Saturday, August 5, 2006

The Body: Tattoo Removal

Tattoo removal presents a difficult scenario to the treating physician. Tattoos may be accidental, caused by dirt or foreign material being driven into a wound, or they may be purposely applied in either an amateur or professional setting by using a varied number of inks and techniques. Successful removal of the latter type of tattoo is dependent upon its cause, size, method of placement, and type of pigment.

Very small tattoos that seldom "show" are often best treated by simple excision and closure. A scar will result, but the scar is often less objectionable than the tattoo itself.

Historically, physicians have treated larger, multicolored, purposely applied tattoos in two ways:

  • Dermabrasion--sanding the skin down below the level of the tattoo ink
  • Carbon dioxide laser vaporization of the entire tattooed area

In most patients, these treatments result in objectionable scars.
Today, Mayo physicians remove tattoos with a type of laser known as a Q-switched YAG laser. This laser fires a very intense beam of light, either invisible or green-colored, into the tattoo in a very rapid burst. This heats the pigment within the tattoo and triggers its eruption from the skin. The laser color is chosen dependent upon the color of the ink--certain colors, like fluorescent yellow, are extremely difficult to remove.

The procedure time varies from 15 to 45 minutes, depending on the tattoo size and the area treated. Topical anesthesia is occasionally used depending on tattoo location, size and the patient's tolerance for the brief burning discomfort associated with each laser burst. Oral or intramuscular sedation can be used at the patient's request.

Following treatment, the wound may ooze small amounts of blood for several hours. The wound must be covered with a dressing for 24 hours and maintained in a moist environment for seven to 10 days.

The risks of scarring with this treatment are quite low. However, complete eradication of the tattoo is quite rare. Although multiple treatments are usually required to obtain successive lightening of the tattoo, final results are dependent upon the depth of the tattoo pigment within the skin. On rare occasions, certain uncommon tattoo inks react with the laser to form a darker-colored chemical which is untreatable.

While some small amounts of pigment may remain, the average patient is quite happy with the improvement obtained. Although multiple treatments are required, the risk of the procedure is quite low.

The Body: Sclerotherapy/Laser Photothermolysis or Spider Vein Treatment

Small, dilated, superficial veins may appear on the body representing tiny blood vessels in the skin that have enlarged to the point that they have become visible. Their treatment is usually best classified by their location --whether on the face or on the extremities, especially the legs.

Dilated veins on the face, which may be called telangiectasias or spider angiomas, are best treated with yellow-light laser therapy. This therapy is very rapid and safe with minimal discomfort, consisting of a brief burning pain when the laser is fired and slight itching afterwards.

The treated areas usually become quite dark and bruised for a period of seven to 10 days following the procedure. During this time, the small blood vessels, which have been clotted by the heat from the laser, begin to slowly disappear over the ensuing months. Risk of scarring is low. However, complete resolution of the problem may require two to three treatments.

The preferable treatment for dilated veins, or spider veins, of the leg is sclerotherapy or vein injection. These small dilated superficial veins on the legs are a common problem, particularly in women after pregnancy and in people with varicose veins. While large varicose veins are most often treated surgically, small superficial veins are best treated with sclerotherapy, which involves injecting a solution into the vein to cause inflammation and subsequent disappearance of the vein.

Sclerotherapy is performed as an outpatient procedure and requires 15 to 30 minutes depending on the number of areas being treated. No sedation or anesthesia is required. The patient experiences a temporary cramping sensation during injection as the solution enters the vessel. This sensation resolves within minutes. Injection sites are then covered with gauze and tape, and the legs are may be wrapped with an elastic wrap. No wound care is required. The treated vessels gradually disappear over the following month.

Sclerotherapy is a safe procedure with few significant risks. The most common complication is the development of brownish pigment in the treated area, which usually disappears within two to six months. Rare patients may develop matte-like telangiectasias, which are small sunburst-like blood vessels at the injection site. Patients may occasionally develop a small scab at the injection site if any of the solution escapes from the blood vessels. This is treated with an antibiotic ointment until the scab clears. There is little risk of infection or bleeding from sclerotherapy.

Sclerotherapy may be performed in conjunction with patients having treatment for large varicose veins, but is preferably performed after treatment of large veins.

The Body: Abdominoplasty or Abdominal reduction

Over time --as a result of pregnancy or weight loss --women often develop excess abdominal skin, fat, and stretched abdominal muscles. Abdominoplasty corrects these problems through surgical removal of lax skin and excess fatty tissue. If the patient's only complaint is excess fat in the abdomen, the problem can sometimes be corrected by liposuction alone.

Abdominoplasty is usually performed under general anesthesia and takes two to three hours to perform. The patient usually must spend one to several nights in the hospital. Following discharge, doctors prescribe oral pain medication to control typically mild to moderate pain. The patient also is given an abdominal binder to provide support while healing. Following surgery, patients should restrict their activities for two to three weeks, and all exertional activities are strictly interrupted for a full four weeks. The stitches generally are removed in one to two weeks following surgery.

Abdominoplasty is performed through a transverse incision across the lower abdomen. An incision is made around the umbilicus (belly button), leaving it attached to the abdominal wall. The skin and fat are then elevated from the abdominal wall and muscles to the level of the rib cage. Sometimes, surgeons may remove some fat from the flanks with supplemental liposuction. If needed, the abdominal muscles are tightened by suturing them together in the midline and shortening them. Surgeons remove excess skin and fat at the upper line of the incision. The umbilicus is then brought out through a small incision and sutured to the new skin in its normal position. Some stretch marks and old scars will be removed in the course of the surgery, but all may not be removed.

In some cases, drains are left beneath the skin for several days following surgery. There may be swelling and collection of fluid following surgery that is occasionally treated by needle drainage in the office. It may be months before all the swelling has completely subsided. Generally, patients experience reduced sensation in the abdominal area and, in some cases, the upper thighs. This will subside in the months following the procedure.

The scars around the umbilicus and the lower part of the abdomen will gradually fade and become less visible. However, these scars tend to be wide because of tension and are variable in final size among individuals.

While most patients with extra abdominal tissue are candidates for abdominoplasty, not all are. Obese patients often are not candidates or require modifications in the procedure as recommended by the surgeon.

Potential complications of abdominoplasty include bleeding, infection and healing problems, which can lead to heavy scars. Some lack of symmetry also may occur. Because the skin is undermined, there is a slight risk of inadequate circulation and loss of some skin. This risk is greater in smokers and in patients with specific kinds of old scars. Patients should quit smoking for 14 days prior to and following surgery, and stop taking aspirin 14 days before surgery.

Following surgery, the patient will enjoy a more attractive figure with a firmer, flatter abdomen.

The Body: Suction Lipectomy/Liposuction or Body Fat Removal

Removal of body fat by suction (liposuction) has been done in the United States since 1982. Today, it is proven to be a safe and effective surgical alternative that can result in a better body contour with minimal scarring. The procedure offers the best result when it is used to remove localized areas of unwanted fat after a person has reached a desirable weight through diet and exercise.

Liposuction normally is performed under general anesthesia, but also can be performed using local anesthetics and sedation in selected circumstances. In either case, however, liposuction is often performed as an outpatient procedure. When a patient wants to have large amounts of fat removed, it is safer to keep the patient in the hospital. In these cases, the physician may recommend that the patient donate several units of his or her own blood that can be used during the surgery. The length of the procedure varies depending on how much fat is removed.

The areas of the body that respond well to liposuction include the abdomen, flanks, hips, buttocks, thighs, knees and legs. Some of the areas, such as the abdomen, hips, buttocks and thighs, yield particularly rewarding results in selected patients.

During liposuction, a small incision is made near the area where the fat will be removed. A thin, blunt-tipped, hollow rod is inserted under the skin and carefully manipulated through the fat tissue. The hollow rod is attached to a vacuum source which suctions out unwanted fat cells. When the fat is removed, the surgeon closes the incisions and applies a dressing. Following surgery, patients wear special conforming garments under their clothes and over the area of fat removal. This minimizes swelling and discoloration, and helps the healing process. However, there will be some swelling and discoloration. The discoloration subsides in several weeks, but the swelling may take several months to subside.

Following surgery, moderate discomfort is well controlled with oral pain medicine. Patients must drink extra fluids postoperatively. Gatorade is a good fluid to drink because it contains electrolytes. After about one week, patients can return to near normal activity, but they should wait several weeks before resuming strenuous exercise.

Complications following liposuction can occur, but are relatively uncommon. Although liposuction has become one of the most commonly performed cosmetic operations in this country, there have been a few deaths that have resulted from infection or blood clots in the lungs. Minor complications include serum- or blood-filled pockets underneath the skin. In most cases, these minor problems will resolve with time. Occasionally, antibiotics are required for minor infections.

The most common problem following liposuction is waviness of sagging skin which results from irregular fat removal or inadequate skin shrinkage over the newly contoured areas. In some cases, there may be depressions from too much fat removal. Sometimes a minor secondary procedure is necessary to achieve optimal results. Cellulite (dimpling) and other surface irregularities that were present before surgery will still be present following the procedure.

Overall, liposuction is a safe and effective procedure for removal of unwanted body fat. The best results can be achieved on younger people who have good skin tone and very focal deposits of extra fatty tissue. However, many older people are quite pleased with their results if they have realistic expectations and recognize the limitations of the surgery.

The Body: Mastopexy or Breast Lift

Breast sagging (ptosis) is a common problem following pregnancies, weight loss or aging. Sagging occurs when breast skin stretches, and breast tissue and fat degenerate over time. This results in a less youthful appearance of the breasts.

Breast sagging can be corrected with a breast lift (mastopexy). If the breast sagging is minimal and the breasts are small, ptosis can be corrected with augmentation mammoplasty. This method causes fewer scars on the breast than mastopexy.

The mastopexy procedure may be performed under either local anesthesia with intravenous sedation or general anesthesia. The operation takes about two hours, and patients often return home the same day.

During mastopexy, surgeons reposition the nipple and areola to a higher position and remove excess skin from beneath the breast. Closing the remaining skin lifts the breast mound to a higher position and recontours the breast to give it a more projected and youthful appearance. If there is inadequate breast tissue to fill the skin and achieve the desired size, a saline-filled breast implant may be placed beneath the breast at the same time, achieving both the desired size, shape and projection. Patients may resume limited activities the day after surgery and normal activities in three to four weeks. Pain usually can be controlled with oral pain medication. Sutures are removed one to two weeks after surgery.

When there is marked sagging, the incisions required and resulting scars are similar to those resulting from a breast reduction (see breast reduction). In cases of less breast sagging, mastopexy can often be accomplished with smaller scars.

Potential complications of mastopexy include bleeding, infection and healing problems. Patients may experience some decrease in sensation in the nipple. In addition, some patients may notice minor irregularities in the size and shape of the breasts, and in the position of the areola and nipple. Occasionally, infection or healing problems can cause scars to widen and a portion of the nipple and areola to be lost. On rare occasions, scars may become thick and red and require revision.

Following mastopexy, patients may be able to breast-feed because the nipple usually is not separated from the milk glands. If an implant is used, however, problems with the implant can occur (see section on augmentation mammoplasty).

Following the surgery and healing period, the breast will have a more attractive and youthful appearance. With time, however, there may be further sagging that could necessitate a revisional procedure.

The Body: Reduction Mammoplasty or Breast Reduction

Women with large, heavy breasts may experience several health concerns related to their breasts: back pain, neck pain, grooves in the shoulders from bra straps, pain in the breasts, and rashes under the breasts. Women with arthritis of the spine and shoulders may have more symptoms than usual because of the added weight of heavy breasts. Some women are bothered by the psychological embarrassment of large breasts. In other situations, athletic, active women and women who are trying to lose weight are inhibited by the size of their breasts. Often, it is difficult and expensive to find clothes that fit.

Breast reduction can minimize or eliminate these problems. During the procedure, excess skin and breast tissue are removed and the breasts reshaped to be smaller and more attractive. The procedure is performed at the hospital under general anesthesia. When only a small amount of tissue is removed, the procedure can be performed under local anesthesia with intravenous sedation as an outpatient procedure.

During the procedure, the surgeon makes incisions so that scars form around the areola, vertically below the areola, and in the crease beneath the breast. Scars are an unavoidable drawback to the procedure, but typically quite acceptable to most patients. The incisions are designed so that the scars will not be visible while wearing normal clothing. Then the surgeon repositions the nipple and areola to a higher position on the breast, and removes excess breast tissue and skin. A drain may be left in place at the time of surgery and removed several days later. The patient can be up and about the day after surgery, and can go home in a few days. Sutures are removed within the first two weeks following surgery.

Potential complications of breast reduction include postoperative bleeding, infection and healing problems. These complications may result in more conspicuous scars. When the nipple and areola are transferred to their new position, it may not "take" or heal, and a portion or all of it may be lost. This is uncommon. Smoking immediately before and after surgery may contribute to this problem.

Although every attempt is made to obtain symmetry and a natural shape, there may be some irregularities in the final size and shape of the breasts or in the positioning of the areola and nipple. Because separating the nipple from the breast tissue during the procedure disturbs the superficial nerves of the nipple, patients may experience a decrease in sensation. Patients also may experience a permanent inability to breast-feed after having the surgery. Because these symptoms are normal side effects of breast reduction surgery, patients should consider these factors seriously before deciding to undergo the procedure.

Since reduction mammoplasty is often performed for the relief of physical symptoms, some insurance companies may pay for the surgery. However, insurance companies differ widely in their policy of payment for this procedure. Patients should check with their carriers about coverage before having the surgery.

Following surgery, most women report that their back and neck pain are reduced. Typical scars are a well-accepted trade-off for most patients. Patients also have fewer problems finding suitable clothes and are able to become more involved in sports.

The Body: Augmentation Mammoplasty or Breast Enlargement

Two different circumstances most frequently create an interest in surgical breast enlargement. The first involves congenital underdevelopment of or an imbalance in the amount of naturally existing breast tissue relative to the other body measurements such as hip circumference and height. In this instance, there may be problems with breast asymmetry or shape deformities. The second situation is caused by a natural loss of breast volume which follows a large weight loss or the child-bearing years. The breast often takes on a collapsed or deflated appearance and clothing no longer fits as nicely through the chest.

Surgical augmentation of the breast is accomplished by using an artificial implant that is placed beneath the breast tissues. The implant varies in size according to the wishes of the patient. The implant itself contains a jacket and a "filler" of a saline (salt-water) solution identical to that used intravenously in hospitals.

While the once popular silicone gel is no longer used as a filler, silicone in its more solid "rubberlike" form is still used to create the implant's jacket, which maintains the volume of the saline filler. In recent years, some patients have raised concerns about the potential for implanted silicone to cause diseases. To date, however, these claims have not been substantiated by carefully performed scientific studies that have examined the health of thousands of previously augmented patients. Saline implants wrapped in a silicone jacket are currently allowed for breast augmentation by the Food and Drug Administration (FDA). The number of breast augmentation procedures performed annually at the Mayo Clinic is once again increasing.

During the consultation for breast augmentation, the physician and patient use simulation to decide the amount of breast augmentation that best meets the patient's needs. During the actual surgery, the implant is placed under the existing breast tissue or under the chest muscle, depending on the patient's pre-existing breast shape and size. The procedure can be done with local anesthetic and sedation or under general anesthesia.

Scars are an unavoidable result of the incisions required to place breast implants, but they generally are small and can be placed inconspicuously. In some cases, the implants can be placed with the aid of a lighted rod called an endoscope, which permits even smaller incisions and scars. Incision placement is influenced by such factors as apparel preferences and implant placement. The surgery is generally performed on an outpatient basis.

Some discomfort arises from the stretching of the breast tissues, but it largely resolves within two to three days and is well-controlled with medications. Patients should not wear blouses or brassieres until the sutures are removed seven to 10 days postoperatively. Patients generally return to work within one week, but should avoid exertional activities over the three to four weeks required for bruising and swelling to resolve.

Postoperative complications include blood accumulation or infection adjacent to the implant. Both problems occur infrequently, but can necessitate a second operation or temporary removal of the implant. Because implants are a medical device, they can fail at any point after implantation. This is uncommon, but it would require implant replacement surgery because leaking would cause the involved breast to shrink to the preoperative size. Some patients develop a firm layer of scar tissue around their implants which can make the breast hard to the touch or painful. Called "capsular contracture," this can cause the breast contour to be asymmetrical and may require secondary procedures for improvement. Nipple sensation can be increased or decreased by the procedure. Although this is almost always temporary, it can be permanent. Most patients are able to breast-feed following augmentation.

Breast implants do cause some interference with the ability of mammography to detect early breast cancers. This is an important consideration that patients should discuss with a physician, particularly patients with a first-degree relative who has had breast cancer. All augmented patients need to inform their radiologists of their implants so the screening technique can be favorably modified.

Despite these limitations, approximately two million women are estimated to have undergone breast enlargement surgery. The overwhelming majority are satisfied with the results.

The Face: Scalp Reduction or Hair Transplantation

There are many reasons people lose their hair. Heredity is the most common cause of alopecia, the medical term for baldness. The trait can be inherited from either the mother's or father's side of the family. Women with this inherited tendency have thinning hair but usually do not become totally bald. Hair loss usually starts in the late teens, twenties or thirties.

Hair loss also can result from many medical conditions, including high fever, severe infection and thyroid disease. Women commonly lose hair after childbirth. Major surgery, certain medications and chemotherapy may cause hair loss.

There are proven medical treatments for hair loss. Results vary greatly because the response to treatment depends on the initial cause of the baldness. Frequent washing is effective at halting or decreasing baldness for some patients, while others require treatments which may include the use of systemic steroids or hormones, or the application of ointments, tar preparations and antibiotics directly to the scalp.

Hair transplantation

Surgery may correct some types of baldness. The most common surgical form of hair replacement is hair transplantation. During this procedure, surgeons transfer grafts of skin and hair from the back of the scalp, where hair growth is full, to bald areas.

Traditional hair transplantation moves round grafts of skin and hair about the size of a pencil eraser from the back and sides of the scalp. These grafts are then placed in the bald areas. Several transplant sessions are always required, and the procedures are usually done at six-week intervals. The number of procedures done depends on the amount of hair replacement desired.

Hair transplantation is performed on an outpatient basis. Hospitalization is not necessary. Patients are given intravenous sedative for relaxation. A local anesthetic is then injected into the scalp.

Micrografts and minigrafts are a new modification to hair transplantation. As few as one or two hairs are transplanted with each graft (several hundred or more per session). This technique provides a more natural hairline but requires a greater number of grafts.

During micrographic transplantation, strips of skin and hair are excised, and the donor site is sutured. These strips are cut into small grafts with varying numbers of hairs per graft. The smallest grafts are called micrografts and minigrafts. While more tedious and time consuming, the results from this procedure are the most cosmetically acceptable and avoid the appearance of having "doll's hair" or "corn rows."

Transplanted hair usually goes into a resting stage after hair transplantation. The short hairs that were transplanted will fall out within a few weeks. You will see no growth for up to three or four months. The second transplant procedure may be performed despite lack of hair growth. Six to eight months will pass before the quality of your new hair can be properly evaluated.

Scalp reduction

Some patients with extensive hair loss may not have enough hair to transplant satisfactorily. In those cases, scalp reduction is considered.
Scalp reduction is another surgical technique. It involves removing areas of bald scalp and stitching the scalp together to bring existing areas of hair growth closer together. Sometimes the skin of the scalp is too tight for this. In that case, tissue expansion is necessary.

Tissue expansion involves placing a silicone balloon under the scalp and then inflating the balloon gradually to expand the scalp. After the scalp has stretched, there is enough skin to work with for the scalp reduction technique.

Postoperative Care

The most common problem following scalp surgery is bleeding. Some bleeding is expected because the scalp contains many blood vessels. Bruising of the skin around your eyes frequently occurs, but it usually goes away within two weeks. Swelling is normal and may occur three to four days after surgery. This subsides within 10 days. Infection is not a common complication.

The Face: Restorative Dentistry and Orthodontics or Cosmetic Dentistry

Anterior and posterior teeth contribute to the aesthetic qualities of the face through their color, shape and position as well as their relationship to adjoining and opposing teeth. Although surgical and orthodontic management can improve the relationship of teeth and jaws to one another, teeth that are deficient or defective in appearance should be restored and absent teeth should be replaced.

Teeth may be defective in appearance because of malformations present at birth or systemic problems that affect the development and maturation of the permanent teeth. The permanent teeth are usually of more concern. Because the tooth buds for the permanent teeth develop during childhood, some or all of these teeth may be systematically susceptible to developmental abnormalities in the enamel or dentin. The degree of developmental deficiency can be quite variable.

Restoring permanent teeth usually includes replacement of the defective or deficient tooth structure with an artificial material. Porcelain, with or without the support of a metal substructure, is usually the material of choice in cosmetic restorations. The existing tooth structure must usually be prepared to receive such restorations so that the artificial material maintains a healthy relationship to the neighboring teeth and their supporting structures. In some situations, it may be sufficient to cover only one surface; in other situations, all tooth surfaces must be covered with the artificial material.

In addition to defective teeth, a patient may have one or many teeth missing. Missing teeth are most ideally replaced with a prosthesis that is not removable from the mouth. The options include a fixed partial denture in which replacement teeth are attached to a single tooth or to multiple teeth on either side of the space. Restorations also may be needed for the neighboring teeth that will serve to anchor the replacement teeth.

Another commonly used option for repair of missing teeth is placement of an osseointegrated titanium implant(s) to which a porcelain crown(s) is subsequently attached. The implant is positioned in the patient's mouth for three to six months before the replacement tooth is attached to it in order to integrate the implant with the patient's own jawbone.

Dental and facial structures may appear deficient due to congenital, developmental or acquired factors. Although deficient bone may be augmented with natural or synthetic bone grafts, the final oral and facial contours are often difficult to predict. Removable prostheses may be needed to replace deficient structures in conjunction with or instead of grafting procedures. When used, removable prostheses can provide support to the lips and facial structures as well as replace missing teeth.


Some of the most important aspects of a person's facial appearance are the smile and the appearance of the teeth. It is natural for the teeth to gradually change position over time. These changes sometimes result in visible rotation, tipping and overlapping of the teeth. In such instances orthodontic treatment can restore the teeth to smooth alignment.
As long as the tissues surrounding the teeth are healthy, orthodontic treatment can be performed at any age. Depending on the severity of the problem, the length of treatment can be from a few months to two years and the mechanism used can vary from a removable device to a complete set of braces on all the teeth.

During active orthodontic treatment, regular visits are required to adjust the orthodontic mechanism so that smooth and efficient tooth movement can occur. The adjustments typically are performed on a monthly basis but can be varied as needed in a specific circumstance. Occasionally the situation may require removal of one or more teeth if the space available is insufficient.

Orthodontic treatment almost always accompanies orthognathic surgery (jaw repositioning) procedures and can be easily combined with prosthodontic procedures when a change in tooth alignment is required before tooth restoration and replacement procedures can be performed.

The Face: Cosmetic Orthognathic Surgery or Alterations of the Jaws

The jaws and teeth are important components of the facial profile and significantly affect facial balance and aesthetics. If the positioning of the upper jaw and the lower jaw is out of balance with one another or with other facial structures, the appearance of the teeth, lips, chin-neck, nose, cheeks and forehead is affected.

Vertical imbalance of the jaws may create cosmetic concerns such as having a "toothless smile" or a "gummy smile" when speaking, resting or smiling. Horizontal imbalance of the jaws may cause cosmetic concerns by creating a facial profile with an exaggerated convex "weak chin" or concave "strong chin." Malpositioning of the jaws also causes an "underbite" or "overbite" condition.

Prior to gum and jaw treatment at the Mayo Aesthetic Surgery Center, patients are evaluated by an orthodontist and an oral-maxillofacial surgeon. The goal of treatment is to shorten or lengthen the horizontal, vertical or transverse dimensions of the jaw so that the facial soft tissue, the teeth and the other facial structures are in proper functional and aesthetic balance. Other surgical and medical evaluations also may be required to assess associated cosmetic (skin, nose and neck) and functional (speech, airway, sleep) problems.

Patients will begin treatment with orthodontic management. Most patients will need to wear braces for six months to two years to properly straighten the teeth. After the first portion of orthodontic work is complete, jaw surgery is performed to produce normal tooth function and aesthetics.

Jaw surgery (osteotomy) is performed through mouth incisions with power bone instrumentation. The repositioned bone is held in position during healing with various small internal metal devices. These devices, except on rare occasions, are retained indefinitely.

Patients undergo general anesthesia and a one-to-three-day hospitalization following surgery. A liquid/soft diet is prescribed for four to six weeks, and lower jaw function is restricted during this period of bone healing. The patient, however, is able to talk and open the mouth.

Orthognathic surgical procedures are safe and predictable. Surgical complications are minor and uncommon. Patients should expect significant swelling and bruising during the first two weeks following surgery. When the lower jaw is repositioned, a period of lower-lip numbness or tingling is present and may last for weeks or months. On rare occasions, this altered lip feeling may persist indefinitely.

Orthodontic treatment will resume six to eight weeks after jaw surgery and frequently last six to 12 months (for a total surgery and orthodontic treatment time of 12 to 24 months). Following removal of the orthodontic braces, the patient can expect a stable cosmetic and functional improvement. Additional cosmetic procedures, such as rhinoplasty and face-lift, can be considered because the internal structures (jaws and teeth) are now positioned for potential maximum aesthetic enhancement of the remainder of the face.

Because of the complexity and length of the surgical and orthodontic treatment, patients must be highly motivated and well-informed about the importance of their participation in treatment.

The Face: Chin Augmentation or Chin Refinement

The chin is an important component of the overall facial profile. A large or small chin may create a proportional imbalance with other facial structures such as the neck, lips, nose and forehead. A chin that is too large in the horizontal, vertical or transverse dimension can be reduced, and the chin that is too small in the same dimensions can be augmented. These chin surgical procedures can be done alone or in concert with other cosmetic surgical procedures. Local anesthesia with intravenous sedation or general anesthesia is required.

A patient's chin may be reduced in size through a mouth incision made behind the lower lip. Surgeons then do bone reduction (genioplasty) with power bone instruments. Following surgery, patients must wear a chin dressing and eat soft foods for two to three weeks. Patients will experience a brief period of lower-lip swelling, discoloration, and a numbness or tingling sensation.

It is more common for patients to seek chin augmentation. This is accomplished by advancing the chinbone or placing an onlay of artificial implant material. The type and complexity of this procedure is dictated by the degree of chin deformity and the patient's treatment goals.

If the patient needs an artificial implant for a minor horizontal or transverse deficiency, surgeons create a pocket by making an incision in the mouth or chin skin. Then, an appropriately sized implant is placed. Following surgery, patients must wear a firm chin dressing and eat soft foods for two to three weeks. Patients will experience a brief period of lower-lip swelling, discoloration, and a numbness or tingling sensation.

Patients with major chin deficiency will require bone surgery (osteotomy) in which the bone of the chin is moved forward following various oblique bone incisions. Using power bone instruments, surgeons perform the procedure through a mouth incision made behind the lower lip. General anesthesia is frequently required. Patients must follow a soft diet for two to three weeks, and the lower-lip swelling, discoloration, and altered lip sensation may last longer than previously described.

The cosmetic chin procedures are safe and offer good results. Surgical complications are minor and uncommon. Wound infection is rare. However, if it occurs, a patient may have to have the artificial chin implant or internal metal devices removed. It is also possible to experience permanent altered sensation of the chin.

Aesthetic procedures of the chin may be combined with orthognathic surgical procedures in which the teeth and jaws are simultaneously repositioned to achieve facial balance. Additional cosmetic procedures such as face-lift or rhinoplasty also may be combined with the chin surgery.

The Face: Facial Implant Surgery or Facial Contour Refinement

The contours of the face are affected by the skin and underlying structures, including subcutaneous tissue, muscle, fat and bone. Occasionally, problems exist that cannot be addressed by altering the skin alone. For example, deficiencies in the cheekbones, jawbone, nasolabial creases and lips significantly affect a person's appearance. Many patients want to change these areas.

Most commonly, patients seek to augment one or more of the facial regions mentioned above to give a more youthful and defined appearance to the face. For augmentation procedures, we at Mayo use synthetic materials that have a track record of safety and efficacy. The nasolabial creases and lips usually are augmented with small, soft implants that are placed deeply in the skin and the underlying subcutaneous tissue.

Mayo surgeons typically perform the chin and cheekbone augmentation surgery through intraoral incisions. Occasionally, however, surgeons will do the surgery through a small incision under the chin. The material to augment these specific regions is then placed and fixed with internal sutures and, occasionally, external sutures.

The surgery for each of these regions takes from 30 minutes to 1 1/2 hours. Most are performed using local anesthesia with sedation or general anesthesia. Following surgery, the patient remains in the recovery room for a period of time and then may return home with a responsible adult. If the surgery is performed with other procedures, overnight observation may be required.

The main risk to patients with synthetic implants is postoperative infection. Meticulous surgical technique is used to help prevent this complication. When synthetic material is implanted, the patient is usually placed on antibiotics after surgery to prevent infection.

Intraoral sutures dissolve on their own five to 14 days after surgery. Any external sutures are removed after surgery. There may be some swelling and bruising in the augmented region. Discoloration takes about one to three weeks to resolve. The swelling may take a total of several months to entirely resolve. Rarely, the implants will shift during the healing phase and need slight repositioning.

Some studies have shown slight bone erosion under some implants placed on the cheekbones or chin. However, this has not been shown to be of significance to the patient over the long term. There have been no reports of any systemic disorders or medical abnormalities caused by using synthetic materials for facial contouring, although there may be associated numbness in the surgical region. This resolves over a period of months. Permanent numbness is an extremely rare complication of these procedures.

Less often, a patient seeks reduction of the cheekbones, jawbone, or lips. This is usually done by contouring the underlying bone or removing excessive skin and subcutaneous tissue. In reduction procedures, there is no associated placement of augmentation material.

The Face: Otoplasty or Ear Refinement

Ear surgery (otoplasty) is a procedure performed to reshape the ear and give it a more normal appearance. The surgery usually is done on ears that are too large or that protrude from the head. Many times, the problem is caused by an undeveloped middle fold of the ear. In addition to the lack of a fold, there may be other deformities. For this reason, it may be necessary to perform several procedures on the ear at the same time. In most cases, patients need surgery on both ears so that they will be similar. Rarely, only one ear may require surgery.

Otoplasty is done under general anesthesia in children, while adults may have the procedure under either general anesthesia, or local anesthesia with intravenous sedation. Otoplasty can be performed in the outpatient facility, and the patient can return home the day of surgery.

During the procedure, the surgeon makes an incision behind the ear and weakens the cartilage, which is folded into the proper position and held with sutures. Sometimes, the surgeon will remove cartilage and skin. Rarely, the surgeon will make the incision in the front of the ear. Upon healing, scarring barely shows. Following surgery, a head dressing is applied. After removal of the dressing, the patient must wear a headband at night for a few weeks to keep from pulling out the sutures during sleep. Swelling and discoloration will subside in a few weeks.

In most cases, the results of ear surgery are very pleasing. However, the ears may not be perfectly symmetrical since even normal ears are not exactly the same. In a small number of patients, the ear may return toward the old position and require a second operation. Rarely, one of the nondissolving sutures left in the ear will work its way to the surface and have to be removed.

Once the ears have healed, they are in a more normal position that complements the patient's overall appearance.

The Face: Rhinoplasty or Refinement of the Nose

Cosmetic nasal surgery (rhinoplasty) is performed to bring the nose into harmony with the face, thereby improving overall appearance. There is no standard procedure for rhinoplasty. It is important for the surgeon to take into account those nasal features the patient would like changed and then to carefully examine the nose and overlying skin. With this information, the surgeon and the patient can discuss the nasal features that can be realistically modified to obtain the desired result. Often there is an underlying deviation of the nasal septum (the cartilage and bony structure that support the nose and separate it internally into two sides), which causes difficulty in breathing. If this condition is present, it is corrected at the time of surgery.

The surgery is performed primarily through incisions inside the nose. If external incisions are necessary, the scars are small and inconspicuously placed. During the procedure, the surgeon separates the skin of the nose from the underlying bone and cartilage, reshapes the bone and cartilage, and allows the natural elasticity of the skin to reshape over the new framework.

The surgery can be done under local anesthesia with intravenous sedation or general anesthesia in the outpatient facility. The patient can return home or to a hotel the day of surgery, provided he or she is under the care of a responsible adult.

Commonly performed procedures include removing a hump on the bridge of the nose, narrowing the nose, refining the nasal tip, and correcting a deviated septum. Chin augmentation may be suggested to further enhance the facial profile in selected patients. (See facial contour section.)

At the conclusion of the procedure, a small splint is placed over the nose for support and to reduce swelling. The external splint is removed on the fifth to seventh postoperative day. Rarely packing is needed for one to two days.

Swelling and bruising around the nose and eyes is expected for three weeks. Although most of the swelling subsides in four to six weeks, there continues to be some swelling that may take six months or longer to subside. Swelling inside the nose can persist for several weeks and cause nasal stuffiness.

In rare cases, an infection can occur and delay the healing process or result in the development of scar tissue. Other problems that can temporarily occur during the postoperative healing phase include bleeding and a diminished sense of smell. It is important to remember that healing continues for some time following surgery as the skin shrinks and adjusts to the new framework.

Rarely, the final result may not be what the patient and surgeon anticipated. Minor irregularities usually can be corrected with a revision procedure. The quality of the skin overlying the nasal cartilage is an important factor in the final appearance of the nose. Thick and oily skin does not conform as well and may compromise the result. Older skin does not possess the elastic properties of younger skin and may preclude an optimal result.

Following rhinoplasty, the nose has an improved aesthetic appearance as it blends into the face. The improved appearance of the nose is long-lasting.

The Face: Submental Liposuction or Chin and Neck Fat Removal

People sometimes accumulate a focal deposit of fatty material in the area between the chin and neck that detracts from the profile contour. This often happens as a result of aging. However, the deformity can also be seen in younger faces as well, long before other signs of aging have begun. Under these circumstances, patients are bothered by the rounding influence and lack of definition along the jawline and neck.

In submental lipectomy, the surgeon removes this fat by suction techniques or by excision, and often tightens the underlying neck muscles. When sufficiently resilient, the skin then can recoil and have a more toned appearance. For some patients the procedure is a less extensive precursor to a formal face-lift perhaps done at a later time. Younger patients generally have good skin elasticity which permits a more focused approach to the problem without formal face-lifting.

Fat removal from under the chin can result in irregularities of the facial contour or "dimpling" that appears unnatural. Temporary numbness or weakness in the chin and mouth can result from the procedure, but permanent problems are very unusual. Submental lipectomy causes swelling and bruising that can extend into the front of the neck and requires two to three weeks to resolve.

The Face: Eyebrow and Forehead Rejuvenation

Progressive drooping of the eyebrows and wrinkling of the forehead are some of the earliest and most recognizable aspects of facial aging. Sagging eyebrows and forehead skin, when advanced, is recognized by contact between the hairs of the eyebrow and eyelash. This phenomenon often prompts patients to comment that their eyes seem to be "shrinking" and that make-up smears on the upper eyelid easily.

This redundancy of tissue also heaps up on the eyelid region itself, creating accordion-like wrinkles. Wrinkles develop in both a transverse and horizontal orientation and fail to disappear even when the eyebrows are at rest. The results of these changes can falsely create a visual image of exhaustion or anger in an individual's face.

The browlift procedure, also called the forehead lift, allows for elevation of the eyebrows and tightening of the forehead skin, giving the eye region a more refreshed and well-rested appearance. Wrinkles are reduced or eliminated by removing the underlying muscles which create them. Excess skin accounting for the laxity is redistributed or removed from the scalp above.

The browlift procedure usually is performed through an incision at or in the hairline, which permits camouflage of the healing scars. In cases where the skin has retained some elastic tone, the forehead and eyebrows can be repositioned using small incisions and a lighted rod called an endoscope. This approach has the additional advantage of minimizing scalp scars, lessening the backward movement of the hairline and decreasing numbness in the central upper scalp, which are common problems associated with traditional approaches. However, both techniques create some swelling and bruising that can last a few weeks before subsiding.

Although the browlift will redrape skin and reduce wrinkling in the upper eyelid and "crow's feet" region, eyelid surgery or a skin resurfacing technique also may be needed to treat these areas most effectively. Puffiness around the eyes, particularly in the lower eyelid region, is also not treated by a browlift procedure. However, if you are looking to optimally rejuvenate aging changes about the eyes, the browlift and eyelid surgery procedures are often mutually complementary and frequently performed simultaneously. In addition, because a face-lift primarily addresses aging changes visible along the jawline and in the neck, a browlift done in conjunction with a face-lift will help to more completely revitalize all regions of the face.

The Face: Skin Augmentation

Small depressions in the skin may be caused by wrinkles, scars from acne, surgery or viral pox. Many times, these small depressions can be corrected without surgery through skin augmentation. In skin augmentation, materials are injected into or under the skin to raise the skin's surface and make it look smooth.

Collagen injections

Collagen is an animal protein found in skin, bones and connective tissues. Purified bovine collagen has been used for skin defects since the early 1970s. Once injected, it stays in the facial skin usually between six and 12 months. After that time, it begins to sink deeper into the skin and is removed by the body, so the correction is reduced or lost. Because the benefit of injectable collagen is temporary, reinjections will be needed on a regular basis. Allergic sensitivity is usually assessed in individuals prior to injection. Allergic reactivity can lead to redness and swelling which can on rare occasion compromise the aesthetic result.

Fat transplantation

In fat transplantation, small amounts of the patient's own fat are injected into or under the skin to fill out defects. Using liposuction techniques, local anesthesia and small incisions, fat is removed from a site of excess on the patient's body. The fat is then placed in a syringe and injected at sites of surface depression or atrophy. Allergic reactions do not occur because the fat comes from the patient's own body. A drawback is that the full extent of correction seen on the day of surgery is never fully retained due to atrophy and absorption of the fat. A good correction sometime requires two or three sessions of fat injections.
Since correction is temporary, retreatment may be needed as soon as six months for wrinkles around the mouth or as late as 12 to 18 months for acne scarring on the cheek, temple or forehead. Patients can receive retreatment as often and as long as they wish. There is no known limit to the amount of collagen or fat that can be injected.

The Face: Blepharoplasty or Eyelid Rejuvenation

Surgery to reduce the amount of excess tissue around the eyes (blepharoplasty) may be performed in conjunction with a face-lift operation or, more frequently, as a separate procedure. When a patient wants both a face-lift and a blepharoplasty, the operations may be performed together or in stages, according to the patient's personal preferences or financial considerations.

In most cases the right and left eyelids are operated on at the same time. However, it is not uncommon to do only the upper eyelids or the lower eyelids, as the patient wishes.

To remove excess skin and other tissue from the upper eyelids, incisions are made in the eyelid fold and extended laterally toward the smile lines. Fatty tissue from the lower eyelids may be removed either through an incision in the skin (just below the eyelashes) or through an incision in the back surface of the eyelid (the transconjunctival approach). Some patients have droopy lids from a weak eyelid muscle (with or without excess eyelid skin and fat). If this problem, which is called blepharoptosis, is diagnosed, it often is amenable to surgical correction.

The operation takes from 30 minutes to two hours and usually is performed using local anesthesia. Intravenous sedation may be given if the patient wishes. General anesthesia often is used if blepharoplasty is performed at the same time as a face-lift.

Sutures typically are removed four to seven days after surgery. Although discoloration around the eyes usually resolves in one to three weeks, swelling (edema) may persist for several weeks. The skin scars heal as inconspicuous thin lines in nearly all patients within a few weeks to months.

Some patients may experience dryness of the eyes after surgery. This symptom may be caused by incomplete closure of the eyelids during the healing phase and usually resolves within a few weeks. In the interim, the eyes may be soothed by using artificial tear drops and ointments. Because people who have dry eyes before surgery have a greater chance of experiencing this problem postoperatively, we recommend an examination by an ophthalmologist before blepharoplasty is performed.

Rarely, there may be other problems after surgery such as persistent drooping or retraction of the eyelids or darkening of the lids because of permanent retention of blood pigments in the skin. These undesirable side effects frequently can be treated satisfactorily.

Complete loss of vision in an eye is an extremely rare complication of blepharoplasty. Temporary visual blurriness occasionally may occur after surgery because of alterations of the tears, but the problem typically is short-lived.

Most patients indicate that their eyes look and feel more rested and youthful after blepharoplasty. In general, it is a relatively safe and straightforward operation.

The Face: Rhytidectomy: Face-lift, Neck-lift

The face-lift procedure is performed to tighten the skin of the face and neck and give the patient a more youthful and rested appearance. Face- and neck-lifting is pursued both by relatively young patients to preserve a more youthful appearance and by older individuals to attain a younger and more rested look. Correspondingly, the results of a face-lift can range from subtle to dramatic according to the extent of aging changes present in the individual.

As we age, our skin begins to wrinkle and lose elasticity. One of the first signs is "cheek creases" that appear without smiling. Further aging deepens the cheek creases and often creates "jowls" along the lower jawline. In advanced facial aging, skin and fat dangle from under the chin forming a "turkey gobbler" with vertically oriented bands and transversely running wrinkles.

Because it is unusual to find aging changes isolated in the face without accompanying changes in the neck, the neck and face are usually treated simultaneously. The face- and neck-lift, which is medically termed a rhytidectomy, is performed through incisions that are made in existing skin creases and hair-bearing regions surrounding the ear. Minimal or no hair is trimmed from the scalp along the incisions. Then, the surgeon retracts and advances the skin and its underlying tissues to affect a smoother and more defined contour to the neck and jawline.

If necessary, the surgeon will trim or suction focal deposits of fat along the jawline or under the chin. This occasionally requires an incision in the shaded area under the chin. Your surgeon tightens the tissue by moving both the skin and often the deeper subcutaneous tissues and muscles. The excess skin is excised and discarded as the incisions are closed with sutures and staples. The tightening is performed symmetrically on each side of the face.

Face- and neck-lifting surgery takes four to five hours and can be performed either with local or general anesthesia. Patients usually are hospitalized for one night postoperatively for observation and can wash their hair on the first postoperative day. Dressings are rarely worn beyond two days, but swelling and bruising may be considerable for two to three weeks. The surgeon will remove the sutures or staples in stages over the first five to ten postoperative days. Patients are generally encouraged to remain in Rochester over the early part of this interval. After the sutures are removed, patients are free to begin using cosmetics and usually return to their "routine" within two and three weeks.

Because the face-lift procedure restructures large areas of tissue, you should be aware of several risks: blood collecting under the skin and compromised blood flow or healing of the skin. These complications can lead to irregularities in the skin or scarring. Patients can minimize these risks by avoiding tobacco products and aspirin-like medications that "thin" the blood.

Because the skin is separated from the nerves and muscles which animate the face, you may experience numbness or weakness in moving the eyebrow or corner of the mouth postoperatively. Fortunately, this usually is resolved within two to three weeks, but it occasionally can take several months to subside.

Scars can require nearly a year to complete a cycle of fading and softening. Those in the scalp can occasionally be more visible due to thinning of the adjacent hair. You may be able to notice scars extending in front of the ear and around the earlobe if you look closely. However, all of these limitations can usually be minimized by using properly selected cosmetics, earrings and hairstyles. Rarely, poorly healed scars require additional measures to improve their appearance.

There are some limitations to a face-lift. First, a face- and neck-lift procedure alone will not affect aging changes in the eye or forehead region, which may require eyelid surgery or a forehead lift. Second, the redraping of the skin addresses skin laxity to a greater degree than wrinkling. Fine wrinkles, like those surrounding the lips and eyes, are due to alterations inherent to aging skin and usually must be addressed by a skin resurfacing procedure such and dermabrasion, chemical peeling or laser treatment. Depending on the area of the face in question, resurfacing can be performed in the same setting as face-lifting. The additional benefits of these skin resurfacing procedures to the skin quality and tone greatly enhances the rejuvenating effect of the face and neck lift procedure.

Finally, while the procedure renders a more youthful appearance, the extent of the enhancement will gradually diminish over time. The longevity of a face-lift is impossible to predict for a given patient since it is influenced by environmental factors like continued exposure to tobacco products and sun as well as factors genetically unique to the individual. It can be said that the face-lifted individual will never look as aged as if the operation had never been done. With sufficient continued aging, repeat face-lifting or "mini-lifting" operations may occasionally become necessary.

The Face: Laser Resurfacing or Wrinkle Treatment With Laser

Among the newest techniques to address aging changes within the skin is the use of the C02 laser. The laser has advantages over traditional resurfacing methods like chemical peels and dermabrasion including a quicker recovery period and reduced patient discomfort. "Laserbrasion" can be programmed to use specified amounts of energy and for that reason brings much more control and safety to resurfacing procedures designed to deal with changes within the skin such as complexion abnormalities and fine lines and wrinkles.

As we age, we acquire wrinkles around the eyes and lips and across the cheeks. These develop due to deterioration in the collagen and elastin fibers which connect the cells of our skin. These changes are accelerated by cigarette smoking, stress, and cumulative lifetime sun exposure. The laser is used to create a controlled burn of the most superficial layers of the skin in order to stimulate the formation of new fibers, which are more organized and plentiful in number. The result after healing is skin of better tone and a refreshed and more youthful configuration. Patients report a softer, silkier, and smoother appearance to their skin following laser treatment.

The technique can be used for regional treatment, for example around the eyes or around the mouth, or can be used to treat the entire facial region. The optimal number of sessions of treatment required depend on the severity of the problem. Laser treatment is not a substitute for formal surgical face-lifting which is done to redrape and reposition tissues that have become loose and sagging over time. There are, however, many patients who are candidates for laser resurfacing at an earlier age who have not yet become candidates for formal surgical face-lifting. Occasionally, surgery and a laser treatment are used in combination during the same sitting to simultaneously treat both loose skin and fine wrinkles.

Laser resurfacing may be done under local anesthesia with intravenous sedation as an outpatient procedure or under general anesthesia when combined with other cosmetic procedures or if the whole face is to be treated. Compared to alternate resurfacing methods, patients generally enjoy a shorter recovery. There is redness and swelling but minimal discomfort throughout the treated region.

Postoperative treatment includes cleansing and coverage with a moisturizer, bandage or some other wound care regimen, particularly during the first week. Within 2 weeks, the swelling has largely resolved and the redness has begun to fade to a color that can be easily controlled with cosmetics. Complete resolution of the redness may take several months. Patients are encouraged to aggressively apply sunscreen products since ultraviolet light exposure is counterproductive to achieving and maintaining a revitalized configuration for the skin. Occasionally, patients will develop irregular hyperpigmentation (brown spots) during their healing interval but this is typically self-limited and, if it does not resolve, spontaneously may be treated with a bleaching medication.

In order to determine whether the patient is a candidate for laser resurfacing in combination with or as an alternative to traditional surgical rejuvenation methods, a consultation with the physician is necessary. It is important to identify any previous viral infections that involve the facial skin or lips, sun sensitivity, the use of a medication called Accutane? within the past year, and any medical history that would suggest problems with healing.

The Face: Chemical Peel

Chemical peel is one of the most effective techniques available for alleviating fine wrinkles and giving the face a long-lasting youthful appearance. People with fine wrinkles, sun damage or color abnormalities of the skin are candidates for a chemical peel. A consultation at the Mayo Cosmetic Surgery Center can be arranged to determine the best type of peel to suit your individualized needs. The results of this procedure are often dramatic and usually long-lasting.

A chemical peel applies a controlled chemical burn to the top layers of your skin. Chemical peels are categorized into superficial, medium and deep peels depending upon the severity of the patient's wrinkles and the degree of sun damage present. The depth of the burn depends upon the concentration of acid that is used. The peel itself should take no more than 30 to 60 minutes and may be painful for the first few hours following the procedure. This pain is usually very well controlled with oral pain medicines.

After receiving a chemical peel, patients usually are sent home with supervision or to an outpatient nursing facility for a day or two. The skin will begin to peel 24 to 48 hours following the application of the acid. New skin will replace the peeled skin within seven to ten days. However, chemically peeled skin takes longer to look normal. A pink hue to the skin can be expected for six months, often necessitating blending with makeup.

The chemical peel procedure is usually done as a full face peel without ancillary procedures being performed about the face. If you would like a face-lift or eyelid surgery, these procedures must be performed three to six months before or after the chemical peel. An exception involves fine wrinkles around the mouth and chin which can be corrected at the same time as a face-lift.

Before you have a chemical peel, it is important for your surgeon to know if you have a history of cold sores. Medication may be administered to prevent them. Your surgeon may recommend two to six weeks of pretreatment with Retin A before your chemical peel. Also, notify your doctor if you've taken Accutane. Patients who have taken Accutane for acne can have problems with scarring following some peels.

The Face: Dermabrasion

Dermabrasion resurfaces the texture of the skin by removing its top layers. The procedure is most often done on the face to remove skin damaged by acne scarring. It is also done to lessen the visibility of wrinkles, tattoos and various other skin lesions. All or a small portion of the face can be done. Blotchy brown spots that occur on the cheeks, temples or forehead also may be treated with the technique. Dermabrasion has much the same effect as a chemical peel.

Dermabrasion results in a leveling or smoothing of the surface skin which makes scars less noticeable. It does not remove scars. Sometimes it is necessary to have a second procedure to get the maximum results.

Dermabrasion is considered the best treatment for improving acne scars. The procedure can be done in the office with a local anesthetic. A machine with a rotating wheel is applied to the face. The patient can go home after the procedure.

A scab normally forms on the treated area for five to seven days. When this comes off, the skin is healed but very pink. Makeup may be used to hide the pink skin. In several months when the skin has faded, it may have a slightly different color, usually lighter. This is more likely to happen with dark complected people. If this occurs, it can be balanced with makeup.

Discoloration and swelling usually occur for two to three months while the wound is healing. Infection and excessive bleeding are rare and can be treated easily if they do occur. Scarring within the healed skin is rare.

Before you have dermabrasion, it is important for your surgeon to know if you have a history of cold sores because medication may be administered to prevent them. Your surgeon may recommend two to six weeks of pretreatment with Retin A before your dermabrasion. Also, please notify your doctor if you've taken Accutane. Patients who have taken Accutane for acne can have problems with scarring following dermabrasion.

Infection and scarring can occur after this procedure, but these problems are not common. Occasionally, small white nodules will develop, but they are temporary.

Choosing Aesthetic Surgery

Candidates for Cosmetic Surgery

Your initial consultation will help you decide if cosmetic surgery is for you. A good candidate for cosmetic surgery is one who understands the procedure, is realistic about the expectations and risks for the surgery, and is motivated primarily to please oneself. In addition, good candidates are willing to tolerate unavoidable inconveniences such as healing time and to temporarily refrain from smoking and some medications that impede healing.

Choosing Aesthetic Surgery

Choosing aesthetic surgery is a personal decision that you should make after consultation at the Mayo Clinic. Combined with exercise and proper diet, an aesthetic procedure may provide the opportunity for you to feel better about the way you look.
Before making an appointment to see a physician about aesthetic surgery, take some time to think about the specific attributes accounting for your dissatisfaction with your appearance. Then, discuss your concerns at your doctor's appointment. He or she will recommend the most appropriate therapy to address your personal needs.

Many characteristics can be successfully altered through aesthetic techniques; others cannot. Your physician will help you understand what you can realistically expect if you choose surgery. Examine the benefits and limitations that aesthetic procedures offer and carefully weigh the options before making a decision to proceed.