Plastic Surgery of the Eyelids (Blepharoplasty or Simply Bleph)

Plastic surgery of the eyelids is effective for making puffy, baggy, tired eyes look more youthful and (in many cases)...more awake. In particular, it can improve baggy lids by removing excess skin, and it can improve puffiness by removing excess fat. Eyelid surgery must be tailored to each individual, depending on their concerns and the condition of their eyelids. For example, some people need only to have their lower lids improved, others have their upper lids done, and some have both done. Some have only skin removed, some fat, and some both. Finally, be aware that eyelid surgery has its limitations and will NOT improve crow's feet, droopy eyebrows, scowl lines, and hoods that droop down from the outer corner of the eyelids.

Blepharoplasty Scars

Scars will fall along your lower lash line or in your upper eyelid crease and will become imperceptible within a few weeks. In some cases (where fat alone is removed from the lower lids), the incision can be made on the inside of your eyelid. Although this leaves no scar at all on your skin, it does tend to delay recovery by making your eye more swollen.

Blepharoplasty Recovery

Length of surgery: 1.5-2 hours

Location of operation: hospital

Anesthesia: often sedation/general anesthesia, but can be performed under local anesthesia

Length of stay: outpatient

Discomfort: mild pain

Swelling and bruising: improve within 3-14 days. You will be instructed to place ice compresses on your eyes for 1-3 days.

Stitches: will be removed in 7 days. Glasses may be worn immediately.

Eye make-up: may be worn in 10-14 days

Exercise: may be resumed at 6 weeks.

Breast Augmentation Surgery (Breast Enlargement with Breast Implants)

Breast augmentation is one of the most popular plastic surgery procedures in the United States. Through placement of breast implants, women have been able to achieve changes in their figure (breast enlargement / breast enhancement) that otherwise would have been impossible. Despite their overwhelming popularity, breast implants have limitations. Breast augmentation surgery will not improve nipple asymmetry, move your breasts closer together, lift droopy breasts, or remove stretch marks. If you have droopy breasts, you may need a breast lift (mastopexy). Breast implants are not free of problems, and any problem associated with breast implants requires more surgery and cost.

Options in Breast Implants

• Position (under or over the muscle): Advantages for placing the breast implant above the muscle include less discomfort post-operatively, less swelling, and less chance that the breast will appear to move when you are exercising your upper body. Advantages for placing the implants under the muscle include less interference with mammography and less rippling.
• Breast Implant surface (textured or smooth): Textured implants were developed because plastic surgeons thought that they would be less likely to cause capsular contractures. However, studies have not shown a consistent advantage of textured implants over smooth when it comes to capsular contractures.
• Shape (round or anatomic (teardrop)): Some surgeons found that teardrop implants may rotate, giving an unnatural appearance.
• Volume: Breast implants come in all sizes with the most common sizes ranging from 300-400 cc.
• Breast Implant projection (standard vs. high profile): A high profile implant, the volume is the same, but the diameter is narrower and the projection is greater.
• Saline Vs. Silicone Gel: Both saline and silicone filled breast implants are approved by the FDA for use in the United States.
• Site of Incision (This Pertains only to Saline Implants, as Silicone Implants are placed via an Incision Under the Breast): The options for the incision are under your breast or around your nipple.

Anesthesia and Surgery Details

• Anesthesia: General Anesthesia
• Location of procedure: Hospital
• Length of surgery: 1.5 hours
• Discomfort: Pain is variable, pain medicine will be given for the first week following surgery. The first 48 hours tend to be the worst.
• Swelling and bruising: Swelling will be present for 2-3 weeks, and visible bruising is usually minimal.
• Stitches: Removed at 1 week
• Restrictions: No driving for one week, no lifting over 10 pounds for 4 weeks, and no exercise for 6 weeks.
• Results: Final results are seen at 3 months.

Breast Lift for Sagging Breasts (Mastopexy)

Some women would prefer to have breast implants rather than a breast lift to fix their saggy breasts. However, this does not work. Simply put, if your breasts are droopy, and your nipples are below the breasts natural crease, and you want them lifted, then you need to have a breast lift.

Incisions and Scars in Breast Lift

Scars are the greatest drawback of a breast lift. They will be around the nipple, and may also extend from the nipple down to the crease, and along the breast crease. The extent of scars is often related to the degree of droop: the greater the droop, the more extensive the scars. Any woman considering a breast lift must realize that she is exchanging one cosmetic breast problem (saggy breasts) for another cosmetic breast problem (scars).

Breast Lift: During and After Surgery

• Anesthesia: General
• Location of operation: Hospital
• Length of surgery: Approximately 3-4 hours
• Length of stay: Outpatient (home same day)
• Discomfort: Mild to moderate. Anticipate 2-7 days of prescription pain medication.
• Swelling and Bruising: Improve in 3-10 days
• Stitches: Are usually dissolvable
• Support: You will wear a sports bra for 3 months
• Back to work: 7-10 days
• Exercise: May be resumed in 6 weeks
• Final result: 3-6 months

Tips and Traps of Breast Lift

• Realize that this operation involves the exchange of one cosmetic problem (droop) for another (scars). If you are unwilling to accept scars, you should not have this operation, as no surgeon can predict how the scars will heal on you.
• As a general rule, the more extensive your droop, the more extensive will be your scars.
• Wait until you are done having children before considering a breast lift & enhancement.
• Quit smoking for at least 4 weeks before surgery and 4 weeks after surgery to reduce your risk of healing problems.
• Breast lifts set the clock back, but your breasts will continue to mature as you age.

Tummy Tuck (Abdominoplasty)

Plastic surgery of the abdomen can accomplish many things that you cannot accomplish on your own - no matter how much you diet and work out. Dieting and working out may tone your muscles and help you lose weight, but they will not tighten your loose skin, nor will they tighten your loose fascia. A tummy tuck can give you a flat stomach by tightening your fascia. It also removes loose skin of your lower abdomen and tightens the skin of your upper abdomen. Abdominoplasty does have limitations. It will not remove stretch marks of your mid or upper abdomen, but it will shift them lower on your abdomen. If you have a thick layer of fat in your upper abdomen, an abdominoplasty will not reduce its thickness.

Abdominoplasty Scars

Will extend across the lowest part of your abdomen, just above your bikini line. You will have another scar around your belly button. These scars are commonly hidden by swimming suit. Many heal discretely, but others remain quite visible. Regardless, you are more likely to look (and feel) better with a flatter abdomen and scars than you are with a bulging belly.

The Inner Girdle

Everyone has an inner girdle. The inner girdle extends from your rib cage down to your pubic bone and from one side of your abdomen to the other. Most surgeons refer to this as fascia. The inner girdle stretches during pregnancy to accommodate the enlarging uterus. After pregnancy, your muscles may regain tone, but your inner girdle is not quite as resilient, nor as elastic. Often the inner girdle fails to regain its shape, even though your muscles may be toned. This is where a tummy tuck can really help. In a tummy tuck, your plastic surgeon will tighten your inner girdle to make it flatter.

Tummy Tuck /Abdominoplasty Recovery

• Location: Hospital
• Length of surgery: 3-4 hours.
• Anesthesia: General
• Discomfort: is moderate to severe. Anticipate 3-8 days of prescription pain medication.
• Abdominal numbness: is expected and will last for 6 months or longer, some areas will be numb permanently.
• Stitches: are all dissolvable.
• Drains: will be placed at the time of surgery, and will be removed 7-10 days after surgery, but could remain for up to 3 weeks.
• Driving: may be resumed in 1 week, provided you have stopped taking prescription pain medication.
• Exercise: may be resumed in 6 weeks.
• Final result: will be evident after your scar has matured, approximately one year.

Tummy Tuck Tips and Traps

• If you seek tummy tuck, wait until you have finished childbearing. Otherwise, the benefits gained through abdominoplasty may be lost with another pregnancy.
• If you have an abdominoplasty, your abdominal tissue will not be available for future breast reconstruction.
• If you smoke, have poorly controlled diabetes, or are overweight, you will be at significantly increased risk for complications and probably should not have an abdominoplasty.

Brachioplasty (Arm Lift)

An arm lift is a surgical procedure that reshapes the under portion of the upper arm, from the axilla to the elbow. This procedure reduces the excess sagging skin, tightens, and smooths the underlying supportive tissue. This sagging skin can be a result of fluctuation in weight, aging, and heredity. An arm lift cannot correct weakened muscles. Brachioplasty surgery leaves a scar placed on the inside of the upper arm, potentially extending from the axilla (armpit) to the elbow. The incision length depends on the amount of skin that needs to be removed; the more skin, the longer the scar.

• Anesthesia: General
• Location of procedure: Hospital
• Length of surgery: 3-4 hours
• Discomfort: Oral pain medication will be provided for the first week following surgery. Keeping your arms elevated will help reduce swelling.
• Swelling and bruising: Expect to be swollen for several days to weeks, with variable bruising.
• Stitches: All stitches are dissolvable.
• Exercise: No exercise for 6 weeks, and no lifting over 10 pounds for 4 weeks.
• Results: Final results are visible in 3-6 months, with the scar gradually fading over a year.

Dermabrasion

The Procedure

The Dermabrasion procedure involves a motor-driven burr used on the skin to remove superficial layers, similar to sanding. This allows healthier skin cells to surface, resulting in a smoother texture and tighter skin.

Acne Scars

Acne scars, similar to wrinkles, are visible because they are lower or deeper than surrounding skin. Light casts shadows into these scars, making them more visible. Dermabrasion can diminish their visibility by leveling the scars with the surrounding skin, reducing shadow effects.

Effectiveness of Dermabrasion

Dermabrasion can be effective in improving wrinkles and acne scars, but it is not a miracle cure. It will not eliminate wrinkles and acne scars entirely. Each treatment can improve acne scarring by 20-40%.

What to Expect

• Anesthesia: General or local
• Location of operation: Office for local anesthesia, hospital for general anesthesia
• Length of surgery: 15-60 minutes
• Length of stay: Outpatient (home the same day)
• Discomfort: Moderate. Anticipate 3-7 days of prescription pain medication
• Swelling: Will last for 7-14 days
• Dressings: You will be instructed to wash your face daily and reapply ointment until your skin has healed, usually 7-10 days. Afterwards, the skin may appear sunburned and will return to its natural color in 4-6 weeks
• Presentable in public: With makeup in 2-3 weeks
• Work: Capable of returning within 3 days, but appearance may be the limiting factor
• Exercise: May be resumed within a week
• Sun protection: SPF 15 or higher for 3-6 months
• Final result: Will be seen in 3 months

Brow Lift (Forehead Lift)

Brow lift (forehead lift) is a plastic surgery procedure designed to raise your eyebrows to a higher and more aesthetic position. It also softens horizontal forehead wrinkles and scowl lines between your eyebrows.

Scars from a Brow Lift

Scars may be located on the top of your head or in front of the hairline, depending on the technique used.

Brow Lift Options

A brow lift can be performed using various techniques, including coronal lift, endoscopic lift, and hairline lift.

• A coronal forehead lift: Involves an incision across the top of the head, from ear to ear, allowing for muscle alteration and scalp removal. It raises the hairline and may result in temporary numbness on the top of the head.
• Endoscopic forehead lift: Uses small incisions behind the hairline for muscle alteration and forehead lifting without scalp removal. This method might not be as long-lasting as coronal lifts and also raises the hairline without causing temporary numbness.
• Hairline forehead lifts: The incision is made across the top of the forehead at the hairline. This technique does not raise the hairline but leaves a visible scar.

During and After Your Brow Lift

• Anesthesia: General
• Location of operation: Hospital
• Length of surgery: 2-3 hours
• Length of stay: Outpatient
• Discomfort: Mild discomfort expected; prescription pain medication recommended for 4-7 days
• Swelling and bruising: Should improve within 10-14 days. Temporary black eyes are possible.
• Bandages: Removed within 1-3 days
• Stitches: Removed within 7-10 days; drain removed in a week
• Exercise: May be resumed in 6 weeks
• Final result: Visible in 3 months

Otoplasty

Plastic surgery of the ear is most commonly performed to correct the position of ears that protrude significantly from the sides of the head. These protrusions can make the ears appear larger than normal and can affect both sides or be unilateral.

Procedure Details

• Anesthesia: General
• Location: Hospital
• Duration: 2-3 hours
• Discomfort: Mild, treatable with prescription pain medications
• Swelling/Bruising: It may take several months for swelling to subside completely
• Stitches: Usually all dissolvable
• Exercise: No exercise for 6 weeks
• Results: Almost seen immediately, but it takes several months for the final result to be evident

Skin Cancer

Skin cancer is the leading reported form of cancer worldwide. The main types of skin cancer are: Basal Cell, Squamous Cell, and Melanoma. Diagnosis of skin cancer and its type requires microscopic evaluation of the tissue. There are many ways to remove skin cancer, depending on the size and location of the lesion. The simplest is direct excision of the lesion. There is also the "frozen section", in which the cancerous lesion is removed and microscopically examined prior to wound closure. Some physicians will use the "Mohs Technique". The Mohs and frozen section are essentially the same type of surgery. Once the cancerous lesion is removed you may have a simple closure or need reconstruction. Reconstruction can be done with a skin graft, local flap, or free flap. If deeper structures are involved, you may also require bone or cartilage grafts.

Procedure Details

• Anesthesia: Depending on the size and location of the skin cancer, this may be performed under local or general anesthesia.
• Location: Usually skin cancer surgery is done on an out-patient basis, in the hospital, some insurance allow the surgery to be done in our office surgical suite.
• Duration: Anywhere from 1/2 hour to several hours depending on size and location.
• Care of Incision: If a simple closure was done, you can shower the day after surgery, and get the incision wet. If a skin graft was used, the dressing must be kept dry until you return for your follow up appointment. You may also get a local flap wet, and use antibiotic ointment on the stitches.
• Stitches: Depending on the location of the skin cancer, stitches will be removed anywhere from 7 days to 3 weeks. In some circumstances, the wound cannot be closed after the cancer is removed. If this is the case, you would be instructed on wound care after your procedure.

Breast Reduction

Large breasts can cause a multitude of problems, including neck, back, and shoulder pain, headaches, shoulder-grooving (where the bra straps dig in), postural problems, interference with activities and exercise, rashes under the breasts, inability to find clothing that fits properly, and problems with self-image. As a result, women with large breasts are often in chronic pain, have little energy, may be overweight because they are unable to exercise, and have self-image problems, all of which interfere with quality of life.

Breast Reduction Surgery

Breast reduction is a surgical procedure that reduces the size of large breasts that are disproportionate to a woman's body and may be causing physical pain. The removal of breast tissue results in a smaller breast. During the operation, your nipples will be moved to a higher position on your breasts, usually without removing your nipples and reattaching them.

Procedure Details

• Anesthesia: General
• Location: Hospital
• Duration of Surgery: 3-4 hours
• Length of Stay: Outpatient
• Discomfort: Moderate. Anticipate 3-7 days of prescription pain medication
• Swelling and Bruising: Improves in 2-4 weeks
• Bandages: Will be removed in 1-7 days
• Stitches: Are usually dissolvable
• Support: You will wear a sports bra for 3 months
• Back to Work: 1-3 weeks
• Exercise: May be resumed in 6 weeks
• Final Result: 3 months to 1 year
• Restrictions: No driving for one week, no lifting over 10 pounds for 4 weeks, and no exercise for 6 weeks. You may shower the day after returning home from the hospital.

Breast reconstruction is achieved through several reconstructive plastic surgery techniques that attempt to restore a breast to near normal shape, appearance, and size following mastectomy. The techniques may include: Tissue expansion, implants, and flaps. Tissue expansion stretches the healthy skin to provide adequate coverage for a breast implant. A breast implant may be placed immediately at the time of mastectomy to create a breast mound. Flaps reposition a woman's own muscle, fat, and skin to create or cover the breast mound. Local flap and tattooing are the final stages of breast reconstruction for the nipple and areola. Reconstruction can rebuild a breast mound, but it will not have the same sensation and feel as the breast it replaces. When only one breast is affected, it alone may be reconstructed. In addition, a breast lift, breast reduction or breast augmentation may be recommended for the opposite breast to improve symmetry bilaterally.

• Anesthesia: General
• Location: Hospital
• Length: 1.5-8 hours
• Discomfort: Moderate, may need pain control through expansion
• Compression: Sports bra
• Stitches: Usually removed at 7-10 days but may be in place longer
• Results: Complete year from the time of initial procedure.
• Restrictions: No driving for one week, no lifting over 10 pounds for 4 weeks, no exercise for 6 weeks, no shower until drains are removed (if you have drains), otherwise 48 hours after surgery.

Liposuction is Best Suited for those who…

Are near their ideal body weight and are seeking reduction of specific areas of diet-resistant fat, such as the hips (love handles), outer thighs (saddle bags), abdomen, neck, inner thighs, knees, or arms. Those whose weight has been stable for at least 6 months do better with liposuction than those whose weight has been changing. Skin tone is also important. If you have good skin tone, your skin will retract after lipo. If you have poor tone with loose saggy skin or stretch marks, then your skin will not tighten and may in some cases look worse.

Scars

Scars are multiple and small. They will be hidden in skin creases where possible. Some cannot be hidden and may be visible for several months.

• Anesthesia: General
• Length of surgery: 2-3 hours
• Compression Garment: You will be in the compression garment for 6 weeks.
• Discomfort: Mild to severe. Anticipate 2-7 days of prescription pain medication.
• Swelling: Peaks within a week and dissipates over 2-8 weeks, although it lasts longer in some.
• Bruising: Lasts up to 2 weeks
• Numbness and tingling: May occur in suctioned areas and may be due to damaged or irritated nerve endings. Sensation will return, and tingling will abate over 1-3 months.
• Stitches: Are dissolvable.
• Exercise: May be resumed in 6 weeks.

Tips and Traps

• Do not expect liposuction to improve your cellulite.
• Maintain stable weight before and after surgery for the best results.
• You cannot predict where you will gain weight following liposuction. You may regain weight in the area of liposuction, or you may develop fat deposits in other places.

Botox®

Botulinum Toxin

Botox® is a toxin produced by a bacteria called botulinum. Botox® is safe in the doses used for cosmetic and therapeutic purposes. It has been used safely for decades in the United States. In the mid 1990's, plastic surgeons began using Botox® injections to treat facial wrinkles.

Wrinkles that Botox® Will Target

Botox® will improve (and often eliminate) horizontal forehead creases, scowl lines between your eyebrows, and crow's feet. Botox injections may take 7-10 days to completely take effect. The results may last 3-6 months, and require additional injections to maintain the desired effect.

How Botox® Works

Dynamic wrinkles, such as crow's feet, frown lines, and forehead wrinkles, are due to repetitive facial expression. Weakening the muscles responsible for these facial expressions can dramatically improve these wrinkles. With Botox®, these muscles can be weakened without detracting from your facial expressiveness.

The Procedure

Botox® can be injected by your plastic surgeon in the office. You may experience brief mild discomfort as you are being injected. Following injection, recovery is immediate: you may place make-up and return to work immediately. A few experience mild bruising that improves within a few days.

Risks of Botox®

No negative long-term effects have been observed. Very few short-term problems have arisen. If Botox® is injected too close to your upper eyelids, temporary upper eyelid droop may result. This can take months to improve. Injection of your forehead will diminish your ability to raise your eyebrows. This is not a problem for most, but those with marked eyebrow droop may find that their droop worsens following injection. Risk of allergic reaction is extremely small. Women who are pregnant or who have nervous system diseases such as ALS should not receive injections of Botox®.

Male Breast Reduction

Gynecomastia, the condition of over-developed or enlarged breasts, is common in men of any age. It may be the result of hormonal changes, heredity, disease, or the use of certain medications. It can cause physical and emotional problems, and impair an adolescent or adult male's self confidence.

Treatment for gynecomastia can be achieved using liposuction, surgical removal of excess glandular breast tissue, fat and skin, or both liposuction and excision.

• Anesthesia: General
• Location: Hospital
• Length of Surgery: 2-4 hours
• Discomfort: Mild, can be controlled with prescription pain medications
• Swelling/Bruising: Will subside in several weeks. You will wear a compression vest for 6 weeks.
• Stitches: Usually dissolvable
• Exercise: Resume all exercise at 6 weeks. No lifting over 10 pounds for 4 weeks.
• Results: 3 months
• Compression: Compression garment for 6 weeks.

Massive Weight Loss

After a massive weight loss, either through diet and exercise, you may find that you still don't have the "look" you desire. Your skin may be loose, saggy, and you may have irregular body contours. Surgical body contouring may be right for you. Body contouring improves the shape and tone of the underlying tissue that supports fat and skin, and removes excess sagging fat and skin. Before you consider body contouring, it is important that your weight has stabilized, because this is usually the final stage in your weight loss experience.

Body Contouring Procedures after Massive Weight Loss include:

• Brachioplasty: To correct sagging skin of the upper arms, often called "Batwings"
• Medial/Lateral Thigh Lift: To correct sagging of the inner, outer and mid thighs - we do not do
• Lower Body Lift: To correct sagging of the abdomen, buttocks, groin and outer thighs - we do not do
• Panniculectomy: To correct the apron of excess skin hanging over the mons/groin
• Breast Lift: To correct sagging, flattened breast
• Facelift: To reduce sagging of the mid-face, jowls and neck - we do not do

It is important to know that body contouring requires incisions to remove the excess skin. These incisions can be quite significant depending on the amount of skin that needs to be reduced, and are permanent. Many times body contouring is done in stages, and it may take just as long to achieve your new look as it did for you to lose your weight.

Details:

• Location: Hospital
• Anesthesia: General
• Length: 1-8 hours depending on procedure
• Discomfort: Variable depending on procedure done
• Drains: Usually in for 1-2 weeks, depending on procedure
• Stitches: Mostly are dissolvable
• Exercise: Not for 6 weeks after each contouring procedure
• Back to work: 1-4 weeks, depending on procedure
• Results: Months to 1 year

SkinMedica Products

SkinMedica is unique in that it uses growth factors to stimulate skin rejuvenation. These growth factors are natural chemicals found in the body that stimulate and regulate tissue growth and repair.

SkinMedica calls their proprietary mixture of growth factors, Nouricel-MD, and it is the key component of their TNS line of products. Skin texture, elasticity, blotchiness, age spots, fine lines, and wrinkles are improved by the twice-daily use of these products.

This system also offers three in-office skin peels, the Illuminize, Vitalize, and Rejuvenate Peels, to further enhance your skin's appearance.

For more information, visit SkinMedica Products.