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Rhinoplasty
One of the most common types of plastic surgery, rhinoplasty ("rhino" is the Greek word for nose) is used to reduce or (far less often) increase the size of the nose, change its shape or angle, remove a bump, correct a deviated septum, narrow the span of the nostrils, or correct a birth defect or injury. It can be performed on persons of any age (though the minimum is usually 14 or 15, when the growth spurt is concluded), and sometimes more than once.
Q. Who can benefit from rhinoplasty?
A. Men and women who would like a better-looking or better-functioning nose, and who realize that perfection is not always possible. Certainly, a "nose job" has helped make millions of women and a lesser number of men more attractive, but it's not for everyone. However, it can be of vital importance if one's nose has been seriously damaged due to an injury or, since birth, has not looked "normal." For those with a deviated (out of place) septum (the structure separating the nostrils), rhinoplasty can facilitate breathing-and thereby make it easier to sleep, run, swim or engage in other activities-and it may even enhance the sense of smell.
Q. What are the risks?
A. When rhinoplasty is performed by a highly skilled aesthetic surgeon, such as Dr. Kapoor, the risk is rare. Still, as with any surgery, there may be complications, such as infection, nosebleed, or a reaction to the anesthesia. In certain instances after surgery, small blood vessels may burst and appear (temporarily or permanently) as tiny red spots on the surface of the skin.
As for scarring, it's usually not a problem. When an "open" (external) surgical technique is used, or if flared nostrils are surgically narrowed, the small scars on the base of the nose will not be visible in most cases. When rhinoplasty is performed from inside the nose, there is no visible scarring at all. Rarely-less than 10% of the time-a minor deformity may require a second, minor procedure.
Q. What's the first step?
A. An initial consultation with Dr. Kapoor in his Beverly Hills office. You'll be asked what you'd like your new nose to look like, and you'll be shown pictures of various sizes and shapes, as well as before-and-after photos of patients who have undergone the procedure. However, there are limitations to what rhinoplasty surgery can achieve. The structure of your nasal bones and cartilage, the size and shape of your face, the thickness and color of your skin, your age and height-all can influence the procedure and the results you can realistically expect.
During your consultation, you'll be asked if you've ever had any injuries to your nose or any operations on it, if you're allergic to anything, if you have any breathing difficulties, if you smoke (it can prevent proper healing), and if you take any vitamins, medications, or recreational drugs. The cost of the procedure will be discussed, and you'll be informed that most health insurance policies don't cover rhinoplasty performed purely for cosmetic reasons. However, some policies do pay for part or all of the cost if it's performed for reconstructive purposes (e.g., after an accident), to correct a marked deformity, or to correct a breathing problem. Check with your insurer and obtain pre-authorization before the surgery.
Q. What's the next step?
A. Once you decide on a date, time and place for your procedure, you'll be given instructions on how to prepare for it. You'll receive guidelines relating to eating, drinking, smoking, taking or avoiding certain vitamins and medications.even how to wash your face after the surgery. You'll need someone to drive you home after the surgery, which is performed on an outpatient basis (no hospital stay), and perhaps to assist you at home for a few days.
Q. What happens during surgery?
A. Depending on the extent of the procedure and what you and Dr. Kapoor prefer, you will be administered either a local anesthesia with intravenous sedation or a general anesthesia. If the former, you will be lightly sedated; only your nose and the surrounding area will become numb. You'll be awake throughout the surgery-relaxed and feeling no pain. Or, with general anesthesia, you'll sleep throughout the operation.
The operation usually takes one or two hours; a complicated procedure will take longer, of course. First, Dr. Kapoor will carefully separate the skin of your nose from its supporting framework of bone and cartilage. Next, like a sculptor, he will reshape the framework according to the desired result. Then he will drape the skin over the remodeled framework and suture it in place.
Depending on what's to be done and the amount of working space available, Dr. Kapoor may perform the procedure from the inside (for an "invisible" or "closed" rhinoplasty) or from the outside (especially if the procedure is complicated). He'll often make a small incision across the columella, which is the vertical strip of tissue between the nostrils. Finally, he'll apply a splint to help maintain the new structure. To stabilize the septum, he'll pack the nose with cotton or place soft plastic splints in your nostrils.
Q. What happens after surgery?
A. You'll awake (if you had general anesthesia) in the recovery room or (if you had a local) just rest there a while until you feel wide awake. During the first 24 hours or so after surgery, your face will look and feel puffy, your nose may ache a little, and you might have a mild headache. Medication can control the pain, and once you're back home, it's best to stay in bed most of the time, with your head elevated, during the first day.
There will be swelling and bruising around your eyes, and you might expect this to diminish as the days go by. Not so. The swelling and bruising will actually increase during the first two or three days, but then they'll decrease, especially if you apply cold compresses. Within about two weeks, most of the swelling and bruising should disappear, although some subtle swelling will remain for several months.
During the first few days, a little bleeding is common, and you may have some stuffiness for a few weeks. Try not to blow your nose for a week or so, until the tissues heal. After a few days, the nasal packing (if any) can be removed and then, a week or two later, the dressings, splints, and sutures can be removed. After about two days, you should feel well enough to move around your home, but wait a week or so before returning to work or school. Avoid any strenuous activity that increases your blood pressure, and avoid rubbing or hitting your nose for eight weeks. Don't let it get sunburned, either. It's important, too, not to wash your face or hair too vigorously.
If you use contact lenses, you can wear them right away. However, because eyeglasses rest on your nose, once the splint is off you should not wear glasses unless they're taped to your forehead. It may look ridiculous, but until your nose is healed they can cause bleeding.
Don't expect overnight results. Your new nose can take months, even a year, before it completes its healing-but the results will be worth the wait.
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Eyelid Surgery
Known to medical people as blepharoplasty ("blephar" is the Greek word for eyelid), eyelid surgery is used to remove excess fat-often excess skin and muscle, too-from the upper and lower eyelids. This procedure is also used to correct drooping upper eyelids and puffy bags under the eyes. It can help people look younger and more alert, and (in some cases) help improve vision. But it can't eliminate dark circles under the eyes, lift sagging eyebrows, or remove crow's feet or other wrinkles. Sometimes, blepharoplasty is performed along with a facelift or brow lift.
Q. Who are the best candidates, and what are the risks?
A. Most are healthy men and women, age 35 or older, who don't want to look tired even when they're not. If droopy, baggy eyelids are common in your family, and you're younger than 35, you need not wait years or decades to have the problem corrected. But regardless of your age, be aware of the risks if you have a thyroid problem (e.g., hypothyroidism; Grave's disease), diabetes, high blood pressure, dry eye (not enough tears), cardiovascular disease, a detached retina, or glaucoma.
Even if you don't have any of these problems, the procedure-like other cosmetic surgery procedures-might cause an infection or an adverse reaction to the anesthesia. Among the minor complications that sometimes occur following blepharoplasty are a few days of double vision or blurred vision, temporary swelling at the corner of the eyelids, or a slight asymmetry (not balanced) in healing or scarring. Also, after the surgery some patients may find it difficult to close their eyes when sleeping, and in rare cases this may be permanent. Also rare but possible is ectropion- the lower lids are pulled down-and additional surgery may be needed.
Risks can be reduced by consulting with, and having the procedure done by, a highly qualified plastic surgeon.
Q. What's the first step?
A. During your consultation at Dr. Kapoor's office, your condition will be evaluated, your medical history will be examined, your vision and ability to produce tears will be tested, and you'll be asked if you have any allergies, if you're taking any vitamins or medications, and if you smoke. Any of these can affect the outcome of the operation.
Dr. Kapoor will then discuss your goals and expectations and whether or not the procedure is appropriate for you. If it is, you can then schedule it, and you'll be given instructions on preparing for surgery. You'll need someone to drive you home after the surgery and also, perhaps, help you at home for a few days.
Q. Where will the surgery be performed?
A. In most cases, Dr. Kapoor performs this type of surgery at a Beverly Hills surgical center or in one of the hospitals he's affiliated with in Los Angeles, on an outpatient basis. Rarely does it require a hospital stay. Usually, a local anesthesia is administered to numb the area around the eyes, and an oral or intravenous sedative is also given. As the surgery is performed, you'll be awake but feeling no pain-just some tugging or mild discomfort. If general anesthesia is administered, you'll be asleep throughout the procedure.
Q. What happens during surgery?
A. Depending on how many eyelids will be operated on, the operation takes from one to two hours. Typically, the doctor will make incisions along the natural lines of your eyelids, in the creases of your upper eyelids and/or immediately below the eyelashes in the lower lids. Cutting a bit deeper into these incisions, he will then separate the skin from the underlying layers of fatty tissue and muscle, remove the excess fat, sand perhaps trim any sagging skin and muscle. Finally, he will close the incisions using ultra-fine sutures. Or, if you want only some pockets of fat removed from under your lower eyelids-and you're young with thick, elastic skin-the doctor may make an incision inside those eyelids, so that there's no visible scar.
Afterwards, the doctor may lubricate your eyes with an ophthalmic ointment and apply bandages where needed. As the anesthesia wears off, any discomfort can be controlled with the pain medications prescribed.
An eyebrow lift-to correct sagging brows that can make you look sad, angry, or tired and add years to your appearance-may be performed by itself or together with other surgery.
Q. Then what?
A. After eyelid surgery, it's important to keep your head elevated for a few days and to apply cold compresses to the surgical area to reduce swelling and bruising. Depending on the patient, bruising may last from two to four weeks, decreasing after the first week. It's also important to clean your eyes with eye drops or a special solution provided. During the first few weeks there may be excessive tearing, your eyes will be sensitive to indoor light, sunlight, wind and other irritants, and you may temporarily experience blurring or double vision.
The sutures will be removed several days to a week after the surgery, and then the swelling and discoloration should go down. You'll begin to look better and feel better, and be able to watch TV or read. But if you wear contact lenses, don't put them in for at least two weeks; even then, they may feel uncomfortable for a few more weeks until your eyelids recover from the surgery. Avoid moderate activities for at least three days (five days would be even better), and avoid strenuous activities for three weeks, especially those (bending, lifting, sports) that raise your blood pressure. Also avoid alcohol for several weeks.
Healing takes time, and scars from eyelid surgery may stay pink for three months or longer, until they fade to a nearly invisible fine white line.
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Facelift
The older you get, the older you look (unless you're the rare exception). Gravity, exposure to the sun, harsh winds, the daily stress and strain, lack of proper exercise, over-eating, and age itself all take their toll. Look in the mirror, or at a recent photo of yourself, and-especially if you're over 40 or 50-you may well see a jaw that's grown slack, more than one chin, a sagging neck, and/or unsightly creases between your nose and mouth.
Although no one can stop the aging process, Dr Kapoor provides several options for rejuvenation of the aging face. He is one of the few cosmetic surgeons in Southern California proficient in the SMAS-platysma bidirectional face list which gives a more natural, longer-lasting result than the standard skin only facelift. He can make you look younger and feel more confident about your appearance, by performing a facelift (also known as a rhytidectomy) to rejuvenate your face and neck. This popular procedure removes excess fat, tightens the muscles just below your skin, and reshapes the skin of your face and neck so it no longer sags.
A facelift can be done by itself or in conjunction with eyelid (blepharoplasty) and eyebrow surgery (brow lift or forehead lift).
Q. Who are the best candidates?
A. They are the men and women whose skin is still somewhat elastic and who have a strong, well-defined bone structure, but their face and neck have started to sag. Most people who opt for a facelift are between 40 and 60 years of age, although many older men and women have facelifts, too. That's because it can make you look younger and more alive. It can uplift your spirits as well as your face. And it can cause you to smile instead of hide when a friend or relative wants to take your picture.
Q. What are the risks?
A. Complications are few and far between when a facelift is performed by a highly qualified cosmetic surgeon like Dr. Kapoor. However, they might occur due to the patient's physical condition, healing ability (e.g., smoking is detrimental to healing), uncontrolled high blood pressure, blood clotting problems, or other factors. Despite the utmost care during surgery, it's sometimes possible to temporarily injure the motor nerves controlling facial muscles. Infections are rare. The patient may react poorly to the anesthesia. Hematoma which is bleeding under the facial skin, is the most common complication, and occurs 3-5% of the time. Although millions of people have had successful facelifts, results cannot be guaranteed.
Q. What's the first step?
A. A consultation at Dr. Kapoor's office. You'll be asked what you'd like a facelift to accomplish, what parts of your face or neck you'd like improved, whether you're a smoker, and what medications, vitamins or recreational drugs you're taking (if any). During your visit, the doctor will evaluate your face and neck, including the skin and bone structure. If you've ever had any surgery or medical problems, or bad reactions to drugs or anesthesia, he'll want to know about it. Then he'll explain what can and can't be accomplished with a facelift, and what is realistic.
Q. Where will the surgery be performed?
A. Depending on what's to be done and how extensive it is, Dr. Kapoor will perform the surgery at a Beverly Hills surgical center or in one of the hospitals he's affiliated with in Los Angeles. It's usually done on an outpatient basis, although you may be hospitalized for a day or so if general anesthesia is administered, or if you have a medical condition (e.g., high blood pressure or diabetes) and must be closely monitored after the surgery.
Q. What happens during surgery?
A. A local anesthesia will be administered, along with a sedative to make you drowsy. You'll be awake, relaxed, and you won't feel any pain, although you may feel occasional discomfort and some tugging as your skin is lifted. However, if general anesthesia is administered, you'll be asleep during the entire procedure, waking up in the recovery room.
Depending on what's to be done, its extent, and any special circumstances, a typical facelift takes from three to five hours. For a facelift, the first incision is usually at the temple, above or at the hairline, and extended in a natural line-in front of the ear or inside the cartilage at the front of the ear. This incision continues behind the earlobe to the lower scalp. If you're having chin work, a small incision is made there, too. Next, the skin is carefully separated from the underlying muscle and fat. To improve the contour, fat may be trimmed or suctioned from the chin and neck area. Then the underlying muscle and deeper tissues (SMAS, Platysma) are tightened, the skin is put back in place, and any excess skin is cut away.
To secure the layers of tissue and to close the incisions, stitches are used, while metal clips may be used on the scalp. Bandages may also be loosely wrapped around your head, to minimize swelling and protect against bruising. Finally, to drain any blood that may collect there, a small narrow tube may be placed under the skin behind the ear.
Q. What happens after surgery?
A. After resting in the recovery room, have someone drive you home and, if possible, assist you there for a day or two. Usually, there will be minor discomfort, which can be controlled with the pain medication prescribed. If, however, you experience severe or continuous pain, or your face suddenly swells up, report it immediately. Minor numbness of the skin is to be expected, and should go away in a few weeks or months.
For a few days after your surgery, keep your head elevated and as still as possible. One or two days after surgery, if a drainage tube was inserted, your doctor should remove it. One to five days after surgery, any bandages can usually be removed. Your face will look pale, bruised and puffy, but in a few weeks you'll appear normal. After about seven to ten days, most of your stitches will be removed.
Q. Then what?
A. Take it easy for the first week after surgery. Move around your home after a day or two of bed rest, but be gentle when washing-or even just touching-your face and hair. At first, your skin will be tender and numb, and the slightest touch may be painful, but gradually it will recover. Your face will feel and look bruised for two to three weeks, you may feel tired most of the time, and you may even be depressed. To avoid a relapse, during the first two or three weeks you should avoid strenuous activity, sex, and heavy housework. For several weeks, avoid steam baths, saunas, and alcohol. Around the third week, things should improve. You'll start to look better and feel better, and you'll start to see the positive changes in your appearance.
If you work outside the home, you may feel well enough to return to work (if it's not strenuous) 10 to 14 days after surgery. Makeup can cover most of the remaining bruises. Yes, you'll have some scars, but they can usually be hidden by your hair (if long enough) or in the natural creases of your face and ears. In time, they'll fade and be almost invisible.
Undoubtedly, many of the people you see every day-in person, on movie and TV screens, or on magazine covers-have had facelifts. They look and feel years younger. Why not join the crowd?
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Breast Augmentation
Technically known as augmentation mammoplasty, breast augmentation is used to enhance the size, shape and appearance of a woman's breast for several reasons:
To enhance a woman's body contour, when she believes her breast size is too small
To correct a reduction in breast volume, following pregnancy
To balance a difference in breast size
As a reconstructive technique following breast surgery
Having a surgeon insert an implant behind the breasts can increase a woman's cup size by one or more.
Q. Who can benefit from this procedure?
A. Adult women, of any age, who seek to improve their appearance and breast volume, can benefit from breast augmentation. If this sounds like you, and you're in reasonably good health, and you're realistic in regard to your expectations, you may be a perfect candidate.
First, though, you should know that:
Due to safety concerns of the Food & Drug Administration, silicon gel-filled implants-whether new or replacements-are currently available only to women participating in approved studies.
Saline-filled implants are still available, on an unrestricted basis, to breast augmentation patients.
For safety, appearance, and other reasons, approved implants should be surgically implanted only by qualified and experienced surgeons.
Q. What are the risks?
A. There are risks associated with any surgery, and there are specific complications that may occur with breast augmentation. For example:
Capsular contracture-the formation of scar tissue around an implant- is the most common problem. It can occur if the scar or capsule around the implant begins to tighten. This squeezing can cause the breast to feel hard. Treatment of this condition may require the removal or "scoring" of the scar tissue, or the removal or replacement of the implant.
Excessive bleeding following the operation might occur (as it might with any other surgical procedure) and cause swelling and pain. Should this continue, a second operation may be needed to stop the bleeding and remove the pool of blood.
In relatively rare cases, an infection may develop around an implant, usually within a week after surgery (but sometimes later on). Should this occur, it may be necessary to remove the implant for several months, until the infection clears. Then a new implant may be inserted.
In some cases, the nipple may become oversensitive, under sensitive, or numb. Numbness may also occur near the incisions made to insert the implants. Usually, these symptoms eventually disappear, but may prove permanent in a few patients.
Breast implants occasionally break or leak, usually as a result of some injury to the breast or from the normal compression and movement of the breast and implant that causes the man-made shell to leak. If a saline- filled implant leaks, that salt water will be harmlessly absorbed by the body, and the implant will deflate in a few days. However, if a gel-filled implant leaks, a second operation may be needed to remove as much of the gel as possible and to replace the implant.
In general, though, most implants have proven to be safe, with no serious consequences.
If you're considering breast augmentation, it's important to schedule a consultation with Dr. Kapoor in advance, at his medical center, so that you and he can discuss the benefits, limitations, potential risks, type and size of implant, pre- and post-surgical procedures, and other relevant topics. Insurance does not usually cover breast implants.
Q. Where and how is the procedure performed?
A. Dr. Kapoor most often performs breast augmentations in a Beverly Hills surgical center or in one of the hospitals he's affiliated with in Los Angeles, on an outpatient basis, with general anesthesia administered to the patient.
An incision can be made in the crease where the breast meets the chest, or around the areola of the breast, or in the armpit. The resulting scars will be as inconspicuous as possible. After working through the incision, Dr. Kapoor will lift the skin and breast tissue and create a pocket-usually beneath the pectoral (chest wall) muscle. An implant is then inserted in each pocket and centered beneath the nipples. Stitches are sewn in to close the incisions, and tape may be used for additional support.
The entire procedure usually takes about an hour, and recovery is usually fast. After a week or so, the stitches will be removed, and you should allow from three to five weeks for the swelling in your breasts to disappear before you engage in normal activities. The scars will be visible for at least six weeks, and then they'll begin to fade, although they'll never disappear completely.
Countless women throughout the world have had breast augmentations for one or sometimes two of the reasons given earlier. Please contact Dr Kapoor to discuss your options.
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Breast Reduction
Although women with small breasts may envy those with large ones, enlarged breasts (macromastia) can be a source of discomfort. Their excessive weight can cause back pain and neck pain, eventually lead to skeletal deformities or breathing problems, and result in bra straps leaving painful indentations on shoulders. Their size can cause skin irritations, as clothing is stretched to the limit and rubbed against the upper body. They make it almost impossible to lie or sleep on one's stomach.
Because they're often the first thing people notice, they can be a source of embarrassment and make a woman-or a teen-aged girl-very self-conscious, especially if she's exercising, or wearing a swimsuit or shorts and a T-shirt at the beach or pool. They often provoke jokes from strangers or co-workers.
For any or all of these reasons, breast reduction-or, as plastic surgeons call it, reduction mammoplasty-is commonly sought by large-breasted women. It may also help women with normal-sized but sagging breasts, when other procedures are not practical.
Q. What are the details of the procedure?
A. During the reduction procedure, the surgeon removes excess fat from the breasts, along with some of the glandular tissue and skin, while endeavoring to make both breasts the same size and shape. This procedure immediately makes them smaller, lighter and less burdensome. At the same time, the surgeon may reduce the size of each areola (the darker skin that surrounds the nipple). The goal: smaller, lighter, better-shaped, and more attractive breasts that are a source of pride, not embarrassment.
Q. What else should I know about breast reduction?
A. Most of the women who undergo this type of surgery have it done to reduce their constant physical burden, and not just for cosmetic purposes. Usually, surgeons recommend that teens with this problem wait until their breasts are fully developed, so that the surgery need not be repeated later on. However, if the discomfort or the embarrassment is intolerable, the procedure can be performed earlier. But it is not recommended for women of any child-bearing age, who intend to breast-feed, because the procedure removes many of the milk ducts.
There are some risks. After the surgery, some patients can develop small sores around their nipples, but these can be treated with an antibiotic cream. The surgery leaves visible, permanent scars, but these are covered when wearing a bra (which, by the way, is often two cup sizes smaller than before). Sometimes, it's impossible to end up with two perfectly matched breasts, or with the nipples positioned precisely where they should be. Also, a few patients may suffer a permanent loss of feeling in their breasts or nipples. And, rarely, the nipples and areolas may lose their blood supply, causing the tissue to die. (But both can usually be rebuilt using skin grafts.)
As noted above, it's not a simple-or completely risk-free-operation. Also, like any surgery, there might be complications, such as infection, bleeding, or adverse reaction to the anesthesia. Still, when the procedure is performed by a superbly trained and experienced cosmetic surgeon, like Dr. Kapoor, in highly accredited and modern facilities, the risks are minimized.
Q. What's the first step?
A. Consult with Dr. Vishal Kapoor and his medical staff. After this consultation, Dr. Kapoor will examine, measure and (for reference purposes during and after surgery) photograph your breasts. Then, you and the doctor or a staff member will discuss your objectives and the variables (your age, current and desired breast size and shape, skin condition, general health, etc.) that may affect the surgery. You'll discuss the anesthesia that will be used, where the operation will take place (a hospital or Dr Kapoor's medical facility), and the cost of the procedure. Some insurance policies will cover part or all of the cost if the reduction is medically necessary; if so, they should be sent a "predetermination letter" by the surgeon. Also, you may need to have a mammogram done. And if a large amount of breast tissue is to be removed, you may be asked to donate a unit of blood ahead of time, so your own blood will be available should a transfusion be needed. As you leave Dr. Kapoor's offices, you'll be given instructions on how to prepare for the surgery: guidelines on eating, drinking, smoking, medications, dieting, and other factors that can affect the success of the procedure.
Q. What happens during surgery?
A. In most cases, the surgeon makes an anchor-shaped incision, starting around the areola. The incision extends downward, following the natural curve of the crease beneath the breast. After lifting a flap of skin, the surgeon removes excess fat and glandular tissue, trims off excess skin, and repositions the nipple and areola so they'll face forward, at the center of the breast. Then he brings down the skin from both sides of the breast, around the areola, as he shapes the breast's new contour. If there is excess fat in the armpit, it may be removed via liposuction.
Usually, the nipples remain attached to their nerves and blood vessels, unless the breasts are pendulous or extremely large. If they are, it may be necessary to remove the nipples and their areolas and graft them into higher positions, resulting in a loss of sensation in the nipples and areolar tissue. At the conclusion of the surgery, stitches are used to fasten the skin around the areola and elsewhere, in a way that minimizes scarring.
But forget all of the above, if all that's needed to reduce the size of your breasts (without reshaping them) is some fat removal. In that case, liposuction (see description) alone may do the job, leaving even fewer scars.
Q. What happens after surgery?
A. Your breasts (now showing signs of swelling and bruising) will be wrapped in an elastic bandage or in a surgical bra over gauze dressings, to help protect against infection and physical damage. A small drainage tube may be inserted in each breast, remaining there for a day or two, to remove excess blood and other fluids. Yes, there will be some pain during the first few days, especially when you move, stretch or cough, and you'll be given a prescription for pain medication. After two days, the bandages will be removed, but you should continue wearing the surgical bra for several weeks, sleeping on your back, until the swelling and bruising go down. In one to two weeks after the surgery, your stitches will be removed.
If, following surgery, your breast skin looks and feels too dry, you should apply a moisturizer several times a day, but keep the suture area dry. Your breasts may become swollen and painful when your first post-surgical menstruation occurs, but this is normal and temporary. There may also be random, shooting pains for a few months. And don't be surprised if there is some loss of feeling (caused by the swelling) in the nipples and breast skin. In most cases, this loss of feeling fades away during the next six weeks; in some patients, it takes a year or more; and in a few cases, the loss may be permanent.
Q. When will I be able to start enjoying the benefits of breast reduction?
A. That depends on how much reduction was done, the condition of your breasts before and after surgery, your activities, and other variables. If you're like most women who've undergone the procedure, here's what you can expect:
Days 1 and 2: If you feel like it, you can start moving around, although your new breasts will ache on occasion for a few weeks.
Weeks 1 and 2: Avoid sex, because arousal can cause your incisions to swell. For as long as six weeks, merely touching your breasts may cause pain.
Weeks 1 to 4: Avoid lifting or pushing anything heavy, including children.
1st several weeks: There may be a small amount of fluid draining from your surgical wound, or some crusting. Both are normal. But if you experience bleeding or severe pain, notify your doctor promptly.
After about 2 weeks: If it doesn't involve strenuous activity (stretching, lifting, bending, schlepping, etc.), you can return to your job and/or resume your normal social activities.
After about 3 weeks: When you stop wearing the surgical bra 24/7, start wearing a good athletic bra for support.
After 6 months or more: Your reconstructed breasts will finally settle into their new shape. But even then, their shape may change a bit in response to hormonal shifts, pregnancy, or if you gain or lose weight.
What about scars? Even though surgeons use techniques to minimize scarring, breast reduction scars are extensive and permanent. Often, they are red and lumpy for a number of months. Gradually, they're less visible. And sometimes they slowly fade to thin white lines. Whenever possible, the scars are in places where they're not visible even if you wear a low-cut top.
Is it worth all the discomfort in order to reduce oversized, embarrassing breasts? The vast majority of women who have had breast reduction would shout a resounding Yes! But if you're still undecided, go back to the beginning of this section and, once again, read the reasons why so many women choose this procedure. If any of those reasons apply to you, talk with the experts at Dr. Kapoor's office for more information.
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Breast Lift
Have your breasts lost their shape or firmness? Do they sag? Would you like to have the problem corrected? Or are you, for some reason, considering breast implants?
If you answered Yes to any of these questions, you should know about breast lifts. As the term implies, this procedure-also known as a mastopexy-is designed to raise and reshape sagging breasts.
Why do breasts often lose their shape and firmness and start to sag? Blame it on the force of gravity ("What goes up must, eventually, come down"), pregnancy, nursing, and aging. As we grow older, the skin loses its elasticity and sagging breasts are one result. Not all women encounter this problem, but it's very common.
Women with small breasts, or with breasts that have lost volume (e.g., after pregnancy and nursing), often combine a breast lift with an implant procedure, for larger, firmer, and perkier breasts.
Q. What can a breast lift accomplish?
A. It can counteract the sagging and loss of firmness, enhance your appearance, and increase your self-confidence. And it works best if your breasts are small and sagging, not extra-large and heavy.
If pregnancy and nursing have left your breasts with stretched skin and less volume, you may be a good candidate for a mastopexy. But hold off if it's possible you'll have more children, since pregnancy may stretch your breasts again and offset the results of a lift. However, this surgical procedure does not usually interfere with a woman's ability to breast-feed.
Q. What else should I know about a breast lift?
A. The best candidates are healthy, emotionally stable women who understand that a breast lift cannot perform a miracle-just better looking breasts.
It's not always a simple, risk-free operation. That's why, if you plan to have one, you should have it performed by a well-qualified cosmetic surgeon, such as Dr. Kapoor. As with any surgery, there are possible complications, including (but uncommon) infection or bleeding, which can result in wider scars. Yes, a lift will produce permanent and noticeable scars, but your bra or bathing suit will cover them. Also, the procedure can result in unevenly positioned nipples and/or a loss of feeling in your breasts or nipples that can be permanent. If you're a heavy smoker, you should know that it's can cause wound healing problems, and often results in wider scars.
Q. What's the first step to take if I'm considering a breast lift?
A. Schedule a consultation with Dr. Kapoor to discuss why you're considering a lift and whether your expectations are realistic. At that time, your breasts will be examined and measured, and you'll discuss all the variables that can have an impact on the results: your health condition, age, breast size and shape, skin condition, allergies, activities, where the nipples and areolas will be positioned (they'll be higher), etc. You'll also be told about the risks, limitations, scarring, where the operation will take place, and the type of anesthesia to be used. In regard to the cost, be aware that the procedure is usually not covered by insurance.
Dr. Kapoor may ask you to have a mammogram before surgery, and you will be given guidelines in regard to eating, drinking, smoking, medications and vitamins that may affect results. You should arrange to have someone drive you home after the procedure, which is done on an outpatient basis (no hospital stay, in most cases), and perhaps stay with you for a few days if need be.
Q. What happens during the procedure?
A. Usually, a breast lift is performed in an outpatient surgery center. You'll be under general anesthesia and asleep throughout the operation, which takes from two to three hours. However, if only a small incision is needed, you may be given a local anesthesia along with a sedative to induce drowsiness. In that case, you'll be awake, relaxed, and feel only a little discomfort.
Once you're sedated, your surgeon will begin the incisions, outlining where the breast skin is to be temporarily removed and where the nipples will be relocated. When these procedures are completed and the breasts lifted, the skin is brought down and reattached with stitches.
However, if your breasts are small, with minimal sagging, you may be eligible for a modified, less intrusive procedure. Such as the "doughnut" or concentric mastopexy, which involves circular incisions around the areola and the removal of a doughnut-shaped area of skin.
And if you're also having an implant procedure at the same time, each implant is inserted into a pocket directly beneath the chest wall muscle (pectoralis major).
Q. What can I expect after the procedure?
A. For a few days, you'll have to wear an elastic bandage or a surgical bra over gauze dressings. During that time, your breasts will look and feel bruised, swollen, and uncomfortable, with moderate pain that can be relieved with prescription medicine. To relieve very dry breast skin, apply a moisturizer several times a day, but keep it away from the sutures.
A few days after surgery, remove the bandage or surgical bra and switch to a soft support bra, which you'll wear for up to four weeks. After a week or two, depending on how your breasts are healing, the stitches will be removed.
For about six weeks after surgery, there will be some loss of feeling in the nipples and breast skin, due to the swelling. As the swelling goes down, the numbness usually fades, but for some patients there's numbness for as long as a year or more. On rare occasions, it's permanent.
Healing takes time, and is deterred by smoking. You may feel well enough to walk around your home after a day or two, but (if at all possible) don't return to work for at least a week or two. Avoid sex for a week or more. For three or four weeks, avoid strenuous sports and lifting anything (including children) higher than your head. After about a month, if you're feeling okay, you can slowly resume your normal activities. But if you have any unusual or severe symptoms, notify your surgeon. Should you become pregnant, a breast lift does not (in most cases) affect your breast-feeding ability, because it does not damage the milk ducts or nipples.
What about scars? During the procedure, your surgeon will do his utmost to make them as inconspicuous as possible. Initially they will be more visible and they may appear red and lumpy. With time, though, they'll usually become less visible and fade to a large degree.
Chances are, you'll appreciate your breast lift very much. However, due to the same reasons mentioned earlier-aging, gravity, pregnancy, weight fluctuations-your younger-looking breasts won't stay up and firm forever. (If you've also had implants at the same time, the results may last longer.) Meanwhile, enjoy the new you!
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Gynecomastia
Though rarely discussed, an estimated 40 to 60 percent of the adult male population is afflicted with "women-like breasts" to at least some degree. This condition may affect one or both breasts, and is most noticeable at a beach or pool or in a locker room. For those who are self-conscious about their condition, known as gynecomastia (the Greek word for women-like breasts), a plastic surgeon can perform breast-reduction surgery.
Similar in many ways to the procedure for women, gynecomastia removes fat and/or some glandular tissue from the breasts and, in extreme cases, excess skin as well. The result: a firmer, flatter, better-contoured and masculine-like chest.
Q. Who are good candidates for this procedure?
A. You are, if you're a man in good health but your breasts look more feminine than masculine. It helps to have firm, elastic skin that can be easily reshaped to a better-looking contour. However, if you're a heavy smoker or drinker, or you take steroids (which may cause gynecomastia), forget about it, unless and until you stop those habits. Men who are obese (and who often have feminine-looking breasts) are not good candidates for this procedure either. Nor are overweight-but not yet obese-men who first haven't tried to correct their breast problem via weight loss and exercise programs.
Q. What are the risks?
A. When the procedure is performed by a highly qualified cosmetic surgeon such as Dr. Kapoor, complications are rare and usually minor. However, as with any surgery, potential risks include infection, excessive bleeding, injury to the skin, adverse reaction to the anesthesia, excessive fluid loss, or fluid accumulation. In addition, the procedure may cause noticeable scars, permanent pigment change in the breast area, or slightly mismatched breasts or nipples (though the latter problem may be corrected by having a second operation to remove more tissue). Temporarily-up to a year or so-there may be a loss of sensation or numbness in the breast.
Q. What's the first step?
A. Arrange for a consultation at Dr. Kapoor's medical office. Bring along a copy of your medical records, so the doctor can look for any health conditions that may affect the surgery or its results. He will examine your breasts as well. Your records and/or the exam may reveal why your breasts became enlarged. It might be an impaired liver function or some other health problem. Or it may be due to your taking anabolic steroids or estrogen-containing medications. In extreme cases, a mammogram is taken, to help determine if there's any cancer, and to see how much fat and glandular tissue are present.
Q. What's the next step?
A. If it's determined that you're a good candidate for a surgical procedure to correct for gynecomastia, a date, time and place will be arranged. Depending on your insurance policy, the cost may, or may not, be covered. If it is, obtain a written pre-authorization from your insurer. If you're a smoker, stop smoking for one or two weeks before the surgery-and later, during the recovery period-because it decreases blood circulation and interferes with healing. Avoid alcohol, too.
Usually, Dr. Kapoor performs this type of surgery at an accredited surgery center or one of the several he's affiliated with in Los Angeles, California-on an outpatient basis. A typical procedure takes about two hours, but more time is needed for more complicated surgery. Depending on various factors, the anesthesia can be either local (along with mild sedation) or general.
Q. What takes place during the operation?
A. That depends on the suspected reason for the gynecomastia. If excess glandular tissue is the cause, it will be removed surgically. First, an incision is made in an inconspicuous location, either in the armpit area or on the edge of the areola (which surrounds the nipple). If a large amount of tissue and skin need to be removed, the resulting scars will be larger and more conspicuous.
Cutting through the incision, a patch of skin is lifted and your surgeon cuts away excess glandular tissue, fat, and skin from around the areola and also from the sides and bottom of the breast. To remove the excess fat, liposuction may be used; the fat is transformed into a liquid and then literally sucked out. Finally, the patch of skin is replaced and sutured in place. A surgical dressing is applied and the chest is wrapped to keep the skin firmly in place.
If your gynecomastia consists mostly of excess fatty tissue, ultrasound or power assisted liposuction will probably be used and there will be less scarring, because the incisions are smaller. A small (less than a half-inch long) incision is made around the areola of the breast or in the underarm area. Then a slim hollow tube called a cannula is inserted. Its other end is attached to a vacuum pump. As your surgeon moves the cannula through the layers beneath the skin's surface, the fat is broken up and suctioned out. You'll probably feel no pain-only a vibration or some friction. And the scarring is almost invisible.
Either way-traditional surgery or liposuction-a small drain may be inserted in each breast afterwards to drain off excess fluids. It will be removed in a day or two. After a brief stay in the recovery room, you'll be ready to leave. Have someone available to drive you home.
Q. What happens after the operation?
A. For a few days after the surgery, you'll feel some discomfort, of course, but any pain can be controlled with prescription medications. For a while-several weeks-you'll be bruised and swollen, wearing an elastic pressure garment for two weeks, and then for several weeks more but only at night. Most of the swelling will go down during the first few weeks, but it may be three or four months, or perhaps even longer, before your chest will look and feel normal. Your stitches should be removed one or two weeks after the surgery.
To aid recovery, do some walking around after you return home. When you feel up to it-which may be in just a few days after the surgery-you can return to work, if you can refrain from any strenuous activity for at least three weeks. Avoid sex for a week or two. Allow about a month before resuming your normal activities. Also, don't expose your scars to the sun for at least six months, or they'll turn dark. Using a strong sun block can help.
As numerous men-more than you might suspect-have happily discovered, having gynecomastia need not be a permanent problem. So if that is your problem, why not consult with Dr. Kapoor and his friendly staff about it. Especially if you're fed up with being embarrassed every time you take your shirt off in public.
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Tummy Tuck
Q. Who can benefit from abdominoplasty?
A. Both men and women who have excess skin and/or fat around their waistline can benefit. With men, this condition, regardless of its actual cause, is often called a "beer belly" and can be a turn-off as well as a health risk. Women, who have had children and as a result developed excess skin and loss of abdominal wall integrity, will benefit. The procedure is also used to reduce or eliminate unsightly stretch marks due to pregnancy, to correct umbilical hernias, and to strengthen the abdominal wall (to correct a condition caused by accident or illness). This helps them to look more attractive, especially when wearing slacks or swimwear that can't hide the bulges. Patients typically request a tummy tuck when diet and exercise programs fail, as is often the case.
Q. What causes excess fat or skin?
A. Over-eating in general, eating too many fat-producing foods, excessive liquor consumption, and lack of exercise are the obvious causes of weight (fat) gain, but are not the only ones. Many women who gain excess weight during pregnancy are unable to get rid of unsightly bulges afterwards; if they don't plan to have more children, they may look for this type of surgical correction. Also, persons who have successfully lost a lot of weight via exercise and/or diet, or by gastric-bypass surgery, may end up with excess skin, and the only way to remove it is with an abdominoplasty.
Q. What, exactly, is abdominoplasty?
A. As its name indicates, it's plastic surgery on the abdomen. Commonly (and appropriately) known as a tummy tuck, this procedure not only removes excess skin and/or fat from the abdomen, it also tightens the muscles of the abdominal wall, to better support its contents. In addition, we use state-of-the-art techniques of abdominal wall contouring, hidden incisions, and adjunctive liposuction (see the Q&A on liposuction) for the best possible results.
Q. Who should not undergo this procedure right now?
A. Are you planning to lose a significant amount of weight or have some other abdominal surgery? Are you a woman planning to have more children? If so, we suggest you may consider delay having a tummy tuck at this time. However, if you're a woman planning to have a hysterectomy or a tubal ligation, you may want to have a tummy tuck (performed by a qualified plastic surgeon) at the same time, since the incision is similar. Also, if you are significantly above your ideal body weight, you will not get optimal results from your tummy tuck. Have Dr. Kapoor evaluate your status during your appointment and he will be able to make appropriate recommendations and provide you with realistic goals and expectations.
Q. What are the risks?
A. Like all types of plastic surgery, a tummy tuck is surgery. Tens of thousands of tummy tucks are performed worldwide every year, and the vast majority of them are successful. Of course, the more highly qualified the surgeon is (please re-read the qualifications of Dr. Kapoor), the better.
We operate only in a safe, sterile environment and take extra care, at every step, to minimize risk. For example, all patients are fitted with anti embolic stockings and compressions devices to minimize risks of blood clots. We make the length of the incision as short as possible, depending on patient size, weight and body frame. We use state-of-the-art devices and methods to close the incision, although scar healing is genetically determined by the patient. If the scar is too noticeable, after-surgery options include laser treatments, injections or surgical revision. To minimize any risk of infection (which is rare), antibiotics are given before, during, and after the procedure.
If you're a smoker, it can adversely affect scar healing, so you should stop smoking at least six weeks before your surgery. In rare instances, blood clots may accumulate in one or both legs, but this risk can be reduced by walking around soon after surgery.
Q. What happens during surgery?
A. A tummy tuck usually takes about two hours. During the procedure, you'll be under general (not local) anesthesia. After marking exactly where the incision will be made-above the pubic bone to just below the hip area- an incision is made, a flap of skin is lifted, and excess skin is removed. The muscles are tightened, using numerous sutures (which later dissolve by themselves), and the belly button is brought out through a new opening in a new location. Finally, all the incisions are closed with more sutures.
Q. What happens after surgery?
A. You'll wake up in the recovery room, and find that you now have a small drainage tube near your surgical area. It's there to remove fluid your body produces in response to the surgery. This tube should be kept in place for about two weeks. In some cases, more fluid may collect later on and will need to be removed.
After a few hours in the recovery room, if there are no complications (there rarely are) you will be discharged and allowed to go home; have someone drive you. Or, if you prefer, you may want to spend a day or two in the hospital to recover further.
We will prescribe pain medications, muscle relaxants, and antibiotics for you to take during the two weeks following surgery. Also, for about one month after surgery, wearing a support garment will be very beneficial.
One week after surgery, external sutures will be removed in our office, and a week later, we'll remove the drainage tube. Complete recovery usually takes four to six weeks, but if you have a desk job you can probably return to it in about two weeks. Meanwhile, you should keep in touch with our office for at least three months, or as long as six months in some cases.
Q. When will I feel like my normal self again?
A. Allow about two months. It will take several months for your scar to heal and to lighten or fade away (although it will never disappear completely). Just remember to eat healthy, non-fattening foods and to exercise regularly from now on. One tummy tuck per lifetime is the norm. And don't smoke, especially while your scar is healing.
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Liposuction
Q. Who can benefit from liposuction?
A. Men and women of normal weight and in good health who have firm, elastic skin, but have stubborn pockets of excess fat in certain parts of their body: buttocks, abdomen, flanks ("love handles"), thighs, hips ("saddlebags"), upper arms, knees, breasts, chin ("double chins"), neck, cheeks, etc.
The patient's age is not usually a factor, but it may not be suitable for older men or women whose skin is not elastic. Nor is it recommended for young children, anyone with such problems as diabetes, serious heart or lung disease, or poor circulation, or those who have recently had other surgery near the problem area.
Q. What, exactly, is liposuction?
A. "Lipo," according to the dictionary, is "a combining form meaning 'fat'" and "suction," of course, is "the act, process, or condition of sucking." Just as its name indicates, liposuction is used to literally suck unwanted fat out of a designated area of the body.
Earlier forms of liposuction-also called lipoplasty or suction lipectomy- have evolved into today's refinements: ultrasound-assisted lipoplasty (UAL), power-assisted liposuction (PAL), the tumescent technique, and the super-wet technique, among others. During a confidential consultation with Dr. Kapoor, you will be advised as to which technique, if any, is best for you-depending on the location of the excess fat, the effectiveness of liposuction, its cost, its safety, and the likelihood of complications. If your excess fat is in your abdomen, you may be advised to have an abdominoplasty instead. Or perhaps a combination of traditional liposuction and UAL would be best.
Q. What takes place before surgery?
A. During your initial consultation in his Beverly Hills office, Dr. Kapoor will evaluate your health and skin condition, determine exactly where the unwanted fat deposits are, and-based on his years of training and experience in cosmetic surgery-select the body-contouring method that's most appropriate and explain to you how it works. This is the time to frankly discuss your expectations, and for Dr. Kapoor to describe the procedure in detail and point out its limitations and risks.
Once you agree on a date, time, and place for the operation (procedures are done at accredited surgery centers in the Beverly Hills area), you will be given instructions on how to prepare for it. Included are guidelines on eating and drinking, smoking, and whether or not you should take or avoid vitamins, iron tablets and certain medications in the days or weeks before surgery. Your procedure may have to be postponed should you develop a cold or infection, especially a skin infection. On the day of your surgery, you should have someone drive you home afterwards, and perhaps be available in your home for a day or two should there be complications.
Q. Where will the surgery take place?
A. As noted, liposuction can be performed at one of several accredited surgery centers in Beverly Hills. However, when major liposuction to remove a large volume of fat is performed we typically recommend an overnight stay in a local aftercare facility with a private nurse to make your recovery as comfortable and safe as possible. Of course, if liposuction is to be performed along with some other surgical procedure, it may take place in a hospital. Dr. Kapoor has operating privileges at several hospitals in Los Angeles, including Cedars Sinai Medical Center and Olympia Midway Hospital.
Q. What's the first step?
A. Minor liposuction, with only a small amount of fat to be removed from just one or a few body sites, a local anesthesia (numbing only the affected are) is usually administered. On request, there can also be intravenous sedation to help you relax. For a more extensive procedure, regional anesthesia (e.g., an epidural block) or general anesthesia is administered.
Q. What happens next?
A. After you're sedated, a tiny incision is made in the designated area of the body. Then a narrow tube, called a cannula, is inserted in order to vacuum out the layer of fat that lies deep beneath the skin. As the cannula is pushed and then pulled through this layer, it breaks up the fat cells and suctions them out, using a special vacuum pump and/or surgical syringe. As he proceeds with his work, Dr. Kapoor endeavors to keep the incision as small and as inconspicuous as possible.
Because vital fluid, as well as fat, is suctioned out, it's necessary to replace it during surgery, to prevent shock. Surgical nurses carefully monitor the procedure and intravenous fluids are administered during and after surgery. Depending on the amount of fat removed and the size of the area, this procedure usually takes from one to three hours.
Q. Are all liposuction procedures the same?
A. No. The procedure described above is the basic technique, but there may also be an enhancement or refinement. For example, with fluid injection, a medicated solution is injected into fatty areas before the cannula is inserted. This solution-a careful mixture of lidocaine (a local anesthetic), epinephrine (a drug used to contract blood vessels), and an intraveneous salt solution-facilitates the removal of fat cells. It also helps reduce blood loss, helps reduce bruising after surgery, and provides anesthesia both during and after surgery.
Another technique is tumescent liposuction, typically performed under a local anesthetic. During this type of procedure, large volumes of fluid (including an anesthetic) are injected into the fatty area. Usually, the volume of fluid injected is two or three times the volume of fat to be removed. It's called tumescent (swollen) because that's what the fatty tissues become when filled with the solution.
Similar to the above, but using smaller amounts of fluid (about the same amount as the amount of fat to be removed), is the super-wet technique. This one- or two-hour procedure often requires IV sedation or general anesthesia.
Ultrasound-assisted lipoplasty (UAL) requires a special cannula that delivers ultrasonic energy to the designated areas of fat. This energy literally (but safely) explodes the walls of the fat cells, transforming the fat into a liquid, which is then easily removed via the traditional suctioning. UAL takes longer than the basic technique, but it's especially effective in fibrous areas (e.g., the upper back or the enlarged male breast) and in secondary procedures requiring extra precision.
Q. What are the risks?
A. Every type of surgery involves risk, and liposuction is no exception. That's why the surgeon's training and experience are so important, and why patients can feel safe and confident when Dr. Kapoor is their plastic surgeon.
Still, it's important to keep in mind that, even with a highly skilled surgeon and staff operating with the utmost care in a state-of-the-art surgical facility, there can be no guarantees. On rare occasions, complications may occur. Among the potential hazards are infection, delays in healing, the formation of blood clots or fat clots (which may migrate to the lungs and prove fatal), excessive loss of fluid (leading to shock or fluid accumulation that requires draining), friction burns or other skin damage, unfavorable drug reactions (e.g., lidocaine toxicity), collection of fluid in the lungs (if too much is administered) perforation injury to the skin or nerves, heat damage from the UAL technique, numbness, or pigmentation change.
Even so, liposuction has been performed successfully far more often than not, and its popularity increases every year.
Q. What happens after surgery?
A. You will probably have some fluid damage from the incisions, and a small drainage tube may be inserted beneath the skin for a few days to prevent a build-up of fluid. Also, you may be fitted with a snug elastic garment to wear over the treated area for several weeks. This is to control swelling and help your skin adjust to its new, slimmer contours. The scars from liposuction are generally small and hidden from view. Sometimes, additional minor surgery may be recommended if the skin surface is irregular, asymmetric, or "baggy" (more common with older patients).
Healing will take time, so don't expect to feel marvelous right away. Medications will be prescribed to control pain, and you may experience burning, swelling, itching, bleeding and/or temporary numbness. Your stitches will be removed or will automatically dissolve within the first week or two, but avoid strenuous activity for at least a month as your body continues healing. Most of the bruising and swelling should disappear within three weeks, though some swelling may linger for six months or so.
Expect to see a significant improvement in your body contour in about four to six weeks, with the final contour visible after about three months.
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Injectable Fillers
You can't see them, but the tissues under your facial skin are working hard for you, continuously, whether you're awake or asleep. Together with your facial muscles and nerves, they're involved every time you smile, talk, eat, squint or laugh. But over the years, like other parts of your body, they're adversely affected by the pull of gravity, by exposure to the sun, natural aging, and by other factors.
These underlying tissues-these marvelous tissues that keep your skin looking young and alive and plumped up (in a nice way)-start to break down as you grow older. Laugh lines and smile lines become permanent, rather than temporary. Crow's feet and facial creases start to set up permanent residence in the areas of your skin where facial muscles do their work. Your cheeks start to sink in. And almost before you realize it, you're looking older.
But help is available. Through the use of soft-base fillers-such as injectable collagen or fat-your cosmetic surgeon can fill in these unsightly lines, creases, and "sinkholes" to help you look younger, with a smoother skin. When injected by an expert, these fillers can add fullness to the lips and cheeks, and reduce or erase those unsightly lines and creases. They can be used alone, together with a facelift, or in conjunction with a laser treatment that resurfaces the skin.
Q. What options are offered?
A. If you'd like to improve the texture and general appearance of your facial skin, or fill out sunken cheeks, deep wrinkles, furrows and creases, consider injected collagen or fat. They can also add more fullness to the lips, and help make some types of scars less visible.
Collagen, a protein derived from purified cow skin, is sold under the trade names Zyderm® and Zyplast® and is produced by the Collagen Corp. in various thicknesses. Primarily, it's used to fill in wrinkles, lines and scars on the face or, less often, those on the neck, back and chest.
The fat-injection procedure is also known as autologous fat transplantation, or as microlipoinjection. Fat cells are extracted from the patient's own body-often from the abdomen, thighs or buttocks-and injected into the facial skin. It's commonly used to fill in sunken cheeks and laugh lines, correct skin depressions, minimize wrinkles, and enhance the lips.
Besides collagen and fat, other commonly used injectables include:
Fibril®-a gelatin powder compound mixed with a tiny amount of the patient's blood and injected to plump up the skin.
Gortex®-a thread-like material, implanted under the skin to help support soft tissues.
Restylane®, Hylaform® and Captique®-fillers similar to a collagen, but lasting longer (up to nine months), depending on the injection site. They're made from "hyaluronic acid," a normal component of all living organisms.
RadiesseT-formerly called Radiance-made from the same calcium compound found in bone. It can last up to two years or, with a touch-up, even five years
Botox®-the brand name of a cosmetic form of botulinum toxin. It temporarily reduces or eliminates forehead creases, frown lines, and crow's feet by blocking the nerve impulses and temporarily paralyzing the facial muscles that cause wrinkles. It can give the skin a smoother and more relaxed appearance.
Injectables can create dramatic, eye-pleasing changes. But the results are only temporary, lasting a few weeks or months (the injected substance is metabolized by the body, at various speeds), unless the injections are repeated. How long each injection remains effective depends, in large part, on the patient's age, genetic makeup, skin quality and lifestyle, the quantity injected, and the size of the area affected. Some patients' bodies are more receptive to certain injectables than others.
Q. What are the risks?
A. Complications are infrequent and usually minor when a qualified plastic surgeon is handling the procedure. With collagen, an allergic reaction is possible for some patients. That's why an allergy skin test should be performed a month or so before the procedure appointment. If, during the next three or four weeks, there are signs of redness, swelling or itching at the test site, this should be reported to the surgeon and collagen may be ruled out. When fat is chosen as the injectable, there is hardly ever an allergic reaction because the fat is from the patient's own body. Other potential risks include infection and failure to heal (a possibility with heavy smokers).
Q. Where is the procedure performed?
A. Usually in the surgeon's own medical facility. However, if you are having a cosmetic surgery procedure, your injections may be given at the same time.
After the injection site-and extraction site, when fat cells are used-is cleaned, a local anesthesia is used. (None is needed with collagen, because it comes already mixed with lidocaine, an anesthetic, but a numbing spray can be applied upon request.) The material is injected, using a needle. Depending on the injectable used, overfilling may be necessary, resulting in a swollen appearance, which is temporary. If you also received anesthesia or a sedative, have someone drive you home.
If a large area was treated, you may want to cut back on your activities for a time. Expect some swelling, bruising and redness, which may last for a brief time or for up to several weeks in some cases. (Ask your doctor what to expect.) For about 48 hours after the injection, avoid the sun, while the redness and bruising fade away.
As many celebrities and "common folk" can attest, you should be very satisfied with how your face looks as a result of this cosmetic treatment. But, as they say, "Don't try this at home!"
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