by its product name Botox®, is a popular non-surgical injection that temporarily reduces or eliminates frown lines, forehead creases, crows feet near the eyes and thick bands in the neck. The toxin blocks the nerve impulses, temporarily paralyzing the muscles that cause wrinkles while giving the skin a smoother, more refreshed appearance. Studies have also suggested that Botox is effective in relieving migraine headaches, excessive sweating and muscle spasms in the neck and eyes.
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What is 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 restore breast volume lost due to weight loss or following pregnancy
- To achieve better symmetry when breasts are moderately disproportionate in size and shape
- To improve the shape of breasts that are sagging or have lost firmness, often used with a breast lift procedure
- To provide the foundation of a breast contour when a breast has been removed or disfigured by surgery to treat breast cancer
- To improve breast appearance or create the appearance of a breast that is missing or disfigured due to trauma, heredity, or congenital abnormalities
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 your surgeon if there is anything you don't understand about the procedure.
The Best Candidates for Breast Augmentation
Breast augmentation can enhance your appearance and your self-confidence, but it won't necessarily change your looks to match your ideal, or cause other people to treat you differently. Before you decide to have surgery, think carefully about your expectations and discuss them with your surgeon.
The best candidates for breast augmentation 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.
Types of Implants
The choice of implant filler, implant size, shape and other features will be determined based on your breast anatomy, body type and your desired increase in size. Your lifestyle, goals and personal preferences, as well your plastic surgeon's recommendations and sound surgical judgment are also determining factors. Implant manufacturers occasionally introduce new styles and types of implants, and therefore there may be additional options available to you.
Breast implants are medical devices with a solid silicone, rubber shell. The implant shell may be filled with either saline solution (sterile salt water) or elastic silicone gel. Both saline and silicone gel breast implants are approved by the U.S. Food and Drug Administration (FDA). Approval means that an implant has been rigorously researched and tested, and reviewed by an independent panel of physicians for safety.
The size of a breast implant is measured in cubic centimeters (ccs) based on the volume of the saline or silicone filler. Breast implants vary both by filler and in size, but there are additional features to consider:
- Texture: the implant shell may be smooth or textured
- Shape: the implant may have a round profile or one that is anatomic (teardrop or tapered shape)
- Profile: the implant may have a low, medium or high projection (the depth of the implant from the base to the highest point of the implant curve)
- Diameter: the width of the implant measured across it's base (the side of the implant that will be positioned over the chest wall)
Adult women of any age can benefit greatly from the enhancement breast implants provide. It is usually recommended, however, that a woman's breasts are fully developed prior to placement of breast implants. Saline implants are FDA approved for augmentation in women 18 years of age and older. Silicone implants are FDA approved for augmentation in women age 22 and older. Saline or silicone implants may be recommended at a younger age if used for reconstruction purposes.
You should be aware that breast implants are not guaranteed to last a lifetime and future surgery may be required to replace one or both implants. Regular examinations for breast health and to evaluate the condition of your implants are important whether you have chosen saline or silicone breast implants.
All Surgery Carries Uncertainty and Risk
Breast augmentation is relatively straightforward. But as with any operation, there are risks associated with surgery and specific complications associated with this procedure.
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 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 within time, but may be permanent in some patients.
Breast implants do not generally interfere with a woman's ability to breast feed, or present a health hazard during pregnancy to a woman or her baby. However, pregnancy and the associated changes to a woman's body may alter the results of any breast surgery, including surgery to place breast implants. Therefore, it is important to discuss the options of breast implant surgery with your plastic surgeon if you are interested in becoming pregnant and breast feeding in the future.
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 man-made shell to leak.
If a saline-filled implant breaks, the implant will deflate in a few hours and the salt water will be absorbed and naturally expelled by the body.
If a silicone-gel filled implant leak or break, the elastic silicone gel may remain within the implant shell, or may escape into the breast implant pocket (a capsule of tissue that surrounds the implant). A leaking implant filled with silicone gel may not deflate and may not be noticeable except through imaging techniques such as an MRI. For this reason, a woman with silicone breast implants is advised to visit her plastic surgeon annually to assess that her implants are functioning well. An ultrasound exam or MRI screening can assess the condition of breast implants; after 3 years it is recommended that all silicone implants be properly screened.
Following the placement of breast implants mammography is technically more difficult. Obtaining the best possible results requires specialized techniques and additional views. You must be candid about your implants when undergoing any diagnostic breast exam. In many cases, an ultrasound exam or MRI may be recommended in addition to mammography.
While the majority of women do not experience these complications, you should discuss each of them with your physician to make sure you understand the risks and consequences of breast augmentation.
Planning Your Surgery
In your initial consultation, your surgeon 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, your doctor may also recommend a breast lift.
Be sure to discuss your expectations frankly with your surgeon. He or she should be equally frank with you, describing your alternatives and the risks and limitations of each. You may want to ask your surgeon for a copy of the manufacturer's insert that comes with the implant he or she will use -- just so you are fully informed about it. And, be sure to tell your surgeon if you smoke, and if you're taking any medications, vitamins, or other drugs.
Your surgeon should 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 Surgery
Your surgeon will give you instructions to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications. A mammogram may be recommended prior to your procedure to ensure breast health and serve as a baseline for future comparison.
In addition to explaining your surgical procedure, you plastic surgeon will discuss anesthesia, the recovery process and your obligations as a patient. You will also discuss where your procedure will be performed. You will be asked to sign consent forms to ensure that you fully understand the procedure you will undergo and any risks and potential complications of your surgery. There may be a waiting period of several days to weeks from the time of your consent to the day of surgery.
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
Your surgeon may prefer to perform the operation in an office facility, a freestanding surgery center, or a hospital outpatient facility. Occasionally, the surgery may be done as an inpatient in a hospital, in which case you can plan on staying for a day or two.
Types of Anesthesia
Breast augmentation can be performed with a general anesthesia, so you'll sleep through the entire operation. Some surgeons 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 Surgery
The method of inserting and positioning your implant will depend on your anatomy and your surgeon'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. In addition, a saline implant may be placed through an incision at the navel. Every effort will be made to assure that the incision is placed so resulting scars will be as inconspicuous as possible.
Working through the incision, the surgeon will lift your breast tissue and skin to create a pocket, either directly behind the breast tissue (submammary or subglandular placement) or may be placed beneath the pectoral muscle and on top of the chest wall (submuscular placement). Once the implant is positioned within this pocket, the incisions are closed with sutures, skin adhesive and/or surgical tape. A gauze bandage may be applied over your breasts to help with healing. The surgery usually takes one to two hours to complete. You'll want to discuss the pros and cons of these alternatives with your doctor before surgery to make sure you fully understand the implications of the procedure he or she recommends for you.
After Your 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 your doctor.
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 your surgeon. 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
You should be able to return to work within a few days, depending on the level of activity required for your job.
Follow your surgeon'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 mammography 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 can be satisfying, even exhilarating, as they learn to appreciate their fuller appearance.
Even if you believe your implants are functioning well, it is important that you follow-up as directed with your plastic surgeon to assess the condition of your breast implants. In addition, whether you choose to have breast implants or not, it is essential to your health that you practice a monthly breast self-exam and schedule regular diagnostic breast screenings.
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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What Is Breast Lift?
If you're considering a breast lift...
Over the years, factors such as pregnancy, nursing, and the force of gravity take their toll on a woman's breasts. As the skin loses its elasticity, the breasts often lose their shape and firmness and begin to sag. Breastlift, or mastopexy, is a surgical procedure to raise and reshape sagging breasts--at least, for a time. (No surgery can permanently delay the effects of gravity.) Mastopexy can also reduce the size of the areola, the darker skin surrounding the nipple. If your breasts are small or have lost volume--for example, after pregnancy--breast implants inserted in conjunction with mastopexy can increase both their firmness and their size. If you're considering a breast lift, this brochure will give you a basic understanding of the procedure--when it can help, how it's performed, and what results you can expect. It can't answer all of your questions, since a lot depends on your individual circumstances. Please be sure to ask your doctor if there is anything about the procedure you don't understand.
The Best Candidates for Breast Lift
A breast lift can enhance your appearance and your self-confidence, but it won't necessarily change your looks to match your ideal, or cause other people to treat you differently. Before you decide to have surgery, think carefully about your expectations and discuss them with your surgeon.
The best candidates for mastopexy are healthy, emotionally-stable women who are realistic about what the surgery can accomplish. The best results are usually achieved in women with small, sagging breasts. Breasts of any size can be lifted, but the results may not last as long in heavy breasts.
Many women seek mastopexy because pregnancy and nursing have left them with stretched skin and less volume in their breasts. However, if you're planning to have more children, it may be a good idea to postpone your breast lift. While there are no special risks that affect future pregnancies (for example, mastopexy usually doesn't interfere with breast-feeding), pregnancy is likely to stretch your breasts again and offset the results of the procedure.
All Surgery Carries Uncertainty and Risk
A breast lift is not a simple operation, but it's normally safe when performed by a qualified plastic surgeon. Nevertheless, as with any surgery, there is always a possibility of complications or a reaction to the anesthesia. Bleeding and infection following a breast lift are uncommon, but they can cause scars to widen. You can reduce your risks by closely following your physician's advice both before and after surgery.
Mastopexy does leave noticeable, permanent scars, although they'll be covered by your bra or bathing suit. (Poor healing and wider scars are more common in smokers.) The procedure can also leave you with unevenly positioned nipples, or a permanent loss of feeling in your nipples or breasts.
Planning Your Surgery
In your initial consultation, it's important to discuss your expectations frankly with your surgeon, and to listen to his or her opinion. Every patient--and every physician, as well--has a different view of what is a desirable size and shape for breasts.
The surgeon will examine your breasts and measure them while you're sitting or standing. He or she will discuss the variables that may affect the procedure--such as your age, the size and shape of your breasts, and the condition of your skin--and whether an implant is advisable. You should also discuss where the nipple and areola will be positioned; they'll be moved higher during the procedure, and should be approximately even with the crease beneath your breast.
Your surgeon should describe the procedure in detail, explaining its risks and limitations and making sure you understand the scarring that will result. He or she should also explain the anesthesia to be used, the type of facility where the surgery will be performed, and the costs involved.
Don't hesitate to ask your doctor any questions you may have, especially those regarding your expectations and concerns about the results.
Preparing For Your Surgery
Depending on your age and family history, your surgeon may require you to have a mammogram (breast x-ray) before surgery. You'll also get specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications.
While you're making preparations, be sure to arrange for someone to drive you home after your surgery and to help you out for a few days if needed.
Where Your Surgery Will Be Performed
Your breast lift may be performed in a hospital, an outpatient surgery center, or a surgeon's office-based facility. It's usually done on an outpatient basis, for cost containment and convenience. If you're admitted to the hospital as an inpatient, you can expect to stay one or two days.
Types of Anesthesia
Breast lifts are usually performed under general anesthesia, which means you'll sleep through the operation. In selected patients--particularly when a smaller incision is being made--the surgeon may use local anesthesia, combined with a sedative to make you drowsy. You'll be awake but relaxed, and will feel minimal discomfort.
The Surgery
Mastopexy usually takes one and a half to three and a half hours. Techniques vary, but the most common procedure involves an anchor-shaped incision following the natural contour of the breast.
The incision outlines the area from which breast skin will be removed and defines the new location for the nipple. When the excess skin has been removed, the nipple and areola are moved to the higher position. The skin surrounding the areola is then brought down and together to reshape the breast. Stitches are usually located around the areola, in a vertical line extending downwards from the nipple area, and along the lower crease of the breast.
Some patients, especially those with relatively small breasts and minimal sagging, may be candidates for modified procedures requiring less extensive incisions. One such procedure is the doughnut (or concentric) mastopexy, in which circular incisions are made around the areola, and a doughnut-shaped area of skin is removed.
If you're having an implant inserted along with your breast lift, it will be placed in a pocket directly under the breast tissue, or deeper, under the muscle of the chest wall.
After Your Surgery
After surgery, you'll wear an elastic bandage or a surgical bra over gauze dressings. Your breasts will be bruised, swollen, and uncomfortable for a day or two, but the pain shouldn't be severe. Any discomfort you do feel can be relieved with medications prescribed by your surgeon.
Within a few days, the bandages or surgical bra will be replaced by a soft support bra. You'll need to wear this bra around the clock for three to four weeks, over a layer of gauze. The stitches will be removed after a week or two.
If your breast skin is very dry following surgery, you can apply a moisturizer several times a day. Be careful not to tug at your skin in the process, and keep the moisturizer away from the suture areas.
You can expect some loss of feeling in your nipples and breast skin, caused by the swelling after surgery. This numbness usually fades as the swelling subsides over the next six weeks or so. In some patients, however, it may last a year or more, and occasionally it may be permanent.
Getting Back to Normal
Healing is a gradual process. Although you may be up and about in a day or two, don't plan on returning to work for a week or more, depending on how you feel. And avoid lifting anything over your head for three to four weeks. If you have any unusual symptoms, don't hesitate to call your surgeon.
Your surgeon will give you detailed instructions for resuming your normal activities. You may be instructed to avoid sex for a week or more, and to avoid strenuous sports for about a month. After that, you can resume these activities slowly. If you become pregnant, the operation should not affect your ability to breast-feed, since your milk ducts and nipples will be left intact.
Your New Look
Your surgeon will make every effort to make your scars as inconspicuous as possible. Still, it's important to remember that mastopexy scars are extensive and permanent. They often remain lumpy and red for months, then gradually become less obvious, sometimes eventually fading to thin white lines. Fortunately, the scars can usually be placed so that you can wear even low-cut tops.
You should also keep in mind that a breast lift won't keep you firm forever--the effects of gravity, pregnancy, aging, and weight fluctuations will eventually take their toll again. Women who have implants along with their breast lift may find the results last longer.
Your satisfaction with a breast lift is likely to be greater if you understand the procedure thoroughly and if your expectations are realistic.
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Breast Reconstruction
If you're considering breast reconstruction...
Reconstruction of a breast that has been removed due to cancer or other disease is one of the most rewarding surgical procedures available today. New medical techniques and devices have made it possible for surgeons to create a breast that can come close in form and appearance to matching a natural breast. Frequently, reconstruction is possible immediately following breast removal (mastectomy), so the patient wakes up with a breast mound already in place, having been spared the experience of seeing herself with no breast at all.
But bear in mind, post-mastectomy breast reconstruction is not a simple procedure. There are often many options to consider as you and your doctor explore what's best for you.
This information will give you a basic understanding of the procedure -- when it's appropriate, how it's done, and what results you can expect. It can't answer all of your questions, since a lot depends on your individual circumstances. Please be sure to ask your surgeon if there is anything you don't understand about the procedure.
The Best Candidates for Breast Reconstruction
Most mastectomy patients are medically appropriate for reconstruction, many at the same time that the breast is removed. The best candidates, however, are women whose cancer, as far as can be determined, seems to have been eliminated by mastectomy.
Still, there are legitimate reasons to wait. Many women aren't comfortable weighing all the options while they're struggling to cope with a diagnosis of cancer. Others simply don't want to have any more surgery than is absolutely necessary. Some patients may be advised by their surgeons to wait, particularly if the breast is being rebuilt in a more complicated procedure using flaps of skin and underlying tissue. Women with other health conditions, such as obesity, high blood pressure, or smoking, may also be advised to wait.
In any case, being informed of your reconstruction options before surgery can help you prepare for a mastectomy with a more positive outlook for the future.
All Surgery Carries Some Uncertainty and Risk
Virtually any woman who must lose her breast to cancer can have it rebuilt through reconstructive surgery. But there are risks associated with any surgery and specific complications associated with this procedure.
In general, the usual problems of surgery, such as bleeding, fluid collection, excessive scar tissue, or difficulties with anesthesia, can occur although they're relatively uncommon. And, as with any surgery, smokers should be advised that nicotine can delay healing, resulting in conspicuous scars and prolonged recovery. Occasionally, these complications are severe enough to require a second operation.
If an implant is used, there is a remote possibility that an infection will develop, usually within the first two weeks following surgery. In some of these cases, the implant may need to be removed for several months until the infection clears. A new implant can later be inserted.
The most common problem, capsular contracture, occurs if the scar or capsule around the implant begins to tighten. This squeezing of the soft implant can cause the breast to feel hard. Capsular contracture can be treated in several ways, and sometimes requires either removal or scoring of the scar tissue, or perhaps removal or replacement of the implant.
Reconstruction has no known effect on the recurrence of disease in the breast, nor does it generally interfere with chemotherapy or radiation treatment, should cancer recur. Your surgeon may recommend continuation of periodic mammograms on both the reconstructed and the remaining normal breast. If your reconstruction involves an implant, be sure to go to a radiology center where technicians are experienced in the special techniques required to get a reliable x-ray of a breast reconstructed with an implant.
Women who postpone reconstruction may go through a period of emotional readjustment. Just as it took time to get used to the loss of a breast, a woman may feel anxious and confused as she begins to think of the reconstructed breast as her own.
Planning Your Surgery
You can begin talking about reconstruction as soon as you're diagnosed with cancer. Ideally, you'll want your breast surgeon and your plastic surgeon to work together to develop a strategy that will put you in the best possible condition for reconstruction.
After evaluating your health, your surgeon will explain which reconstructive options are most appropriate for your age, health, anatomy, tissues, and goals. Be sure to discuss your expectations frankly with your surgeon. He or she should be equally frank with you, describing your options and the risks and limitations of each. Post-mastectomy reconstruction can improve your appearance and renew your self-confidence -- but keep in mind that the desired result is improvement, not perfection.
Your surgeon should also explain the anesthesia he or she will use, the facility where the surgery will be performed, and the costs. In most cases, health insurance policies will cover most or all of the cost of post-mastectomy reconstruction. Check your policy to make sure you're covered and to see if there are any limitations on what types of reconstruction are covered.
Preparing For Your Surgery
Your oncologist and your plastic surgeon will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications.
While making preparations, be sure to arrange for someone to drive you home after your surgery and to help you out for a few days, if needed.
Where Your Surgery Will Be Performed
Breast reconstruction usually involves more than one operation. The first stage, whether done at the same time as the mastectomy or later on, is usually performed in a hospital.
Follow-up procedures may also be done in the hospital. Or, depending on the extent of surgery required, your surgeon may prefer an outpatient facility.
Types of Anesthesia
The first stage of reconstruction, creation of the breast mound, is almost always performed using general anesthesia, so you'll sleep through the entire operation.
Follow-up procedures may require only a local anesthesia, combined with a sedative to make you drowsy. You'll be awake but relaxed, and may feel some discomfort.
Types of Implants
If your surgeon recommends the use of an implant, you'll want to discuss what type of implant should be used. A breast implant is a silicone shell filled with either silicone gel or a salt-water solution known as saline.
Because of concerns that there is insufficient information demonstrating the safety of silicone gel-filled breast implants, the Food & Drug Administration (FDA) has determined that new gel-filled implants should be available only to women participating in approved studies. This currently includes women who already have tissue expanders (see below under Skin Expansion), who choose immediate reconstruction after mastectomy, or who already have a gel-filled implant and need it replaced for medical reasons. Eventually, all patients with appropriate medical indications may have similar access to silicone gel-filled implants.
The alternative saline-filled implant, a silicone shell filled with salt water, continues to be available on an unrestricted basis, pending further FDA review.
As more information becomes available, these FDA guidelines may change. Be sure to discuss current options with your surgeon. (Above guidelines are current as of July 1992.)
The Surgery
While there are many options available in post-mastectomy reconstruction, you and your surgeon should discuss the one that's best for you.
Skin expansion. The most common technique combines skin expansion and subsequent insertion of an implant.
Following mastectomy, your surgeon will insert a balloon expander beneath your skin and chest muscle. Through a tiny valve mechanism buried beneath the skin, he or she will periodically inject a salt-water solution to gradually fill the expander over several weeks or months. After the skin over the breast area has stretched enough, the expander may be removed in a second operation and a more permanent implant will be inserted. Some expanders are designed to be left in place as the final implant. The nipple and the dark skin surrounding it, called the areola, are reconstructed in a subsequent procedure.
Some patients do not require preliminary tissue expansion before receiving an implant. For these women, the surgeon will proceed with inserting an implant as the first step.
Flap reconstruction. An alternative approach to implant reconstruction involves creation of a skin flap using tissue taken from other parts of the body, such as the back, abdomen, or buttocks.
In one type of flap surgery, the tissue remains attached to its original site, retaining its blood supply. The flap, consisting of the skin, fat, and muscle with its blood supply, are tunneled beneath the skin to the chest, creating a pocket for an implant or, in some cases, creating the breast mound itself, without need for an implant.
Another flap technique uses tissue that is surgically removed from the abdomen, thighs, or buttocks and then transplanted to the chest by reconnecting the blood vessels to new ones in that region. This procedure requires the skills of a plastic surgeon who is experienced in microvascular surgery as well.
Regardless of whether the tissue is tunneled beneath the skin on a pedicle or transplanted to the chest as a microvascular flap, this type of surgery is more complex than skin expansion. Scars will be left at both the tissue donor site and at the reconstructed breast, and recovery will take longer than with an implant. On the other hand, when the breast is reconstructed entirely with your own tissue, the results are generally more natural and there are no concerns about a silicone implant. In some cases, you may have the added benefit of a improved abdominal contour.
Follow-up procedures. Most breast reconstruction involves a series of procedures that occur over time. Usually, the initial reconstructive operation is the most complex. Follow-up surgery may be required to replace a tissue expander with an implant or to reconstruct the nipple and the areola. Many surgeons recommend an additional operation to enlarge, reduce, or lift the natural breast to match the reconstructed breast. But keep in mind, this procedure may leave scars on an otherwise normal breast and may not be covered by insurance.
After Your Surgery
You are likely to feel tired and sore for a week or two after reconstruction. Most of your discomfort can be controlled by medication prescribed by your doctor.
Depending on the extent of your surgery, you'll probably be released from the hospital in two to five days. Many reconstruction options require a surgical drain to remove excess fluids from surgical sites immediately following the operation, but these are removed within the first week or two after surgery. Most stitches are removed in a week to 10 days.
Getting Back To Normal
It may take you up to six weeks to recover from a combined mastectomy and reconstruction or from a flap reconstruction alone. If implants are used without flaps and reconstruction is done apart from the mastectomy, your recovery time may be less.
Reconstruction cannot restore normal sensation to your breast, but in time, some feeling may return. Most scars will fade substantially over time, though it may take as long as one to two years, but they'll never disappear entirely. The better the quality of your overall reconstruction, the less distracting you'll find those scars.
Follow your surgeon's advice on when to begin stretching exercises and normal activities. As a general rule, you'll want to refrain from any overhead lifting, strenuous sports, and sexual activity for three to six weeks following reconstruction.
Your New Look
Chances are your reconstructed breast may feel firmer and look rounder or flatter than your natural breast. It may not have the same contour as your breast before mastectomy, nor will it exactly match your opposite breast. But these differences will be apparent only to you. For most mastectomy patients, breast reconstruction dramatically improves their appearance and quality of life following surgery.
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Breast Reduction Surgery
If you're considering 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 procedure removes fat, glandular tissue, and skin from the breasts, making them smaller, lighter, and firmer. It 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, 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 be sure to ask your doctor if there is anything about the 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 your physician's advice both before and after surgery.
The procedure 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 Surgery
In your initial consultation, it's important to discuss your expectations frankly with your surgeon, and to listen to his or her opinion. Every patient-and every physician, as well-has a different view of what is a desirable size and shape for breasts.
The surgeon will examine 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 or she will discuss the variables that may affect the procedure-such as your age, the size and shape of your breasts, and the condition of your skin. 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.
Your surgeon should describe the procedure in detail, explaining its risks and limitations and making sure you understand the scarring that will result. The surgeon should also explain the anesthesia he or she 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 your surgeon write a predetermination letter if required.)
Preparing For Your Surgery
Your surgeon may require you to have a mammogram (breast x-ray) before surgery. You'll also get specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications. Some surgeons suggest that their 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, your physician 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
Breast reduction surgery may be performed in a hospital, an outpatient surgery center or an office-based surgical suite. If you are admitted to the hospital, your stay will be a short one. The surgery itself usually takes two to four hours, but may take longer in some cases.
Types of Anesthesia
Breast reduction is nearly always performed under general anesthesia. You'll be asleep through the entire operation.
The Surgery
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. The surgeon removes excess glandular tissue, fat, and skin, and moves the nipple and areola into their new position. He or she 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.
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.)
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.
After Your 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. Your surgeon 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
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.
Your surgeon 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 your doctor.
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.
Your surgeon 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.
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What Are Facial Implants?
If you're considering facial surgery...
Plastic surgeons use facial implants to improve and enhance facial contours. Frequently, these implants will help provide a more harmonious balance to your face and features so that you feel better about the way you look.
There are many implants available, manufactured from a variety of materials. They may help strengthen a jawline or bring the chin or cheekbones into balance with the rest of the face.
This brochure describes some of the facial implants currently available as well as the techniques for their use. It will familiarize you with these procedures but cannot provide all the details which may be relevant to your particular needs.
If you feel that one or more of the procedures described in this brochure may be of benefit, be sure to ask your plastic surgeon for more information.
What to Expect from a Facial Implant
Facial implants can enhance your appearance and bolster your self esteem. If you are looking for improvement, not perfection, in your appearance and are realistic in your expectations, you may find that a facial implant is the right choice for you.
Plastic surgeons will frequently use such implants to bring better balance to the features of a younger patient. For instance, a teenage girl may want her nose reshaped or her chin brought forward so that these traits are better proportioned. The more mature patient may choose to have an implant placed in conjunction with another cosmetic procedure. For example, during a facelift, a patient may wish to have implants placed over the cheekbones to help restore a more youthful appearance. Implants may also be selected to fill out a face that appears "sunken" or tired.
All Surgery Carries Uncertainty and Risk
Facial implants can produce some remarkable changes. Problems rarely occur, but you need to be informed about such possibilities. This brochure will touch upon a few, but is not intended to provide a detailed or complete inventory of potential risks.
A facial implant can shift slightly out of alignment and a second operation my be necessary to replace it in its proper position. Infection can occur with any operation. If infection were to occur around a facial implant and did not clear up after treatment with antibiotics, the implant might have to be temporarily removed and replaced at a later time. Other, less-frequent risks may be associated with certain implants. Be sure to ask your plastic surgeon for a description of the risks associated with the procedure in which you are interested.
Some of the implant materials are made of a solid silicone. Currently, there is no scientific evidence that this is a harmful substance. Your plastic surgeon will be happy to discuss any current scientific findings concerning the type of implant you're considering.
Planning Your Surgery
When you discuss your surgery with your plastic surgeon, be certain that you clearly express your expectations. Your plastic surgeon will help you determine what it is possible to achieve. It may be helpful to provide your surgeon with photos of people who have facial features similar to those you would like to have.
Be sure you understand the details of the proposed surgery, including the cost and what to expect during your recovery.
If the surgery will entail an incision inside your mouth, it is important that you inform your physician if you smoke or if you have any dental or gum problems. Your plastic surgeon will advise you on these matters.
In preparing for your surgery, be sure to find out if you'll be able to drive home afterward or will require transportation. You should also ask if you'll need to refrain from eating or drinking the night before your surgery, and if you should stop taking any medications, including aspirin and similar drugs. You may be instructed to take oral antibiotics both before and after the procedure to help guard against infection.
Your plastic surgeon will provide information about these important matters during your pre-operative consultation.
Where Your Surgery Will Be Performed
Your operation may take place in an office-based facility, a freestanding surgical center or a hospital outpatient facility. Sometimes, your plastic surgeon may require that you stay overnight. Your doctor will make such a recommendation based on your overall medical condition and whether another cosmetic procedure was performed simultaneously with the facial implant surgery.
Types of Anesthesia
In some cases, facial implant surgery may require only local anesthesia combined with a sedative. However, more frequently, a general anesthesia may be recommended.
Chin Surgery
Insertion of a chin implant may take anywhere from 30 minutes to an hour. During the procedure, the surgeon selects the proper size and shape implant to enhance your appearance and inserts it into a pocket over the front of the jawbone. The small incision to create the pocket and insert the implant is placed inside the mouth (along the lower lip) or in the skin just under the chin area.
Usually, the chin is taped after surgery to minimize swelling and discomfort. Sutures in the skin will be removed in five to seven days. If an intra-oral incision is used, the sutures will dissolve.
Recovering from Chin Surgery
You will experience some discomfort and swelling in the affected area for several days. It's normal to experience some temporary difficulty with smiling and talking. Black and blue marks may be visible around the chin and neck. Your plastic surgeon will instruct you about dental hygiene, eating and any restrictions to your activities after surgery.
Cheek Surgery
Cheek implant surgery usually takes about 30 to 45 minutes. When cheek implants are being placed in conjunction with another cosmetic procedure, such as a facelift, forehead lift or eyelid surgery, the implants may be inserted through the incisions made for those procedures. Otherwise, an incision will be made either inside your upper lip or your lower eyelid. A pocket is then formed and an implant is inserted.
After surgery, a dressing will be applied to minimize discomfort and swelling. The severity and duration of such side effects may vary, especially if another cosmetic procedure was performed at the same time.
Recovering from Cheek Surgery
Your plastic surgeon will provide you with instructions about post-operative care. There will be dietary restrictions as well as limitations to your activities. Again, these instructions will vary, especially if another procedure was performed along with your implant surgery. However, you should be aware that your ability to move your mouth and lips may be diminished temporarily. Stitches used to close the incisions inside your mouth usually dissolve within about 10 days.
Lower Jaw Surgery
Insertion of a jaw implant usually takes about one to two hours. Internal incisions are made on either side of the lower lip to provide access for creating a pocket into which the lower-jaw implant can be inserted. Dissolving sutures are used to close the incisions.
Recovering from Jaw Surgery
Swelling is sometimes significant immediately following surgery, usually peaking 24 to 48 hours afterward. Although most of the significant swelling will subside over a period of several days, prolonged mild swelling may prevent your final facial contour from becoming apparent for several months.
During the healing phase, your activities and diet will be restricted. Your ability to smile, talk or move your mouth in any way may be limited for several days to weeks following surgery. Your plastic surgeon will instruct you about dental and oral hygiene during your recovery.
Getting Back to Normal
Remember, with any facial surgery, you may feel and look better in a short period of time. However, it may not be advisable to participate in certain activities -- especially activity that may result in the face being jarred or bumped -- for several weeks. It's best to check with your plastic surgeon about such matters.
Your New Look
You may not be able to accurately evaluate your appearance for weeks, or perhaps even months. Give yourself plenty of time to get used to your new look.
You may be surprised to find that most people won't recognize that you've had facial implant surgery -- only that you look better.
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What Is A Chemical Peel?
If you're considering chemical peel...
Chemical peel uses a chemical solution to improve and smooth the texture of the facial skin by removing its damaged outer layers. It is helpful for those individuals with facial blemishes, wrinkles and uneven skin pigmentation. Phenol, trichloroacetic acid (TCA) and alphahydroxy acids (AHAs) are used for this purpose. The precise formula used may be adjusted to meet each patient's needs. Although chemical peel may be performed in conjunction with a facelift, it is not a substitute for such surgery, nor will it prevent or slow the aging process. This brochure provides basic information about certain types of chemical peel treatments and the results you might expect. It won't answer all your questions, since a lot depends on your individual circumstances. Once you and your plastic surgeon have decided on a specific peel program, be sure to ask about any details that you do not understand. Deciding if chemical peel is right for you Chemical peel is most commonly performed for cosmetic reasons -- to enhance your appearance and your self confidence. Chemical peel may also remove pre-cancerous skin growths, soften acne facial scars and even control acne. In certain cases, health insurance may cover the peel procedure. Be sure to check your policy and contact your insurance company before the procedure is performed.
Alphahydroxy acids (AHAs), such as glycolic, lactic, or fruit acids are the mildest of the peel formulas and produce light peels. These types of peels can provide smoother, brighter-looking skin for people who can't spare the time to recover from a phenol or TCA peel. AHA peels may be used to treat fine wrinkling, areas of dryness, uneven pigmentation and acne. Various concentrations of an AHA may be applied weekly or at longer intervals to obtain the best result. Your doctor will make this decision during your consultation and as the treatment proceeds. An alphahydroxy acid, such as glycolic acid, can also be mixed with a facial wash or cream in lesser concentrations as part of a daily skin-care regimen to improve the skin's texture.
Trichloroacetic acid (TCA) can be used in many concentrations, but it is most commonly used for medium-depth peeling. Fine surface wrinkles, superficial blemishes and pigment problems are commonly treated with TCA. The results of TCA peel are usually less dramatic than and not as long-lasting as those of a phenol peel. In fact, more than one TCA peel may be needed to achieve the desired result. The recovery from a TCA peel is usually shorter than with a phenol peel.
Phenol is the strongest of the chemical solutions and produces a deep peel. It is used mainly to treat patients with coarse facial wrinkles, areas of blotchy or damaged skin caused by sun exposure, or pre-cancerous growths. Since phenol sometimes lightens the treated areas, your skin pigmentation may be a determining factor as to whether or not this is an appropriate treatment for you. Phenol is primarily used on the face; scarring may result if it's applied to the neck or other body areas.
All chemical peels carry some uncertainty and risk Chemical peel is normally a safe procedure when it is performed by a qualified, experienced plastic surgeon. However, some unpredictability and risks such as infection and scarring, while infrequent, are possible.
AHA peels may cause stinging, redness, irritation and crusting. However, as the skin adjusts to the treatment regimen, these problems will subside.
With a TCA peel, your healed skin will be able to produce pigment as always; the peel will not bleach the skin. However, TCA-peel patients are advised to avoid sun exposure for several months after treatment to protect the newly formed layers of skin. Even though TCA is milder than phenol, it may also produce some unintended color changes in the skin.
With a phenol peel, the new skin frequently loses its ability to make pigment (that is, tan). This means that not only will the skin be lighter in color, but you'll always have to protect it from the sun. Phenol may pose a special risk for patients with a history of heart disease. It's important that you make your surgeon aware of any heart problems when your medical history is taken.
It is also possible that phenol will cause some undesired cosmetic results, such as uneven pigment changes. Certain modified phenol peels are gentler and may be preferred in some circumstances.
Peel Formulas At-A-Glance
Alphahydroxy acids (AHAs)
Uses:
- Smooths rough, dry skin
- Improves texture of sun-damaged skin
- Aids in control of acne
- Can be mixed with bleaching agent to correct pigment problems
- Can be used as TCA pre-treatment
Considerations:
- A series of peels may be needed
- As with most peel treatments, sunblock use is recommended
Trichloroacetic acid (TCA)
Uses:
- Smooths out fine surface wrinkles
- Removes superficial blemishes
- Corrects pigment problems
Considerations:
- Can be used on neck or other body areas
- May require pre-treatment with Retin-A or AHA creams
- Treatment takes only 10-15 minutes
- Preferred for darker-skinned patients
- Peel depth can be adjusted
- Repeat treatment may be needed to maintain results
- Sunblock must be used for several months
- Healing is usually quick, much quicker than with a phenol peel
Phenol
Uses:
- Corrects blotches caused by: sun exposure, birth-control pills, aging
- Smooths out coarse wrinkles
- Removes pre-cancerous growths
Considerations:
- Used on the face only
- Not recommended for dark-skinned individuals
- Procedure may pose risk for patients with heart problems
- Full-face treatment may take one hour or more
- Recovery may be slow - Complete healing may take several months
- May permanently remove facial freckles
- Sun protection, including sunblock, must always be used
- Results are dramatic and long-lasting
- Permanent skin lightening and lines of demarcation may occur
Planning For A Chemical Peel
In some states, no medical degree is required to perform a chemical peel - even the strongest phenol peels. Many states have laws that permit non-physicians to administer certain peel solutions, but regulate the strengths which they are permitted to apply. You should be warned that phenol and TCA peels have been offered by inadequately trained practitioners claiming miracletechniques to rejuvenate the skin.
It is very important that you find a physician who has adequate training and experience in skin resurfacing. Your plastic surgeon may offer you a choice of peel techniques or suggest a combination of peels to obtain the best result for you.
During your initial consultation, it is important that you discuss your expectations with your plastic surgeon. Don't hesitate to ask any questions or express any concerns that you may have. Expect your plastic surgeon to explain the planned procedure in detail, including its risks and benefits, the recovery period and the costs. If you have a history of herpes, you should inform your physician prior to the procedure. Remember, chemical peel treatments are usually not covered by medical insurance unless they are performed for medically related problems.
Preparing For Your Chemical Peel
Your plastic surgeon will instruct you on how to prepare for your peel treatment.
Sometimes Retin A - a prescription medication derived from Vitamin A - is used to pre-treat the skin. This thins out the skin's surface layer, allowing the TCA solution to penetrate more deeply and evenly. If your skin won't tolerate Retin-A pre-treatment, an AHA cream may be used instead. Hydroquinone, a bleaching agent, is sometimes used in conjunction with Retin-A or AHA pre-treatment, especially if you have blotchy skin areas or pigmentation problems. You may have to spend a month or more in the pre-treatment phase before the doctor will schedule your actual peel.
You will need to arrange for someone to drive you home and help you out for a day or two if you are having a phenol or deeper TCA peel. You probably won't need any extra assistance if you're having an AHA peel or superficial TCA peel.
Where Your Peel Will Be Performed
Most chemical peels may be safely performed in a plastic surgeon's office, office-based surgical facility or outpatient surgical center. Your plastic surgeon may want you to stay overnight in a facility or hospital if other cosmetic procedures are performed simultaneously.
Types of Anesthesia
Anesthesia isn't required for phenol or TCA peels because the chemical solution acts as an anesthetic. However, sedation may be used before and during the procedure to relax you and keep you comfortable.
No anesthesia is needed for AHA peels since they cause only a slight stinging sensation during application.
The Peel
AHA peels/treatments: Your doctor will apply the AHA solution to your cleansed facial skin, a process that usually takes no more than 10 minutes. No after-peel ointment or covering is required. Depending on the strength of the peel, periodic treatmentsmay be necessary until the desired effects are achieved.
For some patients, the application of an AHA-based face wash or cream once or twice a day at home will be sufficient to accomplish the desired goal. Your plastic surgeon may add Retin-A or a bleaching agent to your at-home treatment schedule. After several weeks of at-home use, your doctor will examine your skin to determine if your regimen needs adjustment.
Phenol and TCA peels: Typically, the skin is first thoroughly cleansed. Then, the surgeon will carefully apply the phenol or TCA solution. You may feel a stinging sensation as the peel solution is applied, but this feeling will quickly pass.
A full-face TCA peel usually takes no more than 15 minutes. Two or more TCA peels may be needed to obtain the desired result, and those may be spaced out over several months. Mild TCA peels may be repeated as often as every month.
If phenol solution has been used, your plastic surgeon may coat the treated area with petroleum jelly or a waterproof adhesive tape. With lighter peels, no covering is necessary.
A full-face phenol peel generally takes one or two hours to perform, while a phenol peel to a smaller facial region (perhaps the skin above the upper lip) may take only 10 or 15 minutes. A single treatment usually suffices.
After Your Treatment
After an AHA peel, it is common to experience some temporary flaking or scaling, redness and dryness of the skin. However, these conditions will disappear as the skin adjusts to treatment.
After a phenol or TCA peel, your doctor may prescribe a mild pain medication to relieve any tingling or throbbing you may feel. If tape was used to cover your face, it will be removed after a day or two. A crust or scab will form on the treated area. To help your face heal properly, it is essential that you follow your doctor's specific post-operative instructions.
A TCA peel may also cause significant swelling, depending on the strength of the peel used.
If you've had a phenol peel, your face may become quite swollen. Your eyes may even be swollen shut temporarily. You will need someone to help care for you for a day or two. You may also be limited to a liquid diet and advised not to talk very much during the first few days of recovery.
Getting Back to Normal
With an AHA peel, the temporary redness, flaking and dryness that you experience will not prevent you from working or engaging in your normal activities. A fresher and improved skin texture will result with continued AHA treatments. Remember, protecting your skin from the sun is also important following these mild acid peels. Ask your doctor to recommend a sunblock with adequate UVA and UVB protection and use it every day.
With a TCA peel, the moderate discomfort and mild swelling you may experience will subside within the first week. In about a week to ten days, your new skin will be apparent and you should be healed sufficiently to return to your normal activities. It is best to avoid sun exposure unless you are adequately protected.
With a phenol peel, new skin will begin to form in about seven to ten days. Your face will be very red at first, gradually fading to a pinkish color over the following weeks to months. During this time, it is especially important that you use a sunblock or blotchy, irregular skin coloring may result.
About two weeks after treatment, you may return to work and resume some of your normal activities. Your skin will be healed enough for you to wear makeup. (For makeup tips, ask your plastic surgeon for the ASPS brochure on camouflage cosmetics.)
Your New Look
Improvements from AHA peels may be very subtle at first. You may detect a healthier glow to your skin. With continued treatments, you will notice a general improvement in the texture of your skin.
The results of a TCA peel are usually not as long-lasting as those of phenol peel. However, your skin will be noticeably smoother and fresher-looking.
If you're planning a phenol peel, you can expect dramatic improvement in the surface of your skin - fewer fine wrinkles, fewer blemishes and more even-toned skin. Your results will be long-lasting, although not immune to the effects of aging and sun exposure.
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What Is Chin Surgery?
Chin surgery, also known as mentoplasty, is a surgical procedure to reshape the chin either by enhancement with an implant or reduction surgery on the bone. Many times a plastic surgeon may recommend chin surgery to a patient having nose surgery in order to achieve facial proportion, as the size of the chin may magnify or minimize the perceived size of the nose. Chin surgery helps provide a harmonious balance to your facial features so that you feel better about the way you look.
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What Is Cleft Lip / Cleft Palate Surgery?
In the early weeks of development, long before a child is born, the right and left sides of the lip and the roof of the mouth normally grow together. Occasionally, however, in about one of every 800 babies, those sections don't quite meet. A child born with a separation in the upper lip is said to have a cleft lip. A similar birth defect in the roof of the mouth, or palate, is called a cleft palate. Since the lip and the palate develop separately, it is possible for a child to have a cleft lip, a cleft palate, or variations of both.
If your child was born with either or both of these conditions, your doctor will probably recommend surgery to repair it. Medical professionals have made great advances in treating children with clefts and can do a lot to help your child lead a normal, healthy, happy life.
This information will give you a basic understanding of the operation -- 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 you individual circumstances. Please be sure to ask your surgeon if there is anything you don't understand about the procedure.
The Importance of a Team Approach
Children born with a cleft lip or palate may need the skills of several medical professionals to correct the problems associated with the cleft. In addition to needing plastic surgery to repair the opening, these children may have problems with their feeding and their teeth, their hearing, their speech, and their psychological development as they grow up.
For that reason, parents should seek the help of a Cleft Lip and Palate Team as early as possible. Medical professionals with special experience in the problems of cleft lip and palate have formed such teams all over the country to help parents plan for their child's care from birth, or even before. Typically, a Cleft Team might include a plastic surgeon, a pediatrician, a dentist, a speech and language specialist, a social worker, a hearing specialist, an ear-nose-throat specialist, a psychologist, a nurse, and a genetic counselor.
All Surgery Carries Uncertainty and Risk
When surgery is done by a qualified plastic surgeon with experience in repairing cleft lip or palate, the results can be quite positive. Nevertheless, as with any operation, there are risks associated with surgery and specific complications associated with this procedure.
In cleft lip surgery, the most common problem is asymmetry, when one side of the mouth and nose does not match the other side. The goal of cleft lip surgery is to close the separation in the first operation. Occasionally, a second operation may be needed.
In cleft palate surgery, the goal is to close the opening in the roof of the mouth so the child can eat and learn to speak properly. Occasionally, poor healing in the palate or poor speech may require a second operation.
Planning For Surgery
At your initial consultation, your doctor will discuss the details of the procedure he or she will use, including where the surgery will be performed, the type of anesthesia to be used, possible risks and complications, recovery, costs, and the results you can expect. Your surgeon will also answer any questions you may have about feeding your baby, by breast or by bottle, both before and after the surgery.
In most cases, health insurance policies will cover most or all of the cost of cleft lip or cleft palate surgery. Check your policy to make sure your child is covered and to see if there are any limitations on what types of treatment are covered.
Cleft Lip Surgery
A cleft lip can range in severity from a slight notch in the red part of the upper lip to a complete separation of the lip extending into the nose. Clefts can occur on one or both sides of the upper lip. Surgery is generally done when the child is about 10 weeks old.
To repair a cleft lip, the surgeon will make an incision on either side of the cleft from the mouth into the nostril. He or she will then turn the dark pink outer portion of the cleft down and pull the muscle and the skin of the lip together to close the separation. Muscle function and the normal "cupid's bow" shape of the mouth are restored. The nostril deformity often associated with cleft lip may also be improved at the time of lip repair or in a later surgery.
Recovering From Cleft Lip Surgery
Your child may be restless for awhile after surgery, but your doctor can prescribe medication to relieve any discomfort. Elbow restraints may be necessary for a few weeks to prevent your baby from rubbing the stitched area.
If dressings have been used, they'll be removed within a day or two, and the stitches will either dissolve or be removed within five days. Your doctor will advise you on how to feed your child during the first few weeks after surgery.
It's normal for the surgical scar to appear to get bigger and redder for a few weeks after surgery. This will gradually fade, although the scar will never totally disappear. In many children, however, it's barely noticeable because of the shadows formed by the nose and upper lip.
Cleft Palate Surgery
In some children, a cleft palate may involve only a tiny portion at the back of the roof of the mouth; for others, it can mean a complete separation that extends from front to back. Just as in cleft lip, cleft palate may appear on one or both sides of the upper mouth. However, repairing a cleft palate involves more extensive surgery and is usually done when the child is nine to 18 months old, so the baby is bigger and better able to tolerate surgery.
To repair a cleft palate, the surgeon will make an incision on both sides of the separation, moving tissue from each side of the cleft to the center or midline of the roof of the mouth. This rebuilds the palate, joining muscle together and providing enough length in the palate so the child can eat and learn to speak properly.
Recovering from Cleft Palate Surgery
For a day or two, your child will probably feel some soreness and pain, which is easily controlled by medication. During this period, you child will not eat or drink as much as usual -- so an intravenous line will be used to maintain fluid levels. Elbow restraints may be used to prevent your baby from rubbing the repaired area. Your doctor will advise you on how to feed your child during the first few weeks after surgery. It's crucial that you follow your doctor's advice on feeding to allow the palate to heal properly.
The Repaired Lip or Palate
Children with a cleft palate are particularly prone to ear infections because the cleft can interfere with the function of the middle ear. To permit proper drainage and air circulation, the ear-nose-and-throat surgeon on the Cleft Palate Team may recommend that a small plastic ventilation tube be inserted in the eardrum. This relatively minor operation may be done later or at the time of the cleft repair. In addition, surgery may be recommended by your plastic surgeon when your child is older to refine the shape and function of the lip, nose, gums, and palate.
You'll want to discuss further needs with the members of the Cleft Team seeing your child.
Perhaps most important, keep in mind that surgery to repair a cleft lip or palate is only the beginning of the process. Family support is critical for your child. Love and understanding will help him or her grow up with a sense of self-esteem that extends beyond the physical defect.
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What Are Injectables?
As we age, our faces begin to show the effects of gravity, sun exposure and years of facial muscle movement, such as smiling, chewing and squinting. The underlying tissues that keep our skin looking youthful and plumped up begin to break down, often leaving laugh lines, smile lines, crow's feet or facial creases over the areas where this muscle movement occurs.
Soft-tissue fillers, most commonly injectable collagen or fat, can help fill in these lines and creases, temporarily restoring a smoother, more youthful-looking appearance. When injected beneath the skin, these fillers plump up creased and sunken areas of the face. They can also add fullness to the lips and cheeks. Injectable fillers may be used alone or in conjunction with a resurfacing procedure, such as a laser treatment, or a recontouring procedure, such as a facelift.
If you're considering a facial-rejuvenation treatment with collagen or fat, this brochure will give you a basic understanding of the procedure - when injectables can help, how the procedure is performed, and what results you can expect. It may not answer all of your questions, since a lot depends on your individual circumstances. Please ask your doctor if there is anything about the procedure you don't understand.
Knowing Your Options
Injected collagen and fat are primarily used to improve the appearance of the skin's texture. They can help fill out deep facial wrinkles, creases and furrows, "sunken" cheeks, skin depressions and some types of scars. They can also be used to add a fuller, more sensuous look to the lips.
Injectables are usually not sufficient for severe surface wrinkles on the face, such as multiple vertical "lipstick lines" that sometimes form around the mouth. Instead, your plastic surgeon may suggest a resurfacing technique, such as chemical peel, dermabrasion or laser treatments. Rather than filling in facial lines, resurfacing methods strip away the outer layers of the skin to produce a smoother appearance.
Deep folds in the face or brow caused by overactive muscles or by loose skin may be more effectively treated with cosmetic surgery, such as a facelift or browlift. Injectables are sometimes used in conjunction with facial surgery procedures; however, injectables alone cannot change facial contour the way surgery can.
Keep in mind that a plastic surgeon is a specialist that can offer you the full gamut of the most advanced treatments ranging from cosmetic surgery, refinishing techniques, laser therapy, injectables and the use of other fillers. You and your surgeon may determine that a single procedure or a combination of procedures is the best choice for you.
ASPS brochures are available on chemical peel, dermabrasion, laser treatments, facelift and browlift. If you and your doctor think that one of these other procedures might be more appropriate for you, ask your plastic surgeon to provide you with a copy.
A Word About Other Types of Fillers
This page deals with the two most commonly used types of injectable fillers, collagen and fat. However, to a lesser extent, a number of other filler materials are also being used for facial-rejuvenation purposes. They include: Fibril, a gelatin powder compound that's mixed with a patient's own blood and is injected to plump up the skin (similar to injectable collagen); and Gortex, a thread-like material that is implanted beneath the skin to add soft-tissue support.
Each of these options has its own set of risks and benefits. If you're considering any of these alternative filler treatments, tell your doctor.
What to Expect From Treatment
The most important fact to remember about injectable fillers is that the results are not permanent. Injected material is eventually metabolized by the body. You should not expect the same long-lasting results that may be gained from cosmetic surgery.
In some individuals, the results may last only a few weeks; in others, the results may be maintained indefinitely. Researchers believe that age, genetic background, skin quality and lifestyle as well as the injected body site may all play a role in the injected material's "staying power." However, the precise reason for the variation of results among patients has yet to be identified.
If you've had short-lived results from fat injections, you shouldn't necessarily assume that collagen injections will work better for you. And, conversely, if you've had disappointing results from collagen, don't assume that injected fat is the answer. Although it's true that some individuals' bodies are more receptive to one substance than the other, others may find that neither substance produces long-lasting results. Sometimes one substance may work better than the other for a specific problem.
Risks Related to Injectables
When injectables are administered by a qualified plastic surgeon, complications are infrequent and usually minor in nature. Still, individuals vary greatly in their anatomy, their physical reactions and their healing abilities. The outcome of treatment with injectables is never completely predictable.
Collagen: Allergic reaction is the primary risk of collagen. To help determine if you are allergic to the substance, your surgeon will perform an allergy skin test about a month before the procedure. After the test is performed, the test site should be watched carefully for three or four weeks, or as long as your surgeon advises. Any sign of redness, itching, swelling or other occurrences at the test site should be reported to your surgeon.
Risks not necessarily related to allergies include infection, abscesses, open sores, skin peeling, scarring and lumpiness, which may persist over the treated area. Reports of these problems are very rare.
Fat: Allergic reaction is not a factor for fat because it's harvested from a patient's own body. However, there is still a small risk of infection and other infrequent complications.
Planning for Treatment
Facial rejuvenation is very individualized. That's why it's important to discuss your hopes and expectations with a board-certified plastic surgeon who has experience with many different types of surgical and non-surgical facial procedures.
In your initial consultation, your plastic surgeon will evaluate your face - the skin, the muscles and the underlying bone - and discuss your goals for the surgery. Your doctor will help you select a treatment option based on your goals and concerns, your anatomy and your lifestyle.
Your surgeon will ask you about your medical history, drug allergies, and check for conditions that could cause problems, such as active skin infections or non-healed sores from injuries. Collagen injections are generally off limits for pregnant women, individuals who are allergic to beef or bovine products, patients who suffer from autoimmune diseases, and those who are allergic to lidocaine (the anesthetic agent contained in the syringe with the collagen material). For more specific information about the contraindications and risks of collagen use, ask your doctor for the manufacturer's brochure for patients.
Insurance usually doesn't cover cosmetic procedures. However, if your injectable treatment is being performed to treat a scar or indentation from an accident or injury, you may be reimbursed for a portion of the cost. Check with your insurance carrier to be sure.
Where Your Treatment Will Be Performed
Injectables are usually administered in a surgeon's office-based facility. If, however, you are being hospitalized for a facelift, necklift, browlift, or any other procedure, your injections may be administered in the hospital as well.
Types of Anesthesia
Collagen: Because the anesthetic agent lidocaine is mixed in with collagen, additional anesthetic is usually not used. However, if you are especially sensitive to pain, your doctor may use a topical cream anesthetic or a freon spray to numb the injected area. Or, you may elect to have an injected local anesthetic or sedative drugs.
Fat: Both the donor and recipient sites are numbed with local anesthesia. Sedation can be used as well. If you elect to use sedation, be sure to arrange for a ride home after your treatment.
The Treatments
Collagen
Collagen is a naturally occurring protein that provides support to various parts of the human body: the skin, the joints, the bones and the ligaments. Injectable collagen, patented by the Collagen Corporation under the trade names Zyderm and Zyplast, is derived from purified bovine collagen. The purification process creates a product similar to human collagen. Injectable collagen received approval from the Food and Drug Administration in1981. It is produced in various thicknesses to meet individual patient needs.
Collagen is used primarily to fill wrinkles, lines and scars on the face and sometimes the neck, back and chest.
The procedure: Treatment with collagen can begin after a skin test determines that you're not allergic to the subsstance. The collagen is injected using a fine needle inserted at several points along the edge of the treatment site. If a local anesthesia has not been used, you may feel some minor stinging or burning as the injections are administered.
Since part of the substance is salt water that will be absorbed by the body within a few days, your doctor will slightly overfill the area. You may be asked to hold a hand mirror during the procedure to help your doctor decide when you've had enough.
After treatment: Immediately following treatment, you may notice some minor discomfort, stinging or throbbing in the injected area. Occasionally some bruising or swelling will occur, but it is usually minor. Any redness that appears in the injected site usually disappears within 24 hours. However, in some individuals, particularly fair-skinned patients, this redness may persist for a week or more. Tiny scabs may also form over the needle-stick areas; these generally heal quickly.
No bandaging is needed and you are free to eat, drink, and wear makeup with sunblock protection shortly thereafter. There may be some temporary swelling and redness in the treated area which should dissipate within a few days. If these symptoms persist, contact your surgeon.
Results: As stated earlier, the duration of results from collagen injections is variable. Collagen's longevity depends on the patient's lifestyle and physical characteristics as well as the part of the body treated. In general, the injected material is likely to disappear faster in areas that are more affected by muscle movement.
Your doctor can help you determine how long you can go between treatments to best maintain your results.
Fat
In the medical world, the fat-injection procedure is known as autologous fat transplantation or microlipoinjection. It involves extracting fat cells from the patient's abdomen, thighs, buttocks or elsewhere and reinjecting them beneath the facial skin. Fat is most often used to fill in "sunken" cheeks or laugh lines between the nose and mouth, to correct skin depressions or indentations, to minimize forehead wrinkles and to enhance the lips.
The procedure: After both the donor and recipient sites are cleansed and treated with a local anesthesia, the fat is withdrawn using a syringe with a large-bore needle or a cannula (the same instrument used in liposuction) attached to a suction device. The fat is then prepared and injected into the recipient site with a needle. Sometimes an adhesive bandage is applied over the injection site.
As with collagen, "overfilling" is necessary to allow for fat absorption in the weeks following treatment. When fat is used to fill sunken cheeks or to correct areas on the face other than lines, this overcorrection of newly injected fat may temporarily make the face appear abnormally puffed out or swollen.
After treatment: If a larger area was treated, you may be advised to curtail your activity for a brief time. However, many patients are able to resume normal activity immediately. You can expect some swelling, bruising or redness in both the donor and recipient sites. The severity of these symptoms depends upon the size and location of the treated area. You should stay out of the sun until the redness and bruising subsides - usually about 48 hours. In the meantime, you may use makeup with sunblock protection to help conceal your condition.
The swelling and puffiness in the recipient site may last several weeks, especially if a large area was filled.
Results: The duration of the fat injections varies significantly from patient to patient. Though some patients have reported results lasting a year or more, the majority of patients find that at least half of the injected fullness disappears within 3-6 months. Therefore, repeated injections may be necessary. Your doctor will advise you on how to maintain your results with repeat treatments.
Your New Look
If you're like most patients, you'll be very satisfied with the results of your injectable treatments. You may be surprised at the pleasing results that can be gained from this procedure.
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What Is Dermabrasion?
Dermabrasion and dermaplaning help to refinish the skin's top layers through a method of controlled surgical scraping. The treatments soften the sharp edges of surface irregularities, giving the skin a smoother appearance.
Dermabrasion is most often used to improve the look of facial skin left scarred by accidents or previous surgery, or to smooth out fine facial wrinkles, such as those around the mouth. It's also sometimes used to remove the pre-cancerous growths called keratoses. Dermaplaning is commonly used to treat deep acne scars.
Both dermabrasion and dermaplaning can be performed on small areas of skin or on the entire face. They can be used alone, or in conjunction with other procedures such as facelift, scar removal or revision, or chemical peel.
If you're considering surgery to refinish the skin, 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 ask your doctor about anything you don't understand.
Considering Alternative Procedures
If you're planning surface repairs on your face, you may also be considering chemical peel, an alternative method of surgically removing the top layer of skin. However, dermabrasion and dermaplaning use surgical instruments to remove the affected skin layers, while chemical peel uses a caustic solution.
Many plastic surgeons perform all three procedures, selecting one or a combination of procedures to suit the individual patient and the problem. Others prefer one technique for all surface repairs. In general, chemical peel is used more often to treat fine wrinkles, and dermabrasion and dermaplaning for deeper imperfections such as acne scars. A non-chemical approach may also be preferred for individuals with slightly darker skin, especially when treating limited areas of the face, since dermabrasion and dermaplaning are less likely to produce extreme changes and contrasts in skin color.
If you'd like more information on chemical peel, ask your plastic surgeon for the ASPS brochure on that topic.
The Best Candidates for Dermabrasion
Dermabrasion and dermaplaning can enhance your appearance and your self-confidence, but neither treatment will remove all scars and flaws or prevent aging. Before you decide to have a skin-refinishing treatment, think carefully about your expectations and discuss them with your surgeon.
Men and women of all ages, from young people to older adults, can benefit from dermabrasion and dermaplaning. Although older people heal more slowly, more important factors are your skin type, coloring, and medical history. For example, black skin, Asian skin, and other dark complexions may become permanently discolored or blotchy after a skin-refinishing treatment. People who develop allergic rashes or other skin reactions, or who get frequent fever blisters or cold sores, may experience a flare-up. If you have freckles, they may disappear in the treated area.
In addition, most surgeons won't perform treatment during the active stages of acne because of a greater risk of infection. The same may be true if you've had radiation treatments, a bad skin burn, or a previous chemical peel.
All Surgery Carries Some Uncertainty and Risk
Dermabrasion and dermaplaning are normally safe when they're performed by a qualified, experienced board-certified physician. The most common risk is a change in skin pigmentation. Permanent darkening of the skin, usually caused by exposure to the sun in the days or months following surgery, may occur in some patients. On the other hand, some patients find the treated skin remains a little lighter or blotchy in appearance.
You may develop tiny whiteheads after surgery. These usually disappear on their own, or with the use of an abrasive pad or soap; occasionally, the surgeon may have to remove them. You may also develop enlarged skin pores; these usually shrink to near normal size once the swelling has subsided.
While infection and scarring are rare with skin-refinishing treatments, they are possible. Some individuals develop excessive scar tissue (keloid or hypertrophic scars); these are usually treated with the application or injection of steroid medications to soften the scar.
You can reduce your risks by choosing a qualified plastic surgeon and closely following his or her advice.
Planning For Your Surgery
Because these treatments have sometimes been offered by inadequately trained practitioners, it's especially important that you find a doctor (generally a plastic surgeon or a dermatologist) who is trained and experienced in the procedure. After all, dermabrasion and dermaplaning usually involve the most visible part of your body-your face.
In your initial consultation, be open in discussing your expectations with your surgeon, and don't hesitate to ask any questions or express any concerns you may have. Your surgeon should be equally open with you, explaining the factors that could influence the procedure and the results-such as your age, skin condition, and previous plastic surgeries.
The surgeon will discuss your medical history, conduct a routine examination, and photograph your face. He or she should explain the procedure in detail, along with its risks and benefits, the recovery period, and the costs. Insurance usually doesn't cover cosmetic procedures, however, it may cover dermabrasion or dermaplaning when performed to remove precancerous skin growths or extensive scars. Check your policy or call your carrier to be sure.
Preparing For Your Surgery
Your surgeon will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, and on avoiding aspirin and other medications that affect blood clotting. You may also be given special instructions regarding the care and treatment of your skin prior to surgery. If you smoke, you'll probably be asked to stop for a week or two before and after surgery, since smoking decreases blood circulation in the skin and impedes healing.
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 day or two if needed.
Where Your Surgery Will Be Performed
Your treatment may be performed in a surgeon's office-based facility, an outpatient surgery center, or a hospital. It's usually done on an outpatient basis, for cost containment and convenience. However, if you're undergoing extensive work, you may be admitted to the hospital.
Types of Anesthesia
Dermabrasion and dermaplaning may be performed under local anesthesia, which numbs the area, combined with a sedative to make you drowsy. You'll be awake but relaxed, and will feel minimal discomfort. Sometimes a numbing spray, such a freon, is used along with or instead of local anesthesia. Or, in more severe cases, your surgeon may prefer to use general anesthesia, in which case you'll sleep through the procedure.
The Surgery
Dermabrasion and dermaplaning can be performed fairly quickly. The procedures usually take from a few minutes to an hour and a half, depending on how large an area of skin is involved. It's not uncommon for the procedure to be performed more than once, or in stages, especially when scarring is deep or a large area of skin is involved.
In dermabrasion, the surgeon scrapes away the outermost layer of skin with a rough wire brush, or a burr containing diamond particles, attached to a motorized handle. The scraping continues until the surgeon reaches the safest level that will make the scar or wrinkle less visible.
In dermaplaning, the surgeon uses a hand-held instrument called a dermatome. Resembling an electric razor, the dermatome has an oscillating blade that moves back and forth to evenly skim off the surface layers of skin that surround the craters or other facial defects. This skimming continues until the lowest point of the acne scar becomes more even with the surrounding skin.
The surgeon may then treat the skin in a number of ways, including ointment, a wet or waxy dressing, dry treatment, or some combination of these.
After Your Surgery
Right after the procedure, your skin will be quite red and swollen, and eating and talking may be difficult. You'll probably feel some tingling, burning, or aching; any pain you feel can be controlled with medications prescribed by your surgeon. The swelling will begin to subside in a few days to a week.
If you remember the scrapes you got when you fell down as a child, you'll have an idea of what to expect from this type of surgery. A scab or crust will form over the treated area as it begins to heal. This will fall off as a new layer of tight, pink skin forms underneath. Your face may itch as new skin starts to grow, and your surgeon may recommend an ointment to make you more comfortable. If ointment is applied immediately after surgery, little or no scab will form.
In any case, you surgeon will give you detailed instructions to care for your skin after surgery. For men, this will include delaying shaving for a while, then using an electric razor at first. It's very important that you understand your doctor's instructions and follow them exactly, to ensure the best possible healing.
If you notice the treated area beginning to get worse instead of better-for example, if it becomes increasingly red, raised, and itchy after it has started to heal-it may be a sign that abnormal scars are beginning to form. Call your surgeon as soon as possible, so that treatment can begin early.
Getting Back to Normal
Your new skin will be a bit swollen, sensitive, and bright pink for several weeks. During this time, you can begin gradually resuming your normal activities.
You can expect to be back at work in about two weeks. Your surgeon will probably advise your to avoid any activity that could cause a bump to your face for at least two weeks. More active sports-especially ball sports-should be avoided for four to six weeks. If you swim, stick to indoor pools to avoid sun and wind, and keep your face out of chlorinated water for at least four weeks. It will be at least three to four weeks before you can drink alcohol without experiencing a flush of redness.
Above all, it's important to protect your skin from the sun until the pigment has completely returned to your skin- as long as six to twelve months.
Your New Look
Refinishing treatments can offer dramatic improvements in the surface of your skin, but it will take some time before you see the final results.
The pinkness of your skin will take about three months to fade. In the meantime, you'll probably want to wear non-allergenic makeup when you go out. (For tips on hiding your condition while it heals, ask your surgeon for the ASPS brochure on camouflage cosmetics.) When your new skin is fully repigmented, the color should closely match the surrounding skin, making the procedure virtually undetectable.
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What Is Ear Surgery?
Ear surgery, or otoplasty, is usually done to set prominent ears back closer to the head or to reduce the size of large ears.
For the most part, the operation is done on children between the ages of four and 14. Ears are almost fully grown by age four, and the earlier the surgery, the less teasing and ridicule the child will have to endure. Ear surgery on adults is also possible, and there are generally no additional risks associated with ear surgery on an older patient.
If you're considering ear surgery for yourself or your child, this information will give you a basic understanding of the procedure-when it can help, how it's performed, and what results you can expect. It can't answer all of your questions, since a lot depends on your individual circumstances. Please be sure to ask your doctor if there is anything you don't understand about the procedure.
All Surgery Carries Some Uncertainty and Risk
When ear surgery is performed by a qualified, experienced surgeon, complications are infrequent and usually minor. Nevertheless, as with any operation, there are risks associated with surgery and specific complications associated with this procedure.
A small percentage of patients may develop a blood clot on the ear. It may dissolve naturally or can be drawn out with a needle.
Occasionally, patients develop an infection in the cartilage, which can cause scar tissue to form. Such infections are usually treated with antibiotics; rarely, surgery may be required to drain the infected area.
Planning For Surgery
Most surgeons recommend that parents stay alert to their child's feelings about protruding ears; don't insist on the surgery until your child wants the change. Children who feel uncomfortable about their ears and want the surgery are generally more cooperative during the process and happier with the outcome.
In the initial meeting, your surgeon will evaluate your child's condition, or yours if you are considering surgery for yourself, and recommend the most effective technique. He or she will also give you specific instructions on how to prepare for surgery.
Where The Surgery Will Be Performed
Ear surgery is usually performed as an outpatient procedure in a hospital, a doctor's office-based surgical facility, or a freestanding surgery center. Occasionally, your doctor may recommend that the procedure be done as an inpatient procedure, in which case you can plan on staying overnight in the hospital.
Types of Anesthesia
If your child is young, your surgeon may recommend general anesthesia, so the child will sleep through the operation. For older children or adults, the surgeon may prefer to use local anesthesia, combined with a sedative, so you or your child will be awake but relaxed.
The Surgery
Ear surgery usually takes about two to three hours, although complicated procedures may take longer. The technique will depend on the problem.
With one of the more common techniques, the surgeon makes a small incision in the back of the ear to expose the ear cartilage. He or she will then sculpt the cartilage and bend it back toward the head. Non-removable stitches may be used to help maintain the new shape. Occasionally, the surgeon will remove a larger piece of cartilage to provide a more natural-looking fold when the surgery is complete.
Another technique involves a similar incision in the back of the ear. Skin is removed and stitches are used to fold the cartilage back on itself to reshape the ear without removing cartilage.
In most cases, ear surgery will leave a faint scar in the back of the ear that will fade with time. Even when only one ear appears to protrude, surgery is usually performed on both ears for a better balance.
Getting Back to Normal
Adults and children are usually up and around within a few hours of surgery, although you may prefer to stay overnight in the hospital with a child until all the effects of general anesthesia wear off.
The patient's head will be wrapped in a bulky bandage immediately following surgery to promote the best molding and healing. The ears may throb or ache a little for a few days, but this can be relieved by medication.
Within a few days, the bulky bandages will be replaced by a lighter head dressing similar to a headband. Be sure to follow your surgeon's directions for wearing this dressing, especially at night.
Stitches are usually removed, or will dissolve, in about a week.
Any activity in which the ear might be bent should be avoided for a month or so. Most adults can go back to work about five days after surgery. Children can go back to school after seven days or so, if they're careful about playground activity. You may want to ask your child's
