Monday, December 24, 2007
Generally, blepharoplasty entails the removal by surgery of a little excess skin and fat. In my mom's case, she felt her eyelids were much too fatty and hung low over her eyes, closing them off. At the time, I thought she was quite insane, but she had read her resources well, and the truth was that the blepharoplasty opened her eyes a great deal, making them much more noticeable, expressive, and attractive. (Yes, Mom, I admit I was wrong.)
Like with rhinoplasty, the blepharoplasty risks are few. It is not risk-free, simply because no surgery is, and any resource that says otherwise is lying to you. Possible but rare complications could include having too much skin removed, which would cause incomplete lid closure and subsequent trouble with eye dryness.
The only bad part of the procedure for my mom was the recovery, especially since she had her blepharoplasty as part of a larger cosmetic surgery. The bruising and swelling was unbelievable. She looked far worse than Rocky Balboa ever did at the end of a fight. She stayed swollen and bruised for a long time. Believe me -- you don't want to go through recovery the way she did. Take the SinEcch, reduce the swelling, and get out of the mummy bandages much, much sooner.
By Thomas Fiala, MD, FRCSC
Women who come to my office to learn about breast augmentation surgery often have many questions about the procedure. Typically, they have been thinking about having the procedure performed for a long period of time, and have many questions about the details of the procedure.Here are answers to some of the questions most frequently asked regarding breast augmentation.
1. Q: What types of implants are available?
A: Saline (salt-water) filled implants, which are FDA-approved, are the most commonly used implants. They are filled with "normal saline," which is a solution typically used for intravenous lines. If there is any leakage of fluid from the implant, the saline is harmlessly absorbed by the body. A selection of different implant sizes and shapes is available. The choice of implant, which is individualized for each patient, is based on their appearance goals and the anatomy of the chest. I have found that the most popular implants are the standard "round" smooth surface implants, with 360-420 cc fill.
2. Q: What about silicone gel implants?
A: These are available through an FDA-approved study protocol, but only for patients that meet the defined selection criteria. In over 20 major scientific studies since 1992, silicone gel implants have not been statistically linked to any systemic diseases, including breast cancer or autoimmune syndromes. While this is very reassuring, the FDA has not yet approved the gel implants for general usage outside of the current study protocols.
3. Q: Which incision is best?
A: There are a number of approaches. These include the "inframammary" (in the fold underneath the breast), the "periareolar" (around the outside of the nipple), "trans-axillary" (armpit) or the new "TUBA" procedure, which utilizes a belly-button incision. Each has pluses and minuses, which should be explained at the time of the patient's consultation. For example, the transaxillary approach has the potential drawback of an overly wide cleavage, particularly if the endoscopic equipment is not used.
It is important to understand these choices.
4. Q: What about putting the implant under the muscle? What does that mean, and why does it matter?
A: This refers to making a space for the implant behind the main muscle of the upper chest, known as the pectoralis major muscle or 'pec.'
The advantages of this method include: less scar tissue forming around the implant than if the implant were above the muscle, a more natural-looking transition from the chest onto the breast (avoiding what I call the "Baywatch syndrome"), and improved mammography compared to implant placement above the muscle.
Disadvantages include: increased soreness in the first 3-5 days postoperatively, movement of the implant with flexing the muscle, and concern about breast shape in women who have ptosis (droop) of the breasts.
5. Q: How is the size of the implant selected?
A: This depends on what the patient has in mind. Most of the patients we see tell us "they want to look more proportional." For cases like this, matching the width of the implant to the width of the patient's rib cage works very well. While there is no perfect method to demonstrate the postoperative appearance exactly, we have found that the combination of trying implant 'sizers' in a sports bra, and digital computer imaging to work quite well.
6. Q: What about the 'teardrop' shaped implant? Is it more natural looking?
A: There is some considerable debate among surgeons about this issue. In my experience, patients that select an appropriately sized implant can achieve a very natural look with either the teardrop or the standard implant. The teardrop implant does have a little less fullness in the upper part of the breast, compared to the standard implant. The patient's appearance goals and an open discussion process with the surgeon are important for sorting this out.
7. Q: How long do I need to be off work?
A: I usually tell women to set aside one week for recovery, and to be off work during this time. I also recommend avoiding significant lifting or physical activity for the first 3 weeks after surgery, to minimize postoperative soreness.
8. Q: What about 'capsular contracture'? What is that?
A: The layer of scar tissue that each patient's body makes around the implant is called the capsule. This is the human body's normal reaction to an implanted material, and everybody who has an implant has a capsule, to some degree. In some cases, however, the capsule tightens up, squeezing the implant into a firmer, more ball-like shape. This is called a capsular contracture. It is a frustrating problem.
While the exact percentages vary from study to study, this problem occurs on average in 7-8% of patients with saline implants placed underneath the muscle. Currently, there is no test prior to surgery that can predict if or when a woman will develop this problem. A capsular contracture can occur despite the best intentions of the surgeon and patient, even with optimal surgical techniques and postoperative care. It is an as-yet unsolved problem of the augmentation procedure that the patient must understand and accept before undergoing the surgery. In cases of significant contracture, re-operation may be beneficial.
Overall, patient satisfaction with breast augmentation is very high. The operation is one of the most commonly performed in North America, with over 200,000 procedures performed in the year 2000, according to the American Society for Aesthetic Plastic Surgery. As always, choose your surgeon with care. Excellent information sources include the ASAPS and ASPS web pages.
Sometimes a neck or brow lift may be done in conjunction with a facelift. A neck lift focuses on tightening the skin around the neck and jowls. A brow lift raises the eyebrows and tightens the skin on the patient's forehead.
Face Lift Candidates
The best face lift candidates will have realistic expectations and will follow the advice of their plastic surgeons. There is no specific age that is best for having facelift performed. Skin condition and texture are more important factors. After meeting with a cosmetic surgeon, the patient will usually be advised as to whether he or she is a good candidate for facelift or whether an alternate procedure might be preferable.
Face Lift Surgery
For the two weeks before face lift surgery is performed, patients will be asked to stop smoking and taking aspirin. They may also be given special prescription medications to use prior to the operation. Facelifts can be done either in an outpatient or a hospital setting.
The plastic surgeon begins the facelift procedure by making an incision (usually at the hairline) and separating the facial skin from the underlying tissue. Excess fat and skin are removed, and the surrounding muscles are tightened in order to improve the contours and appearance of the patient's face. The skin is then reattached, using stitches or staples, and the area is wrapped in bandages.
The healing process continues for several weeks beyond facelift surgery. During that time, pain medication is usually prescribed. Physical and social activity may be limited for the first few weeks after facelift surgery.
Face Lift Surgery Risks
There are certain risks inherent in any surgical procedure, but face lifts are considered relatively safe. Some scarring should be expected. Conditions that may occur but should prove temporary include blood or fluid retention under the skin, crusting of the scars, and numbness. The risk of nerve damage or infection is low but does exist. Neck lifts and brow lifts are less complicated procedures that usually involve less pain and lower risk than a complete facelift. The cosmetic surgeon should discuss all possible risks and complications with the patient before the surgery is performed.
Of course, certain factors, such as geographic location, availability, and cost, are always going to be major influences on your decision to go with one surgeon over another. Yet, some of the others that should be given equal consideration are the facilities out of which the doctor is operating. Is the doctor affiliated with an accredited hospital? and if so, which one(s)? Will your procedure be performed in a hospital or ambulatory care center or will the surgery take place in the office of the doctor? These are all important and legitimate questions, which are often overlooked when cost considerations and techniques become the focus of the discussions.
It is always a good idea to focus on the individual patients that your prospective surgeon has handled in the past -- not simply before and after photographs. Ask about the entire procedure, from initial consultation through follow-up appointments. Cosmetic surgery is an especially sensitive area of surgical practice and often requires a higher level of patient care and re-assurance, since all of the work of the doctor is going to be readily visible on the body of the patient - permanently.
The benefits that can be realized from effective and well-thought-out cosmetic and plastic surgery can be very significant and positively life-altering. Regardless of your motivation to pursue a cosmetic procedure, you should be aware that there are numerous qualified physicians and professionals that are dedicated to your safety and your satisfaction, both with their efforts and with your appearance. Although the cosmetic and plastic surgery industry is often a controversial topic, it is increasingly gaining acceptance and the industry as a whole has taken great strides in recent years.
The most common risk factors that are associated with cosmetic and plastic surgery are related to the permanence of the results of the procedures. The implications of the anesthetics used (when necessary) are also important factors and all cosmetic and plastic surgery patients should be thoroughly screened for allergies to certain anesthetics and pain relievers. Of course, the selection process for a suitable and qualified surgeon is of paramount importance. Be certain to verify the credentials of any surgeon that you select and to follow-up with any references that are provided. Other important risks are associated with the patient's reaction to the sometimes drastic physical changes that are being made to their bodies.
Please keep in mind that the risks and benefits of cosmetic and plastic surgery are unique to each individual and should be considered accordingly. We strongly recommend that all individuals considering these types of procedures consult their primary physicians directly, in addition to researching objective sources of information, such as this web site.
Generally, fat removal of the jowl areas and cheeks is avoided in most cases. Older people have hollow cheeks, younger ones have fuller cheeks. In many people, the hanging jowls and deep cheek folds are actually mid-cheek skin and fat that has fallen down. If they are brought back up to where they once were, the result is a longer-lasting and more natural look.
The face and neck are usually lifted together. A small incision is made under the chin to tighten the neck muscles and fix the neck bands if they are present.
Face-lifting typically takes about 3 hours (although special circumstances may require more time or multiple procedures) and is performed either while the patient is asleep or sedated by IV. Patients are usually fully mobile the same day and back to most activities within 5 days, albeit with makeup to cover residual bruising. Pain is very minimal, though most patients note a feeling of tightness that can last for a few days to weeks following the procedure. Many patients combine face-lifting with an eyelift or brow lift for complete facial rejuvenation.