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Breast Augmentation
Breast augmentation has been one of the leading cosmetic surgeries for more than 40 years. Thoroughly refined and well tested, it enables women to enhance their self-esteem by safely enlarging and reshaping their breasts. Given the proper balance of patient presentation, patient expectations and the surgeon's skill and esthetic, modern techniques allow for dramatic results.
What is the specific breast augmentation procedure?
Although the procedure varies widely based on individual requirements, the basics are straightforward: A computer-designed breast implant is placed behind your own breast tissue through a small incision. This implant may enlarge and/or improve the breast's shape. Patients undergoing breast augmentation may be under local or general anesthesia.
Where are the incisions made in breast implant surgery?
Depending on the patient's unique presentation, incisions are made in one of three locations: periareolar, inframammary and axillary.
Periareolar indicates the areola, or the boundary of the colored area around the nipple that borders regular breast skin. This incision tends to heal nearly invisibly, though in a few patients a thin line remains. Some patients experience temporary numbness in the nipple, but sensation generally returns.
Incisions placed under the breast are called inframammary; they fall at the fold where the breast joins the chest wall. Although this incision is more noticeable than the periareolar, it can heal with minimal scarring and nipple sensation is usually not affected.
Axillary means in the underarm (armpit). This incision offers the benefit of no breast scarring at all. Although there is an underarm scar, it generally fades to near-nothing with time. Nipple sensation is rarely affected by this approach.
Where and how are the breast implants placed?
Implants are placed behind your breast tissue, either over or under the pectoralis (chest wall) muscle. Whether it is placed over or under the muscle is determined by your particular breast and chest structure. Click here for more information on how implant placement decision is made.
What filler material is inside of a breast implant?
All implants have a silicone rubber shell, which is filled with either medical-grade silicone gel or saline (salt-water solution). Many people believe that silicone-filled implants offer a more natural look and feel than the saline variety. Now that the FDA has determined that silicone gel breast implants are safe for use is cosmetic breast augmentation, they are rapidly becoming the more popular of the two options..
Which breast augmentation procedure is best for me?
Ultimately, the procedure I perform is the one that's right for you. Just as no single blouse looks great on every woman, so too is there no one-size-fits-all breast augmentation surgery. A surgeon who insists on a particular approach regardless of your case parameters is really communicating that he makes the patient fit the operation. My approach, on the other hand, is to make the operation fit the patient. At your consultation, we will discuss the options, and together we will choose the procedure that is right for you.
How do I know which implant size is right for me?
Breast size and good proportions are subjective. Within a safe range determined by the surgeon, you make the final decision. I'll help you choose by analyzing your general body shape and how different sizes will alter your appearance both clothed and unclothed. Trying on different-size implants at your consultation will also help you determine the most comfortable option. We recommend bringing along photos of similarly sized women with breasts you find attractive.
What possible risks or complications are posed by breast augmentation surgery?
Though breast augmentation is a long-running procedure and considered safe, there are complication risks. As with any operation, bleeding, infection and scarring can develop. Asymmetry in size or placement, decrease or loss of sensation, and implant rejection are possible. Capsule scar formation that results in overly firm breasts is the most common complication.
We minimize the risk of capsule scar formation by promoting post-surgical breast massage. However, a small number of patients may need follow-up surgery to treat this problem. This information is intended to help you make an informed decision; no question or concern is silly or insignificant. At your consultation, I will gladly discuss any complications with you and answer your questions.
Is there a connection between breast implants and breast cancer risk?
Many reliable scientific studies have been done, and they have concluded that breast augmentation neither increases nor decreases breast cancer risk. Regular breast self-exams can still be performed easily after implants, as can mammography.
What is the standard recovery time after breast enlargement surgery?
Recovery time varies for each patient. Typically, the surgery is an outpatient procedure, and stitches are removed in 7-10 days. Although many patients return to work in as little as three days, I usually recommend one week off, with limited activity for 2-3 weeks.
What are the FDA findings on breast augmentation with silicone and saline implants?
In November of 2006, the FDA determined that silicone breast implants are safe for use, and they are now widely available for cosmetic breast augmentation. At your consultation, we will discuss the important issues and reccomendations regarding the new availability of silicone breast implants.
Can I get fat injections instead of implants as a form of breast enhancement?
Fat injection to the breasts is currently an area of controversy. Because questions remain over whether injected areas can mimic X-ray findings of breast cancer in mammograms, this procedure is not frequently performed.
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Breast Reduction
A medical as well as an aesthetic concern, large breasts can cause their bearers to suffer chronic shoulder, neck and back pain, as well as challenges finding well-fitting clothing. Breast reduction is a safe procedure designed to reduce and raise the breasts, and offers dramatic and pleasing results.
What is the specific breast reduction procedure?
Overly large breasts are usually caused by three areas of excess: breast glands inside the skin, the skin surrounding the gland, and the areola (the dark area around the nipple). Often, the nipple area is also placed too low. To reduce breast size, I must first trim the gland. The skin, which supports breasts like a natural bra, is then reduced to match the gland size. Lastly, the areola is minimized and repositioned.
How is the nipple/areola affected during breast reduction surgery?
The nipple and areola are generally not affected. In most cases, the nipple-areola is left attached and moved by relocating the entire gland. There are rare exceptions, such as with patients who have extremely large breasts.
Where are the incisions made during a breast reduction?
Traditionally, closed breast reduction incisions circle the areola and extend beneath the breast into an upside-down T. This is called an anchor-shaped or inverted-T incision.
What is the Inverted-T incision and are there any alternatives?
Yes, there are alternatives to the Inverted-T incision. A newer technique called vertical reduction reduces the seam significantly by minimizing or even eliminating the bar of the Inverted-T, so there is only an incision circling the areola and a vertical line.
Will I have scars after my breast reduction?
For several months following surgery, incisions can be quite red and sometimes raised. However, they generally fade with time. Final results depend largely on your individual healing capacity.
How painful is breast reduction surgery?
Breast reduction is performed on patients under general anesthesia. Post-surgical discomfort is generally minimal. You will be offered pain medication after the procedure, of which most patients require very little.
How much time will I need to take off work after a breast reduction?
I recommend taking a minimum of one week off from work to recover. After one week, you may resume non-strenuous activities, limiting lifting and stretching for an additional week. Our San Francisco cosmetic surgery practice uses the most advanced healing techniques to get you back on your feet quickly.
Do breast reductions require blood transfusions?
It is extremely rare to need a blood transfusion for a breast reduction.
Does the breast reduction procedure require any medical tests prior to surgery?
If you are due for a mammogram, then this should be done prior to surgery. As with all surgeries, routine lab work is done as well.
To what extent can my breast size be reduced?
That depends on your case and functional esthetics. Our primary goals are to relieve any discomfort you are experiencing and create a better balance between your breast and body size. This will be discussed in detail at your consultation.
What are the possible risks and complications of breast reduction surgery?
As with all surgical procedures, bleeding, scarring or infection may occur. Occasionally, small differences in the size and shape of the breasts may appear. Rarely, loss of nipple areola or sensation in this region may occur. Unfavorable reactions to medications and anesthetics can develop. Finally, future breastfeeding could be impaired. Knowing these risks enables you to make an informed choice to proceed.
Can breast reduction surgery be covered by my insurance?
Although insurance companies used to provide generous coverage for medically-necessary breast reductions, recent changes in managed care have resulted in greater restrictions. In extreme cases, coverage may still be available and my office will help submit the necessary insurance forms, pre-authorization documents and supporting materials, including photographs and physical examination data. As a leading San Francisco plastic surgeon, I am familiar with the latest health insurance documentation. Regardless of coverage, however, the patient is ultimately responsible for the procedure fees.
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Breast Lift
Many women regard droopy breasts as a considerable threat to their self-esteem. Whether caused by pregnancy, weight loss or simply age and gravity, loss of breast volume or over-stretching of the skin can compromise breasts' firm, youthful appearance. Contemporary mastopexy (breast lifting) can reverse many of these problems.
What is the specific breast lift procedure?
Mastopexy literally lifts the breast, resulting in a more attractive contour. Breast droopiness, or ptosis, can be caused by three factors: a stretched skin envelope; shrunken glands caused by pregnancy or breastfeeding; and too-low nipples. After the cause of the sagging is determined, I create a custom procedure. Frequently, this involves reducing the amount of breast skin, which supports the breasts like a bra. The nipple may need to be repositioned higher, and breast volume may require reduction or enlargement.
Is the placement of the nipple and areola affected by a breast lift?
The nipple and areola are left alone and moved by relocating the entire gland.
Where are the incisions made during breast lift surgery?
Incision locations are particular to each patient, based on the amount of skin that requires removal. In the mildest breast lifts, the cut may lie around the upper part of the nipple areola. With more ambitious procedures, the incision may reach around the areola, downward vertically or even horizontally beneath the breast.
Can I expect scars after breast lift surgery?
For several months following surgery, incisions can turn red and raised. Typically, these scars fade nicely over time. The final result depends on your individual capacity for healing.
What sort of pain should I expect during/after a breast lift?
The surgery is done while the patient is under local or general anesthesia. Afterwards, the discomfort is said to be minimal. You will be offered pain medication after the procedure; most of our Bay Area breast-lift patients require very little.
Will I need to take time off work for a breast lift?
I recommend taking a minimum of five days off from work to recover. After one week, you may resume non-strenuous activities, limiting lifting and stretching for an additional two weeks.
Will I require any blood transfusions during breast lift surgery?
It is extremely rare to need a blood transfusion for a breast lift.
Does breast lift surgery require any prior medical tests?
If you are due for a mammogram, then this should be done prior to surgery. As with all surgeries, routine lab work is done as well.
Is it possible to increase or decrease my breast size during surgery?
Yes. Our overall goal is to improve the appearance of your breasts in the context of your body as a whole. Toward that end, we might discuss supplementary breast enlargement or reduction at your consultation.
What are the risks and possible complications of breast lift surgery?
As with all surgical procedures, bleeding, scarring or infection may occur. Occasionally, small differences in the size and shape of the breasts may appear. Rarely, loss of nipple areola or sensation in this region may occur. Unfavorable reactions to medications and anesthetics can develop. Knowing these risks enables you to make an informed choice to proceed. Also, it is important to note that natural aging may cause breasts to droop again at a later date. Overall, in our practice in San Francisco, breast lift complications are very rare.
Is it possible to have my insurance cover my breast lift surgery?
No. Breast lifting is a cosmetic procedure.
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Liposuction
No recent innovation in cosmetic surgery has revolutionized body sculpting like liposuction. Practiced by a skilled surgeon, liposuction can rejuvenate a patient's face, neck and body contour, permanently removing and reshaping localized fat deposits. Though not an appropriate treatment for obesity, liposuction can produce dramatic results. New advancements in liposuction like tumescent anesthesia and ultrasound assisted liposuction (UAL) have greatly improved this time-tested procedure.
What is the specific liposuction procedure?
Liposuction describes the removal of fat using a powerful suction device. Surgeons snake a very narrow tube through tiny skin incisions in the area that needs sculpting. Carefully migrating the suction tube, the fat is removed.
How much pain should I expect during/after liposuction?
As with most surgeries, anesthesia is used. Sometimes local anesthetic is adequate; other times, general anesthesia is recommended. Afterwards, patients are uncomfortable and stiff, as if following vigorous exercise; severe pain is very rare. Mild pain pills are usually enough to treat discomfort.
Can everyone benefit from liposuction?
Liposuction is best suited for patients within 20 pounds of their ideal body weight, but who possess fat deposits that do not respond to diet and exercise. Virtually any area of the body that appears disproportionate weight-wise may be improved with liposuction. Age is irrelevant; I have successfully performed liposuction on patients as young as 16 and as old as 80. In the Bay Area, liposuction is an extremely popular treatment for stubborn excess fat.
After the fat is extracted, the overlying skin will shrink to fit your new shape. It is important to note, however, that just as a one-size-fits-all sweater loses some of its tone with age, so too may skin lose some elasticity. In that case, slight irregularities in the skin can be expected.
How will I know if the condition of my skin is appropriate for liposuction?
During your consultation, I will examine the area of interest for suitability. Even if your skin is not ideal, liposuction may still be a good option for you. Disproportionate weight distribution, for example (e.g., heavier hips and thighs) may be rectified for a much-improved in-clothes appearance, even if slight skin irregularities visible only when the patient is unclothed remain.
Is it possible to eliminate abdominal fat deposits through exercise and diet alone?
Exercise and diet are necessary for health, and I strongly encourage them. Unfortunately, they will not treat disproportion. Along with eye and hair color, body shape and fat patterns are strongly dictated by genes. Features such as love handles, heavy thighs, double chins and chubby bellies may linger in spite of exercise and diet. Targeted weight reduction is simply not realistic. When you lose weight, your general size is reduced, but your body shape is fundamentally unchanged.
After liposuction will the fat suctioned off simply return?
Absolutely not. Many studies verify that once we reach adolescence, the total number and distribution of fat cells is fixed. When we gain weight, we don't increase the number of cells, we just make each individual cell bigger (except in cases of morbid obesity). Likewise, when we lose weight, the cells shrink. Liposuction results are permanent in that actual cells are removed, and they won't be replaced. Therefore, if you have a disproportionate number of cells around your hips, that disproportion will be fixed. When you subsequently gain or lose weight, those areas will also gain or lose, but the disproportion will not return.
What are the risks and possible complications of liposuction surgery?
In healthy patients, the risks are quite small. As with any surgical procedure, there are risks of bleeding, infection and scar formation. Irregularities in the skin, such as rippling and depressions, can occur, as can asymmetry between sides. Depending on your healing capacity, swelling and bruising may linger, and in rare cases, a slight increase in skin pigment can happen. There have been reported cases of lung embolism following liposuction, and even death. I will be happy to discuss and put to rest any questions or concerns you may have regarding the procedure. Rest assured that, in my practice in downtown San Francisco, liposuction is treated with extreme care and our results reflect that.
What is the standard recovery time after liposuction?
Recovery time varies. Patients generally go home the same day as the surgery with elastic bandages or tight-fitting support garments. These remain in place for about three weeks. Many patients return to work in as little as 3 days, but I generally recommend one week off. Bruising lasts 1-3 weeks, and most swelling is gone in 6 weeks. The final result is usually apparent in 3-4 months.
What type of anesthesia is used in liposuction surgery?
Developed in the late 1980s, the revolutionary technique tumescent anesthesia involves placing large quantities of dilute anesthesia solution in the proposed surgical areas. Blood loss is greatly reduced and pain massively decreased. General anesthesia, once required for liposuction, has become optional. I use tumescent anesthesia in almost every liposuction case.
I keep hearing about Ultrasound Assisted Liposuction (UAL). What does this mean?
Developed in Europe, where more than 50,000 cases have been performed, Ultrasound Assisted Liposuction (UAL) is a new and very exciting development in body sculpting. Available in the US since 1997, UAL uses ultra-high-frequency sound waves to "melt" fat prior to removal. Through a skin incision slightly larger than the standard liposuction incision, a cannula is placed into the fatty deposit. When the ultrasound is applied, the fat surrounding the end of the cannula liquifies and is removed with much less suction than conventional liposuction.
Has conventional liposuction been replaced by Ultrasound Assisted Liposuction?
Absolutely not. Conventional liposuction is more precise and is applied in conjunction with UAL. UAL is most effective in areas of fibrous fat, such as the upper abdomen, love handles, back and breast area (particularly in men). UAL is generally not used in the thighs, legs and face. In your consultation, I will discuss UAL and its possible application to your particular case. There are some additional risks and costs involved with UAL, and these will be thoroughly explored.
What is the most advanced type of liposuction?
Vaser Liposuction (also called Liposelection by Vaser) is a form of UAL that wields advanced technology to avoid many of the complications inherent in traditional UAL. With the Vaser device, patients enjoy a much faster recovery, less bruising and swelling and a better end result. I use the Vaser device in the majority of the liposuction procedures I perform.
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Tummy Tuck
Contemporary fashions and increasingly active lifestyles have amplified our awareness of the size and shape of our bodies, as has greater understanding of the link between weight and health. Consequently, in the Bay Area, "tummy tuck" surgery is an ever-more popular means of enhancing one's figure. Although recent media attention has focused on liposuction as the leading method of body contouring, abdominoplasty remains the preferred surgical solution for treating excess abdominal skin and weak musculature.
What is the source of problems in the abdominal area?
The three primary enemies of smooth, toned abdomens are pregnancy, weight gain and loss, and age. Essentially, rapid weight gain or loss strains the skinóand sometimes even the abdomen's core musclesóbeyond its original, firm shape. Abdominoplasty restores the tummy's contours by removing excess skin and tightening muscles. Liposuction, on the other hand, simply removes excess fat.
What are the specifics of the abdominoplasty procedure?
First, Dr. Mosser makes an incision, usually along the lower abdomen and upper thighs ("bikini line"). Next, he lifts the skin of the abdominal region, removes surplus fat and tightens the abdominal muscles. Finally, the skin is pulled down and any excess is removed. Sometimes, the patient's navel will need to be repositioned to accommodate a firmer tummy. Following surgery, a bandage is applied to provide abdominal support. Click here for a more in-depth description of abdominoplasty in San Francisco.
What conditions require tightening of the abdominal muscles?
Abdominoplasty is often indicated following pregnancy. One of the body's primary muscle girdles is the rectus abdominis, the area that allows us to perform movements like sit-ups. Comprised of two parts, these muscles are contiguous from the breast bone to the pubic bone, forming an internal restraint system that holds the tummy firmly in. During pregnancy, these muscles split to allow the baby to grow. Following birth, these muscles often stay separated, making it impossible to firm the lower abdomen through exercise, diet or other nonsurgical means. During abdominoplasty, this condition, called diastasis recti, is treated by bringing these muscles back together, restoring their strength and tone.
Is it possible to remove stretch marks with an abdominoplasty?
Stretchmarks, or "prune belly," are the bane of many patients' existence. Depending on the distribution of the marks across the abdominal skin, many, if not all of these marks, can be removed during an abdominoplasty. Typically, much of the lower abdominal skin is removed during the procedure, the exact place where stretchmarks tend to be concentrated.
Can scars in the abdominal region, such as those from Cesarean sections or appendicitis, be corrected during surgery?
Old scars can often be removed as part of a standard abdominoplasty, without additional complication.
I'm not fat, but my lower tummy sticks out. Am I still a good candidate for a tummy tuck?
Protruding, rounded abdomens are a common problem, particular among thin, athletic women who've borne children. In these cases, a "mini"-tummy tuck is indicated. A much simpler procedure than a traditional abdominoplasty, the mini requires a smaller incision, and therefore a faster recovery.
I have extra fat in the abdominal region, but my skin is still smooth and has good tone. Am I a candidate for abdominoplasty?
In such cases, you may be a candidate for liposuction alone. Although some liposuction is performed in many abdominoplasties, liposuction alone may or may not solve your problems. Only an in-office consultation and examination can answer this question.
After losing a lot of weight my tummy hangs out. Can you fix this?
First of all, congratulations on your weight loss! Men and women who've suffered obesity and lost weight often possess a large "apron" of skin and fat on the abdomen. Thankfully, this condition can be corrected with an abdominal lipectomy, a procedure which removes not only surplus tummy skin, but also "love handles" and excess back flesh.
How painful is abdominoplasty?
Abdominoplasties are performed while the patient is under general anesthesia, so there's no discomfort during the surgery. Following the procedure, most patients take pain medications foronly 5-7 days. One of our primary goals during surgery is to keep you comfortable afterwards; we do everything possible to minimize soreness. In San Francisco, abdominoplasty is very common and not considered a particularly painful operation.
What is the standard recovery time for tummy tuck surgery?
Most patients spend just one day in the hospital following surgery. Although athletic activity is limited for 4-6 weeks, many patients return to work in 7-10 days.
What are the possible risks and complications of abdominoplasty?
As with any surgery, risks exist. Bleeding, infection and scarring may occur. Occasionally, fluid collects, or a small patch of skin at the incision line is lost. Very rarely, patients experience abdominal pain that last longer than the usual period, or blood clots form in the leg. Remember: this information is intended to help you make an informed decision. Prior to surgery, we will discuss the full range of risks with you. Although abdominoplasty is considered a very safe procedure, all decisions regarding surgery should be carefully made.
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Rhinoplasty
Whether by genetic inheritance or trauma, many people are unhappy with the resulting shape of their noses. Rhinoplasty, or nasal surgery, provides a safe, permanent way to alter nose contour. Using the latest techniques, nasal surgery can deliver a natural-looking, balanced and refined nose that dramatically enhances a person's self-image.
What is the rhinoplasty (nasal surgery) procedure?
Small instruments are placed through tiny incisions inside the nose. These work under the skin to reshape and refine the bones and cartilage of the nose.
How painful is nasal surgery?
As with all surgery, anesthetic is used during the operation. This can be either local or general, depending on your wishes. Patients generally report little pain after surgery, mainly just stuffiness from nasal swelling. Medication for discomfort is available, but most patients require very little. Although many of my patients worry about discomfort following a rhinoplasty, at our practice in San Francisco, "nose job" patients are often pleasantly surprised by the ease of recovery.
Which parts of my nose can be changed with rhinoplasty?
Concerns about the nose fall into four target areas: The tip, the profile, the width and the nostrils. Generally, the nose can be made smaller, larger, narrower or simply given a more optimal shapeóall without changing the overall size. All of these areas can be addressed while still creating a nose that fits your face.
What is the standard recovery time after rhinoplasty?
After surgery, a splint supports the new shape for 5-7 days. When the splint is removed, the nose remains slightly swollen for 4-6 weeks, though this is not really visible after two weeks. Discoloration around the eyes may be present for 5-10 days, but is usually concealable after the seventh day with light makeup. Most patients plan one week off work, and three weeks of limited activity. A unique thing about nose surgery is that there is a small amount of swelling that persists for months. Therefore, the final result is apparent only after 9-12 months.
Can my breathing be improved with nasal surgery?
In many patients, an obstructive deviation of the wall separating the two sides of the nose, called the septum, makes breathing challenging. Frequently, the stuffiness worsens with mild allergies or colds, and can cause sinus headaches. A separate procedure, performed alone or at the same time as the rhinoplasty, can generally eliminate the obstruction. This procedure is called a septoplasty. Other structures in the nose, such as turbinates or polyps, may contribute to the blockage. If this is the case, they too can be fixed.
Can my nasal surgery be covered by insurance?
Insurance companies usually cover corrective treatments that help fix a functional problem like breathing obstruction. If you have a deviated septum, you may receive some assistance. Furthermore, if your nose problems emanate from an accident, insurance will generally cover some of the cost. We can assist our San Francisco nasal surgery patients with submitting a claim.
Which nose shape is best for me?
In the past, so-called "nose jobs" could be easily sourced given their lack of individuality. Observant people could even identify different surgeons' signature styles! Modern techniques have changed all this, allowing us to design noses that appear utterly natural, and well-suited to the person's face. If you have a large face, for instance, a small upturned nose is probably ill-advised. Conversely, if you have a large hump with otherwise classic features, a straight nose with a refined tip is the goal.
Can you use computer imaging to plan my nasal surgery?
Computer imaging, a technology that uses digital photography to manipulate a patient's image electronically, is an excellent tool for educating doctor and patient alike. We do offer this technology, which helps us define our goals and set realistic expectations for nasal surgery. Note that computer imaging presents an ideal, not a reality, and that your result may differ due to limitations of your tissues and surgical techniques. Rest assured that we work together to give you a balanced, natural look.
What other techniques can be used to improve the appearance of my nose?
It is not uncommon for people with large noses to have small, somewhat receded chins. This produces a profile that greatly exaggerates the prominence of the nose. Along with reducing the nose, a simple procedure can be done to enlarge the chin, dramatically balancing the face. This procedure is called chin augmentation, and is done through a small incision inside the mouth or under the chin. Healing time is no longer than with a standard rhinoplasty.
What are the risks and possible complications of rhinoplasty?
While all surgery has risks, and rhinoplasty is no exception, these risks are minimal. Bleeding, infection and scarring may arise, as may irregularities from surgery or your body's healing process. Secondary surgery is sometimes required. Short-term stuffiness following surgery is expected, though long-term breathing problems are rare. Risks of anesthesia are quite minimal. This information is provided not to deter you, but to help you make an informed decision about your care.
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Facelift
Facelifts have been used to reverse the signs of aging for more than 70 years. Modern techniques deliver natural, long-lasting results. Considerable wrinkling and sagging can be erased, resulting in an attractive, vibrant look. If you think the right procedure for you may be a facelift, San Francisco, with its premier surgeons and access to leading-edge technology, is the place to start!
What is the specific procedure for a facelift?
Facelifts relocate sagging skin and muscle caused by aging and gravity, and remove surplus stretched skin. Both skin and underskin tissue is surgically treated. Fat deposits in the lower jaw and neck are also removed.
What is a "two-layer" facelift and how are the results different from a traditional facelift?
In the distant past, facelifts involved simply lifting the skin, pulling it back and removing the excess. This produced unnecessary support tension in skin, resulting in a rigid, unnatural, too-tight look. In addition, skin stretched out again, and the results did not last long.
In the mid-1970's, plastic surgeons developed the innovative new two-layer facelift. The skin is still lifted, but in this case, a secondary layer of muscle, called the SMAS-Platysma, is raised. Primary tension for supporting the face is placed on this deeper layer, allowing surface skin to drape naturally over a smooth, strong base. This technique is ideal for improving tone in the lower face and neck.
Where are the incisions made during facelift surgery?
Incisions begin above the ear, behind the hairline, and continue in a natural fold on top of the ear. They may then stretch in front of or inside the ear, around the lobe, behind the ear and into the hairline. I place incisions where they are least visible. Sometimes, an additional incision must be placed under the chin.
What sort of pain should I expect during/after facelift surgery?
Anesthetic to keep you comfortable may be either local or general, in accordance with your wishes. Patients generally report very little pain, although most experience swelling afterward. Pain medication is made available to you, but most people require very little.
What is the necklift procedure and how is it different from a facelift?
Neck muscles stretch from ear to ear, supporting the area like a hammock. With time, this hammock loses its youthful firmness, resulting in a double chin or "turkey gobble" neck. Fat may also collect under the chin. A necklift tightens the muscle hammock and removes excess fat. On a side note, many people have genetically ill-defined necklines they desire corrected before they embark on a full facelift to treat aging.
What is the standard recovery time after facelift surgery?
Recovery time varies depending on your individual proclivity for healing. Bandages are generally applied for 1-3 days, and stitches removed after 5-10 days. For the most part, swelling and sometimes bruising lasts 7-10 days. Most patients recommence work in 1-2 weeks. The face and neck will feel tight for 1-3 months, and any numbness will be temporary.
How long will the results of my facelift surgery last?
This depends largely on the individual, skin quality and your natural aging rate. The saying "We can turn back the clock, but we can't prevent it from ticking on" is accurate; you will always appear younger than if you hadn't had surgery, but aging resumes eventually. In general, patients want additional work after 8-10 years, though this varies.
What are the risks and possible complications of facelift and necklift surgery?
As with all surgery, one risks bleeding, scarring and infection. Rarely, a small amount of blood called a hematoma collects under the skin and requires removal. Very occasionally, small parts of the skin flap may not heal well, and require a longer recovery. Cigarette smoking increases this likelihood as nicotine compromises circulation. Facial nerve damage may occur, though this is very rare, and generally self-healing. At your consultation, we will inform you of all risks, rare though they may be, so that you can enter surgery confident of a positive outcome.
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Blepharoplasty
It's with your eyes that you first interact with other people; it's also your eyes that first reveal your age. Blepharoplasty, a thoroughly tested procedure performed for more than 75 years, holds the potential to turn back the clock on many of those years, producing a dramatically youthful result.
What are the specifics of the blepharoplasty (eyelid lift) procedure?
Local sedation is administered continuously to make you sleepy and comfortable during surgery, which takes place in either a surgeon's office or a hospital. Essentially, excess skin, muscle and eyelid fat are removed through carefully placed incisions. The procedure usually takes about an hour. Immediately afterwards, a light temporary bandage covers your lids, ice packs minimize swelling and you are given a short rest period to recover, after which you may either go home or stay overnight. Generally, only dissolving stitches are used.
Should I expect bruising after my eyelid surgery?
The degree to which you generally bruise determines how much discoloration develops around your eyes. Bruising typically lasts 5-10 days, give or take a few days. After stitches are removed, a light cosmetics application camouflages bruising until it disappears altogether. We recommend this approach for both men and women.
How much time will I need to take off work following eyelid surgery?
It is crucial to rest for 2-3 days, because overdoing activity can cause bleeding, which will prolong your recovery. After three days, you may return to work, though some discoloration will remain. Most of my San Francisco blepharoplasty patients allow 1-2 weeks to recover before resuming a full schedule.
Where do you make the incisions in eyelid surgery?
One incision is made at the normal horizontal fold in the middle of the upper eyelid. On the lowers, the incision is placed just below the eyelashes. Most scarring is nearly undetectable over time. In some cases, such as when treating under eye bags, incisions can be placed inside the eyelid, so there are no exterior scars.
Is it possible to reshape my eyes with blepharoplasty?
Increasingly, yes. Scientific knowledge has grown in recent years, accommodating such procedures as creating folds in Asian eyes and raising sagging eyelids. These types of alterations are slightly more complex, and can be discussed at your consultation.
How will my ability to wear cosmetics be affected by eyelid surgery?
Some people are initially drawn to blepharoplasty when they can no longer apply cosmetics to the upper eyelid because of drooping. After surgery, this is generally corrected. We will also suggest new makeup application techniques, so that your fresh eyes are shown to best advantage!
Can my blepharoplasty procedure be covered by my insurance?
If eyelid droop drastically compromises your peripheral vision, insurance companies may partially cover the surgery, although the trend is toward increasing restrictions on coverage. You may be asked to submit to an ophthalmologic exam to establish the extent of the problem.
At what age is blepharoplasty most appropriate?
The answer is simple: whenever it's necessary! Occasionally, treatment is indicated on lower lids in the late teens or early 20's. More often, image-conscious men and women in their early to mid-30's choose upper eyelid surgery, while the 40's are the average time for both men and women.
Do you perform eyelid surgery for men?
Certainly! Of all facial cosmetic surgeries, blepharoplasty is the most popular among men. Why? Saggy eyelids are not only aging, they can create the impression of constant exhaustion. Although we tend to be more accepting of male aging, men too may suffer the stigma of eye bags or apparent exhaustion.
How long can I expect the results of my eyelid surgery to last?
Eyelid surgery produces very long-term results. Nevertheless, natural aging progresses from the new baseline of improvement. It is rare for patients to desire surgery before the 7- to 10-year mark; most patients never require additional surgery. Eyebrow droop may create the appearance of heaviness in the upper eyelids, but this is a separate problem. Click here for more information on browlift surgery.
What are the risks and possible complications of blepharoplasty?
There are a few risks to blepharoplasty, as with any surgical procedure. These include bleeding, infection and scarring, asymmetry between the eyelids or continued eyelid sag. It is not unusual to experience eye dryness for several weeks after the procedure. Loss of vision, though extremely rare, has occurred. By making an informed decision, you can choose this generally safe procedure feeling confident about the results.
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Brow Lift
A browlift, or upper facelift or forehead lift, offers astounding potential to enhance your appearance. Among features that can be improved are horizontal forehead lines, deep between-brow creases and droopy eyebrows.
How do you define eyebrow sagginess and how is it treated?
As we age, our skin loses elasticity, causing the brow to droop. Sometimes the outside of the brow sags, resulting in a sad expression. In other cases, the central portion hangs, mimicking anger. Many people operate under the misconception that these symptoms require an eyelift, since brow droop can cause hooding of upper eyelid skin, when the solution is actually a browlift. What causes brow tone to change? Typically, photodamage (sun), gravity, and facial tension. Sun changes the actual structure of the skin, reducing elasticity. Gravity exerts constant force on the entire body. Facial tension caused by life's everyday stressors, places deep wrinkles in our brow.
How do I know if I need a browlift, eyelift, or both?
Here's a reliable test: Using a mirror, observe the positions of your brow and eyelid skin. Next, gently lift the skin above your eyebrow into a pleasing positionónot too highówith your thumb and forefinger. If that eradicates most of the excess skin in the upper eyelid, a browlift may be indicated. Another common sign of brow droop: no surface to place makeup on the upper eyelid with increasing age.
Is it possible to have both an eyelift and a browlift done at the same time?
Yes. Patients frequently face both brow droop and surplus upper eyelid skin. These patients require both a browlift and an upper eyelift.
What is the cause of wrinkles in the brow region?
First, there are two types of brow wrinkles. Glabellar, or vertical, wrinkles, fall between the eyebrows. They are caused by corrugators, active little muscles located between the brow that exhibit anger or tension. Frontalis, or horizontal wrinkles, fall across the forehead and are caused by contractions in the frontalis muscle located in the central part of the forehead. Whether between the brows or centered in the forehead, it is tension that causes wrinkling.
What are the different browlift techniques?
In the past decade, science has developed a number of approaches that specifically address different brow problems.
Transpalpebral surgery is conducted entirely through eyelid incisions, usually with an accompanying eyelid lift. No incisions are made in the scalp, and only limited raising of the eyebrows is possible. This procedure is ideal for correcting vertical wrinkles between the eyebrows.
The temporal browlift requires two small incisions in the scalp. This procedure lifts the eyebrows and is performed only with a concurrent eyelid lift. The between-eyebrow muscles are reached through the eyelid incision; brow elevation is achieved through the scalp incisions.
When appropriate, I most often choose the endoscopic browlift. Using 2-5 small incisions in the scalp, the muscles are shortened and the eyebrows elevated using an endoscope, a tool for visualizing the internal structures of the forehead skin on a monitor. No eyelid incisions are needed, vertical wrinkles are minimized, and the eyebrows can be elevated.
The traditional bicoronal browlift relies on a single longer incision across the top of the scalp. This approach provides the best visualization for correcting horizontal wrinkles, addressing the deepest vertical wrinkles between the brows and for relocating the eyebrows.
Will a browlift raise my hairline?
Somewhat. For instance, if eyebrows need to be higher, there will be a slight elevation of the anterior hairline. If no repositioning is needed, or only lateral eyebrow droop needs fixing, the hairline change is usually imperceptible.
Can I have a browlift if I already have a high hairline?
If a patient presents with a too-high or receded hairline, a forehead reduction can be done with the browlift. Moving the scalp hair forward surgically will lower the upper forehead hairline.
How painful is browlift surgery?
The procedure itself is painless, as anesthetic is used during the operation. At your consultation, we will determine whether full general anesthesia or "twilight" sedation is best for you. You may experience some swelling and tightness for a week or two following surgery, but little pain is expected. Most patients require little medication.
What is the standard recovery time from browlift surgery?
Although nearly all patients are fully mobile the day after the procedure, most take 5-7 days off work, depending on their individual healing rate. Full healing, as with any surgery, takes a bit longer. Until three months post-surgery, the brow may be oilier or slightly numb.
When is the proper age to have a browlift?
Some women may never need a browlift, while others may benefit as early as their late twenties. Men generally don't benefit until their late forties at the earliest. Sometimes, following unsuccessful injections of Botox, San Francisco clientele inquire about browlifts.
How long should I expect the effects of my browlift to last?
Browlifts are among the longest-lasting cosmetic procedures we perform; nine out of ten people who have a browlift never need another.
What are the risks and possible complications of browlift surgery?
As with any surgical procedure, there is a small risk of bleeding, infection or scarring. Slight asymmetry between the brows may occur. Very rarely, loss of brow muscle function develops. Being informed prior to surgery will help you make optimal choices regarding your care.
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Cheek and Chin Enhancement Surgery
By altering the underlying structure of the face, a skilled cosmetic surgeon can create beautifully balanced features, with a well-defined jaw line and cheekbones and a slight hollow in the cheeks. Chin and cheekbone enhancement, though not minor in nature, can dramatically improve one's appearance.
What is the standard procedure for chin or jaw enhancement surgery?
Chin surgery is accomplished through a mouth incision or existing under-chin skin crease. To alter chin projection, surgeons use either a small implant or cut and shift the bone's position. Afterward, incisions are closed and a small elastic dressing is applied. If the posterior portion of the jaw requires fixing, it is accessed inside the mouth.
What is the procedure for cheekbone enhancement?
Cheekbone implants rest on the existing cheekbone (the malar eminence). The implant is inserted through a mouth incision or, in some cases, through the lower eyelid, brow or ear front. Incision placement is dictated by your unique needs and any concurrent surgeries being performed.
What material is used in cheek and chin implants?
The two most popular materials are solid flexible silicone and Gore-tex. Both plastics are biocompatible, which means they cause negligible reactions when placed under the skin.
How painful is chin and cheek augmentation surgery?
Surgery is performed with either a local or general anesthetic, and thus causes only minor discomfort. After surgery, there is some soreness, but this is easily managed with drugs.
What procedures are available to correct a small or shallow chin?
Chin augmentation, or thrust-forward enlargement, is the most popular chin procedure. It can be done alone, or as an accompaniment to nasal or facelift surgery. There are two methods of augmentation. The simplest, implant augmentation, involves inserting a plastic implant directly onto the bone of the chin. This is done under local anesthetic through a mouth or under-chin incision. A more involved, no-implant procedure called intraoral incision requires a cut into the chin bone, sliding it forward and wiring it in place. General anesthetic is mandated. Although the implant is used more often, each method has specific benefits and drawbacks.
What if I have an overly long or prominent chin?
Reduction genioplasty is performed under general anesthesia. Again, through a mouth incision, the chin bone is trimmed and moved back as needed.
The back of my jaw, just below my ear, is too wide/narrow. Can you correct this?
The so-called "angle of the jaw" can be decreased or widened via techniques similar to those used for chin alteration.
Can cosmetic surgery fix my underbite/overbite?
For the most part, yes. Various surgical methods are available, and a comprehensive evaluation is required before deciding on the appropriate procedure.
I have a double chin or "turkey gobble" neck. How can this be corrected?
Double chins and turkey gobbles involve the skin, fat and muscles of the neck. These problems are common among those with weak chins and can be corrected simultaneously.
Is it possible to augment my cheekbones to fix my puffy cheeks?
Chubby, cheekbone-obscuring cheeks can be greatly refined by removing cheek fat (the buccal fat pad). This is done under local anesthesia through a small mouth incision.
What is the standard recovery time from cheek or chin enhancement surgery?
These surgeries are usually performed on an outpatient basis, allowing you to go home the same day. For one week, a limited diet is prescribed, after which patients may return to normal activities. The jaw is not wired, and only minimal dressings are used. Most patients return to work in 2-7 days. Bruising and swelling can last longer, and lip numbness may last 3-6 weeks.
What are the possible risks and complications of cheek or jaw surgery?
As with all surgery, the possibility of bleeding, scarring and infection exists. Nerves and muscles may be injured, causing permanent numbness or lower lip immobility, though this is rare. The implant may shift, requiring a second surgery to correct. Dental injury, while atypical, can occur. Additional, though rare, risks will be discussed at your consultation. In San Francisco, facial cosmetic surgery offers the most advanced techniques during and after surgery to minimize risk of complication.
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