Plastic Surgery

Breast Augmentation: About the Procedure, Risks & Recovery

2009-01-06T10:43:00.000-08:00

INTRODUCTION
If you are thinking about breast augmentation, you are not alone. Last year more than 125,000 women chose to enhance their looks through a procedure that is now the second most popular of all cosmetic plastic surgeries. In fact, doctors have been performing—and perfecting—the procedure for thirty years.

Breast augmentation (also called mammaplasty) is a surgery to contour and enlarge breasts using implants. Many women choose the procedure because they feel their breasts are too small for their body. Some women lose breast size after childbirth or breastfeeding. For others, nature was not overly generous to begin with. And there are other women who are bothered by uneven breasts and would like a more naturally balanced look.

Is It Vain to Consider a Surgical Procedure That Can Change Your Appearance?
Certainly not. To want to look good, to have an appearance that is inviting to others, and to look attractive in clothing is only natural. Nothing is wrong with a heightened sense of self-esteem, and breast augmentation has given many women a greater confidence and better feeling about their own femininity and body.

Do They Look Natural?
Implanted breasts tend to be rounder and firmer than breasts that have not been augmented—characteristics that some people think are actually improvements on mother nature. What breast size is your ideal? We usually think “cup size” when we think breasts. After all, that’s how we choose our bras and bathing suits. If you tell your doctor you want a “C” cup, he or she will understand the general size you wish to be after breast augmentation. But in reality, implants don’t come in cup measurements—they come in “cc's” (cubic centimeters, a measurement of volume) as well as a few different shapes. There are some things you can do to more clearly convey the breast size you wish to be, although your body size and proportions will be a determining factor in the breast size and shape that is right for you.

Most often breast augmentation takes place in an outpatient surgical clinic or hospital under general anesthesia. In some cases, the surgery is done using a local anesthesia combined with sedation so you are awake but drowsy and relaxed. You and your doctor will discuss these options. The surgery usually takes from one to two hours. After surgery, you’ll be taken to the recovery room for several hours before you are able to go home. Plan to have someone accompany you; you’ll be drowsy and feel discomfort. Pain medication will be prescribed which you will probably want to take for a few days.

The Implant
A soft, pliable implant—(imagine a clear plastic pillow filled with Jell-O or salt water) is placed in a pocket the surgeon has formed in your tissue either behind the pectoral muscle or in front of the muscle wall.

Placement of the Implant
Your own anatomy helps determine what placement position is right for you. As a rule, implants behind the muscle are less likely to form a hardening called capsular contracture and less likely to show a rippling on the skin. They usually result in a more natural, softer looking bosom, and this placement is often preferable because it can allow for a better mammogram. Most implants are placed behind the chest muscle.

On the other hand, women with very droopy breasts may have better results when the implant is placed on top of the muscle because that can give their bust a rounder and firmer appearance where the chest was once flattened out.

The Incision
In order to place the implant in your breast tissue, the surgeon will need to make a surgical incision. The incision can be made around the areola (periareolar )— the darker skin that surrounds your nipple; in the armpit; or directly under your breast.

When the incision is made in the areola, usually the scar is barely noticeable, the tiny line blends into the surrounding skin. An incision made under the breast (inframammary) can be inconspicuous as well because the breast itself will hide the scar. Armpit (axillary) incisions may be noticed when the arm is raised, and some surgeons find that it is more difficult to accurately form the pocket that the implant is tucked into from this entry point. Some surgeons use an endoscope, a surgical instrument consisting of a long, thin, lighted tube, to aid them in the insertion of breast implants.

TUBA Method
Some newer endoscopic procedures involve making an incision in the navel (“TUBA” or “transumbilical” or periumbilical method). One tiny half-moon incision is made in the navel and the surgeon then creates a tunnel to the breast area. A "pocket" in the breast tissue is formed that will hold the saline implant. (Endoscopically-assisted surgery allows the surgeon to see on a video screen the pathway and placement site.)

When the pocket is ready, the surgeon will guide the implants-which at this point are empty thin sacs that are rolled up like a cigar-into place. The implants are filled with sterile saline solution; when the surgeon removes the filling tube, the saline implant port self-seals.

"The big advantage is there is no visible scar and it appears that patients have less pain. They seem to recover rapidly," reports Dr. Robert Gerson, a board-certified plastic surgeon who practices in Illinois and Wisconsin and is one of the few doctors in the US trained to perform the procedure. He believes that the TUBA method results in less chance of damaging nerves that can lead to loss of feeling in the breasts.

With this technique, breast implants are most successfully placed on top of the muscle wall. That may be a drawback for some: Many women, including very flat-chested patients, have better, more natural-looking results when their implants are placed behind the pectoralis muscle. But for the patient who is very concerned about any visible scarring-TUBA might be a technique to investigate and consider.

Who Is a Candidate?
Women who want an improvement to the way they look, but have realistic expectations, are the best candidates for breast augmentation.

If you are looking for a nicer appearance, but not an unattainable one, the procedure might be for you. Most women who have had the surgery say they feel more attractive and self-confident. That's not surprising-when you look good, you feel good. Breast augmentation is not without risks and some discomfort, but many women decide that the long-term benefits of more shapely, enhanced breasts are well worth it.

Of course your physician will want to make sure you are in good physical health if you are considering breast augmentation. A pre-op physical, health history and blood work-up will be done before you go in for surgery. Age is not a limiting factor as long as your general health is good.

If you are a serious candidate for this type of plastic surgery, make sure the doctor you choose is board certified. Discuss procedure, risks, benefits and treatment options. "Use this opportunity to determine whether or not you are comfortable with the surgeon and whether or not you want him or her to do the surgery," advises Gregory Mesna, M.D.

In most cases the procedure is considered elective or "cosmetic" and means you will probably have to pay for it yourself. Costs vary in different regions of the country, but average between $5,000 and $6,000.

Preparing for Surgery
Breast augmentation, as with any other surgical procedure, requires you to be in good health. Discuss any health concerns and problems that you may have with your doctor.

Before your surgery, routine laboratory tests including blood counts and blood chemistries, as well as an electrocardiogram if you are over 40 years old, will be performed.

Here are a few general guidelines that you should follow:

Don't take aspirin or any drugs containing aspirin for at least two weeks before surgery. Aspirin can interfere with normal blood clotting.
Don't eat or drink anything after midnight the night before surgery. Your stomach needs to be completely empty when undergoing anesthesia or sedation.
Avoid drinking alcohol a few days prior to surgery.
If you smoke, stop smoking before your procedure and for some time afterward. Smoking reduces the rate of healing.
Shower or bathe the evening before surgery, but don't shave your underarms for at least 12 hours before surgery.
The morning of surgery you may brush your teeth, but don't swallow any water.
Wear something loose that opens in the front. You don't want to put on anything that goes over your head after surgery.
Arrange for someone to drive you home. Arrange for a friend or relative to stay with you for 24 hours after surgery.

Pain
You will experience pain, swelling, tenderness and some bruising after surgery, but your doctor will prescribe pain medication to ease you through this time. If the implants have been positioned behind the chest pectoral muscle, expect the kind of pain you would experience with a pulled muscle—because that’s exactly what the surgeon has to do to fit the implant in its pocket. If the implant has been placed in front of the muscle, pain is often minimal.

Prescription pain medications can be used for 4 to 7 days. Take only when needed, don’t take more than prescribed, and don’t take them for more than a week. After several days, most women find that acetaminophen is all they need.

You may be prescribed an antibiotic to fight infection.

Ice packs will help reduce swelling and soothe the incision.

If at any time following surgery you experience fever, bleeding or other symptoms of infection, let your doctor know right away.

Recovery
How will I feel? When can I get back to work? When can I get back to my normal routine? Recovery time is individual, depending upon the patient, the placement and type of the implant, and the surgical technique.

However, here are some general guidelines:

You’ll feel tired and tender for the first 24 to 48 hours. Plan to take it easy.
You’ll probably be able to go back to work in several days if your job is not too physically demanding. If your work requires physical energy and stamina, you’ll need to allow more time for your recovery.
Avoid vigorous exercise for six weeks.
Your stitches will be removed in a week to 10 days. The incision scars will be firm and pink for at least six weeks, and then will begin to fade. Your breasts will remain swollen for three to four weeks following surgery. They will be tender to touch and exercise.
No lifting for two weeks and no heavy lifting for four weeks.
Allow about two months for “complete” recovery from breast augmentation surgery.

Following surgery, your surgeon will apply gauze bandages to your incision sites and you will be placed in a surgical bra which you will wear for about two days. You will receive instructions about changing the gauze and keeping the incision clean; positions for sleep and rest; raising your arms, breathing exercises and breast massage.

Call your doctor if:

There is an increase in pain, swelling, redness, drainage or bleeding in the surgical area;
You develop headache, muscle aches, dizziness or a general ill feeling and fever, nausea or vomiting.

Usual follow up after surgery is at one week, one month, three and/or six months and thereafter at annual exams.

Risks
Breast augmentation is a relatively straightforward procedure, but as with any surgery, there are risks and uncertainties.

These are not common, but you should be aware of the possible complications that include:

Bleeding following the operation. If it continues, another operation may be needed to control the bleeding and remove the accumulated blood.
Postoperative infection. A small percentage of women develop an infection around the implant. If the body does not respond to antibiotics, the implant may need to be removed for several months until the infection is cleared, and then a new implant is inserted.
Changes in nipple or breast sensation. Nipple numbness may be temporary or permanent.
Capsular contracture. If the scar or capsule around the implant begins to tighten, the breast will feel hard and sometimes result in a baseball-like appearance. The implant may need to be removed or replaced, or the scar tissue may need to be surgically removed.
Rippling or wave-like appearance on breast that look like indentations. In most cases the ripple occurs as the implant moves.
Shifting of the implant. The device can move from its original placement and/or push through layers of tissue and become visible at the surface of the breast. (Placing the implant beneath the muscle may help to minimize this problem.)
Implant leaking or rupture. An injury from a blow to the chest, a compression during mammogram, or even normal movement could cause the implant casing to leak. If a saline-filled implant breaks, the implant will deflate in a few hours and the salt water will be harmlessly absorbed by the body. A ruptured or leaking implant must be replaced which requires a second surgery.

Costs
In most cases, breast augmentation is considered elective or "cosmetic" surgery, which means you will probably have to pay for it yourself. Total costs vary in different regions of the country, but average between $5,000 and $6,000.

According to the American Society of Plastic Surgeons (ASPS), in 1998, the average fee charged by the surgeon for breast augmentation was $3,077. (That does not cover anesthesia, hospital/surgical center charges, or the cost of the implant, which adds $1,500 to $2,000.)

The ASPS reports the following state-by-state averages of fees charged by plastic surgeons in 1998: California, $3,234; New York, $4,417; Florida, $2,616; Texas, $2,851.

More to Know
How will your life change after breast augmentation? Aside from the fact that there is a good likelihood that you'll be happier with your new shape, you'll find few restrictions or big changes. But here are a few things to keep in mind.

Breast cancer screening and mammography. As for all women, you will need regular mammography exams after a certain age to detect breast cancer. Both saline and silicone implants can obscure the tissue in which a tumor may be present, making detection more difficult. However, breast implants that have been positioned under the muscle are less likely to interfere. When you book your mammogram, tell them you have implants and that you want a technician who has been specially trained. At your appointment, remind them again. Breast implants can rupture with improper mammogram handling.
Breast-feeding. You should be able to breast-feed successfully after breast augmentation. According to La Leche League, many women with silicone breast implants have successfully nursed with no apparent harmful effect to themselves or their children.
Implants don't last forever. Most likely you will need to replace the implants at some point down the road, which means you'll need another surgery. Discuss implant product warranty with your doctor so you are clear about what is and isn't covered in the cost of the surgery.

Types of Breast Implants
A breast implant is a silicone shell filled with either a saline (salt water) solution or silicone gel. The implant most often used today is saline-filled. Under some conditions, silicone gel implants can be used, but these are mostly used for reconstructive surgery. Because saline is similar in composition to other body fluids, if a saline implant should rupture and leak, the saline solution, which is harmless, is absorbed by the body.

There are round implants and anatomic implants. The anatomic implants may also be described as "teardrop", "anatomical",or "tapered" implants. The tapered implant is sometimes suggested for thinner women because it may result in a more natural-looking upper chest.

The rounded implant gives a fuller upper chest and cleavage. Implants of either type placed behind the muscle may provide a similar appearance.

The outer surface of the implant may be either textured or smooth. Textured implants may help reduce capsule formation around the implant. The evidence is not conclusive. Some surgeons have found that textured implants have more of a tendency to ripple. Advocates of smooth implants claim that they are less likely to cause visible rippling (especially if placed below the pectoral muscle) and are more natural to the touch.

Because there is a lack of evidence supporting the safety of silicone gel-filled implants, the Food & Drug Administration (FDA) restricted their use to primarily reconstructive procedures in approved clinical studies. Some women requiring replacement of existing gel implants may also be eligible to participate in the study. Saline-filled implants are currently under review for both reconstructive and elective purposes.

Adjustable-fill implants allow the implant size to be adjusted after the initial surgery. A self-sealing tube and valve allow the surgeon to add or remove additional fluid to increase or decrease the size, respectively. The valve is often removed surgically and the implants remain at their adjusted size.

An alternative implant filled with a purified form of soybean oil is also being evaluated and it is not known if it will be available for general use.

Liposuction - Safe or Unsafe?

2009-01-06T10:12:00.000-08:00

Liposuction, or liposculpture is the most common cosmetic surgical procedure in the United States. Traditionally, liposuction was associated with an outpatient surgical setting, where excess fat was removed and patients experienced rapid recovery and gratifying results.

In recent years, procedures have become more ambitious with larger amounts of fat being removed. Though this progress frequently allows for more dramatic results, it has unfortunately been associated with serious complications, including death. Because liposuction remains an attractive cosmetic procedure, patients want to know if liposuction is fundamentally safe and, if so, how they can make sure their particular procedure is done safely.

Liposuction is conceptually simple. A healthy patient with areas of excess fat has these areas reduced by vacuuming the fat through small metal tubes called cannulas. This procedure is frequently done on an outpatient basis under general anesthesia in the hospital or accredited surgical facility.

Most liposuction begins with the surgeon infiltrating a special solution into the fatty tissues to be suctioned. This solution is mostly salt water, but also contains adrenaline to reduce blood loss and may contain a local anesthetic to reduce pain. Following the injection of this "tumescent" fluid, fat removal begins. In certain cases, the initial phase of liposuction involves ultrasound cannulas that loosen the fat to be removed. This is followed by standard liposuction, where a vacuum is employed to remove the excess fat.

At the end of the procedure, the patient is placed in a compression garment to reduce postoperative swelling. In most cases, the patient is discharged home the same day and returns to work in a few days. When more significant fat removal is performed (greater than 10 pounds), patients are usually observed overnight.

It sounds so simple, so how could anything go wrong? Easy – each factor in liposuction can be critical to a safe outcome. For instance, if the patient is not healthy, even liposuction can result in significant problems, such as a heart attack or trouble breathing. If the surgeon is overly aggressive in fat removal, excessive blood loss can occur. If the anesthesia is not administered properly, too much fluid can be given with serious consequences. If the surgical facility is poorly maintained, infections can be more frequent and lifesaving equipment might not be available in an emergency.

There Are a Few General Factors that Influence the Safety of Liposuction:

Patient: Liposuction is for healthy patients who are within about 40% or their ideal body weight. Liposuction is not intended to be a strategy for weight loss. Obese patients should be considered only rarely. Patients with significant heart or lung disease are not candidates.

Doctor: Ideally, liposuction should be done by surgeons familiar with all facets of liposuction, including the tumescent technique and ultrasound-assisted liposuction. Board certification, preferably by the American Board of Plastic Surgery, is mandatory. This ensures that a national organization feels this surgeon is competent and safe. Additionally, and equally as important, the surgeon should have privileges to perform the procedure in a local hospital. Such privileges mean the surgeon has demonstrated to his or her peers locally that he or she is capable of performing the procedure safely.

Anesthesiologist: Whether general anesthesia is being used or not, all patients undergoing liposuction should be monitored by someone other than their surgeon. This is preferably done by a board-certified anesthesiologist, but can also be done by an experienced, certified registered nurse anesthetist. Experience is essential as it can be difficult to manage liposuction patients, especially during a large volume liposuction.

Facility: Liposuction should always be performed in a hospital or accredited surgery center. The surgery center should be approved by the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF). This certifies that the facility is of the highest quality. Frequently, I hear of patients who have undergone liposuction done under local anesthesia without proper monitoring, who have done well. I try to point out that just because the surgery was successful, it does not mean it was performed safely. Since liposuction is a real operation with real risks, the conditions for the procedure should be the same as those for any other surgical procedure such as a hysterectomy. Accepting anything less is simply making liposuction more risky than it needs to be.

Liposuction is like any operation in cosmetic surgery in that it can have unsatisfactory results. Specifically, too much or too little fat can be removed, contour irregularities can develop and swelling can be prolonged. However, when adequate precautions as outlined above are taken, life-threatening complications should be exceptionally rare. When done properly by an experienced surgeon in an accredited facility, liposuction remains an extremely safe and effective way to improve one’s shape by fat removal.

Liposuction is real surgery and involves risks such as bleeding, infection and scarring. Results will vary.

Hair transplantation: The Pluck and Sew Technique

2009-01-06T09:24:00.000-08:00

Summary
A novel and simple approach to single hair follicle transplantation for alopecia is a hair threaded on a curved needle with the follicle attached. It is the best aesthetically acceptable means of doing so in certain circumstances. These are the eyebrow, the sideburn, the hair margin, areas requiring precise grafting following facelift procedures and the eyelash. The presented technique simplifies the precise, oriented placement of single hair grafts and has been time-tested by the senior author for the last 20 years.

Introduction
Surgical techniques of hair restoration have generally fallen far short of normalcy. Current techniques of composite tissue grafting and flap restoration often lead to hair or browlines which appear quite peculiar. Punch graft growth patterns are uneven, resembling the distortions seen in doll's hair. The hair of locally transposed flaps angle in the wrong direction and have too even a margin with an apparent perimeter scar. Tissue expander reconstruction leaves central defects with hair, usually, again growing in the wrong direction. Microvascular transfer, in skilled hands, offers a meaningful alternative although few surgeons have the experience and expertise required to assure a good result. Strip grafts 1 and square scalp grafts 2 have been advocated as solutions to the hairline problems in selected patients but can often lead to an abnormal appearing hairline. Since the senior author presented this novel approach of individual hair transplantation in 1980, the techniques of mini and micro grafting 3 and the development of specific punches 4 for the harvesting of grafts have been developed which improve the aesthetic outcome of alopecia correction.

In small, defined areas, the technique which gives best aesthetic result is individual hair placement. This is particularly true in the reconstruction of the eyelash for which there is no good currently available reconstructive option. Marritt 5 advocated single hair transplantation for such areas, using one or two hairs from standard 4mm punch grafts inserted with a 16-gauge angiocath as a punch.

We offer a delicate, simplified technique for individual hair transplantation, leading to minimal (if any) scarring, with the ability to control the direction of hair growth. The current technique has been used by the senior author for over twenty years in hairline, eyebrow and eyelash reconstruction. In selected areas and for selected patients this technique allows a precise placement and angulation of individual hair follicles.

Technique
The accurate and atraumatic placement of individual hairs in the proper orientation and without the production of scars in the recipient bed is difficult but simplified by our technique. The first step is the harvesting of the hair follicle. A donor graft is harvested from an area of the scalp distant to the traumatic defect and/or one unlikely to be affected by male pattern baldness. The hair is left long in the area to be harvested. A strip 2 to 3mm in width is ideal for harvesting. The graft should have a generous amount of subcutaneous tissue adherent to the underside in an effort to ensure complete inclusion of the hair follicle. 7X loupe magnification makes the harvesting easy. Retrograde dissection of the hair is accomplished with micro or very fine iris scissors leaving a generous cuff of subcutaneous tissue around the follicle and bulb. This tissue appears translucent in the scalp. The follicle is liberated up into the dermis where a Jeweler's forceps with, filed-down, blunted edges are used to "pluck" the follicle gently from the scalp in the direction opposite its growth; carrying the hair along with it.

If the transplants are to be numerous, harvesting of individual hairs may take place on the day prior to the recipient bed grafting with storage of the hair grafts in moistened gauze at 4 degrees C. This allows the tedious procedure of individual hair follicle harvesting to occur in a sterile area without the detainment of either the patient or operating room staff. The survival of the hair follicles is not significantly altered by such storage overnight. We have however noted that survival does diminish significantly after 24 to 36 hours of storage.

Placement of the individual hair follicles in the skin at the recipient site has been successfully performed using several tools. Initially a trocar was used followed by a specially constructed grasping forceps to pull the hair into the recipient site in a retrograde manner. These techniques resulted in more donor site scarring and more difficulty in achieving the exact direction of hair growth desired than the technique currently used. The current technique is also much gentler and allows less manipulation of the hair, particularly at the follicular end. Currently, we use a number 5, French-eye, cutting edge needle (Anchor Products Co., Addison, Ill.). As a general rule, the smallest free needle manufactured is usually the perfect size. It allows the snug introduction of follicle and minimal surrounding adipose tissue to slide comfortably into its tract. Leaving too much surrounding bulb attached to the follicle can force the hair from its follicular sheath, loosing the bulb and the potential for regrowth. The needle may be either 1/2 or 3/8 circle depending upon the needed direction of hair growth and recipient site skin thickness. The hair end loops through the eye of the needle and follows the needle through the skin and into the subcutaneous tissue exiting in the desired direction at a precise location with precise angulation. Accuracy can be enhanced with loupe magnification. The hair is then cut slightly above the level of the skin so that it is not removed by entrapment in dressings or otherwise inadvertently removed. A coating of antibiotic ointment is applied to minimize drying of the recipient bed surface.

Results and Discussion
This technique is exceptionally useful for small, localized areas of alopecia and is particularly suited to hair margin, the brow and lost sideburn aesthetic reconstruction. It is also the only workable reconstructive option available in eyelash reconstruction known to the authors. It has previously been suggested that single hair micrografts would be the most natural in eyebrow repair, for sideburn reconstruction in women after facelift and for the softening of border hypopigmentation in the transplanted hairlines of blond, fair-skinned patients. We agree with and extend these uses of single hair grafts.

The only limitation to the technique is its tedious nature and its current inappropriateness for large areas needing grafting. It does, however, lend itself well to "streamlining" with harvesting performed by technicians. Causes of graft failure are bulb transection during the harvesting procedure and inadvertent loss of the sheath, as described earlier, usually due to too much bulb being left on the follicle. Graft failure from drying of the follicles and use of transplants which are too old rarely occurs. Unlike most grafts, fresh follicles which have been carefully harvested and kept moist may grow without first exfoliating.

The senior author presented this technique 13 years ago following perfecting its use in the decade preceding its presentation. It has been used in over 25 patients with good results (space limitations disallow extensive presentation of results in a techniques paper). The intended publication after its initial presentation was delayed due to an overwhelming referral of patients which the senior author was unable to accept. The technique is now offered knowing that it will be streamlined by those especially interested in hair replacement surgery.

Bibliography
1. Vallis, C. Surgical treatment of the receding hairline. Plast. Reconstr. Surg. 44: 271, 1969.

2. Coiffman, F. Use of square scalp grafts for male pattern baldness. Plast. Reconstr. Surg. 60: 228, 1977.

3. Frechet, P. Micro and mini hair grafting using the standard hair implantation procedure. J. Dermatol. Surg. Oncol. 15: 533, 1989.

4. Arouete, J. Correction of baldness by grafts. Ann. Chir. Plast. Esthet. 35: 19, 1990.

5. Marritt, E. Single-hair transplantation for hairline refinement: A practical solution. J. Dermatol. Surg. Oncol. 10: 962, 1984.

Published in 1994. Previously presented at the May 1980 meeting of the American Society of Aesthetic Plastic Surgeons, Orlando, Florida.

Breast Augmentation from a Surgeon's Perspective

2009-01-06T09:20:00.000-08:00

By Franklin D. Richards, MD Bethesda, MD

Breast augmentation is a surgical procedure to enhance the size and shape of a woman's breast for a number of reasons. Most often a woman seeks breast augmentation to enhance the body contour, who, for personal reasons, feels her breast size is too small or to correct a reduction in breast volume after pregnancy. Some desire to improve an imbalance in breast size. By inserting an implant behind each breast, surgeons are able to increase a woman's bustline by one or more bra cup sizes.

Breast augmentation can enhance your appearance and your self-confidence. Before you decide to have surgery, think carefully about your expectations and discuss them with your surgeon. If you're physically healthy and realistic in your expectations, you may be a good candidate.

Possible Complications
A breast implant is a silastic shell filled with a saltwater solution known as saline. Breast augmentation is relatively straightforward. But, as with any operation, there are risks associated with surgery and specific complications associated with this procedure.

The most common problem, capsular contracture, occurs if the scar or capsule around the implant begins to tighten. If this occurs it can make the breast feel firm or even hard. Capsular contracture can be treated by removal or scoring of the scar tissue.

Complications with this procedure are possible, but fortunately, unusual. They include bleeding, infection, nipple numbness and implant leaking. Sporadically, breast implants may break or leak. Rupture can occur as a result of injury or even from normal compression and movement of your breast and implant, causing the shell to leak. If a saline implant breaks, the implant will deflate in a few hours and the salt water will be harmlessly absorbed by the body. However, the ruptured or leaking implant must be replaced. This involves opening the original incision and inserting a new implant.

While there is no evidence that breast implants cause breast cancer, they may change the way mammography is done to detect cancer. When you request a routine mammogram, be sure to notify the center that you have breast implants. Often this will mean that additional oblique mammographic views are performed. Ultrasound examinations may be of benefit in some women with implants to detect breast lumps or to evaluate the implant.

While the majority of women do not experience the above complications, you should discuss each of them with your physician to make sure you understand the risks and consequences of breast augmentation.

The Surgical Procedure
Breast augmentation is most commonly performed in an outpatient facility using general anesthesia, so you'll sleep through the entire operation. Some surgeons may use local anesthesia, combined with a sedative to make you drowsy, so you'll be relaxed but awake, and may feel some discomfort.

The method of inserting and positioning your implant will depend on your anatomy and your surgeon's recommendation. The incision can be made either in the crease where the breast meets the chest, around the areola or in the armpit. Usually the incision around the areola is less conspicuous, however, the incision under the breast is frequently hidden by the breast itself. The armpit incision often heals well, but it may be noticeable with a raised arm, and it is difficult to create an accurately placed pocket with this incision.

The implant may be placed in a pocket under the pectoralis muscle or directly on top of it. Generally, saline implants are placed behind the muscle as there is often better breast form, less chance of capsular contracture (hardening) and it helps to prevent any waviness‚ of the implant from being noticed. If you have any significant breast droopiness (ptosis), the implant pocket may need to be placed on top of the muscle. This allows the implant to fill out the breast skin and results in a better correction of the droopy breast.

Shape of the Implant
Several considerations are made in choosing a breast implant. There are round implants and also tapered sometimes called contoured or anatomical implants. Generally, for a very thin individual, a tapered implant will result in a more natural, less rounded appearance to the upper portion of the breast. However, if the implant is placed behind the muscle, the appearance is very similar.

Additionally, implants may have a smooth or textured surface. The textured implant was developed to help reduce the incidence of capsular contracture (hardening). Again, if the implant is placed behind the muscle, there does not appear to be significant differences between the implant surfaces.

You’ll want to discuss the pros and cons of these alternatives with your doctor before surgery to make sure you fully understand the implications of the procedure. The surgery usually takes one to two hours to complete. There is often a wrapped gauze dressing around the breasts for one or two days.

After the Surgery
You should be able to return to work within a few days, depending on the level of activity required for your job. Follow your surgeon's advice on when to begin exercises and normal activities. Your breasts will probably be sensitive to exercise and direct stimulation for two to three weeks.

Your scars will be firm and pink for at least six weeks. Then they may remain the same size for several months, or even appear widened. After several months, the scars will begin to fade, although they will never disappear completely.

It's Your Own Decision
For may women, the result of breast augmentation can be satisfying, even exhilarating, as they learn to appreciate their fuller appearance. Your decision to have breast augmentation is a highly personal one that not everyone will understand. The important thing is how you feel about it.

Lasers: New Technology for Skin Conditions & Tattoo Removal

2009-01-06T09:17:00.000-08:00

We’ve all heard about the many uses of lasers in medicine. Lasers are used in surgery to destroy cancerous and precancerous tissue, to remove tissues such as tonsils with much less pain and swelling than with conventional surgery, and to remove tumors which contain many blood vessels that otherwise might be difficult or dangerous to remove.

Earlier lasers such as the C02 and Argon Lasers were also used to treat certain skin conditions such as birthmarks, tattoos, and warts. These earlier lasers had the disadvantage of leaving more scars after the treatment of certain skin lesions especially if the tissue to be removed extended deeper into the skin, as in many tattoos. The patients generally preferred the scar to the tattoo; however, since the scar had less social stigma than the tattoo. As a plastic surgeon in the military, I had abundant experience removing tattoos with these early lasers, but I was not satisfied with the scars that resulted.

Fortunately technology came to the rescue. A second generation of lasers was developed for treatment of these superficial skin lesions. Depending on the color and depth of the skin lesion, we are now able to select from a number of lasers that differ in the wavelength of light that the laser produces. When the laser light hits the brown or red skin discoloration or tattoo pigment, it is selectively absorbed. The rapid absorption of the light energy causes the tattoo ink or the pigmented cells in the skin brown spot to destruct or burst apart. The body’s natural filtering system then removes the debris. Because the surrounding normal tissue does not absorb the laser energy, the treated area is less likely to scar.

Superficial skin spots such as brown age spots, "liver spots", and freckles are usually removed with one to two treatments. Common areas that develop brown spots are the sun exposed areas of the face and back of the hands. Occasionally after laser treatments, some brown birthmarks may return after several months to a year. Elevated brown spots such as moles or lesions that may be cancerous should not be treated with the laser, but should be removed surgically so that they may be sent to a pathologist for a definitive diagnosis, as further treatment may be needed.

Red skin spots and superficial blood vessels especially on the face may be treated with the laser, which is selectively absorbed by the red blood cell hemoglobin. The overlying skin is usually left undamaged, but the superficial vessels and/or spots are destroyed. Small spider veins of the legs may be treated with the laser but generally respond better to other treatment methods, such as injection of sclerosing solutions.

Tattoo Removal
The most exciting use of the new lasers are in the treatment of tattoos. Decorative tattoos have been in vogue for at least 5,000 years and a multitude of tattoo removal techniques have been used throughout history including sanding of the skin, chemical treatment of the skin, and laser removal of the skin containing the tattoo. All treatments lead to the same problem; a scar similar to a burn scar, since most tattoos extend deeper into the skin. With the advent of this new generation of lasers that selectively send energy only into the tattoo pigment, we have seen a marked decrease in the scarring. Tattoos are either professional, where a large amount of pigment is placed using a tattoo machine, or non-professional where a small amount of pigment is placed usually using a needle. Non-professional tattoos require fewer laser treatments than professional tattoos as they have less pigment to be destroyed. On the average, non-professional tattoos required three to four treatments and professional tattoos require six to eight treatments. Usually the treatments are spaced at one to two month intervals to allow the body’s filtering mechanisms to clear out the tattoo pigment debris. Not all colors respond equally well with all lasers, but fortunately several different types of lasers are available so that most pigments will respond to one of the available lasers.

Laser treatment is usually performed in the office, requires no anesthesia, and takes only ten to twenty minutes. The impact of the laser light hitting the skin produces a sensation similar to the snap of a thin rubber band. After treatment the area will feel similar to a mild sunburn.

For treatment of brown spots the area remains reddened for two to four weeks then gradually returns to its normal coloring and texture. For red skin spots, the area typically bruises, but does not leave an open wound. For tattoos which are deeper, there may be pinpoint bleeding and an antibacterial ointment and dressing is applied to the area. A small amount of lighter discoloration and texture change is evident, which gradually improves over time. Permanent scarring is rare.

Laser treatments are usually less expensive than conventional surgery. Costs range from $300 - $600 per treatment session and are usually dependent on the amount of time the laser is in use and on the type of laser used. Insurance usually does not cover the cost of laser surgery for tattoo removal, but may cover the removal of other skin lesions depending on the particular policy.

So the next time you have to cover up those brown discolorations with make-up or conceal that tattoo that you got in your twenties, think about taking advantage of this latest development of laser technology to create healthier and more attractive skin.

Laser Resurfacing for the Treatment of Facial Imperfections

2009-01-06T09:15:00.000-08:00

Did you ever look in the mirror only to see your facial imperfections, such as wrinkles, dark spots, blemishes and acne scars staring back at you?

We now have a new laser technology that removes the outermost layer of the facial skin very selectively. When the new skin grows back, in five to fourteen days, this skin is smoother and less likely to have such prominent surface irregularities.

The areas that are most effectively treated with this technology are wrinkles, pigment irregularities and acne scars. Other blemishes such as raised moles, broken vessels and large pores are better treated with surgery, other laser technology or skin care programs utilizing Retin A and glycolic acid. Usually a skin care evaluation by the plastic surgeon can effectively identify which techniques are best to correct the problem areas that are of most concern to you.

If laser resurfacing is recommended then often Retin A is applied to the facial skin each evening after removal of makeup, if worn, for several weeks prior to treatment.

Areas of the face to be treated are identified. Choices include the entire face, the cheeks, the area around the mouth and the area around the eyes. Treating large areas often requires anesthesia to sedate the patient. Local areas may be done without anesthesia in select patients.

After treatment, a tape dressing is applied and remains in place for three to seven days. Discomfort is minimal as long as this tape remains in place. Healing is usually complete in five to fourteen days although the skin must be protected from ultraviolet rays for several months after surgery. At first the new skin is more delicate and often reddish in color for two weeks to two months after treatment. Occasionally, this reddish tint may last up to six months usually with more extensive treatment in certain patients with skin types susceptible to this redness.

Laser resurfacing is safest in patients with fair skin and is more likely to have prolonged redness in patients with deep wrinkles. Creams can be used to decrease the redness and makeup can be used to camouflage the redness. Patients with olive or pigmented skin have a risk of discoloration of the skin that is resurfacing the face.

After the new skin heals and has time to mature, the surface is smoother and often has less pigment variations.

With the use of an effective skin care program to help maintain this improved skin surface and of course sun blocks to help prevent further sun damage to the skin, you can now face the mirror with a more vibrant and youthful appearance.

Avoiding End Hits In Ultrasound-Assisted Lipoplasty

2009-01-06T09:09:00.000-08:00

A potential disadvantage of ultrasound-assisted lipoplasty is tissue burns. These may occur when the tip of the probe hits the undersurface of the skin. These "end hits" occur when the tip of the probe is vertically oriented to the skin surface, and they are more likely to happen when the surgeon is trying to go around the sides of the patient from centrally located access incisions.

To help avoid hitting the skin’s undersurface around the lateral aspect of an area being treated, a lateral meridian is drawn before surgery with the patient standing. The surgeon should not cross this lateral meridian when working in an anterior direction from the central access incisions with the patient in a prone position or when working in a posterior direction with the patient in a supine position. The prone position displaces this lateral line posteriorly, whereas the supine position displaces it anteriorly because the operating room table pushes up against the patient’s body.

The surgeon’s non-dominant hand assists by rolling tissue toward the probe so that its tip does not approach the skin in a vertical orientation. Early in my experience, I would sometimes push the probe too far around a contour. The surface orientation provided by the lateral line has helped prevent that problem so the tip of the probe is not perpendicular to the skin.

I limit access incisions to well-concealed sites. One or two incisions at the superior border of the escutcheon or umbilicus for the anterior abdomen and lateral flanks, and one at each of the lower lateral borders of the escutcheon for the inner and outer thighs have been adequate when the patient is in the supine position. Incisions on either side of the spine and in each buttock crease have sufficed to treat flanks and thighs with the patient in the prone position.

Facelift: Prevention and Treatment of Facial Aging

2009-01-06T09:03:00.000-08:00

Facial aging is due to a combination of factors. In a previous article we discussed photoaging or aging due to sun exposure which is fortunately a largely preventable cause of aging. In this article we will explore some other factors that contribute to aging. Some of these factors are less preventable, but fortunately are able to often be corrected once established.

Gravity
One prominent cause of aging is due to the effect of gravity. As you study the difference in facial features between the extremes of age, you see a drooping of certain areas of the face and neck frequently. Such areas include the jowls or lower cheeks, the neck or "turkey wad", the chin, the nose, the eyebrows and forehead, and the upper and lower eyelids.

Plastic surgery has various techniques designed to rejuvenate the face once gravity has caused these areas to droop and thus form the folds and deeper wrinkles associated with aging. No other form of facial rejuvenation such as chemical peel is effective in treating these drooped areas once formed.

Plastic surgery techniques include facelift which typically elevates the cheeks, jowls, and neck. Facelifts remove excess skin from the lower face and neck through incisions around the hairline and ear area and underneath the chin. Typically deeper layers including the muscles are tightened to help prevent recurrent drooping of facial tissue. Facelifts are rarely necessary before age 40 and are usually performed in men and women when they have sufficient laxity of tissue to justify the small but real risk of surgery.

Sometimes a chemical peel can achieve some tightening of tissue and thus delay the time when facial laxity would only be corrected with a facelift. The neck, however, cannot be treated with a deep chemical peel due to potential complications, so this area is best treated with a facelift. On occasion, usually in men who do not object to a visible neck scar, excess neck skin can be removed directly. This scar is much more prominent and visible than the usual facelift scars. Facelifts usually last from 5 to 10 years although some patients with poor skin elasticity notice a recurrence of facial drooping sooner. Usually the second facelift is longer lasting.

Other areas which are susceptible to gravity include the chin and nose. Elevation of the chin directly or elevation using a prosthetic implant produces a more youthful appearance. Many different techniques are available and the particular technique best suited to your bone structure and appearance is best discussed with a plastic surgeon. Incisions are placed inside the mouth or under the chin. Elevation of the nose including the nasal tip can usually be accomplished through incisions hidden inside the nose.

One early sign of facial aging is around the eyes and brow area. Perhaps this is due to the thinner tissues of the eyelids and their constant motion compared to other areas of the face. Most people show their first signs of facial aging around the mid 30's when the eyebrows begin to droop. You can see for yourself if your eyebrows are drooped by elevating the outer half of the eyebrows while looking in the mirror. Do you see the small fold of excess skin of your upper eyelid become less prominent?

Drooping of the brow has several effects including a shift in position of the eyebrow, especially the outer half, drooping of the tissue of the eyelids due to pressure of the brows on the thinner skin of the upper eyelids, and horizontal forehead wrinkles due to constant elevation of the forehead muscles in order to relieve this pressure from the drooped brows. Vertical forehead wrinkles are usually due to overactivity of certain muscles and will be discussed later under expression lines.

The treatment for drooped brows is a forehead lift. This is usually performed by making an incision across the top of the scalp and lifting the tissues of the brow and forehead. The overactive muscles can be removed and the elevation of the forehead and brow helps eliminate the horizontal forehead wrinkles after a browlift. Often crows feet are softened or eliminated. There is less upper eyelid skin to remove after elevation of the brow and in some patients a browlift is all that is required to correct aging around the eyes.

For drooping of the upper eyelids not corrected with a browlift, or in patients who prefer less surgery, an eyelid lift or blepharoplasty is possible. Excess skin and fat is removed from the upper eyelid and the incision is mostly hidden in a natural crease. Some insurance policies will cover the costs of an upper eyelid blepharoplasty or a browlift if visual field tests by an ophthalmologist or optometrist are abnormal. If you have a moderate to severe amount of hooding of the brow and upper eyelid skin that may be obstructing your vision off to the side, you may consider having this test performed.

For drooping of the skin and treatment of the fatty bulges that develop in the lower eyelid area, a lower eyelid lift or blepharoplasty may be helpful. This procedure removes excess skin, muscle, and fat from the lower eyelid. The incision is usually made just under the lash line and usually heals with minimal scarring. Sometimes the incision can be made through the conjunctiva, or pink tissue on the inside of the eyelid, if there is only fat to remove.

Depending on your particular facial structure, gravity is more likely to take its toll in one area before another. Although one cannot neutralize gravity, various methods exist to counteract its effects.

Expression Lines
The next category of facial aging involves expression lines. These lines form due to facial muscle activity such as squinting and smiling and are mostly prominent around the eyes and mouth.

Preventive measures include wearing sunglasses to avoid squinting and never smiling or laughing. Only so much prevention is possible, however, and I would not recommend limiting your facial expression, unless that expression is that of frowning. Treatment for facial expression lines depends on the position and depth of the line. Lines that are less deep may be treated with a chemical peel. Medium deep lines are treated with placement of fat, dermis, or filler materials such as collagen and fibrel under the crease. Some of these materials last longer than others. Deeper lines are usually treated with surgery such as facelifts, and eyelid and brow lifts.

Inherited Facial Features
Inherited facial features can contribute to premature aging. Lack of adequate bony support in the area of the upper cheeks can cause premature drooping of the lower eyelids. This can be corrected with malar or cheek implants at the time of the lower eyelid lift so the condition will be less likely to recur. Upper eyelids are more likely to droop with inadequate bony support of the brow.

Fatty deposits in the cheeks and under the chin can contribute to a plumper, older appearing face. These can be corrected using facial liposuction and/or the removal of the cheek fat pad through an incision made inside the mouth. A thinner more youthful appearance results from sculpturing the unwanted fat from the face. If the skin is still elastic, it will redrape without needing more extensive plastic surgery procedures which remove excess skin.

Balance of facial features such as the chin and nose creates a youthful appearance. In some people, plastic surgery procedures are done to create fuller lips or reduce lips that are too full in order to restore balance to the face.

Stress
The last cause of facial aging I would like to discuss is stress. Researchers studying aging have discovered that aging often occurs in spurts. You may have noted this in yourself or your friends when you see signs of accelerated aging after particularly stressful times. If you don't believe me, look at pictures of our former presidents before and after their 4 to 8 year terms.

One field of research that I feel is largely unexplored is that of the effect of stress reduction techniques on aging. The ability to reduce stress through daily practices such as exercise, yoga, and meditation can produce remarkable delays in facial aging and may even reverse some already established signs of facial aging. Of course a healthy diet including use of distilled or filtered water is also advisable, for the skin acts as a secondary organ for the elimination of unwanted material from the body. Dermatologists have long been able to study the effect of various diseases and malnutrition by the appearance and quality of the skin.

So what can you do to maintain your youthful skin and face? Avoid sun exposure, use a sunblock of S.P.F. 15 or higher, wear sunglasses to avoid squinting, eat a healthy diet consisting of fresh vital foods with elimination of excess fat and sugar, drink filtered or distilled water, and exercise regularly. I would also advise you to investigate some form of meditation where you quiet the mind perhaps while listening to soft music or perhaps while walking in nature, to allow the daily stresses to dissolve. Take time also to listen to your inner guidance for solutions to your stressful situations. And above all, celebrate and enjoy life, for in the enjoyment of the simple pleasures, we are renewed and rejuvenated in our body and soul.

Prevention and Treatment of Sun-Damaged Skin

2009-01-06T09:00:00.000-08:00

What causes facial aging? What can we do to prevent facial aging, and once established how can the damage from facial aging be corrected?

Facial aging is a result of a combination of factors, many of which are avoided with some awareness and preventive measures. A largely preventable cause of facial aging is called photoaging, or damage from sun exposure. Even if you are not a sun worshipper, cumulative exposure to sun over a lifetime can take it's toll. The once pink and fresh quality of the skin turns more yellow and sallow appearing, just as fabric on your furniture that is constantly sun exposed turns pale and yellow.

To avoid this chronic exposure of sun, we recommend a makeup with a sunscreen or sunblock built into the base. This provides yearlong protection. For those occasions that call for extra protection, use a sunblock with a 15 or higher rating applied prior to the makeup on all sun exposed surfaces. Photoaging appears as the yellow, sallow change in the skin, but may also result in multiple fine wrinkles, blotchy pigmentation spots, and a dried out or leathery appearance to the skin.

Prevention of course is the best course, but if you find yourself with sun damaged skin, there are several treatments available. In addition to a vigorous prevention program to avoid any further damage, we recommend a treatment program with Retin-A, often using a glycolic acid cleanser to loosen surface skin cell connections, so that the Retin-A is more effective. Retin-A or tretonin is a medication that helps to return the epidermal skin cells (or those cells on the skin surface) to normal after they are sun damaged. There is some evidence that Retin-A may help prevent skin cancer due to this effect. Currently Retin-A is only approved for the treatment of acne, but dermatologists and plastic surgeons have noted some improvement in the fine wrinkles and other signs of photoaging probably as a result of the changes of the epidermal cells at the skin surface.

Retin-A is used at night after your makeup is removed. A low concentration (0.025% to 0.01 %) is usually prescribed followed by a gradual increase in strength up to 0.1% in order to see full benefits from the treatment. As Retin-A can be irritating to the skin with redness and dryness, a moisturizing program usually twice daily is necessary. Retin-A makes the skin very susceptible to sun damage, therefore a sunscreen program must be started at the same time. Retin-A's effects take several weeks to months, but clinical benefits include improvement in blotchy pigmentation, smoother texture, decreased pore size, softening, or even resolution of fine wrinkles. We believe new fresher skin may also be less prone to superficial skin cancers.

Another program that helps with photoaging is glycolic acid. Glycolic acid is a weak acid found naturally in sugarcane, that acts as a super moisturizer to help reduce the dryness caused by sun exposure, helps to remove superficial pigmentation or brown spots, helps to even out the epidermal or skin surface, and helps to reduce pore size. It does not appear to have the benefit of Retin-A in repairing damage that may cause skin cancer. Glycolic acid is placed in various products supplied for daily use on the face. The most effective program consists of daily treatment with a general glycolic acid facial cleanser for two to three weeks prior to a glycolic acid peel at a higher strength. The glycolic acid peels are performed by trained personnel usually in plastic surgery or dermatology offices. A series of peels given at one to two week intervals is recommended for optimal results.

The advantage of glycolic acid peels, compared to other facial peels, is that after neutralization, the surface changes consist usually only of some mild to moderate redness. Makeup can usually be applied after the peel and no special precautions are needed. For this reason, we are able to use this peel on women of color with virtually no risk of pigmentation irregularities, often seen with deeper peels. Not all brown spots and pigmentation problems respond to glycolic acid peels, however. This is why your dermatologist and/or plastic surgeon evaluates your skin prior to recommending a particular skin program.

For more severe photoaging with leathery skin and deeper wrinkles, a deeper chemical peel is needed. The depth of the skin damage determines the depth of the chemical peel needed to correct the damage. A chemical peel of medium depth usually involves T.C.A. or trichloracetic acid which is a stronger acid than glycolic acid. This acid is applied to the facial skin alone or in combination with other agents, in order to create a deeper degree of peel.

After a T.C.A. peel there is usually a more noticeable degree of redness and superficial blistering and peeling of the skin surface similar to a severe sunburn. After five to ten days, the epidermal or surface layer regenerates as a smoother and more even skin surface with less blotchy pigmentation. It is critical not to expose this delicate new skin to the sun. Inadvertent sun exposure can lead to complications of blotchy pigmentation, irregularities, and the need for additional chemical peels to correct these problems. A moisturizer program is also advised after a peel and many dermatologists and plastic surgeons pretreat peel patients with Retin-A for two to six weeks to help reduce potential unevenness of the peel due to thickened, dried epidermal skin cells.

For those patients with severe sun damage, a phenol chemical peel may be advisable. This peel has several ingredients of which the main one is phenol which produces a deeper peel that is used to treat deeper wrinkles. The disadvantage of this peel is the length of recovery (usually seven to fourteen days) during which wound care to the face is needed, and the persistent redness of the skin for many months after the peel. As sun exposure is very detrimental to the newly formed skin, this peel is usually performed in the fall or winter so some healing has taken place prior to the sun intensive seasons. Neither T.C.A. or phenol peels would be performed on patients who are taking Accutane for acne.

As there are many factors to consider in choosing a peel including skin type, depth of wrinkles, skin pigmentation, pre-existing skin conditions such as acne, skin sensitivity, pore size, and lifestyle as well as many types and subtypes of peels available, evaluation by a plastic surgeon or dermatologist is advisable.

If facial aging is more severe, a plastic surgeon also has a variety of surgical procedures to correct other aspects of facial aging such as those due to gravity, expression lines, and localized fat deposits in the cheeks or under the skin.

Laser Breast Reduction

2009-01-06T08:57:00.000-08:00

Dr. Grant Stevens, Medical Director of Plastic Surgery Associates, has performed hundreds of breast reduction operations for women who share many similar experiences. He has observed a dramatic increase in the number of patients seeking breast reduction surgery. Although the procedure is not new, traditional reduction mammoplasty has had its drawbacks, including loss of nipple sensation, inability to breast feed, prolonged surgical time, blood loss that sometimes requires transfusion, and poor cosmetic results. Dr. Stevens has helped to refine the surgical techniques in order to minimize these concerns using laser. Women have breast reduction surgery for many reasons. Many complain of pain and soreness of the back, shoulders and neck, while others experience pain and indentations from bra straps. Women who are active in athletics often experience soreness from the constant weight shifting during their activities.

The psychological aspects of very large breasts are also compelling. Women understandably feel self-conscious when their breasts are the focal point of attention. Many women experience difficulty finding fashionable clothing. Some are forced to split sizes and may avoid wearing bathing suits and other clothing altogether. Overall, these experiences may have serious negative effects on a woman's self-esteem.

Dr. Stevens assures women considering laser breast reduction that sensation to the nipple is rarely lost and, in fact, often times increases once the heavy breast tissue is removed. In addition, since the nipples are not detached during laser breast reduction surgery, the overwhelming majority of patients are able to breast feed their children.

Laser breast reduction surgery is performed under general anesthesia. The incisions are made horizontally and vertically, adhering to the natural contours and folds of the breast. The laser is then used to preserve the pedicle of breast tissue that supports the nipple. The entire breast is lifted along with the nipple that remains attached to the breast at all times. Excess tissue, fat and skin are removed from the sides of the breast. Once the breast is repositioned properly and the excess tissue removed, the incisions are closed with dissolving sutures placed beneath the skin. With this technique, there are no cross-hatches or stitch marks visible and no need for sutures to be removed. Most women experience minimal post surgical discomfort and generally a quick recovery period. Women frequently return to work in one week and resume full activities in 2-3 weeks.

Dr. Stevens not only reduces the size but also aesthetically sculpts the breast when performing the laser breast reduction. He is actually able to "sculpt" and lift the breast for optimum aesthetic appearance and balance within the overall structure of the patient's body contours. This "liposculpting" is done over the chest and armpit area. This cosmetic sculpting not only improves the appearance of the final breast reduction, but also minimizes the size of the incisions. While reduction mammoplasty is still performed primarily for medically indicated situations, more women are electing to have this surgery for cosmetic purposes.

Laser breast reduction, along with liposculpting of the breast, has resulted in decreased surgical time, minimized scarring, decreased blood loss, preservation of nipple sensation and a natural lifting of the breasts. With the addition of the laser and breast liposculpture, breast reduction surgery achieves the goals of relieving the pain and suffering while beautifying the natural form and contour of the breast.

Laser Skin Resurfacing can help ease the effects of sun damage, aging, and acne on facial skin

2008-12-24T17:53:00.000-08:00

Laser skin resurfacing is a cosmetic surgery procedure that can help ease the effects of sun damage, aging, and acne on facial skin. Laser skin resurfacing works by removing the outer layers of skin where the problems are located and stimulating the production of collagen and new skin cells in the underlying layers. Laser skin resurfacing is popular because it is relatively safe and effective and is often done as an outpatient procedure. The result is usually smoother, younger, healthier looking skin.

Laser Skin Resurfacing Candidates

Laser skin resurfacing is appropriate for patients who want to diminish discoloration as well as wrinkles, sun damage, acne marks, or other types of scarring. Laser resurfacing can often effectively treat skin that is uneven in color or texture. Still, those with severe scarring may need to use additional scar revision techniques in order to achieve the best results possible. Also, if skin is loose, a facelift may be needed to fully improve its appearance. The best candidates are those who have realistic expectations and who discuss their questions and concerns with the physician beforehand. An initial consultation with the cosmetic surgeon can help to ensure optimal results are achieved.

How is Laser Skin Resurfacing Performed?

Before laser skin resurfacing is performed, the cosmetic surgeon administers a local numbing treatment, a mild sedative, or general anesthesia. The choice depends on the individual patient and his or her specific needs.

Once the necessary medication has been administered, the cosmetic surgeon uses a special laser to resurface the skin. Using a precise and controlled beam of light, the outer layers of skin are vaporized, revealing the smooth, unblemished skin beneath. While the old, damaged layers are removed, the growth of new skin cells is stimulated.

Currently, carbon dioxide and erbium lasers are the two types of lasers most commonly used for laser skin resurfacing. Both lasers allow for quick procedures. They also help to minimize the risks for the patient by limiting the amount of heat that the skin absorbs and offering the cosmetic surgeon a high level of precision.

Botox Injections – Treatments for the Reduction of Wrinkles

2008-12-24T17:29:00.000-08:00

Botox injections utilize Botulinum Toxin Type A to treat wrinkles. Botox was originally slated to treat neurological disorders; today, it is widely and successfully used to remove facial lines, especially frown lines, "crow's feet," and forehead lines.

Who is the Best Candidate for Botox Injections?

Good candidates for Botox injections include younger people with facial wrinkles and those who cannot undergo a more extensive plastic surgery procedure such as a facelift. Certain medications may alter the potency of Botox injections, increasing the likelihood of bruising and bleeding. These include some antibiotics, anti-inflammatories, and aspirin, as well as some vitamins and herbs. People with neurological disorders should avoid having Botox injections. Also, women who are pregnant or nursing should not have Botox injections, because the effects on the fetus and on breast milk are unknown.

How are Botox Injections Administered?

Botox is injected directly into the muscle surrounding the wrinkle with a very small needle. If patients experience any discomfort, it is usually minimal and only lasts a few seconds. Once injected, Botox works by preventing nerve impulses from reaching the muscle, allowing it to relax. The effects of the procedure are usually noticeable within a few days. Although the results are not permanent, they usually last for a number of months. Botox injections are performed on an outpatient basis and may be repeated when the results diminish.

Botox Side Effects

Botox injections are relatively safe for most patients. The most common side effects of Botox injections are mild numbness, swelling, bruising, or tingling in the area. Most of these do not occur when the procedure is performed correctly. The patient can help prevent bruising and numbness by refraining from rubbing or touching the treated area for the first day after the procedure is done. A small number of patients report no improvement following their Botox injections. Patients should be screened for allergy to Botox before the procedure is undergone.

If you are interested in learning more about Botox injections, contact a plastic surgeon in your local area.

Abdominoplasty or Tummy Tucks

2008-12-24T17:19:00.000-08:00

Abdominoplasty, also known as "tummy tuck" surgery, is a procedure to remove excess skin and fat from the middle and lower abdomen and to tighten the muscles of the abdominal wall. This surgery is helpful to women who, through multiple pregnancies or significant weight loss, have stretched their abdominal muscles and skin beyond the point where that skin will be able to naturally return to normal.

Sometimes fat deposits are limited to the area below the navel and may require a less complex procedure called a partial Abdominoplasty or "mini tuck." You may benefit more from a partial or a full Abdominoplasty, done in conjunction with liposuction to remove fat deposits from the hips for a better and more pleasant body contour.

Regular smokers should plan to quit at least 2 weeks before surgery and not resume for at least two weeks after surgery. Avoid over exposure to the sun before your surgery, especially to your abdomen. It is also important to maintain a regular eating schedule (no strict dieting) prior to the procedure. The primary incision is made along the bikini line, just above the pubic area, and a second incision may be required to free the navel from surrounding tissue.

Abdominoplasty typically takes four hours, depending on the extent of the tuck required. You will need someone to drive you home from the hospital. You may wish to arrange help for two to three days following your surgery.

After your surgery, you may have a small drain inserted to release fluid from the surgical site. This drain will be removed when drainage has slowed or stopped. For the first few days your abdomen will probably be swollen. Any pain or discomfort you have will be controlled by medication. You will usually have gauze dressing on your abdomen covered by an abdominal binder. This will remain in place until you visit your physician post operatively. Sutures are typically removed in about ten days and your abdominal dressing will be replaced by a support garment.

You may expect to go back to work within one to two weeks. During the first three to six months, your incision will be pink and raised. Expect it to take nine months before your scars flatten out and lighten in color.

Q & A: Nasal Refinement, Will my voice change after rhinoplasty?

2008-10-28T19:56:00.000-07:00

Your nose is so much about who you are, that if you are not on good terms with it, life seems somehow out of balance.

The nose is also the last organ on your body to stop growing as you get older. So even if your nose was a point of pride as a teenager, it may not have kept pace with your adult life, or it could be telling your age to all who see it.

Rhinoplasty, the surgical term for nasal refinement, is among the most performed cosmetic procedures in the world. And it is one of the few that is often covered by insurance because it’s so involved with your general health. When you consult with surgeon about changing your facial profile, your nose is the first area he will look at, because little changes can have a huge effect.

Improving your appearance through nasal surgery can reduce or increase the size of your nose, change the shape of its tip or bridge, or narrow the span of your nostrils. It may also correct an injury or birth defect, or alleviate some breathing problems.

A procedure as simple as raising the tip can take years off your appearance. Changing the angle between the bottom of the nose and the upper lip can balance the entire lower part of your face. The next time people see you, all they’re likely to notice is that your smile seems somehow more "full of life."

Surgeon may also recommend changes to your chin or cheeks at the same time, so that the individual parts of your face will work in better concert as a whole. You can count on surgeons’ long experience and aesthetic judgment to do what it takes to create the well-proportioned image you’ll carry confidently wherever you go.

Through nasal refinement procedures, surgeon will help you define the profile that can enhance your appearance and self confidence. Your nose will always be the part of you that focuses your entire face, and it can be the nose that truly represents who you are.

Q. Will my voice change after rhinoplasty?
A. No. Such changes will only occur if major sinus work is performed at the same time. This does not include septoplasty or turbinectomy.

Q. How long is the recovery period?
A. The splint is removed within five to seven days after surgery. There is mild to moderate swelling with slight bruising. This dissolves within 1-1/2 to 2 weeks. Small amounts of cover makeup will conceal this. Most people can return to work within 2 weeks, some sooner after rhinoplasty.

Q. Is there more bruising and pain if the nose is fractured?
A. There seems to be a lot of misinformation about whether nasal infracture is necessary. Certain surgeons who are performing removal of the hump with replacement of artificial materials are actually causing irreversible damage to the patient. The infracture should not be feared. It is neither painful nor is there any further bruising. It is only a small bone less than a centimeter in length, and only a millimeter or less in thickness, that is fractured. People assume that a fracture means pain but this is not true when it comes to the nose.

Q. How long does the nose take to heal?
A. Noses tend to look pretty good at one month and are about 90% healed at four months. But it will take as long as two years for all the swelling to go down and changes to occur.

Cosmetic nasal surgery: Incisions, Recovery

2008-10-28T19:53:00.000-07:00

Nose Surgery

Cosmetic nasal surgery is more popular than ever. People are seeking cosmetic nasal surgery for a wide range of reasons. It can help people who feel that their nose is too small, too large, too long, too short, too wide, too narrow, too prominent, too flat, or crooked.

The potential for cosmetic nasal surgery seems boundless. Because each nose is different, the surgical plan for refining the nose is highly specialized according to the patient’s anatomy, desires, and other facial features. It involves a combination of refining, rearranging, augmenting, or reducing the underlying bones and cartilage of the nose to achieve the desired refinement.

Incisions

Most of the incisions are inside the nose and are, therefore, not visible. In some cases, your plastic surgeon may recommend a small incision under the nose to facilitate the surgery and optimize your result. When this small incision is used, the surgery is referred to as "open rhinoplasty". Even though this incision involves a small scar under the nose, it is minimally visible.

Recovery

Cosmetic nose surgery, or rhinoplasty, is most commonly performed as an outpatient procedure. You may be awake or asleep during the procedure, depending on the preference of you and your plastic surgeon. Light packing may be placed in your nostrils to prevent bleeding following surgery and is usually removed with a day or two. Discomfort is mild to moderate and is controlled with prescribed pain medication. Swelling is variable and can last from one week to one month or longer. Sleeping with your head elevated for the first several nights following surgery will significantly diminish the swelling. Bruising usually resolves within one to two weeks. Most are able to return to work within one to two weeks and resume exercise within a month.

African Americans Rhinoplasty (Nose Job, Nose Refinement)

2008-10-28T19:26:00.000-07:00

Rhinoplasty helps to refine the nose and brings it into harmony with the rest of the face. I will emphasize at this early stage that there are no structural defects in the black nose. The difference between an African and a Caucasian nose may be due to adaptation to their unique environments.

There is great reluctance amongst African Americans about doing any type of cosmetic surgery, however it has become increasingly popular in the last 10-15 years as a result of well publicized successful surgeries in prominent African American entertainers.

Good results in Black rhinoplasty are greatly increased with a better understanding of the cultural diversity of the Black nose. Following the works of prominent Black plastic surgeons, the Black nose has been classified into three main groups:

Afro-American Afro-Caucasian Afro-Indian

A typical Afro-American nose has a nasal bridge that is wide, short, flat or saddle shaped. The tip of the nose is bulbous with no significant projection. Nostrils are wide, height is short and the skin envelope is thick and oily.

Low or concave dorsum is corrected by dorsal augmentation. Augmentation can be accomplished by cranial, rib or iliac bone graft, cartilage graft or silastic implant. The silastic implants are employed only in primary rhinoplasty, when the skin is thick, and preferably when a cartilage tip graft is in place. The cartilage tip graft ensures that the caudal end of the implant does not press directly into the skin and therefore reduces the possibility of skin erosion and implant extrusion.

Dorsal augmentation can be accomplished without breaking and putting together (osteotomy and infracture) the nasal bones. The dorsal graft not only raises the dorsum, but also creates the illusion of narrowness.

The main concern of patients with African type noses is the bulbosity of the nasal tip. This bulbosity arises from the thick oily skin and the extensive fibro-fatty tissue covering the alar cartilage and attached to the overlying skin. Correction of bulbosity therefore involves defatting of the alar cartilages, the space between the domes, and sometimes the surrounding skin. The alar cartilages are smaller and thinner, excision of the upper portion of the cartilage is limited in order to avoid alar collapse. Poor tip projection is corrected usually by tip grafts using septal or conchal (ear) cartilage.

Another major concern with African type noses is the width of the nostrils. These are narrowed by excision of the alar rims and reduction of the nostril floor. Sometimes in patients with very wide nostrils, there is a limit to which this can be reduced in order to avoid a pinched look.

Afro-Caucasian Nose

The Afro-Caucasian nose is longer and the bridge is narrower with a hump. The tip is thinner and projects. The nose is higher and nostrils are narrower.

In the Afro-Caucasian nose, dorsum can be narrowed by separating the nasal bones from each other, as well as their attachments, and compressing these bones together in order to narrow the dorsum of the nose. Dorsal augmentation may not be necessary to narrow the nasal bridge, but if required it is usually thin.

Management of the tip in the Afro-Caucasian includes generous excision of the alar cartilages because they are usually big and thick. The domes of the alar cartilages can be sutured together with non-absorbable sutures to further narrow the tip.

The width of the nose is usually smaller than the Afro-American nose, therefore nasal floor reduction is not usually necessary.

Afro-Indian Nose

Afro-Indian noses are long and straight. The bridge is wide with a big hump, with a bulbous tip and wide nostrils.

The management of the dorsum in the Afro-Indian type of nose is very similar to the Afro-Caucasian. The nasal bones are usually broken from their attachments and pushed together to narrow the nasal bridge. In addition, the Afro-Indian nose usually has a hump that needs to be shaved down. There is less frequent need for an augmentation.

The management of the nasal tip involves more generous resection of the alar cartilages, like in the Afro-Caucasian nose, as well as an extensive defatting, as in the Afro-American nose. Better tip projection is also achieved by suturing the alar cartilages together until the desired result is achieved. The nostril are usually wide in the Afro-Indian nose and nostril floor reduction is usually indicated.

What patients should know

Other important information to let patients know, prior to surgery, includes the need for nasal packings for a couple of days and drainage from the nostrils for about the same length of time after surgery.

The nose is swollen for up to six months following surgery, and patients will need to wait for the swelling to go down to fully appreciate their new features.

As pointed out earlier, there is nothing wrong with the Black nose, provided it is well proportioned to the face. Corrections are needed in parts of the nose where there may be excesses or inadequacies. The ultimate correction depends on what the individual patient wants, within the capability of the surgeon to make the changes.

Middle-aged affluent Blacks want refinement with maintenance of their ethnicity. These patients generally have good results. Problems generally occur with patients who desire Caucasianization of their noses, but do not request it at the time of their initial surgery. Overall, rhinoplasty can be dramatically positive with a proper pre-surgical evaluation and appropriate surgery.

Q & A: What Can I Reasonably Expect From Plastic Surgery? What Are The Risks, Cost?

2008-10-28T08:30:00.000-07:00

How do I choose a Physician?
You should be aware that in California, ANY medically licensed physician can legally claim to be a plastic surgeon. So, you'll need to ensure that your doctor is trained in plastic surgery, and is certified by the American Board of Plastic Surgery. Physician who are certified by the American Board of Plastic Surgery have received specialized residency training and have successfully completed a rigorous oral and written examination in this specially.

Should I have plastic surgery?
This is a very personal decision, and one that should always be discussed with a certified plastic surgeon. The surgeon will be able to explain exactly what is involved, and what kind of changes in your appearance you can reasonably expect. While plastic surgery cannot completely change a person's appearance, significant improvement can often be achieved through reconstructive or cosmetic surgery. Use the following questions in assessing if cosmetic surgery is right for you:

What is it that I want changed?
This could be anything from losing pounds of unwanted fat, to losing the "crow's feet" by your eyes. If you're unhappy with some part of your appearance, it's worth looking into. Is this just a passing whim, or do I really want this changed? Most cosmetic surgery patients have wanted a change for some time.

Is this just a passing whim, or do I really want this changed?
Most cosmetic surgery patients have wanted a change for some time.

What can I reasonably expect?
Your surgeon will help you determine if your surgery goals are reasonable and attainable. It could be that the way you see yourself after having surgery is not a realistic picture. Your surgeon can help you understand how much of a change will be made, and what the final result will look like.

How much will this cost?
Besides telling you the cost of the surgery, if your goal is to have a number of different surgeries (perhaps having your nose and lips done), your surgeon will be able to help you best use your surgery dollars. It may be possible to have a few procedures performed at the same time and save some money.

You should also note that most insurance does not cover plastic surgery unless it is deemed medically necessary for health or well-being. Check with your insurance company to see if your operation will be covered, and what conditions may be required for coverage.

Procedures` Average Cost

Breast augmentation $3,000.00

Breast lift $3,500.00

Breast reconstruction Implants $2,500.00 to 3,000.00
Flaps $5,000.00 to 7,000.00

Breast reduction $5,000.00

Buttock lift $3,500.00

Cheek implants $2,000.00

Chemical peel (full face) $1,600.00

Dermabrasion $1,600.00

Ear surgery $2,500.00

Eyelid surgery (upper) $1,500.00

Facelift $4,700.00

Laser skin resurfacing (full face) $2,700.00

Liposuction - a single site $1,800.00

Nose reshaping $3,000.00

Tummy tuck $4,000.00

Retin-A treatment - per visit $ 100.00 t0 $300.00

Is it safe?
It's important to realize that, like any other surgery, there are risks associated with plastic surgery. Discuss in detail the risks of your desired procedure with your surgeon. Find out what complications are possible, how likely they are. Also find out what physical limitations you may have immediately after your surgery. By selecting a qualified plastic surgeon, one who is board certified in plastic surgery risks can be minimized.

Where will the surgery take. place?
Plastic surgery generally takes place in a hospital or your surgeon's facility. Simpler operations can be performed at your surgeon's facility, while more complex surgeries may require a hospital setting.

What kind of information your surgeon will need in planning your surgery?
Be sure to tell your surgeon if have any underlying medical condition that my cause problems during or after surgery such as uncontrolled high blood pressure, bleeding disorders, or tendency to form excessive scars.

If you taking any medications, herbal supplements, specially drugs that affect bleeding.

What kind of anesthesia is needed?
You may receive a local anesthetic to numb the area to be worked on, or be given a general anesthetic where you'll sleep through your surgery.

What preparation will you need for your surgery?
Instructions will be given to you by your surgeon on how to prepare for surgery, including guidelines on taking or avoiding certain medications and vitamins, eating, drinking and smoking. If you smoke, it is specially important to avoid it at least 10 days before your surgery. After surgery, smoking inhibits blood flow to the skin, and can interfere with the healing of your incision areas.

Is it painful? How long will it take me to recover?
This will depend on the type of surgery you choose. In general, the more invasive the procedure is (i.e. bone reconstruction, internal sutures) the longer the recovery time can be and the more recovery time may be needed. Of course, these will all vary by how MUCH is done, age of patient, etc, but you can say that as well.

Most patients will require assistance for the first two days. Then most patients are able to care for themselves, but may still need assistance if they have small children to care for. The specific lengths of disability are outlined below by procedure. These are approximations, and do not include return to exercise.

Eyelid Surgery - Usually can get around independently by the second day. With the use of sunglasses, may feel comfortable going to the store by day 3-4, and with make-up could return to work by 5-7 days.

Facelift Surgery - Usually can get around independently by the second day. Usually do not feel comfortable going out in public for 5-7 days. Requires 10-14 days before returning to work if in the public eye.

Breast Surgery - Usually can get around independently by the second day. May return to work at 5-7 days if not required to lift more than 15 pounds.

Liposuction - Usually can get around independently by the second day, earlier if smaller number of areas treated. One can return to work and normal activities in 5-7 days.

Abdominoplasty - Patients may take between 2-4 days before getting around independently. The recovery is almost identical to C-section. One can return to a desk job at 5-7 days, other jobs 10-14 days.

When can I resume normal exercise?

The time a patient resumes regular exercises varies based on the operation performed. All patients are encouraged to start a slow walking routine on the second postoperative day. Regular aerobic and more vigorous activities are not allowed during the first 2 weeks in order to decrease the risks of bleeding, swelling, and bruising. Weight lifting and contact sports are allowed at 1 month in most cases.

Does plastic surgery leave scars?
All surgery leaves scars. The type of procedure performed and an individuals ability to heal both play a part in type of scar that results. Some scars eventually become a fine line that scarcely noticeable. A plastic surgeon is trained to close wounds in a way that makes the scars asinconspicous as possible.

What is the most common plastic surgery procedure?
The most common plastic surgery procedure overall is tumor removal (for skin lesions such as skin cancers). The most common cosmetic surgery procedure is liposuction, followed by blepharoplasty (eyeled surgery), rhytidectomy (face lift), rhinoplasty (cosmetic nose surgery), breast augmentation (enlargement),
and abdominoplasty (tummy tuck).

Is it true that the numbers of cosmetic surgery procedure have increased dramatically?
A study by the American Society of Plastic Surgeons revealed during the past 5 years all cosmetic surgery procedures have increased by more than 50%, and more than tripling with liposuction and breast augmentation (enlargement).

Which plastic surgery procedure do men have performed most often?
Men most often have the nose reshaped, followed by eyelid surgery.

How much cosmetic surgery is performed on teenagers?
About 3% of all cosmetic surgery is performed on people 18 years old or younger. The top procedure is nose reshaping.

How old are most people when they choose to have cosmetic surgery?
Usually about 35-50 years of age is the primary category for cosmetic surgery. In 1992 and 1994, this group accounted for more than 40% of all cosmetic surgery.

In which state is cosmetic surgery most popular?
1 out of 5 cosmetic surgery patients reside in California.

What is a facelift?
A facelift or "rhytidectomy" is a surgical procedure designed to improve the most visible signs of the aging process by eliminating excess fat, tightening the muscles beneath the skin of the neck, and removing sagging skin. It doesn't stop the aging process but merely "sets the clock back".

Who would be the best candidate for a facelift?
Most patients are in their 40s to 65s. A man or woman whose face and neck have begun loose some elasticity of the skin and begun to sag, and whose bone structure is strong and well-defined.

What is the Submusclar Aponeurotic System?
The SMAS is a layer beneath the skin which invests the facial muscles. By tightening the SMAS, the jowls are lifted, the neck is tightened, the cheeks are elevated. This "deep" or "2-layer" facelift is an improvement over earlier skin-only techniques.

How long does a facelift last?
No one can say for sure. The clock is turned back, but keeps on running. Ten years later, you will look better than if you never had facelift plastic surgery. Many patients never have a second facelift, while others may desire further plastic surgery seven to 15 years later.

Can facelift plastic surgery be done without scars?
The scars from facelift plastic surgery usually fade and are barely perceptible. In some patients, especially younger ones, endoscopic surgery can be used to lift the eyebrows, remove frown lines, elevate the cheek and jowls, and tighten the neck. This endoscopic surgery can be done with tiny scars. However, if there is excessive skin, it must be removed for the best results through standard facelift incisions.

How long will I be out of work after facelift plastic surgery?
Most patients are able to return to work in two to three weeks after facelift plastic surgery. You should allow four to eight weeks before major social engagements.

How can I hide things during the time until I return to normal?
Your plastic surgeon will discuss post-operative camouflage techniques with you prior to your surgery, but be assured that while almost everyone has some sort of temporary side effect such as bruising and swelling, there are makeup techniques that both men and women can use almost immediately to disguise them.Generally speaking, makeup techniques can be used soon after facelift plastic surgery to cover discolorations, and to hide incision lines after the stitches have been removed and the incision is completely closed. Camouflage cosmetics include three basic types of products: Concealers to hide incision lines and discolorations; contour shadows to disguise swelling; and color correctors to neutralize color in reddened skin.

What is liposuction?
Liposuction is the surgical vacuuming of fat from beneath the surface of the skin. It is used to reduce fullness in any area of the body. It is an excellent method of spot reduction but is not an effective method of weight loss.

What is the tumescent liposuction technique?
The tumescent technique involves injection beneath the skin of large volumes of salt water containing lidocaine, a local anesthetic and small amounts of adrenaline, a naturally occurring hormone which shrinks blood vessels. By injecting this solution to the fat prior to performing liposuction the plastic surgeon numbs the tissues and shrinks the blood vessels thereby eliminating pain and reducing and minimizing bleeding, bruising, and swelling. The tumescent technique permits some patients who were previously treated under general anesthesia to be treated under local anesthesia with sedation.

Who is a candidate for liposuction?
Generally people who have localized areas of protruding fat achieve the most dramatic results. Patients who are slightly overweight can benefit from liposuction. It is best to be at or near your normal weight. Good skin elasticity permits the skin to shrink easily to the reduced contour. There are no absolute age limits for liposuction.

What areas are most frequently treated?
In women, the single most frequently treated areas are the outer thighs, followed by the stomach. In men, the flank area or "love handles" are treated most frequently.

Can liposuction tighten up a loose neck?
If there is excess fat in the area under the chin and the skin is taught, liposuction alone can produce a more sculpted, angular, and youthful jaw line. If, however, the skin of the neck is loose, hanging, or crepey, even if there is excess fat, liposuction alone will not produce the desired result. Patients with loose skin usually require a face and neck lift in addition to or instead of liposuction. In general, most patients who benefit from liposuction of the neck are under 40. Most patients over 40 will require some surgical skin tightening.

Liposuction seems very simple and safe. Are there any dangers associated with liposuction plastic surgery?
Although liposuction is very safe and effective, it is a surgical procedure and can cause complications such as infection, bleeding, and nerve damage. In addition, aesthetic complications such as skin irregularity or waviness can occur if too much fat has been removed. Fortunately, complications are uncommon and most patients are satisfied with their results.

What will my nose look like after surgery?
In general, rhinoplasty, cosmetic nose surgery, is designed to reduce excess cartilage and bone in the nose, removing irregularities and bumps to give a straightened, smooth and, usually, smaller appearance. Adding tissue to enhance certain features of the nose can also occur. The overall trend in modern rhinoplasty is away from over-reduction of tissue which can reduce the ability to breath through the nose and towards individualized treatment of each segment of the nose to give a balanced and refined look without compromising function.

How long does nose plastic surgery take and what kind of anesthesia is used?
Usually, rhinoplasty takes from one to three hours depending on the complexity of the condition of the nose. Most patients have sedation prior to and during the procedure while some patients request a general anesthesia. Nearly all rhinoplasty operations are done as outpatient surgeries.

Is there a lot of bruising after nose plastic surgery and how long will it last?
This depends again on how complex the procedure is, but in general most patients
experience five to seven days of purple discoloration and swelling around the eyes and upper cheeks. The nose itself will be swollen for around ten to fourteen days or longer, but subtle resolution of the swelling at the tip of the nose can take many months after surgery to go away.

If you have trouble breathing through my nose and have terrible sinus problems. Will my insurance policy pay for nose plastic surgery (rhinoplasty)?
The condition described is usually associated with a deviated septum or a bent internal framework of the nose. Most of the time this results from trauma such as a broken nose but many patients with this condition cannot recall an episode where this might have occurred. The condition described in this question however, could also result from allergies or the two conditions can exist simultaneously. Careful examination is needed before surgery to separate the two conditions. While individual insurance policies can vary, in general, functional surgery to improve breathing is considered a covered benefit in many group policies. If additional correction of a cosmetic deformity of the nose is done at the same time the cost of this part of the procedure is usually not covered by insurance.

Where are the incisions placed during nose plastic surgery?
In general, most or all of the incisions in rhinoplasty are hidden in the inside of the nostril. While external incisions hidden in the creases where the nose meets the cheek can be used to narrow the nose, incisions on the bridge or tip are not usually used in cosmetic surgery of the nose.

Will my nose grow after surgery?
In general, our noses tend to elongate as we enter the middle years of our life and
drooping of the tip of the nose can occur in the later years as elasticity disappears from the body. While undergoing a cosmetic rhinoplasty as a teenager or young adult will not prevent the effects of aging on the nose, the final shape that results from this surgery is expected to last a lifetime and regrowth of bumps and deformities corrected by the operation is a rare occurrence.

What is a blepharoplasty?
Blepharoplasty offers to eyelid surgery and is designed to remove the excess fat, along with skin and muscle, from the upper and lower eyelids. It is the second most common aesthetic procedure performed by plastic surgeons.

How is the eyelid plastic surgery performed?
Eyelid plastic surgery is usually performed using local anesthesia and light intravenous sedation. It is commonly done in a doctor's office, outpatient surgical center or, in some cases, in a hospital. Eyelid plastic surgery is most often performed on an outpatient basis.

Are there scars from the eyelid plastic surgery procedure?
Scars are a result of any surgical procedure. The incisions made to accomplish the goals of plastic surgery of the eyelids are barely visible after several months as they are placed within the normal creases and folds of the upper and lower eyelids. In patients who only need removal of fat from the lower eyelids, the incision can be made on the inside of the eyelid, and will therefore result in an invisible scar.

Will the fine wrinkles around my eyes go away after eyelid plastic surgery? What about my sagging eyebrows and dark circles under my eyes?
The blepharoplasty procedure will not eradicate the wrinkles around the eyes (crow s feet) nor will it elevate droopy eyebrow. There are other procedures designed for these purposes. Dark circles under the eyes may improve a bit if this is related to large bags, but most often the dark appearance of the lower eyelid skin remains.

Can anyone have eyelid plastic surgery?
The best patients are those who are healthy, psychologically stable and well motivated. Some medical conditions may increase the risk of blepharoplasty surgery such as thyroid disease, high blood pressure, and patients who do not make sufficient tears to keep their eyes well lubricated.

What are the risks involved with eyelid plastic surgery?
Fortunately, when performed by a competent plastic surgeon, complications are infrequent and minor. All patients will experience some bruising and swelling for a few days after the surgery. In addition, a temporary problem with closure of the eyelids is usually seen. Some may have temporary blurring of their vision, usually due to the ointments applied to the incisions post operatively.

In rare instances, the lower eyelid may be pulled down causing an ectropion. If this does not resolve on its own, further surgery may be necessary. The theoretical complications of any surgical procedure, such as bleeding, infection, wound disruption and heavy scarring are also possible, but rare

Laser Skin Surgery: What you need to know

2008-10-11T17:42:00.000-07:00

Laser for Skin Rejuvenation - Laser Resurfacing Surgery

Cosmetic laser surgery has come to the forefront of facial rejuvenation surgical procedures. This has actually occurred over many years and it is most recently due to significant changes in technology with the application of the CO2 laser. While the CO2 laser has been used in medicine for almost two decades, recent advances including the superpulse CO2 laser mode and higher power of CO2 lasers, have made cosmetic facial rejuvenation more viable and the results more predictable and desirable. It is for this reason that laser resurfacing has become a most popular and effective method of treatment of sundamaged skin or photoaging, lax or aging skin, wrinkles and facial scarring such as that due to acne. It is also useful for other conditions.

Laser surgery is carried out on an outpatient basis under "twilight anesthesia." The surgical procedure takes from 45 minutes for resurfacing of the mouth region to approximately two hours for resurfacing of the full face. Following laser resurfacing, the skin appears pink, moist and usually quite smooth. The outer layers have been removed during the surgical procedure and after the anesthetic wears off, the skin will be somewhat tender and some swelling is expected for the first two to three days. A burning sensation may be present but will be helped by the medication provided. It is important to keep the head elevated as much as possible for two days following the surgical procedure. A recliner is most helpful since it allows one to be able to sleep on his/her back. While the ability to work is not impaired, most patients may return to work and social activities within seven to 10 days, depending on the extent of treatment. The skin at that point will look red and sunburned in appearance; however, makeup is available for both men and women. Exercises may be resumed within one to four weeks. Extremes of heat, cold and wind should be avoided for several months.

Once the skin has healed, it is imperative to avoid sun exposure for at least six weeks; otherwise, sunburn, hyperpigmentation and other complications may occur. Laser areas should be protected by using wide-brimmed hats and potent sunscreen products for at least six weeks. This office provides two types of kits for laser procedures. The pre-laser surgery kit is extremely important since preparation of the skin prior to laser procedures is essential. Preparation of the skin consists of the use of glycolic acid products and bleaching agents containing hydroquinone and cogic acid. These products are utilized for a minimum of two weeks; however, in most patients we prefer to use them for at least six weeks prior to surgery. Following surgery, a post-laser kit is provided which allows for the use of the proper products to protect the skin from sun rays and to promote complete healing of all laser areas.

Laser Skin Surgery for Pigmented Lesions and Skin Blemishes

The development of laser treatment for port wine stains, broken blood vessels (whether they are the result of birth marks or whether they are acquired in later life), hemangiomas, tattoos and other skin lesions, is a wonderful advance in medicine. Laser treatments are possible because high intensity laser light is produced by the laser and focused on unwanted tissues, blood vessels or pigments to destroy them. In this manner, the normal portions of the skin are damaged less by laser than other traditional treatments.

This form of laser therapy involves the use of the Surgica K-1 laser, a device that produces an intense burst of yellow-green laser light that is specially optimized to treat vascular-pigmented lesions (broken blood vessels, dark spots, the so called liver spots and skin lesions). The light from the Surgica K-1 laser is absorbed mostly by the blood vessels in the lesions and passes harmless through the surrounding tissue and skin. Some lesions require only a few pulses and can be treated in one session, while larger lesions like port wine stains require multiple patient visits with multiple treatments. The treatment is carried out strictly on an outpatient basis and under topical (surface) local anesthesia. Work can be resumed immediately after treatment. Sun exposure should be avoided in the treated areas for a few weeks after surgery to prevent the skin from healing with a darker or lighter tone.

About Risks

Like any other treatment, there are some risks inherent to laser surgery, pertaining mostly to scarring and pigmentation of the skin. These complications are quite rare.

What Can Be Treated

Some birthmarks, port wine stains, hemangiomas (especially strawberry hemangiomas), telangiectasia (vascular spiders) and broken veins of the face, scars, tattoos, brown freckles and light brown birthmarks, skin cancers, warts and numerous other skin lesions.

Insurance

Many, but not all, insurance companies will pay for laser surgery. Generally, we obtain prior determination and authorization for payment of the treatment. As with most of our cosmetic treatments, laser treatments must be paid for in advance.

Typical Laser (Ultrapulse) Pricing (full facial):

Champaign/Bloomington Facilities: Facility: $900.00 Surgeon's Fee: $2600.00
Procedural Fee for Lids Only, OR Included: $800.00
Procedural Fee for Mouth Only, OR Included: $900.00

Elmhurst Facility: Facility: $900.00 Surgeon's Fee: $2700.00
Procedural Fee for Lids Only, OR Included: $1000.00
Procedural Fee for Mouth Only, OR Included: $1100.00

Nose surgery (Rhinoplasty): Surgery and Risks

2008-10-11T17:36:00.000-07:00

Rhinoplasty is the most common of all plastic surgery procedures. It can reduce or increase the size of your nose, change the shape of the tip or bridge, narrow the span of the nostrils, or change the angle between your nose and your upper lip. It may also correct a birth defect or injury, or help relieve some breathing problems.

Who’s a Candidate?

The best candidates are people who are looking for improvement in the way they look. Age may also be a consideration. Many plastic surgeons prefer not to operate on teenagers until after they’ve completed their growth spurt.

What Are the Risks?

After surgery, small burst blood vessels may appear as tiny red spots on the skin’s surface. These are usually minor but may be permanent. As for scarring, when rhinoplasty is performed from inside the nose, there is no visible scarring. When an "open" technique is used, there will be small scars at the base of the nose.

Preparing for Surgery

The surgeon will ask you what you’d like your nose to look like, evaluate the structure of your nose and face and discuss the possibilities with you. He or she will also explain the factors that can influence the procedure and the results, including the structure of your nasal bones and cartilage, the shape of your face, the thickness of your skin, your age and expectations.

Be sure to tell your surgeon if you’ve had previous nose surgery or an injury to your nose, even if it was quite some time ago. You should also inform him or her about any allergies or breathing difficulties you may have.

The Surgery

Rhinoplasty is usually performed on an outpatient basis under local anesthesia, depending on the extent of the procedure.

During the surgery, the skin of the nose is separated from its supporting framework of bone and cartilage, which is then sculpted to the desired shape. The nature of the sculpting will depend on the nature of your problem and your surgeon’s preferred technique. The skin is then redraped over the new framework.

Many plastic surgeons perform rhinoplasty from within the nose, making the incisions inside the nostrils. The "open" procedure is often used in more complicated cases.

Once the surgery is complete, a splint will be applied to help your nose maintain its new shape. Nasal packs or soft plastic splints may be placed in your nostrils to stabilize the septum, the dividing wall between the air passages.

After Your Surgery

After surgery, particularly during the first 24 hours, your face will feel puffy, your nose will ache and you may have a dull headache. Plan on staying in bed with your head elevated for the first day.

You’ll notice that the swelling and bruising around your eyes will increase at first, reaching a peak after two or three days. You may apply a cold compress to reduce the swelling. Most of the swelling and bruising should disappear within two weeks. Some subtle swelling may remain for months, especially in the tip. The final results of rhinoplasty may not be apparent for a year or more.

A little bleeding is common during the first few days following surgery, and you may continue to feel some stuffiness for several weeks. Your surgeon may ask you not to blow your nose for a week or so while the tissues heal.

If you have nasal packing, it will be removed after a few days. All dressings, splints and stitches should be removed within one or two weeks. You can wear contact lenses as soon as you feel like it; however, if you wear glasses, they will have to be taped to your forehead or propped on your checks until your nose is completely healed in approximately seven weeks.

How to Choose the Facelift That Is Right for You

2008-10-07T21:03:00.000-07:00

A layperson using the term "face lift" usually means surgery that rejuvenates the entire area from the top of the forehead to the bottom of the neck, including every structure in between. But to the plastic surgeon, there are probably half a dozen different surgeries to improve that territory, including: brow/forehead lift; upper and lower eyelid lift; face lift; neck lift; chin and cheek implants; and various peels or laser treatments. What surgery or treatment do you really need to get you where you want to go? To know what you need, start with taking a "facial inventory". In a facial inventory, you take stock of your various facial features. All of the steps are done while sitting upright and looking in a full-size mirror.

STEP 1: Think of the face as being divided into three zones or areas:

Zone 1

Zone 2

Zone 3

STEP 2: Examine each of these zones separately and evaluate the aging process:

Zone 1

Zone 2

Zone 3

Not all areas of the face necessarily age at the same rate. Some people will find that they have aging characteristics in each of the three zones and therefore may need to have a more comprehensive, corrective procedure. However, many others will find that their problems or changes are limited to just one or two areas.

Modern rejuvenation techniques allow the plastic surgeon to accomplish significant improvement with more limited operations than were required just a few years ago. Together, you and your plastic surgeon can decide on the area or areas of your face and particular aesthetic surgery that can help you achieve a more youthful or attractive appearance.

If you think aesthetic surgery is right for you, there are only two other considerations - the fear factor and the wallet factor. Aesthetic surgery, like all surgeries, carries a degree of risk. However, understanding those risks, you also recognize that they are generally uncommon and treatable if they do occur. Regarding cost, aesthetic surgery is elective. Insurance companies do not cover it.

Now that you may possibly know a little more about aesthetic surgery, and are still interested, it is time to talk to a board-certified plastic surgeon. Together, you and your surgeon can discuss how best to meet your expectations.

Getting Started
If you are considering a cosmetic medical procedure, consult a board-certified plastic surgeon about the process, risks, recovery time and costs.

What to Know About Surgery in Your Doctor's Office

2008-10-07T19:51:00.000-07:00

Surgery, once upon a time, was almost solely confined to the hospital operating room. Today, many surgeries are being performed in ambulatory or "outpatient" settings-and a growing number are taking place right in the doctor's office. In many cases, office-based surgery is more affordable and more convenient for the patient.

A recent television broadcast focused on this trend, leading off with the tragic report of a nine-year-old girl who died on the doctor's operating table while undergoing relatively simple ear tube surgery. Out-dated and malfunctioning anesthesia equipment in the doctor's office was identified as a cause.

Is surgery in the doctor's office risky? What's hype-what's truth? And what do you need to know before consenting to a surgical procedure in your doctor's office?

Regulation of Office Surgical Facilities

State regulation
In-office surgery is not regulated in most states. In fact, only four states currently have comprehensive laws covering surgeries and anesthesia in doctor's offices-New Jersey, California, Florida and Texas.

Voluntary regulation
But doctor's offices that do surgery can voluntarily have their surgery practice accredited, licensed or certified - an assurance that the facility meets high standards for patient safety and complies with local, state, and federal codes.

The American Association for Accreditation For Ambulatory Surgery Facilities (AAAASF) is a voluntary program of inspection and accreditation in surgery facilities. Surgeons working in AAAASF-accredited facilities must be board-certified and have equivalent hospital surgical privileges.

What's the safety record of these accredited office surgical facilities? "Excellent," concludes research commissioned by the AAAASF. What's more, the study shows that overall risk is comparable to a free-standing or hospital ambulatory surgical facility.

The experts Dateline spoke to recommended that if you are going to have surgery in an office, ask if it meets one of the following standards:

Accredited by an accrediting organization such as the Joint Commission on Accreditation of HealthCare Organizations (JCAHO); or Accreditation Association for Ambulatory Health Care (AAAHC); or American Association for Accreditation of Ambulatory Surgery Facilities, Inc. (AAAASF)
Licensed as an ambulatory surgical center by the state
Certified as an ambulatory surgical center by the Medicare program

Know Your Doctor's Credentials
What about your surgeon's qualifications? If you are unsure, ask him, or direct your inquiries to your local or state medical society, advises the American College of Surgeons. Take note: Any doctor can call himself a plastic, facial plastic, or cosmetic surgeon. Find out whether he is board-certified or board-eligible and in what specialty. "One good sign of a surgeon's competence is certification by a national surgical board approved by the American Board of Medical Specialties. All board-certified surgeons have satisfactorily completed an approved residency training program and have passed a rigorous specialty examination," according to the American College of Surgeons.

Anesthesia
What about anesthesia in doctor's-office surgery? The American Society of Anesthesiologists takes the position that ambulatory (or outpatient) anesthesia and surgical care "has been proven to be safe, convenient and cost-effective."

Talk to your doctor about the kind of anesthesia you will need and the risks associated with it. The person giving you anesthesia should be an anesthesiologist, a certified nurse anesthetist, or a physician with credentials in anesthesia. Ask questions about the doctor's office surgical room: Is a heart monitor used? How close is the nearest hospital? Is the anesthesia equipment inspected, calibrated and regularly maintained? Is it equipped with the latest safety devices? In LASIK eye surgery procedures, what kind of microkeratome is used and how often is the microkeratome blade changed? How often are the laser and microkeratome serviced? (You can check with the manufacturer for recommendations.) How many nurses work with the surgeon? Who assists? Is there a recovery room? Are emergency procedures in place? Is the surgeon trained in ACLS, Advanced-Cardiac Life Support? Who runs the operating room? Ask to see the room; is it tidy, clean and organized?

Don't be intimidated about asking questions. A caring, competent surgeon will understand that you are being thorough and will be willing to address your concerns.

Believe Your Instincts
Trust your first impression and trust your surgeon, writes Elizabeth Morgan, M.D., F.A.C.S., in "The Complete Book of Cosmetic Surgery: A Candid Guide for Men, Women & Teens." Ask to see the operating facility. "If the operating room doesn't look right, say that you prefer a hospital or surgery center," cautions Dr. Morgan.

"If you have a good surgeon, trust him. Good surgeons take good care of their patients. A conscientious surgeon will do your surgery where it is safe for you. You can't be an office accreditation committee."

More to Know

The AAAASF research project set out to identify complications and deaths related to in-office surgery and compare data with other outpatient surgery data. A questionnaire was sent to 418 accredited facilities; 241 (or 57 percent) responded. The study found that significant complications (hematoma, hypertensive episode, wound infection, sepsis, hypotension) were infrequent, occurring in 1 in every 213 cases. A death occurred in 1 in 57,000 cases (0.0017 percent). "This study documents an excellent safety record for plastic surgery done in accredited office surgical facilities by board-certified plastic surgeons," the report concluded.
Dateline NBC queried medical boards in all 50 states. The District of Columbia and 43 states reported that they have no rules specifically regulating surgeries in a private doctor's office. Three states-Virginia, Illinois, and Missouri-reported some kind of regulation. Four states currently have comprehensive laws covering surgeries and anesthesia in doctor's offices-New Jersey, California, Florida and Texas.
According to the AAAASF, studies have shown that costs to a patient in a single-specialty facility, such as an accredited surgery facility, are only one-third to one-half those charged by a hospital for the same procedure.
The American Society for Aesthetic Plastic Surgery (ASAPS) 1999 Statistics show that 53 percent of cosmetic procedures were performed in an office-based surgical facility.

Getting Started
If you are considering a cosmetic medical procedure, consult a board-certified plastic surgeon about the process, risks, recovery time and costs.

Breast Uplift Specific Risks

2008-10-07T19:44:00.000-07:00

In any discussion or recitation of risks, not every conceivable risk or potential consequence can be mentioned. The ones that are touched on are those that occur with some relative frequency.

Besides the general risks associated with any surgical procedure, there are the risks that are unique to that surgery. In the case of Mastopexy (breast uplift), among the specific risks are:

Unfavorable Scarring – Regardless of which mastopexy pattern or design is used, thick, wide, or raised scarring can occur. The causes are not clear, although hereditary predisposition plays a role, & some people are more prone to this kind of scarring than others. The scars can be treated in a number of ways to try to improve them, including scar revision surgery.

Skin Loss/Slough – A problem with blood supply to an area of skin, including the nipple, can occur. The reasons are not always clear. However, it is far more likely to occur in smokers!

Asymmetry – Breasts, like most paired structures of the human body, are not naturally exactly the same (not mirror-images of one another). Surgery cannot make them exactly the same, although the surgeon may try to improve symmetry. Patients should expect some degree of asymmetry.

Interference with Breast-Feeding – If you have breast-fed before, breast implants should not interfere with breast-feeding in the future.

Residual Drooping – While the goal of mastopexy is to lift the breasts, patients should expect some degree of drooping to remain. This issue should be discussed before surgery, so that expectations are realistic.

When implants are used, the risks are the same as for breast enlargement (augmentation mammaplasty), namely:

Capsular Contracture (Hardening/Encapsulation) – A veil of scar tissue naturally forms around the breast implant after surgery. If that scar tissue thickens and tightens, it is called “capsular contracture”. It can result in a breast that feels hard and may look distorted. If this does not respond to non-surgical methods of treatment such as regular breast massage and compression, surgical release may be necessary.

Interference with Mammography – The position of the breast implant may make interpretation of a standard screening mammogram more difficult. Therefore, with breast implants, it is important to go to an experienced mammography center where the needed special mammogram views can be done, and where ultrasound examinations are available as well. There is, however, no evidence of a relationship between implants and breast cancer!

Leak or Rupture – Like any man-made device, breast implants can and do break. How often is not exactly known, but one manufacturer studied saline-inflatable implant breakage over the past 13 years and found the incidence to be less than 1%. And silicone-gel implants break less frequently than the saline. If a saline-inflatable implant breaks or leaks, the breast will "go flat", usually over a period of about a week. The saline (sterile salt-water) is absorbed into your system. If a silicone-gel implant breaks, and the silicone stays within the scar capsule that has been formed, you may not be aware that it has broken until it is discovered in a mammogram or ultrasound exam. If, however, the scar capsule breaks as well, the silicone can move into the adjacent tissue or even migrate to other contiguous areas, where the body surrounds it with scar tissue. Broken implants should be removed and replaced. Sometimes with silicone gel, it is not possible to remove all of it.

Rippling – This phenomenon is palpable and even visible ripples (seen as lines or grooves of the breast) appear to be most prominent in textured (rough surface) implants – especially those that are saline-inflatable – but also silicone-gel filled ones, as well. It is probably a function of the thickness of the implant shell. In an attempt to avoid this visibly unpleasant phenomenon, we prefer implants with a smooth surface. They tend to ripple much less.

Autoimmune Effects – Beginning in the early 1990's, there was some concern about a possible causal relationship between silicone and a group of disorders of the immune system called "connective tissue disorders". Since that time, however, major scientific studies undertaken to examine any possible relationship have consistently not shown any. They concluded that silicone gel either in implants or that which escapes from a broken implant is unrelated to autoimmune disorders and symptoms.

For additional information concerning risks specific to breast uplift, please consult with your own plastic surgeon, or the websites for ASPS (The American Society of Plastic Surgeons) or ASAPS (The American Society for Aesthetic Plastic Surgery).

Liposuction: Suction Assisted Lipectomy (SAL) Procedure and FAQ

2008-10-07T19:17:00.000-07:00

Synonym: liposuction, suction assisted lipolysis, "fat suctioning", and "fat sucking"

Currently, and for a number of years, liposuction – the most commonly performed aesthetic (cosmetic) surgery (ASPS 1998 National Clearinghouse of Plastic Surgery Statistics) – has produced almost instant gratification and fulfillment of dreamlike wishes. Although intended as a method of sculpting and shaping areas of the body, its use as a weight loss alternative has opened it to potential abuse. These abuses may take the form of massive liposuctions in unsuitable candidates; poor patient selection in general; advertising-generated and misleading expectations; and non-plastic surgeons performing cosmetic surgery. Some of these abuses have resulted in spectacular complications and have generated lurid exposés in the media. This adverse publicity, unfortunately, places blame on the operation as opposed to the operators.This is regrettable, since liposuction is such a valuable cosmetic procedure. Anyone considering liposuction surgery needs to seriously examine both motives and expectations. What do you really hope to gain through liposuction surgery? Can it actually be accomplished by a combination of moderate weight loss and toning through exercise? Should you invest in a meeting with a nutritionist and a trainer instead of a plastic surgeon? Are your expectations for what surgery can do realistic? If your answers to these questions still lead you to want liposuction, you should prepare for your consultation carefully, armed with further questions.

Indications

Ideally this surgical technique would be reserved for people who:

Are at or near ideal weight
Have localized areas of abnormal or disproportionate fat deposits
Have regional fat deposits that are unresponsive to a program of reduced dietary intake and exercise
Have reasonably good elastic skin tone that will "shrink to fit" when excess fat is removed
Have reasonable expectations
Are looking for improvement, not perfection
Are in good health both physically and emotionally

However, it is not surprising that the criteria have been expanded to include a broad segment of people with problems of body shape and proportion. Among women, the most common areas requested for reshaping are thighs, hips, buttocks, abdomen, and face and neck. For men, the more common needs are for the abdomen, love handles, and neck. But virtually any area where "fat comes to rest" may be the object of liposuction.

The basic science of fat metabolism that allows liposuction to work is interesting. Suffice it to say, removed fat doesn't "grow back". But this doesn't prevent post-liposuction patients from gaining weight. Patients wishing to get and maintain the best results from liposuction continue to sustain a healthy lifestyle including dietary discretion and regular exercise.

Objectives & Facts

Shaping and sculpting areas of localized fat
Not meant for weight reduction
Will not tighten skin
Will not eliminate "cellulite"

Before Surgery

Whether at the time of consultation or later, once you have made up your mind to go ahead, you will need to take measures to ready yourself for surgery. While many of these measures will be at your plastic surgeon's request, others will be a matter of laying the mental groundwork for surgery, both for yourself and your family.

From a medical perspective, in preparing for any cosmetic surgery, there are certain steps that need to be taken. While each plastic surgeon may differ somewhat in the preparations they recommend, the basic objectives will be the same:

That you are in good physical and mental health
That you are not taking medications or over-the-counter supplements that could interfere with surgery or anesthesia
That transportation to and from surgery and homecare arrangements have been made

When surgery is scheduled, you usually will receive instructions from the staff covering all of the necessary pre-surgical planning. These instructions will include:

A list of drugs, medications, and food supplements that you will need to avoid because of their negative effect on surgery
Information about smoking cessation and the additional risks of surgery and smoking
Do's and don'ts in the weeks before surgery
Reporting any colds or infections that arise which may force surgery to be delayed
Making arrangements for transportation and assistance for post-operative care
Forms for your doctor for medical history and physical examination

The Surgical Procedure

Location – When the volume of liposuction is very small and/or the number of areas few, the procedure is usually performed as a day-patient. Under some circumstances, however – even with these criteria – we will recommend an overnight stay. For larger volume liposuctions, where many areas are involved, or when other surgical procedures are performed simultaneously, we advise staying overnight or even several nights.

Anesthesia – There are various anesthetic techniques that are used in liposuction surgery. However, for most liposuctions (except for very small areas), surgeons uses general anesthesia (complete sleep) exclusively. It is administered by a physician anesthesiologist in order to provide the safest, most controlled form of anesthesia.

Surgery Techniques – Once you are asleep, the first step in the process of liposuction – is the injection of the large amounts of fluid into the fat. In this "tumescent" or superwet technique, the fluid reduces the amount of bleeding and provides some anesthesia to the areas. It also separates the compartments of fat and makes the extraction easier. Then, surgeons uses both standard "tumescent" liposuction [SAL] and "ultrasonic-assisted liposuction" [UAL]. In the standard technique, a number of tiny incisions (so small that when they heal, they are barely perceptible) are made, through which hollow metal tubes or cannulas attached to suction are inserted. These cannulas vary in size with the largest being about the diameter of a pencil and the smaller ones the diameter of spaghetti. As the cannula is moved in-and-out of the fat, it removes cores of fat until the desired shape has been attained.

Where the fatty area is very tough and fibrous – such as in the back, flanks, breasts, and hips (especially in men) – or where there are very large volumes to be removed, ultrasonic-assisted liposuction (UAL) may be used. In this technique, there are special cannulas attached to a device that emits ultrasonic waves that rupture the fat cells before they are suctioned away. It is believed that this method may result in less bleeding and bruising and may create some degree of skin shrinkage. It, however, has its own set of risks and is used as an adjunct to standard tumescent liposuction, not a replacement.

Risks & Complications – All surgeries are associated with some risks. These relate to the potential for complications and untoward events during or after a surgical procedure. We can think of these in two groups:

1. General Risks – Risks that are common to all operations and
2. Specific Risks – Those that are unique to a particular surgery.

General Risks include:

Bleeding
Infection
Scarring
Swelling
Bruising
Anesthetic risks

Specific Risks include:

Unfavorable scarring
Skin loss/slough
Asymmetry
Alterations in skin sensitivity
Lumpiness
Waviness
Irregularities
Loose skin
Areas of hard scar tissue
Discoloration (permanent or temporary)
Injury to deeper structures (very rare)

After Surgery

Following discharge from the recovery area, you will either be sent directly home or spend the night and be discharged the next day. As mentioned earlier, there are numerous reasons for staying overnight, including: personal preference, number of areas and amount of fat removed, other surgeries performed simultaneously, and so on.

Everyone has some degree of pain after any surgery. The amount and the way you deal with it are very individual. You will receive medication to control the pain.

Surgeons encourage his patients to be physically active as soon after surgery as is practical. This is particularly true of liposuction. You will be wearing various elastic garments and girdles for 3-6 weeks. These both control the amount of post-operative swelling and help to shape the new contours. You will be able to change these daily (or more often, if necessary). The timing of normal showering and bathing will depend on a number of factors.

Most people recover sufficiently to return to work in about 1 week. You will be encouraged to quickly resume full, normal physical activities and exercise. Your new shape should be a motivator to resume or begin a regimen of exercise, shaping, and toning.

Suture removal is generally not required. The small scars will take months to soften and decolorize from red-to-pink-to-white. The results will be evident within several weeks. Still, where the fat has been removed, the tissues will be firm and even somewhat swollen for weeks to months. Staff will instruct you in the appropriate method of massaging these areas to speed the softening.

Conclusions and Patient Acceptance

Because the resulting new shape is often so dramatic, liposuction is among the most satisfying cosmetic procedures. Please refer to FAQ (frequently asked questions) below to review the details and concerns of many patients.

Liposuction FAQ

Will the fat come back?
You are born with essentially a fixed number of fat cells that increase or decrease in size based upon weight gain or loss. When cells are removed, they do not grow back. However, that does not mean that you can't gain weight! You can and will, if you overindulge. But the excess fat will be deposited predominantly in areas other than those that have been liposuctioned. That means other areas will get fat. And you may not be pleased with which areas they are!

How long does it take to heal?
We encourage patients to be physically active as soon after surgery as is practical. This is particularly true of liposuction. You will be wearing various elastic garments and girdles for 3-6 weeks. These both control the amount of post-operative swelling and help to shape the new contours. You will be able to change these daily (or more often, if necessary). The timing of normal showering and bathing will depend on a number of factors.

Most people recover sufficiently to return to work in about 1 week. You will be encouraged to quickly resume full, normal physical activities and exercise. Your new shape should be a motivator to resume or begin a regimen of exercise, shaping, and toning.

Suture removal is generally not required. The small scars will take months to soften and decolorize from re-to-pink-to-white. The results will be evident within several weeks. Still, where the fat has been removed, the tissues will be firm and even somewhat swollen for weeks to months. Massaging these areas will help to soften them more rapidly. You can combine professional massage (as long as it is gentle) and lymphatic drainage techniques in these areas with your own self-massage. Staff will instruct you in the appropriate method of massaging these areas to speed the softening.

Should I apply heat or ice to the areas?
Absolutely not! Both cold and heat can severely injure the skin in the liposuctioned areas. The skin will not tolerate these.

How long will the results last?
The results are permanent. But this doesn't mean that you can't gain weight! It just means that the fat cells that were removed will not grow back. If you gain weight, very little of it will be deposited in the remaining cells in the liposuctioned areas. It will tend to find its way to other areas which will then enlarge in size and become unattractive. See "Will the fat come back?"

Is this surgery covered by my insurance?
Generally, no. This is a cosmetic operation and is not covered by health insurance. Very infrequently, when there is a functional problem such as a large fatty tumor – a lipoma for example – or when a breast reduction is being performed using liposuction, some insurances may cover this procedure.

When can I start jogging and lifting weights?
As soon as you are comfortable. Everyone's pain tolerance is different. But you will probably find that within a few days, you are able to resume brisk walking and within a week or so, jogging. Weight lifting probably almost immediately.

Will I have bandages?
There will be little adhesive clear plastic dressings over each incision. The general areas of liposuction will be covered with a girdle or compressive garment. Other than these, there will probably not be any dressings.

When can I bathe and shower?
It depends on whether liposuction has been combined with other surgeries, as well as, other factors. However, assuming just liposuction has been performed, you will be able to shower — but not take a bath — beginning at about 48 hours after surgery. When you do shower, you will need to keep in mind:

No hot water on the liposuctioned areas; they will burn very easily!
No rubbing the liposuctioned areas
Blot or pat the areas dry
Reapply your girdle or garment as soon as you are dry after completing your shower

Does someone have to be with me at home after surgery?
Unless you have had only a small area liposuctioned under a local anesthetic, you should plan to have someone with you for the remainder of the day and night of surgery.

Could I really get the same results if I just dieted and exercised?
If it's a matter of becoming thinner and more toned that you're after, yes, diet and exercise is the answer, not liposuction. On the other hand, if there are shapes, bulges, and contours that don't seem to change much regardless of your weight or level of fitness, liposuction is the solution. We cannot "spot weight reduce"; we can't change the unattractive shapes that we have inherited, like full "saddlebags" or love handles and so forth. But liposuction can sculpt away these unpleasant shapes that dieting won't remove.

Can I drive myself home after surgery?
No. Even if you have had a very limited liposuction under local anesthesia, the surgical experience may make you weak, shaky, or distracted enough that it is dangerous to drive. You should have someone bring you to surgery and take you back home. If you have had a general anesthetic, driving is out of the question.

Will Endermologie help?
Don't waste your time or money. Endermologie has not been demonstrated to produce any long-term change or improvement, in spite of what the advertisements say.

Can I have my surgery with a local anesthetic like I saw on TV?
No. We really don't believe that this particular method as shown on TV is safe, useful, or effective for our patients. As presented, it really was a gimmick that doesn't provide a safe and controlled surgical environment for the performance of good liposuction.

Will liposuction lift my butt?
No. In fact, liposuctioning the buttocks under most circumstances has the opposite effect and makes the buttocks flat and sagging.

Will my skin be looser after surgery?
It depends on a number of factors including: your skin tone, elasticity, and the amount of fat removed. If the elasticity is fair- to- poor, you may have some degree of looser skin after liposuction. It's not always possible to be sure about the amount of laxity that will be present after surgery. To an extent, the surgery will cause the skin to shrink a bit, even where skin tone is only fair. In making your decision to have liposuction surgery, this may be one of the considerations. We will try to inform you to the best of our ability how much skin laxity, if any, to expect.

Should I lose weight before the surgery?
I don't recommend losing weight specifically for the liposuction surgery. If you were to go on a major short-term diet and lose weight, it might give an unrealistic picture of the locations and amounts of surgical sculpting that are needed. Then, after surgery, you might gain back the weight and create new problems. It is preferable to save the weight loss and toning exercise for after the surgery.

Massage?
See "How Long Does It Take To Heal"

How many scars will I have?
We won't know for sure in advance. The number of scars will be determined at surgery by the number of access incisions necessary to get to the fat that needs to be sculpted. In any case, they will likely heal well with minimal visibility.

When will the results be complete?
It will probably take up to 6 months or more for all of the normal scar tissue to soften and for all swelling to be completely gone. Nevertheless, your new shape will be clearly present and enjoyable in about one to three months.

Can I continue my vitamins and supplements up until surgery?
It depends on just what those are. Please give the staff a complete list of these well in advance of the surgery date (at least 2 weeks) so that ones that interfere with surgery or anesthesia can be discontinued in time. Vitamin E and supplements that are intended to assist in weight loss or contain stimulants must be discontinued by at least 2 weeks prior to surgery.

When can I resume my vitamins and supplements?
Probably by 2 weeks after surgery. But speak with the staff to be sure.

When can I begin having sex again?
As with exercise, in the case of liposuction, we encourage resuming sex when you are comfortable and as long as no pressure or trauma is applied to the areas that have been liposuctioned. You will find, however, that especially if the abdomen has been liposuctioned, the genital area may be very swollen and bruised for a while. Don't be concerned. It will eventually disappear and look normal again.

Do I have to sleep in a special position?
No.

Do I have to stop smoking or should I use the nicotine patches or gum instead?
The nicotine in cigarettes as well as the nicotine replacement medications have a very bad effect on the skin following surgery and can result in poor healing with areas of skin loss. Therefore, no smoking, nicotine replacements, or supplements following surgery for at least 1 week. Drugs that suppress the desire to smoke, such as Zybanâ can be used. Our staff will prescribe this for you if you wish. See also "Effects of Smoking".

Should I be on a special diet before surgery?
No. We suggest that you be on a well-balanced diet. Avoid radical or weight-reducing diets prior to surgery. You may take vitamin and mineral supplements, but avoid health-food supplements the ingredients of which are uncommon and may have drug effects.

Are there special medicines that I should take before surgery?
Our staff will provide you with preoperative instructions that include any medicines or supplements that we wish you to take. You should, of course, inform us of any medications that you are taking regularly or which your own doctor has prescribed. If those will not interfere with surgery or anesthesia, we will allow you to continue to take them. Otherwise, supplements such as iron, vitamin K, Vitamin C, Beta Carotene are all right. But Vitamin E needs to be eliminated beginning 2 weeks prior to surgery, as it causes prolonged bleeding.

Will I need any special tests before surgery?
Yes. You will be asked to have a complete pre-operative medical history, physical examination, and laboratory tests before surgery. Especially as this is elective surgery, we need to be sure that you are in good health. These can be performed either by your own physician or our staff will recommend a physician or a Physician Assistant to complete these for you.

How soon can I lie in the sun or use a tanning bed?
You need to protect the areas that have been liposuctioned from the sun until all bruising has completely disappeared. Otherwise, you will find that the skin will take-on a pigmentation that looks as if the skin is "dirty". This is from iron pigment being deposited and fixed in the skin by the sun-tanning effect. In addition, early on in the healing course, when the skin doesn't have normal "feeling" (is a little numb), you could get a severe burn from sun exposure without being aware of it. Otherwise, (disregarding the skin cancer risks) as long as you protect the liposuctioned skin zones, you can be in the sun or tan other areas to your heart's content.

Will both sides of my body be completely even?
No. The body is not symmetrical to begin with. You are probably aware that your shoes don't fit exactly the same on both feet, and gloves don't fit exactly the same, as well. A woman will find that her breasts are not exactly the same either. This is normal human asymmetry. Liposuction will not be able to create perfect symmetry; you shouldn't expect it.

What about touch-ups?
It's not uncommon to need to perform a little adjustment to the final result. This probably wouldn't be for many months or even a year after the original surgery. It should be a minor bit of "tailoring" but would not include any additional fat that you gained (obviously, this should be avoided) in the interim.

Can you put the fat that you take out somewhere else?
Some small amounts of fat can be transplanted to areas such as the face or certain other small spots or divots and indentations. Such fat transplants, if done in a way that layers small quantities in various places, will have a good chance of "taking" and remaining for a prolonged period of time, though not permanently. However, large volumes can't be transplanted with any success. Transplanting fat to the breasts is contraindicated, as it becomes calcified and on a mammogram looks like a cancer.

Is there anything to be done if my skin is loose after the liposuction?
Depending on the area of loose skin, sometimes it's possible later on to remove excess skin and tighten the location. This is true of the abdomen, upper-inner thighs, and back of thighs in particular.

How much weight will I lose?
Remember, this is not a weight loss surgery. We have no idea as to how much weight will be lost. And, this is not as important as contour changes. A small weight loss can produce a major contour change.

Cosmetic Laser Surgery Procedures 101

2008-08-29T19:20:00.001-07:00

LASER PEEL FOR WRINKLES

If you have wrinkles on your face, especially around the mouth or eyes that can be seen by others across the dinner table, you most likely will benefit from facial resurfacing, also called laserbrasion, laser abrasion, or a laser peel.

On the other hand, if your wrinkles, or the beginning of them, can only be seen when you study your face in a triple-magnification mirror, you're probably a candidate for alphahydroxy acids, Renova, and other beauty-before-the-beam measures, and not a laser peel - just yet.

Facial resurfacing is not a face lift! A face lift is a surgical procedure that has more to do with lifting the cheeks and recontouring the neck to counteract the effects of gravity. It is a "nip and tuck" that removes sagging, unwanted skin and extra fat deposits. No laser peel can correct these problems but it can improve the appearance of lines and wrinkles on the face. After a laser peel, in fact, it is not uncommon for people to appear ten to twenty years younger than their actual age!

In truth, lasers cannot make you look "light years" younger, but ten or twenty is another story. There is also no guarantee that your new face will "launch a thousand ships," but who wants to launch ships anyway!

If wrinkling is only in a limited area of the face, a person may opt for a perioral laser peel, which removes the fine lines in the "mustache" area of the upper lip as well as lipstick "bleed lines," and/or a periorbital laser peel, which removes the fine lines around the eyes (in the area covered by ordinary eyeglasses). In addition, there is the laser peel of the nose, which eliminates many effects of sun damage, or a laser peel of the earlobes, which improves the wrinkles on and dramatically shrinks their size.

EYELID SURGERY

Also called upper blepharoplasty, this laser procedure removes a crescent of skin and some underlying fat from the upper eyelids to correct their drooping or sagging. Anyone with droopy, overhanging upper lids that diminish the appearance, seem to impair vision, or obscure the area where eye shadow is applied, is a good candidate for this procedure.

A laser-assisted transconjunctival lower-lid blepharoplasty is a procedure that removes excess fat from the lower eyelid. Anyone with "bags" or puffy lower lids is most likely a candidate for this procedure.

RESURFACING OF ACNE SCARS

Candidates for this procedure have depressed acne or chickenpox scars that indent the skin. After resurfacing, when the skin heals, a new band of horizontal collagen forms in the upper layers of the skin, greatly improving the skin's contour and tightening its overall appearance. While this procedure can erase years of heartache, it involves a warning: anyone who has taken Accutane for cystic acne must not have laser treatment for one to two years after discontinuing the medication.

RED-NOSE SYNDROME (RHINOPHYMA)

Remember the bulbous red nose of W.C. Fields? He suffered from rhinophyma, a condition that is characterized by a gradually enlarging, reddened, and misshapen nose with enlarged pores. This is a condition that makes people very self-conscious but with laser resurfacing it vanishes within minutes.

Resurfacing lasers also treat a variety of other skin conditions:

* Seborrheic keratoses, the common wart-like brown growths that appear to be "stuck on" to the surface of the skin.

* Warts ~These common and often distressing flesh-colored bumps are caused by the human papilloma virus and have the potential to spread and persist for years.

* Scars and keloids.

ROSACEA

In this condition tiny blood vessels under the skin "break," dilate and, increase in number, causing flushing in the central portion of the face around the cheeks and nose. Quite common in women, it is often (but mistakenly) called "adult acne." It affects thirteen-million Americans. The problem is eliminated with laser treatment, but it may return, requiring follow-up treatments.

PORT-WINE STAINS

It is always distressing when a baby is born with a port-wine stain, particularly one that covers a beneath portion of the face. This dense network of blood vessels the surface of the skin enlarges as the child gets bigger and never goes away on its own.

Laser surgery, performed in several sessions, is tremendously effective in eliminating port-winestains. But before such surgery is undertaken, a child must be fully evaluated to rule out other, rare conditions that might account for the stain.

The laser(s) that is used for red problems also treats a variety of other skin conditions:

* Hemangiomas ~ These "strawberry marks" usually disappear on their own. However, if they interfere with a vital function, laser treatment can help them disappear safely and more quickly.

* Scars, keloids, warts, spider veins, psoriasis, Kaposi's sarcoma, and miscellaneous vascular lumps and bumps can also be treated with the laser that treats red problems.

STRETCH MARKS

Typically, stretch marks occur as a result of pregnancy, adolescent growth spurts, weight lifting, or rapid weight gain in areas that have undergone extensive stretching such as the hips, tummy, and breasts. The hormone estrogen seems to play a role in their development.

Cocoa butter and other "potions" that promise to firm the slackened skin and prevent or heal stretch marks do little to improve their appearance. However, they may diminish slightly with the daily application of Retin-A or alphahydroxy acids. Laser treatment is highly effective.

AGE SPOTS

Also known as sun spots, liver spots, or large freckles, these blemishes are largely the result of life-long sun damage. Sometimes, topical medications, bleaching creams, or alphahydroxy acids can lighten the spots, but the appropriate laser eliminates them in one easy treatment.

The laser(s) that is used to treat these brown problems also treats a variety of other skin conditions:

* Cafe-au-lait spots are flat, light brown, or tannish lesions - which are the color of coffee with milk and always benign. They are, however, a cosmetic nuisance and often respond to the laser.

* Dark circles ~ Many people hate the raccoon-like appearance that the dark circles under their eyes create. Again, laser can improve them.

* Beauty marks are really moles that, for the most part, are not beautiful. These, along with other large and small nevi, can often be improved with laser surgery. But sometimes laser surgery is not the best way to remove these spots. Beauty and the Beam explains why.

* Melasma (or chloasma) ~ Commonly called "the mask of pregnancy," this discoloration of the skin often disappears after childbirth but can also be treated safely with the appropriate laser, as can a variety of other conditions which are covered in Beauty and the Beam.

TATTOOS AND TATTOO REMOVAL

An estimated ten million people in the United States have at least one tattoo. Female college students account for the application of fifty-thousand to one-hundred thousand tattoos a year, while ten percent of adult males sport at least one. Yet, more than half of all people with tattoos eventually regret having them and many want them removed.

If a tattoo is comprised of different colors, several lasers are commonly used to remove it, each one targeting different-colored tattoo inks. While the procedure only takes a few minutes, several treatment sessions may be required. The good news is that the result will last forever, although in some cases trace pigments of the tattoo may be visible.

PERMANENT MAKE-UP REMOVAL

There are a variety of reasons why women seek out physicians or paraprofessionals trained in micropigmentation - the art of depositing small amounts of colored pigments into the skin. Whether they choose permanent make-up to add color to their eyebrows or to create eye liners, lip liners, or even rouge for their cheeks, the goal is the same: cosmetic enhancement. But sometimes women change their minds and want the "permanent" make-up removed. The same laser methods used to remove body tattoos are used to remove permanent make-up. For both, however, risks exist, which are spelled out in Beauty and the Beam.

REMOVAL OF LEG VEINS

Varicose and spider veins have a great deal to do with family inheritance. Simply, genes play a big role in who does and does not get them. But inheritance is not the only risk factor. Women who are overweight, have frequent pregnancies, or take birth control pills or estrogen and progesterone replacement are also vulnerable to varicosities and to the little spider veins that have such a rude and unexpected way of making themselves apparent. The situation is aggravated as well by wearing clothing that is tight around the waist, standing in one place for long periods, prolonged sitting, the habitual crossing of one leg over the other, and straining from constipation.

Many women try compression stockings to improve circulation and reduce discomfort, although they don't eliminate the veins. Others opt for sclerotherapy, which involves injecting a chemical solution into a vein, which causes the vein to collapse and disappear. Lasers or light sources are the newest, non-invasive way to zap these unsightly veins.

NEARSIGHTEDNESS

Photorefractive keratectomy, or PRK, is the surgery performed with the excimer laser that, since FDA approval in 1996, has been allowing nearsighted Americans to throw away their eyeglasses!

Nearsightedness occurs when light enters the eye and focuses at a point in front of the retina, causing close-up vision to be clear and distant objects blurry. In just a few minutes, the excimer laser changes the shape of the eyeball and often restores vision to 20/20! (Read a detailed description of this exciting laser procedure in Beauty and the Beam.)

GUM RECONTOURING

Dentists who practice cosmetic dentistry can now recontour overgrown gums and give their patients the smiles they always dreamed of. Although not every one with gingival (gum) overgrowth is eligible, many are. (Read a detailed description of this laser procedure in Beauty and the Beam.)

TOOTH WHITENING

In the same way, tooth whitening has been revolutionized by laser technology. Some people even find that their childhood tetracycline stains and adult nicotine stains are removed. (Read a detailed description of this laser procedure in Beauty and the Beam.)

SNORING

In a recent study, nineteen percent of subjects described themselves as habitual snorers, while twenty-four percent of males and fifteen percent of females said they sometimes had a problem with snoring. Snorers don't enjoy peaceful sleeps; they usually find it hard to wake up and go through the day feeling uncharacteristically fatigued. And anyone who sleeps with a snorer suffers from both sleep deprivation and aggravation. Occasionally, snoring may be a sign of a more serious condition known as sleep apnea, a momentary cessation of breathing. Laser surgery, specifically the LAUP procedure (or, more complicatedly, laser-assisted uvulopalatoplasty) can eliminate snoring! (Read a detailed description of this laser procedure in Beauty and the Beam.)

LASER HAIR REMOVAL

Most women are enslaved to their tweezers, bleaching creams, razors, and depilatories, or to the aestheticians who perform electrolysis or waxing on the hair of their upper lips, eyebrows, arms, legs, and bikini areas. Every week they must attend this ritual, week in and week out, year in and year out, over a lifetime.

In contrast, laser hair removal is so efficient and rapid that small areas can be treated in seconds and large areas can be treated in minutes without the risk of contamination or scarring; electrolysis of the same areas would take months of weekly visits. However, the jury is still out about how "long-lasting" or "enduring" the resuls will be. (Read a detailed description of this laser procedure in Beauty and the Beam.)

LASER HAIR TRANSPLANTATION

Women may have an interest in removing body hair, but men, by and large, are the ones who are interested in adding it - particularly to the head. Most men, when they find themselves losing hair, "try everything" to bring it back, from toupees and wigs to special shampoos and conditioners to hair thickeners and even vibrating hair brushes that promised to "stimulate" hair growth. Others try Rogaine (minoxidil), a topical, over-the-counter drug that promises to retain or restore the hair that seems destined for the shower floor.

Laser-assisted hair transplants seem better than all these methods but, again, the jury is still out about whether the laser offers any advantage over a traditional hair transplant. With this procedure, the experience of the laser surgeon is paramount; he or she must have a good cosmetic eye for achieving a natural hairline. (Read a detailed description of this laser procedure in Beauty and the Beam.)

Blepharoplasty (remodeling of the eyelid) Risks

2007-12-24T22:02:00.000-08:00

Ah, blepharoplasty. Sounds like something that comes out of your nose when you blow it. Happily, I know from no less a resource than my mother that it's no such thing, since she had it done as part of her facial plastic surgery. Blepharoplasty is basically a remodeling of the eyelid.

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.)

Blepharoplasty Risks

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.

Breast Augmentation FAQ

2007-12-24T18:05:00.000-08:00

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.

Face Lift – Facial Plastic Surgery Risks

2007-12-24T17:58:00.000-08:00

A face lift, or rhytidectomy, is a plastic surgery procedure meant to remove wrinkles and decrease the signs of aging and sun damage. While it is not a cure-all by itself and is a serious medical procedure, the results can yield a more satisfying appearance for those who deem the process worthwhile. Facelift may be combined with others, such as facial implants or a skin peel in order to improve the final results.

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.

Choosing a Surgeon procedure can often be a long and difficult one

2007-12-24T17:25:00.000-08:00

The process of choosing the correct surgeon for a cosmetic or plastic surgery procedure can often be a long and difficult one. There is no shortage of qualified doctors in almost every field of cosmetic surgery, yet there are also less scrupulous and less qualified individuals who are also competing for your business. Just because a doctor is offering a lower rate for services does not necessarily mean that he or she has less experience or is less skilled as a surgeon. However, an extraordinarily below market price for a particular procedure should be a warning sign to research the background of the physician extensively, setting up contact with previous patients whenever possible.

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.

Risks & Benefits associated with cosmetic and plastic surgery

2007-12-24T17:23:00.000-08:00

As with any medical procedure, there are certain inherent risks and benefits associated with cosmetic and plastic surgery, all of which should be thoroughly considered prior to making the decision to proceed.

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.

Face Lift no longer depends on unnatural skin pulling

2007-12-24T17:22:00.000-08:00

Face-lifting has advanced tremendously over the last few decades. This procedure no longer depends upon unnatural skin pulling. Through incisions that are mostly hidden in the hair and within the ear, the skin is lifted and the facial muscles and fat are re-suspended to where they were when you were younger.

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.

The Body: Tattoo Removal

2006-08-05T13:49:00.000-07:00

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

2006-08-05T13:48:00.001-07:00

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

2006-08-05T13:48:00.000-07:00

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

2006-08-05T13:47:00.000-07:00

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

2006-08-05T13:46:00.000-07:00

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

2006-08-05T13:45:00.001-07:00

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

2006-08-05T13:45:00.000-07:00

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

2006-08-05T13:43:00.000-07:00

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

2006-08-05T13:42:00.000-07:00

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.

Orthodontics

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

2006-08-05T13:41:00.000-07:00

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

2006-08-05T13:39:00.000-07:00

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

2006-08-05T13:38:00.001-07:00

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

2006-08-05T13:38:00.000-07:00

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

2006-08-05T13:37:00.000-07:00

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

2006-08-05T13:36:00.000-07:00

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

2006-08-05T13:31:00.000-07:00

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

2006-08-05T13:30:00.000-07:00

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

2006-08-05T13:29:00.000-07:00

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

2006-08-05T13:28:00.000-07:00

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

2006-08-05T13:27:00.001-07:00

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

2006-08-05T13:27:00.000-07:00

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

2006-08-05T13:26:00.000-07:00

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

2006-08-05T13:23:00.000-07:00

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.

Liposuction Considerations

2005-09-06T10:37:00.000-07:00

Liposuction is a procedure to remove unwanted fat deposits from specific areas of the body. It is not a substitute for weight reduction, but a method of removing fat that doesn't respond to dieting or exercise. Before surgery, you will want to discuss several factors with your surgeon. Foremost, be realistic about your expectations. Liposuction can improve your appearance and enhance your self-confidence, but it won't drastically change your life. It is recommended that your weight be relatively normal, but you have pockets of excess fat in certain areas. You also should have firm, elastic skin. If you have loose or sagging skin, it will not reshape to your body's new contour and may require additional surgeries to remove the excess skin. Also, liposuction is not recommended if you have poor circulation or other skin complications. Discuss these factors with your surgeon as well. Your surgeon will be able to address these and other concerns with you if you are considering liposuction. For more information, contact a plastic surgeon.

Cellulite, What Is It?

2005-08-06T10:36:00.000-07:00

Cellulite is fat which accumulates in areas where the skin and underlying tissue tend to pucker and wrinkle. These areas are commonly found around the waist in men, and in the thighs, buttocks, and abdomen in women. Some people attempt to rid themselves of cellulite using creams, gels, and wraps. These anti-cellulite products may work on a temporary basis by giving the skin a thicker appearance, however, these products are at best, a one day respite from some of the deeper craters of cellulite.

Because the puckering of the skin is due to engorged fat compartments in between the skin and underlying structures, the key to controlling cellulite is through fat reduction. This can be done by switching to a low-fat diet, by exercising, or, if the problem is unusually unsightly or persistant, through liposuction. Liposuction removes these pockets permanently but is best performed on isolated areas that remain after diet and exercise have failed to help. The best candidates for liposuction are those of relatively normal weight but who have pockets of excess fat in particular areas. You should be physically healthy, psychologically stable, and realistic in your expectations. Most important, having firm, elastic skin will result in a better final contour. Hanging skin won't reshape to your body's new contours, and may require an additional procedure to surgically remove the excess skin. This procedure will leave visible scars. For more information on cellulite, talk with a plastic surgeon.

What Will Happen During Breast Surgery?

2005-07-06T10:30:00.000-07:00

Breast surgery is used either for medical or personal reasons. There are three types of surgery involving the alteration of breast tissue. Breast reduction, where the breasts are made smaller, is most common in women with disproportionately large breasts that cause pain to the back or shoulders.

During the breast reduction procedure, incisions are made around the nipple area and in the crease of skin under the breast where it meets the chest. Excess fat, tissue and skin are then removed. Depending on how much the breast is reduced, the surgeon may have to reposition the nipple and underlying tissue. Incisions are then sutured and the healing process begins.

The second type of surgery is a breast lift and is available to women with sagging breasts. The incisions are similar to those of breast reduction but all that is removed in the breast lift is excess skin. Finally, breast augmentation is an option for those who wish to enlarge small or underdeveloped breasts.

The breast enlargement is accomplished by use of an implant surgically placed either directly under the tissue in the breast or under the chest muscle behind the breast. Incisions can be made either around the nipple, under the breast, or in the armpit for placement of the implant. The first step for breast surgery is a consultation with a plastic surgeon. He or she can discuss your options and decide which treatment is best for you.

Placement in Breast Enlargement

2005-06-06T10:29:00.000-07:00

A woman can choose to enlarge her breasts through a process called augmentation. This surgical procedure involves the placement of an implant under the breast in order to increase its size. There are two types of placement options for implants. A breast implant can be placed either over or under the pectoralis chest muscle. There are advantages to each approach depending on a patient's age, degree of breast sagging, and requirements for mammography. In general, the sagging breast requires an implant to be placed above the muscle in order to provide the most aesthetically contoured breast. However, an implant placed below the muscle makes mammography a little easier. These factors as well as others should be carefully considered to determine which placement option is most appropriate for you. Consult with an experienced board certified plastic surgeon familiar with both approaches.

Techniques for a Natural Looking Face Lift

2005-04-06T10:29:00.000-07:00

Today's deeper and more advanced facelift redrapes skin and underlying tissue for a younger, natural facial look. A composite facelift, or composite rhytidectomy, is a technique that can make you look year's younger. It lifts not only your skin, but also the underlying fat of the cheeks and drapes the skin and fat back over the cheek bones. Rather than a stretched, mask-like look, the skin and fat are repositioned to your facial structure which creates a more natural appearance. the surgeon will surgically tighten your neck muscles to give you a more defined and firmer neckline.

In the composite facelift, the neck muscle that goes over the jawline is lifted with facial skin to correct any sagging jowls. This new technique is more effective and natural looking than ever before. Gone is the streched mask-like plastic look of yesteryear's facelift. Not every plastic surgeon performs this particular type of facelift. During your consultation, ask the surgeon if he or she performs the composite facelift and to advise you of the risks and benefits involved.

Mini Tummy Tuck

2005-03-06T10:25:00.000-08:00

A mini-tuck is a partial abdominoplasty and is best performed on a patient with loose skin and muscle only in the lower abdomen. This out-patient procedure usually allows the patient to go home the same day. Although you will probably be able to recover quickly, you'll need to spend your first week primarily resting and recuperating. Liposuction, or fat suction, is often performed at the same time as the mini-tuck. An incision is made just above the pubic mound. The excess skin is cut away and the remaining skin is stitched back together again forming a tighter, firmer tummy. The navel remains in it's original place. The resulting permanent scar can be easily concealed by clothing or swim wear. After the procedure, you'll have a flatter, firmer tummy by excising loose skin and paunchiness in the lower abdomen. The success of this operation is quite high if you choose your surgeon carefully and follow his or her advice. Complications are always a risk when undergoing any type of surgery and your surgeon should discuss these in length with you.

Medium and Deep Facial Peels

2005-02-06T10:17:00.000-08:00

A chemical peel, also known as chemosurgery, is a process that minimizes the aging effects of fine lines and wrinkles of the forehead, eyelids, cheeks, and mouth. The peel is also effective for acne or uneven skin pigmentation. A peel doesn’t give you the same results as a face lift, but is often performed along with a face lift. How does a face peel work? A chemical solution is applied to your face to peel away the top layers of the skin. A peel can be light, medium, or deep, depending on how deep into skin the solution penetrates. A deep peel, or dermabrasion, is a procedure that uses a high-speed wheel with a sandpaper-like surface to abrade the skin. This type is used when you have extensive sun damage, acne scars, or deep skin wrinkles. You may feel a burning sensation when the chemical solution is first put on, but the solution acts as a local anesthetic and masks the pain shortly afterwards. The procedure lasts a little more than an hour and is done on an outpatient basis. Afterwards, you’ll have to wear a mask made of adhesive tape for one to two days. Within 24 hours of the peel, a crust or scab will form to protect the new skin. When this falls off, the skin appears bright red as if you’re sunburned. Your skin will gradually lighten to pink, and in the end will be a lighter tone than it was prior to the peel.

Cosmetic Surgery is Increasing in Popularity

2005-01-06T09:12:00.000-08:00

Is Everyone Doing It?
Cosmetic Surgery is Increasing in Popularity — for Some Very Good Reasons. Not so long ago, cosmetic plastic surgery was one of those "does she or doesn’t she?" topics. Except for obvious celebrity transformations such as Ivana Trump and Cher, many people couldn’t be sure why even a good friend looked so rested and relaxed after a recent trip to Manhattan or southern California. On the newsstand, articles about cosmetic plastic surgery were generally confined to magazines devoted to health. Today, however, cosmetic surgery has become a popular subject at suburban cocktail parties, coffee shops and in the workplace.

Articles about microdermabrasion ("Improve your complexion on your lunch hour!"), collagen injections ("Kiss your thin lips goodbye!") and other cosmetic surgery trends can be found every month in high profile fashion magazines such as Vogue, Harper’s Bazaar and Elle.

An Affordable Option for Millions of Americans
No longer the private domain of wealthy women, cosmetic surgery is rapidly becoming an affordable option for millions of Americans. Recently, a vibrant 73 year old woman approached a plastic surgeon at a Minneapolis cocktail party. Smiling, she said "I know who you are, I know what you do and I’ve been thinking about breast implants." As they chatted, she told him that she was a widow and that she felt it was time to do something that made her feel good about herself. She said "I could go out and buy a whole new wardrobe, but I want to do something more meaningful for myself. I realize there will be some risk, some pain and some recovery time associated with the surgery, but to me, it’s worth it." As the surgeon recounted their conversation, he smiled and said "This woman’s vitality, confidence and realistic expectations make her an ideal candidate for cosmetic surgery. I’d be honored and delighted if she chooses me to be her surgeon."

Over One million Procedures in 1998
According to statistics published by the American Society of Plastic and Reconstructive Surgeons (ASPRS), the number of cosmetic surgery procedures has increased 50 percent over the last two years and 153% over the last six years, to top the million mark at 1,045,815 in 1998. Liposuction, at 172,079 procedures, (a 57% increase since 1996 and a 264% increase since 1992) remains the most commonly performed cosmetic procedure in the United States, followed by breast augmentation at 132,378 procedures (a 51% increase since 1996 and a 306% increase since 1992), eyelid surgery (120,001 procedures), facelifts (70,947 procedures) and chemical peels (66,002 procedures).

Cosmetic Surgery for Aging Baby Boomers
The ASPS has identified a number of trends that account for these dramatic increases in the number of cosmetic surgery procedures, including the vast number of aging baby boomers, the increasingly competitive workplace and the general decrease in the cost of cosmetic surgery. According to American Demographics, over the next ten years, a baby boomer will turn 50 every 8 seconds. Since 1996, when the first boomer turned 50, the number of cosmetic surgery procedures in this age group rose from 164,662 (1996) to 242,427 (1998), an increase of 47%. Says Paul Schnur, MD, ASPRS president, "Due to healthier lifestyles, men and women age 50 and older are feeling good about themselves and want to maintain a youthful appearance. As this large segment of the U.S. population ages, we anticipate the increase in cosmetic surgery to continue."

Competitive Workplace Pressures
Increased pressures in the workplace are one reason that 9 percent of all cosmetic procedures are performed on men. In bold letters, the cover of Fortune magazine (February 1) declares that experienced executives are "Finished at 40." Inside, the article states that "…a new trend is emerging: In corporate America, 40 is starting to look old." To combat the painful reality of this trend, more and more men are choosing liposuction to eliminate their not so lovable love handles, blepharoplasty to adjust their drooping eyelids and facelifts to boost their sagging jowls. Wrinkles, crows feet and other tell-tale signs of aging are being erased with laser skin resurfacing and chemical peels. Says Dr. Schnur, "More and more men are having cosmetic surgery, not only to look and feel younger, but also to give themselves a competitive edge in the workplace."

"I don’t Want to Look Like my Mother!"
Another reason why cosmetic surgery appeals to the baby boom generation is the ability to minimize their resemblance to their parents. As the first generation to dramatically redefine adulthood in America, both men and women boomers are loathe to let Nature take its toll. Says John M., a successful 49 year old business owner, "I run and do push-ups every morning, even when I’m on the road. I watch what I eat and I just got some hip new eyeglasses. Despite my best efforts, whenever I look in the mirror, I see my dad staring back at me!"

Says Claire N., a striking woman in her early 40’s, "I’m comfortable with my age – I didn’t mind turning 40 at all. However, when someone tells me that I look like my mother, I feel like crying!" When asked if she’d consider cosmetic surgery, Claire admits that she’s already scheduled a cosmetic surgery consultation as a birthday gift to herself.

Active, youthful boomers are not the only ones choosing cosmetic surgery. More seniors age 65 and over are choosing to enhance their retirement years with cosmetic surgery. Like the boomers, the most popular procedures with seniors are eyelid surgery, facelifts, liposuction and laser resurfacing. While many Americans may question the decision to undergo surgery at an advanced age, thousands of others would no doubt agree with the vibrant 73 year old Minneapolis woman when she says "I just want to feel good about myself again."

The Silicone Breast Implant Controversy

2005-01-06T09:06:00.000-08:00

In 1992, the Food and Drug Administration officially banned the use of silicone breast implants in most cosmetic surgeries, citing concerns over the dangers of silicone leakage in the body.

Today reputable surgeons use saline-filled implants which are less harmful when leakage occurs but may still elicit an immune response if the silicone shell the saline is housed in breaks down in the body. I've performed numerous breast surgeries in the past 12 years and I myself have had silicone gel breast implants since 1985, -- so I can understand women's concern on this issue. Ongoing studies may not produce conclusive results for many years, but here is what we know so far:

1. All Implants Can Rupture or Leak.
Most silicone gel implants, especially those manufactured prior to 1985, were known to have small amounts of silicone gel "bleed" or leak through the shell. In the early 1980's, Dow Corning developed a "low bleed" gel implant with a silicone shell that was less likely to bleed, although this leakage occurs to some extent in all silicone gel implants-even those that have not ruptured.

Since silicone-gel implants were banned for use in most surgeries in 1992, plastic surgeons today generally use either smooth-wall saline-filled implants (which are felt to have fewer problems with wrinkling) or textured saline-filled implants (which have a lower incidence of capsular contracture, a tightening or hardening of the scar tissue around the implant).

2. Silicone Leakage in the Body Can Require Additional Surgery.
When saline-filled implants leak out of the silicone shell, the salt water is usually reabsorbed by surrounding tissue without much difficulty. But when silicone bleeds through the shell, it usually requires surgical removal of the material. Fortunately, the body tends to isolate the majority of the silicone within the scar capsule, making this removal much easier. It is important that the explanting surgeon use a technique that minimizes the risk of free silicone coming into contact with bodily tissues and that all of the scar capsule be removed, since it contains silicone particles.

3. Silicone Leakage May Cause Complications or Disease Elsewhere in the Body.
In the past three years, I've seen more than 120 patients with silicone breast implants who have suffered a variety of chronic ailments. Their symptoms range in severity from mild chronic fatigue and occasional joint and muscles aches to more debilitating illnesses, such as fibromyalgia, Lupus, and rheumatoid arthritis. Some plastic surgeons speculate that a low-grade chronic infection around a silicone gel implant may lead to a chronic illness, in which the immune system is unable to eradicate the infection or dispose of the foreign body.

The good news is that we have seen an improvement of symptoms after surgeons remove the scar capsule and implants. Patients often report return of their normal energy levels, sometimes within several weeks following surgery. Some patients only experience a partial improvement, but to date most have not had their symptoms progress unless large amounts of silicone gel still remain in the body.

4. If You Experience Symptoms of Rupture, Consult Your Surgeon as soon as Possible.
Any woman with silicone gel breast implants who experiences a sudden change in shape and/or contour of her breast, or develops burning pain or numbness and tingling in the arm should be evaluated by a plastic surgeon for the possibility of implant rupture. If you experience generalized symptoms such as chronic fatigue and muscle and joint aches-and especially if these symptoms are progressive-you may wish to consider removal of the scar capsule and implant, even if tests do not show a ruptured implant. If the symptoms are severe, I would not advise replacement of the implants with saline implants-recovery is often delayed if the saline implants are replaced at the time of implant removal.