Plastic Surgery Procedures and FAQs
From The American Society for Aesthetic Plastic Surgery

  • Body
  • Armlift
    • An arm lift, or otherwise known as brachioplasty, can remove the excess skin and fat deposits, leaving the upper arms with a more pleasing and youthful contour. As a person ages, upper arm skin can become loose and flabby. Plastic surgeons will consult with patients about undergoing surgery for an arm lift if they wish to tighten this skin to look and feel more youthful. The incision extends from the elbow to the underarm, and sometimes on to the side of the chest. In some instances, your Plastic surgeon may recommend that liposuction be used alone or in conjunction with an arm lift to remove excess fat in the upper arms. Upper arm excess in a massive weight loss patient usually crosses the arm pit and involves loose skin that extends onto the chest region. Brachioplasty, or upper arm reduction surgery, usually involves reducing the skin through a scar that runs on the inner part of the upper arm, often crossing onto the arm pit.

      Am I good candidate for upper arm lift?

      Arm Lift surgery can be performed on a large variety of patients including normal weight patients who simply need a little tightening. However the majority of patients are massive weight loss patients that have stabilized their weight loss and do not have out of control medical problems. They present with excess skin and fat in their upper arms. Many of these patients complain that their arms feel and look like "bat wings". Occasionally some older women have a lot of extra skin that is bothersome and would also be reasonable candidates.

      Arm Lift Standard Procedure Techniques

      For patients who have minimal upper arm fat excess, with no skin excess, liposuction alone can be effective. For patients that have some extra skin that is minimal in nature and is located near the arm pit, an improvement can be attained through a scar limited to the arm pit. For patients who present with a lot of upper arm excess, as in the case of most massive weight loss patients, tissue must be removed through a scar that runs from the elbow, through the arm pit, and onto the side of the chest.

      Pre-Operative

      If you are a smoker, it is recommended that you stop smoking well in advance of the surgery. Smoking can affect your ability to heal. Certain medications that increase the risk of bleeding such as Aspirin, non-steroidal anti-inflammatory medications, and some vitamins/homeopathic regimens should be discontinued prior to arm lift surgery.

      Arm Lift Benefits/Advantages/Options

      Reduction in upper arm excess
      Better self image/confidence
      Being able to wear short sleeve clothing without being self conscious
      Arm Lift Risks/Complications/Patient Safety
      Bleeding
      Infection
      Unattractive scarring
      Swelling of the hands
      Seroma formation (seromas are fluid collections that can arise after surgery along the incision line)

      Arm Lift Recovery Process

      Some surgeons prefer to wrap the arms or use compression garments
      Most surgeons prefer that the arms are elevated for a few days, above the heart
      Slow return of normal function of the arms and hands over a couple of weeks
      You should avoid Aspirin and non-steroidal anti-inflammatory medications for the first few days after your arm lift surgery. Smoking and exposure to second-hand smoke may impair the healing process and should be avoided.

      FAQ

      Will arm lift surgery be painful?

      Postoperative pain is subjective and will vary considerably from person to person. The average patient undergoing an upper arm reduction procedure will usually require a few days of oral pain medication to treat discomfort. Over a 7 to 10 day period most people resolve the majority of their acute postoperative pain.

      Will there be scarring with arm lift surgery?

      Upper arm reduction involves the removal of skin and necessitates the creation of a scar that starts near the elbow, traverses to the arm pit, and often crosses onto the chest wall. Any scar goes through a maturation process, which takes a year to complete. Most scars are conspicuous, at least initially. Some surgeons prefer to place the upper arm reduction scar on the inner arm aspect so that it is not visible when the patient's arm is by their side. Other surgeons prefer to place the scar a bit more towards the back of the arm so that it is not visible from the front, especially when the patient is observed from the front while moving the arm.

      What are some typical short term side effects of having an arm lift?

      Immediately after surgery some patients will have a feeling of tightness in the upper arm as the area swells due to the trauma of surgery. Some patients may develop swelling and some tingling of the hands as well. Most of these symptoms resolve with time.

      What type of anesthesia will be used for arm lift surgery?

      Most arm lifts are performed under a general anesthetic, although some surgeons will utilize a local anesthetic, with sedation. It is important that the facility that the procedure is performed in is an accredited facility where the type of anesthesia utilized is allowed.

  • Liposuction
    • Any one or combination of the following conditions may indicate that you are a good candidate for liposuction surgery:

      Areas of fat deposits that are out of proportion with the rest of your body and do not go away with diet and exercise – so called "diet resistant fat"

      Areas with minimal amounts of excess skin (Liposuction removes fat not skin) and good skin elasticity

      Liposuction surgery may be considered to treat areas of excess fat in the stomach, buttocks, hips, love handles, saddlebags, thighs, calves, ankles, breasts (including male breast enlargement), back, arms and neck Liposuction is equally effective in both men and women.

      Liposuction Results

      Liposuction surgery usually improves contours. In some instances it may be used in a circumferential fashion, thinning an area. Since the healing process is gradual, you should expect to wait at least several months to get an accurate picture of the results of your surgery. The small incisions used for access of the instrument known as a cannula, will fade over a number of months usually becoming barely visible. The results of liposuction surgery are usually long-lasting, but they may be affected by weight gain, aging, pregnancy and lifestyle factors.

      Your Personal Consultation-- How will my Plastic surgeon evaluate me for liposuction surgery?

      During the initial consultation, you may be asked to look in a mirror and point out exactly what you would like to see improved. Pictures may be taken of you especially if the areas that will be treated are on your posterior aspect (back, buttock, etc.). This will help your Plastic surgeon to understand your expectations and determine whether they can realistically be achieved. A determination of the elasticity of the skin will also occur.

      A discussion concerning your ideal weight and realistic weight will most likely occur. Plans such as future pregnancies, etc. may be discussed. You should come to the consultation prepared to discuss your medical history including previous surgeries, past and present medical conditions, allergies and current medications. It is important for you to provide complete information. High blood pressure, thyroid problems, diabetes, etc. should be reviewed as these medical conditions may increase some risks associated with surgery.

      How Liposuction Surgery is Performed

      The basic technique of liposuction involves the removal of fat via a hollow metal tube (cannula) that is passed through the fatty tissue. One of the most common types of liposuction involves the aspiration of fat by attaching a pump that generates a vacuum. This is known as suction assisted liposuction (SAL). In addition, a motor may be used on the cannula that causes the cannula to vacillate back and forth thus performing much of the "work" of liposuction know as power assisted liposuction (PAL). An ultrasonic generator may produce sound waves above audible frequency that "breaks" the fat cells and the broken down fat is removed by SAL. A laser can also be employed to break down the fat cells. Each of the methods has advantages and disadvantages. These methods will be discussed with you at the time of the consultation. Additionally, the above techniques may be combined to yield optimal results. The decisions concerning the appropriate technique will best be accomplished by your Plastic surgeon.

      Understanding Risks of Liposuction

      Fortunately, significant complications from liposuction surgery are infrequent. Liposuction surgery is one of the two most common procedures performed by Plastic surgeons. Most often this surgery is performed without experiencing any major problem. The subject of risks and potential complications of surgery is best discussed on a personal basis between you and your Plastic surgeon, or with a staff member in your surgeon's office. The risks in most surgeries are similar. Some of the potential complications that may be discussed with you include hematoma (an accumulation of blood under the skin that may require removal), infection, changes in sensation, scarring, allergic reactions, damage to underlying structures, need for revisions, unsatisfactory results possibly necessitating additional procedures and medical risks. Other risks more specific to liposuction may include indentations and irregularities. You can help minimize certain risks by following the advice and instructions of your Plastic surgeon, both before and after your liposuction surgery.

      Your Liposuction Surgical Experience (Preoperative Preparation and Recovery)

      Pre-Operative

      The goal of your Plastic surgeon and the entire staff is to make your surgical experience as easy and comfortable for you as possible. If you are a smoker, it is recommended to stop smoking well in advance of surgery since smoking can impair the healing process. Certain medications that increase the risk of bleeding such as Aspirin, non-steroidal anti-inflammatory medications, and some vitamins/homeopathic regimens should be discontinued before undergoing liposuction surgery. Your surgeon will provide you with additional preoperative instructions.

      Liposuction surgery is usually performed on an outpatient basis. If this is the case, be sure to arrange for someone to drive you home after surgery and to stay with you for the next 24 hours. If you are undergoing large volume of liposuction, it may be suggested that you be hospitalized even for one night.

      The Day of Liposuction Surgery

      Your liposuction surgery may be performed in an accredited hospital, free-standing ambulatory facility or office-based surgical suite. Medications are administered for your comfort during the surgical procedure. Frequently, local anesthesia and intravenous sedation are used for patients undergoing liposuction surgery, although general anesthesia may be desirable in some instances. For your safety during the operation, various monitors are used to check your heart, blood pressure, pulse and the amount of oxygen circulating in your blood.
      When surgery is completed, you will be taken into a recovery area where you will continue to be closely monitored. You will most likely be wearing a compression garment, usually used to help "shrink" the skin. Concerning postoperative pain, many patients state that the area feels sore, as if they underwent a vigorous work out.

      You probably will be permitted to go home after a short period of observation, although some patients may stay overnight in the hospital or surgical facility.

      Recovery from Liposuction Surgery

      It is important to realize that the amount of time it takes for recovery varies greatly among individuals. The first few days after surgery, you should rest quietly. If you can elevate the body part, it is usually suggested that you do so. Remember, you must not take aspirin or certain anti-inflammatory medications. You most likely will wear a garment. If it is too tight you should promptly notify your surgeon. During the first 48 hours following surgery, patients experience varying degrees of swelling and bruising. The swelling persists longer. Bruising typically disappears within seven to ten days. Stitches are usually removed within a week of surgery.
      Straining, bending over and lifting should be avoided during the early postoperative period. In many instances, you will be able to resume most of your normal activities within ten days or less.

      How much will liposuction cost?

      Cost is always a consideration in elective surgery. Prices for liposuction vary widely, and are often dependent on the surgeon's experience and the geographical location.
      The fees are often broken down into several components:

      Surgeon's professional fee
      Facility fee
      Anesthesia fee
      Medications
      Surgical garments
      Medical tests

  • Lower Body Lift
    • The lower body lift surgical procedure tightens loose, sagging skin in the buttocks, posterior thighs, hips, outer thighs, and anterior thighs. It utilizes incisions which pass from the back around the hips to the front of the thighs. The loose skin, as well as underlying fat tissue, is removed from below the incision to allow suspension of the remaining tissues to stretch and smooth the lower body, especially the buttocks and thighs. The surgery begins in the back and requires repositioning during the surgery to address the hips and outer thighs and front of the thighs. It can be combined with an abdominal skin tightening if needed. If a previous tummy tuck (abdominoplasty) has been performed or is not needed, the lower body lift can be extended to tighten the inner thighs.

      The incisions are designed to be hidden by clothing and sportswear or to lie in normally occurring anatomic folds. Layered suture techniques are used to carefully close the area of incision in order to maintain the lift, tightening and smoothing the remaining skin.

      Swelling, which is commonly seen after body lift surgery, is controlled by compression garments and the use of drains, sterile collection tubes used to evacuate excess fluid. Weekly follow up visits help to achieve an optimal outcome by allowing adjustments based on visible progress which varies among patients. Full healing of the circumferential incisions may take four weeks or even longer.

      Am I a good candidate for lower body lift surgery?

      Patients who benefit from lower body lift surgery have:
      Loose skin in their buttocks and back of their thighs
      Loose skin in their hips and side of their thighs
      Loose skin in the front of their thighs
      Loose abdominal skin or in their inner thighs
      Relatively thin layers of fat below the skin of these areas
      Acceptance of the thin scars around the waist
      Patients who have had massive weight loss

      Each patient's anatomy and proportions of loose skin vary from individual to individual. The decision to utilize lower body lifting techniques depends upon your goals and expectations as well as an examination by your surgeon. This will help determine whether the lower body lift will achieve a satisfactory outcome for you.

      Lower Body Lift Standard Procedure Techniques

      All lower body lift techniques tighten the buttocks/back of the thighs and hips/outer thighs. Loose sagging skin below the incision is removed. The remaining skin in the buttock and thighs is pulled upwards, and the skin is repaired, suspending the tissues and tightening them. This requires positioning the patient on their tummy or side during the procedure. Incision closure is performed in multiple layers over drains, to control stretching and swelling.

      Once the back and sides of the patient have been addressed, the front of the patient is treated with the patient positioned on his/her back. Two options are available. These options should be discussed with you preoperatively and are chosen based upon your choice. One option is to combine the lower body lift with abdominal contouring, otherwise known as tummy tuck (abdominoplasty). The other option is to combine lower body lift with an inner thigh lift, if the abdomen does not require contouring, or if the patient has had previous abdominoplasty. These techniques utilize the removal of skin, or excision of skin, to tighten loose, sagging tissue. It can include the removal of the fat layer under the excised skin to lessen fullness and padding in the lower body.

      Candidates for body lift surgery all have extra skin which must be removed by excision. This differs from liposuction, in that liposuction removes only fat through small quarter inch incisions, but no skin. However, liposuction may be done in conjunction with body lifting techniques to smooth and contour areas separate from the effects of the body lift excisions. Again, a thorough discussion and examination are essential to determining a comprehensive surgical plan.

      Lower Body Lift Benefits/Advantages/Options

      Multiple areas (buttocks, thighs, possibly abdomen) addressed in one single operation
      Tightening extends lower in the back, side and front of thighs than other circumferential excisional procedures

      Can be combined with breast surgery or arm contouring procedures
      Can be combined with liposuction in selected areas
      Other Considerations of Lower Body Lift Surgery
      Since the operation achieves tightening of the lower body by excising loose tissue (skin and fat), the lower body lift should be performed when the patient is as close to their desired or ideal body weight as possible. If, for example, the patient has tightening of their lower body and then loses weight, the tightened skin will loosen and become saggy. Conversely, post operative weight gain will either stretch the skin which has been tightened or undo the improvements of the body lift.

      Because the lower body is lifted and suspended to the skin closure, excessive heaviness in the thighs and buttocks at the time of surgery may prevent a long lasting effect. In such cases, further weight loss may be recommended before performing body lifting procedures. If this is not feasible, liposuction may be an option to thin the thighs and buttocks before attempting excisional body lifting.

      Lower Body Lift Surgery Risks/Complications/Patient Safety

      Seromas (collections of fluid below the skin) may require the use of drains
      Delayed healing from small separations in the incision closure in areas of high tension and stretch
      Numbness in areas adjacent to the incision
      Slight asymmetries may occur in spite of efforts to balance skin and fat removal
      Bleeding may lead to bruising, but it is very rare to require transfusions
      Blood clots to the lung (pulmonary emboli) are rare. Sequential compression devices (SCD's) on the calves during surgery has significantly lessened the incidence in body contouring procedures

      Surgical operating time and duration may last six hours or more for the body lift. Measures are taken to warm the patient carefully during surgery. Medical conditions are addressed preoperatively to ensure the safety of the patient for such durations.

      Lower Body Lift Recovery Process

      Surgical drains are placed to remove fluid which accumulates within the incisions. The amount of fluid is measured by the patient on a daily basis. Once the output falls low enough arrangements are made for removal of the drain in an office outpatient setting. Drains typically remain in place two to three weeks, but may be left longer.

      Sutures in the incision closure may require removal. This typically occurs around two weeks after surgery, and this, too, is done in an office as an outpatient treatment.
      Compression garments may be placed on the patient to control swelling, to support the suspended tissues, and to smooth and flatten the skin. Placement can occur at the time of surgery, or later, at the surgeon's discretion.

      Activity is determined by the progress of the healing of the incision. Patients are encouraged to walk the day after surgery. Once the drains are removed, movement is easier.

      As a patient you would be admitted to the hospital after surgery. You may stay a couple of days to learn care of their drains and feel comfortable in walking and moving. Once comfortable with oral pain medications, you would be discharged.

      Usually resumption of normal activities can occur four to six weeks after surgery.

      Lower Body Lift Frequently Asked Questions

      Will lower body lift surgery be painful?

      For the most part, pain is controlled by oral pain medications. The first day of surgery, you may require injections or intravenous pain medications, but usually pain pills satisfactorily relieve discomfort after that.

      Will there be scarring from body lift surgery?

      There will be a scar along the incision. It will be as thin as your surgeon can make it, using multiple layers of sutures to prevent spreading. However, there will always be some evidence of the surgical incision. Your surgeon may be able to show you pictures of the scar locations, as an example.

      What are some typical short-term side effects from body contouring surgery?

      Numbness or decreased sensation can occur in the upper buttocks or thighs and in the lower abdomen (if the abdomen is included in the body lift surgery) Seromas, collections of fluid (serum) under the skin may occur even after drain removal. These may require removal by aspiration in the office using a syringe. Swelling may require the use of compression garments around the waist and thighs for four to six weeks after surgery.

      What type of anesthesia will be used for body lift surgery?

      Body lift surgery is typically performed under a general anesthesia. In this type of surgery, you would be put to sleep with an intravenous sedative. After you are asleep, a breathing tube would be placed in your mouth to ensure that the airway is secure during the position changes necessary during the surgical body lift procedure.

  • Post Bariatric
    • Body contouring after major weight loss reduces the excess skin and fat that is left behind from the expansion of skin, loss of fat and lack of tissue elasticity that often occurs after a major weight loss. This sagging skin commonly develops around the face, neck, upper arms, breast, abdomen, buttocks, and thighs and can make your body contour appear irregular and misshapen. If you have undergone dramatic weight loss either through diet and exercise or bariatric surgery, and you are at your optimum weight loss goal, you may be a good candidate for this surgery and may wish to consider undergoing this procedure.
      The success of body contouring, whether it is done to reduce, enlarge or lift, is influenced by your age and by the size, shape and skin tone of the area to be treated. Some contouring procedures leave only small, inconspicuous scars. More noticeable scars may result when surgical removal of fat and skin is necessary to achieve your desired result. Most patients find these scars acceptable and enjoy greater self-confidence when wearing a bathing suit or form-fitting clothes.

      It is not uncommon, depending on individual patient factors, the extent of surgery needed and surgeon preference, for massive weight loss patients to have multiple operations performed in stages. In such cases, the waiting period between surgeries ranges from weeks to several months or longer.
      Face and Neck Lift

      After dramatic weight loss, the face skin can become flaccid, resulting in the cheek pads dropping, and jowls forming, resulting in the loss of a defined jaw line. In addition, the neck is loose and sagging.

      A face and neck lift raises the cheek pads, corrects the jowls, and removes the loose and sagging skin. The incisions are inconspicuous. They are placed in front of and behind the ears, and extend into the hair above and behind the ear.

      Post-bariatric surgery patients may be nutritionally deficient, and this can have consequences for surgery and recovery. Patients may be referred for nutritional counseling and advised to wait a year or longer following their weight loss before undergoing Plastic surgery. It is also important for the patient's weight to stabilize before body contouring begins.

      Patients may be surprised to learn the extent of Plastic surgery that is required to bring their body back to a more normal and aesthetic appearance. Many of these patients will need a total body lift. While surgeons may define this term somewhat differently, treatment most likely would include a tummy tuck, circumferential lower body lift, thigh and buttock lifts, removal of back rolls, breast lift and upper arm lift as well as face and neck procedures to get rid of loose, hanging skin in these areas.

      Remember no two patients will have exactly the same results. You should realize that to re-contour and shape your body after dramatic weight loss, you will have visible scars, and uneven contours can develop. While the results of body contouring are visible immediately, if you have poor skin elasticity or gain weight, you will have some relapse of the sagging skin.

      Through recent advances in all types of body contouring surgery, it is now possible for many patients to have a more proportionate body, better body image, and more self-confidence. The best way to get answers to your specific questions to see if you are a good candidate for this type of surgery is through a personal consultation with a board-certified Plastic surgeon.
      Arm Lift (Brachioplasty)

      An arm lift, or otherwise known as brachioplasty, can remove the excess skin and fat deposits, leaving the upper arms with a more pleasing and youthful contour. As a person ages, upper arm skin can become loose and flabby. Plastic surgeons will consult with patients about undergoing surgery for an arm lift if they wish to tighten this skin to look and feel more youthful. The incision extends from the elbow to the underarm, and sometimes on to the side of the chest. In some instances, your Plastic surgeon may recommend that liposuction be used alone or in conjunction with an arm lift to remove excess fat in the upper arms.

      Upper arm excess in a massive weight loss patient usually crosses the arm pit and involves loose skin that extends onto the chest region. Brachioplasty, or upper arm reduction surgery, usually involves reducing the skin through a scar that runs on the inner part of the upper arm, often crossing onto the arm pit.

      Am I good Candidate for Upper Arm Lift

      Arm Lift surgery can be performed on a large variety of patients including normal weight patients who simply need a little tightening. However the majority of patients are massive weight loss patients that have stabilized their weight loss and do not have out of control medical problems. They present with excess skin and fat in their upper arms. Many of these patients complain that their arms feel and look like "bat wings". Occasionally some older women have a lot of extra skin that is bothersome and would also be reasonable candidates.

      Arm Lift Standard Procedure Techniques

      For patients who have minimal upper arm fat excess, with no skin excess, liposuction alone can be effective. For patients that have some extra skin that is minimal in nature and is located near the arm pit, an improvement can be attained through a scar limited to the arm pit. For patients who present with a lot of upper arm excess, as in the case of most massive weight loss patients, tissue must be removed through a scar that runs from the elbow, through the arm pit, and onto the side of the chest.

      Pre-Operative

      If you are a smoker, it is recommended that you stop smoking well in advance of the surgery. Smoking can affect your ability to heal. Certain medications that increase the risk of bleeding such as Aspirin, non-steroidal anti-inflammatory medications, and some vitamins/homeopathic regimens should be discontinued prior to arm lift surgery.

      Arm Lift Benefits/Advantages/Options

      Reduction in upper arm excess
      Better self image/confidence
      Being able to wear short sleeve clothing without being self conscious

      Arm Lift Risks/Complications/Patient Safety

      Bleeding
      Infection
      Unattractive scarring
      Swelling of the hands
      Seroma formation (seromas are fluid collections that can arise after surgery along the incision line)

      Arm Lift Recovery Process

      Some surgeons prefer to wrap the arms or use compression garments
      Most surgeons prefer that the arms are elevated for a few days, above the heart
      Slow return of normal function of the arms and hands over a couple of weeks
      You should avoid Aspirin and non-steroidal anti-inflammatory medications for the first few days after your arm lift surgery. Smoking and exposure to second-hand smoke may impair the healing process and should be avoided.

      FAQ

      Will Arm Lift surgery be painful?

      Postoperative pain is subjective and will vary considerably from person to person. The average patient undergoing an upper arm reduction procedure will usually require a few days of oral pain medication to treat discomfort. Over a 7 to 10 day period most people resolve the majority of their acute postoperative pain.

      Will there be scarring with Arm Lift surgery?

      Upper arm reduction involves the removal of skin and necessitates the creation of a scar that starts near the elbow, traverses to the arm pit, and often crosses onto the chest wall. Any scar goes through a maturation process, which takes a year to complete. Most scars are conspicuous, at least initially. Some surgeons prefer to place the upper arm reduction scar on the inner arm aspect so that it is not visible when the patient's arm is by their side. Other surgeons prefer to place the scar a bit more towards the back of the arm so that it is not visible from the front, especially when the patient is observed from the front while moving the arm.

      What are some typical short term side effects of having an Arm Lift?

      Immediately after surgery some patients will have a feeling of tightness in the upper arm as the area swells due to the trauma of surgery. Some patients may develop swelling and some tingling of the hands as well. Most of these symptoms resolve with time.

      What type of anesthesia will be used for Arm Lift surgery?

      Most arm lifts are performed under a general anesthetic, although some surgeons will utilize a local anesthetic, with sedation. It is important that the facility that the procedure is performed in is an accredited facility where the type of anesthesia utilized is allowed.

      Breast Lift
      A breast lift will raise and firm sagging, flat breasts. Some patients also may require breast implants to improve the shape and size. Incisions are placed around the nipple, from the nipple to the crease under the breast, and horizontally along the breast crease.

      Medial Thigh Lift
      The medial thigh lift will lift and tighten the sagging skin of the inner thigh. Incisions are usually placed in the groin.

      Panniculectomy
      A panniculectomy is performed to remove the hanging pannus, or apron of skin, from the lower abdomen below the belly button. The excess skin and fat above the belly button are not removed. A panniculectomy is often performed on patients who are still significantly overweight but have skin irritation from their hanging skin. After surgery, these patients have less skin problems but have little improvement in the contour of their bellies.

      Lower Body Lift
      In one procedure, the sagging skin of the abdomen, outer thighs, buttocks, hips, and waist is corrected. Incisions extend completely around the body to remove a "belt" of excess skin and fat. Another common name for this procedure is a "belt lipectomy."

      When people gain a lot of weight they usually deposit their fat around their entire lower trunk, which involves the front, sides and back starting from just below the ribs to the pelvic region. When they lose the weight they end up with a lot of excess fat and skin that is most obvious in the front, often looking like an apron that will hang to varying degrees. However the hanging excess does not stop in the front, and most often it will continue on to the sides and the back involving the outer thighs, lower back, and buttocks regions. This type of problem is called circumferential excess.

      To treat circumferential excess of the lower trunk in the massive weight loss patient, a lower body lift/belt lipectomy is most often employed. In this procedure, a wedge of tissue that goes around the lower aspect of the lower trunk is removed to treat the entire region so that the greatest amount of improvement can be attained. Although a tummy tuck/abdominoplasty, a procedure where only the front of the belly area is reduced, can be used in some massive weight loss patients, the results are often less than ideal because the sides and back are not adequately addressed.

      Am I good candidate for lower body lift?

      Lower Body Lift is indicated in patients who were obese and have lost a significant amount of weight leading to circumferential lower truncal excess. To operate on a patient they should:

      be medically stable
      be psychiatrically stable
      have stabilized their weight loss (neither losing nor gaining weight)

      Although this type of procedure is most often utilized in massive weight loss patients, there are three other groups that may benefit from this type of surgery:

      Women who were never obese but are 30 to 40 pounds over weight and are not able to lose the weight
      Normal weight patients who desire outstanding body contour
      Patients who underwent liposuction with excess skin in the area of the lower trunk and/or thighs

      Lower Body Lift Standard Procedure Techniques

      Lower Body Lift surgery involves removing a circumferential wedge of tissue. In the front the procedure involves removing the hanging apron of skin and fat and tightening up the underlying muscle wall, which is very similar to what is accomplished in a tummy tuck. To remove the excess tissues located in the back and sides the patient has to be turned in the operating room to allow for exposure of these areas. Liposuction of the thighs is often performed at the same time. The final scar has a similar shape to a "thong bikini" for most surgeons.

      Elimination of the hanging apron
      Flattening of the belly
      Pulling up the droopy pubic region
      Creation of a waist
      Lifting the thighs
      Lifting and defining the buttocks
      Lower Body Lift Risks/Complications/Patient Safety

      Lower body lift should be thought of as an extensive operation and a major life event. Potential risk and complications may include:

      Bleeding
      Infection
      Unattractive scarring
      Seroma formation, which are fluid collections that can arise after surgery along the incision line
      Separation of the incision because of the tension created by taking out the wedge of tissue
      Potential for blood clots in the legs that can travel to the lungs called pulmonary embolism
      Difficulty in healing the incision edges together

      Lower Body Lift Recovery Process

      This procedure may take 3 to 4 weeks to recover from
      Some surgeons prefer to use compression garments
      Most patients may be instructed to walk bent at the waist for a week
      Usually patients will have drains, Plastic tubes that drain blood and body fluids, from the areas that were operated on. They will stay in place for a variable amount of time, from a few days to weeks

      The final results may not be apparent until all swelling has resolved which may take up to a year for this type of procedure

      FAQ

      Is lower body lift surgery painful?

      The amount of pain that any particular patient will have after surgery is dependent on their pain tolerance, the type of procedure performed, and the methods used by the surgeon to control pain. Postoperative pain is subjective and will vary considerably from person to person. The average patient undergoing a lower body lift procedure will usually require a few days of pain medication to treat the feeling of discomfort. Over a 7 to 10 day period most people resolve the majority of their acute postoperative pain. Although some pain may persist after this period of time, it is usually not severe enough to require significant doses of pain medication.

      Will there be scarring from a lower body lift?

      The scar created by a Lower Body Lift goes around the entire trunk in the shape of a "thong bikini". Scarring quality is variable and mostly dependent on the patient's genetic makeup. It is usually covered by the patient's underwear, although not in all cases.

      What are some typical short term side effects of lower body lift?

      Immediately after surgery some patients will have a feeling of tightness in the abdomen, sides and back. There will be swelling and obviously pain as discussed above. Most patients have to walk slightly bent at the waist for at least one week, if not longer. Because this is an extensive operation, most patients will need a few weeks to regain their strength and activity level.

      What type of anesthesia will be used for lower body lift?

      Almost all body lift procedures are performed under general anesthesia. Some Plastic surgeons will combine the general anesthetic with epidural anesthesia, mostly to manage postoperative pain. It is important that the facility that the procedure is performed in is an accredited facility where the type of anesthesia utilized is allowed.

  • Tummy Tuck
    • Women and men who have loose abdominal skin and fat that is concentrated in the abdomen can benefit from abdominoplasty. Sometimes these conditions are inherited. In other instances, substantial weight loss may cause abdominal skin to become flaccid. Abdominoplasty also can tighten muscles that have been separated and weakened by pregnancy. The procedure may somewhat improve the appearance of stretch marks, especially those located below the navel.

      Your Personal Consultation

      During the consultation, you will be asked about the results you would like to achieve from abdominoplasty. This will help your surgeon to understand your expectations and determine whether they realistically can be achieved.

      Am I a good candidate for abdominoplasty?

      You may be a good candidate for abdominoplasty if you have one or more of the following conditions:

      excess or sagging abdominal skin
      an abdomen that protrudes and is out of proportion to the rest of your body
      abdominal muscles that have been separated and weakened
      excess fatty tissue that is concentrated in your abdomen
      If you plan to become pregnant or lose weight in the future, you should discuss this with your Plastic surgeon. Scarring from previous abdominal surgery may limit the results of your abdominoplasty.

      How will my Plastic surgeon evaluate me for abdominoplasty?

      Your Plastic surgeon may examine your abdomen while you are standing as well as lying down. Your skin tone and the degree of loose skin in the abdominal region will be assessed. Your surgeon also will evaluate the amount of excess fat in your abdomen and the condition of your abdominal muscles.

      You should come to the consultation prepared to discuss your medical history. This will include information about any medical conditions, drug allergies, medical treatments you have received, pregnancies, previous surgeries and medications that you currently take. It is important for you to provide complete information.

      Will my insurance help cover the cost of surgery?

      Abdominoplasty, as an aesthetic (cosmetic) procedure, generally is not covered by insurance. In some instances, however, a patient may have a hernia and not just a spreading of the abdominal muscles. Insurance reimbursement may be available for that portion of the procedure that is not cosmetic.

      Many factors determine your eligibility for coverage, including the specific terms of your insurance policy. A letter of predetermination may be required by your insurance company prior to surgery. Your Plastic surgeon or a staff member in your surgeon's office will discuss these matters with you.

      How Abdominoplasty Is Performed

      Individual factors and personal preferences will determine the specific technique selected to smooth and flatten your abdomen.

      Where are the incisions placed?

      Generally, a horizontal incision is placed just within or above the pubic area. The length of the incision, which extends laterally toward the pelvic bones, depends largely on the amount of skin to be removed. The contour of this incision will vary somewhat according to the structure of your abdomen and the style of bathing suit or undergarments that you prefer. Your Plastic surgeon will try to keep the incision within your bathing suit lines, but this may not always be possible.

      Generally, a horizontal incision is placed just within or above the pubic area. If there is loose skin above the navel, the surgeon may make a second incision around the navel. Skin in the shaded area is separated from the abdominal wall.

      Some patients have loose skin above the navel. In such cases, the surgeon may make a second incision around the navel so that the redundant skin above it can be pulled down. The excess abdominal skin is then removed. The position of the navel remains unchanged.

      To tighten the abdominal wall, the surgeon brings loose underlying tissue and muscle together with sutures. Skin of the lower abdomen that contains stretch marks may be removed as well. Any remaining stretch marks may be somewhat flattened and improved, but you should not expect a dramatic change in their appearance.Abdominal skin is pulled downward, and the excess is removed. A small opening is made to bring the navel through.

      The procedure may include tightening of the underlying abdominal muscles using sutures.

      What are some variations to the common abdominoplasty technique?

      There are many variations both to the design of the incisions and the technique itself. In some instances, it may be possible to avoid an incision around the navel. When the amount of loose skin is minimal and the excess fat deposits are located below the navel, a short horizontal incision is all that is necessary. This procedure is called a partial, or "mini," abdominoplasty.
      Sometimes liposuction may be used alone, or in conjunction with abdominoplasty, to remove abdominal fat. Endoscopic abdominoplasty is another technique for minimizing scars and may be useful when patients have only a mild degree of excess fat and muscle laxity.

      Your Plastic surgeon will discuss with you the particular method that he or she recommends for achieving the best result in your particular case.

      Understanding Risks

      Fortunately, significant complications from abdominoplasty are infrequent. Every year, many thousands of people undergo successful aesthetic surgery of the abdomen, experience no major problems and are pleased with the results. Anyone considering surgery, however, should be aware of both the benefits and risks.

      I understand that every surgical procedure has risks, but how will I learn more so that I can make an informed decision?

      The subject of risks and potential complications of surgery is best discussed on a personal basis between you and your Plastic surgeon, or with a staff member in your surgeon's office.
      Some of the potential complications that may be discussed with you include bleeding, infection and reactions to anesthesia. Tissue loss along portions of the horizontal incision is a possibility when the abdominoplasty is very extensive. This complication, which delays healing and prolongs recovery, is more common in patients who smoke or have medical conditions such as diabetes. Revisionary surgery is sometimes helpful in certain instances where incisions may have healed poorly.

      Following surgery, occasionally, fluid may accumulate under the skin. Removal of this serum is a painless process but may require several visits to the Plastic surgeon's office.

      You can help to lessen certain risks by following the advice and instructions of your Plastic surgeon, both before and after surgery.

      Your Surgical Experience

      The goal of your Plastic surgeon and the entire staff is to make your surgical experience as easy and comfortable for you as possible.

      How should I prepare for surgery?

      If you are a smoker, you will be asked to stop smoking well in advance of surgery. Aspirin and certain anti-inflammatory drugs can cause increased bleeding, so you should avoid taking these medications for a period of time before surgery. Your surgeon will provide you with additional preoperative instructions.

      Abdominoplasty may be performed on an outpatient basis. If this is the case, be sure to arrange for someone to drive you home after surgery and to stay with you for at least the next day or two. When abdominoplasty is performed in conjunction with medically necessary procedures such as hysterectomy or hernia repair, a short hospitalization may be required.

      What will the day of surgery be like?

      Your abdominoplasty may be performed in a hospital, free-standing ambulatory facility or office-based surgical suite.

      Medications are administered for your comfort during the surgical procedure. Often, a general anesthetic is administered, so that you will be asleep throughout the procedure. Abdominoplasty may be performed using local anesthesia and intravenous sedation. When surgery is completed, you will be taken into a recovery area where you will continue to be closely monitored. In many instances, small drain tubes will have been placed within the abdominal tissues to help avoid accumulation of fluids. Gauze or other dressings may be applied to your abdomen and covered with tape or an elastic bandage.

      You may be permitted to go home after a few hours, unless you and your Plastic surgeon have determined that you will stay in the hospital or surgical facility overnight.

      How will I look and feel initially?

      The day after surgery, you will be encouraged to get out of bed for short walks to promote blood circulation. Although you may not be able to stand up completely straight, it is best if you do not sit for long periods of time during the first several days. Straining, bending and lifting must be avoided, since these activities might cause increased swelling or even bleeding. You may be instructed to sleep on your back with a pillow under your knees.

      Any surgical drains probably will be removed within a week following surgery, at which time your dressings may also be changed or removed. Depending on the abdominoplasty technique used, you may be instructed to wear a support garment for several weeks. Generally, stitches will be removed in stages over a period of approximately one or two weeks.

      You will notice swelling and bruising, which is to be expected. The bruising and much of the swelling will disappear over a period of weeks. However, it may be months before all swelling subsides and you see the final result of your abdominoplasty. You may also notice some numbness over portions of the abdominal area, and this may persist for several months. Incisions will initially be red or pink in color. They will remain this way for many months following surgery and may even appear to worsen before they finally begin to fade.

      When can I resume my normal activities?

      It is important to realize that the amount of time it takes for recovery varies greatly among individuals. Depending on the extent of your abdominoplasty and your general physical condition, you may be able to return to non-strenuous work anywhere from one to three weeks after surgery. In many instances, you can resume most of your normal activities, including some form of mild exercise, after a few weeks. You may continue to experience some mild, periodic discomfort and swelling during this time, but such feelings are normal. Severe pain should be reported to your doctor.

      Any sexual activity should be avoided for a minimum of two weeks, and your Plastic surgeon may advise you to wait longer.

      Results of Your Abdominoplasty

      Abdominoplasty will enhance your body contour by making your abdomen firmer and flatter. You may find that you feel more comfortable in your clothing and are more confident about your appearance.

      The incisions from the procedure will heal and fade over time. It is important to realize, however, that the incision lines will be permanently visible. In some instances, they will eventually be only faint lines. Certain individuals may have incision lines that are more noticeable. Fortunately, the incisions for your abdominoplasty are usually in locations concealed by most bathing suits and undergarments.

      How long will the results last?

      Unless you gain or lose a significant amount of weight or become pregnant, your abdomen should remain firmer and flatter for many years. However, gravity and the effects of aging will eventually take their toll. If, after a period of years, you again become dissatisfied with the appearance of your abdomen, you may choose to undergo a second procedure to restore a more youthful body contour.

  • Body Countouring
    • One or more procedures may be recommended to achieve your goals for a more youthful, contoured body. Body contouring goals may be achieved in one surgical session or may be more safely performed in stages depending on your overall health, the type and extent of procedures being considered along with the outcome from discussions and recommendations by your Plastic surgeon during the consultation process. Improvements to your body's shape and overall image may be achieved by reducing excess fat and/or sagging skin and tissue.

      Following a well-balanced diet to maintain a healthy weight, and exercising consistently to maintain or attain a fit and healthy body are important contributing factors when it comes to an individual's body image. However, heredity, changes in the body over time such as weight gain or loss, pregnancy, and even aging can result in a change in your body's proportions and curves that may affect both your body image and self-confidence. Reshaping disproportionate curves or reducing unwanted fat cannot always be achieved through weight loss and exercise alone. Fitness and skin care have little effect on uneven contours or bulges as well as skin that lacks elasticity. Body contouring surgery can help many people reshape body features that cannot be improved by other measures. Body contouring can dramatically improve the shape and proportion of your body, enhancing your appearance and boosting your self-confidence. Areas treated by body contouring include the neck, upper arms, female and male breasts, abdomen, flanks, back, hips, buttocks, thighs, knees and ankles.

  • Face
  • Nose Reshaping (rhinoplasty)
    • Plastic surgeons usually recommend that patients wait until they are at least 14 or 15, and possibly older for boys, before undergoing rhinoplasty. This is because the nose may not be fully developed at a younger age. If you are a teen, your Plastic surgeon will want to be certain that you have thought carefully about surgery and that the desire to change your appearance is based on your own feelings rather than those of your parents or friends.
      Assuming you are in good health, there is no upper age limit for having your nose reshaped. Rhinoplasty is sometimes performed in conjunction with a facelift or other rejuvenate surgery to correct aging changes of the nose such as a drooping tip.

      Sometimes certain breathing problems related to the internal nasal structures can be corrected at the same time as nose reshaping is performed. Your Plastic surgeon will be able to help you determine whether these structures should be modified along with reshaping your nose.

      Rhinoplasty After

      Your Personal Consultation

      During the initial consultation, you may be asked to look in a mirror and point out exactly what you would like to see improved. This will help your Plastic surgeon to understand your expectations and determine whether they can realistically be achieved.

      Am I a good candidate for rhinoplasty?

      Some of the indications that you may be a good candidate for rhinoplasty are:
      your nose appears too large for your face
      there is a bump on the nasal bridge when viewed in profile
      your nose seems too wide when viewed from the front
      the nasal tip droops or plunges
      the tip is thickened or enlarged
      your nostrils are excessively flared
      your nose is off-center or crooked
      previous injury has made your nose asymmetrical
      It is important that you have a clear idea of how you would like your nose to look and, at the same time, realize that there are limitations to the procedure. Patients with sufficient physical and emotional maturity who undergo rhinoplasty because they want to enhance their self-image are usually very satisfied with their decision.
      Your Plastic surgeon can provide further information if you have an interest in any of these additional procedures.

      How will my Plastic surgeon evaluate me for rhinoplasty?

      You should come to the consultation prepared to discuss your medical history. This will include information about any medical conditions you may have, medical treatments you have received, previous surgeries including repair of nasal injuries, and medications that you currently take. Your Plastic surgeon may also ask whether you have difficulty breathing through your nose, suffer from allergies that may cause nasal stuffiness, or are a chronic user of nasal spray. It is important for you to provide complete information.

      In evaluating you for rhinoplasty, your Plastic surgeon will conduct a routine and painless examination of your internal nasal structures. Your skin quality as well as the size and shape of your nose and its relationship to your other facial features will be carefully studied. In some instances, your Plastic surgeon may recommend surgery of your chin, making it either more or less prominent, to improve facial balance. This procedure can be done at the same time as your rhinoplasty.

      When will I learn about the cost of surgery?

      It is understandable that you would like to have information about the cost of surgery as soon as possible. Your Plastic surgeon must first complete a thorough evaluation before your individualized surgical plan can be developed. Following this, the fees required for your surgery will be discussed with you. While most insurance plans will not pay for aesthetic nose reshaping, they frequently will cover surgery performed on the internal structures of the nose to improve breathing problems. Your Plastic surgeon can discuss this with you at the same time of consultation.

      How Rhinoplasty is Performed

      Because of individual factors, not everyone will achieve the same results from rhinoplasty. Your surgeon's goal is to obtain the best possible results for you.

      Where are the rhinoplasty incisions placed?

      Alterations may be made to increase or decrease the nasal bridge, reduce the size or width of the nose, narrow the nostrils, change the angle between the nose and upper lip, or reshape the tip.

      Small wedges of skin, as shown, are removed to narrow the base of the nose or reduce the width of the nostrils. The surgical techniques employed will depend primarily on the goals established by you and your Plastic surgeon. In many instances, all of the incisions will be placed inside your nose, where they will not be visible. If the base of the nose is narrowed or the nostrils reduced, small wedges of skin at the base of the nostrils will be removed. Incisions are hidden in the natural crease where the nostril joins the cheek.

      Sometimes a very short incision is made across the vertical strip of tissue that separates the nostrils, called the columella. This technique is called an "open rhinoplasty." Whatever incisions are used to reshape your nose, they will ultimately be very inconspicuous.

      Understanding Risks

      Fortunately, significant complications from rhinoplasty are infrequent. Every year, many thousands of people have their noses reshaped, experience no major problems and are pleased with the results. Anyone considering surgery, however, should be aware of both the benefits and risks.

      How is my Plastic surgeon able to reshape my nose?

      Incisions are placed inside the nose to provide access to the cartilage (blue shaded area) and brown (light brown shaded area) that form the nasal framework.
      Through the small incisions described previously, work is done on the cartilage and bone that form the framework of your nose.

      Sometimes, the position of certain bones may need to be altered slightly in order to make your nose look narrower and straighter. If your nose needs to be built up in some areas, this can be done using nasal cartilage, or perhaps bone or cartilage from another site. The skin and soft tissues then redrape themselves over this new "scaffolding."

      Your Surgical Experience

      The goal of your Plastic surgeon and the entire staff is to make your surgical experience as easy and comfortable for you as possible.

      I understand that every surgical procedure has risks, but how will I learn more so that I can make an informed decision?

      Depending on the surgical technique used, a splint may be placed on the bridge of the nose for the purpose of holding the tissues in place until they have stabilized.

      The subject of risks and potential complications of surgery is best discussed on a personal basis between you and your surgeon, or with a staff member in your surgeon's office.
      Some of the potential complications that may be discussed with you include hematoma (an accumulation of blood under the skin that may require removal), infection and reactions to anesthesia. Numbness of the skin following rhinoplasty may occur but is usually temporary. Occasionally, if the surgical outcome needs further improvement, additional surgery may be necessary.

      You can help minimize certain risks by following the advice and instructions of your Plastic surgeon, both before and after your surgery.

      How should I prepare for surgery?

      If you are a smoker, you will be asked to stop smoking well in advance of surgery. Aspirin and certain anti-inflammatory drugs can cause increased bleeding, so you should avoid taking these medications for a period of time before surgery. Your surgeon will provide you with additional preoperative instructions.

      If your rhinoplasty will be performed on an outpatient basis, be sure to arrange for someone to drive you home after surgery and to stay with you at least the first night following surgery.

      What will the day of surgery be like?

      Your rhinoplasty may be performed in a hospital, free-standing ambulatory facility or office-based surgical suite.

      Medications are administered for your comfort during the surgical procedure. Frequently, local anesthesia and intravenous sedation are used for patients undergoing nose reshaping, although general anesthesia may be desirable in some instances. For your safety during the operation, various monitors are used to check your heart, blood pressure, pulse and the amount of oxygen circulating in your blood.

      When surgery is completed, you will be taken into a recovery area where you will continue to be closely monitored. There may be some discomfort, but this can be controlled by medication which you may continue taking at home. Depending on the surgical technique used, a splint may have been placed on the bridge of your nose for the purpose of holding the tissues in place until they have stabilized. The splint will protect your nose while you sleep and shield it from accidental bumps. Frequently, you may also have a small triangular bandage beneath the tip of your nose. Packing or soft internal splints are sometimes used inside the nostrils, especially if work has been done to improve your breathing.

      You probably will be permitted to go home after a few hours, although some patients may stay overnight in the hospital or surgical facility.

      How will I look initially?

      It is important to realize that the amount of time it takes for recovery varies greatly among individuals.

      The first couple of days after surgery, you should restrict your activities and sleep with your head elevated. This will help to minimize swelling and reduce the possibility of minor bleeding, which is not uncommon. Remember, you must not take aspirin or certain anti-flammatory medications.

      Generally, bruising around the eyes and cheeks is most apparent during the first three days following surgery. Most discoloration will disappear within a week. A few days after surgery, you can begin to use makeup as a concealer, if desired. Noticeable swelling may last for several weeks. Minor residual swelling, most frequently affecting the nasal tip, may continue for many months, but generally this should not be apparent to others. If packing was used, it will either dissolve by itself or be removed three to seven days after surgery. Stitches may also be removed at that time. You may need to continue wearing the nasal splint for up to a week, during which time you should avoid getting it wet.

      Results of Your Rhinoplasty

      The goal of rhinoplasty is a nose that looks natural and blends harmoniously with your other facial features. Since the healing process is gradual, you should expect to wait up to one year to see the final results of your rhinoplasty. You are likely, however, to begin enjoying your new look within weeks of your surgery.

      Occasionally, a touchup may be desired to further improve the results. If this is the case, the additional procedure is usually less extensive than the original operation.

      When can I resume my normal activities?

      Straining, bending and lifting should be avoided during the early postoperative period. In many instances, you may be able to return to work within a week or ten days after surgery. Most normal activities including exercise can usually be resumed within three weeks.
      It will be a few months before you can expose your reshaped nose to direct sunlight. Your nose will be sensitive during this time, and you must be conscientious about using a sunblock to protect your skin. If the bones of your nose were altered, it may be a number of weeks before you can wear glasses without special support such as tape.

      How long will the results last?

      In most instances, the results of rhinoplasty are permanent, except for possible changes associated with the normal aging process.

  • Cheek Augmentation
    • Cheek Implants Procedure Description:
      Many people consider full cheeks very attractive. Weak cheeks can make your face appear gaunt, and create an aged appearance to the under-eye area. Cheek augmentation can restore the fullness to your cheeks if it has been lost with aging, or can create the appearance of strong cheek bones if you never had them. There are many options for aesthetic cheek surgery, depending on your particular appearance, and the look you wish to attain. The operation adds volume to the cheek by effectively augmenting the bone structure of the cheek region, enhancing the foundation of your mid-face.

      Am I a good candidate for cheek implants?

      If you have lost volume in the malar region associated with aging, or if you were born with weak cheeks and desire a fuller, more youthful appearance, you may be a candidate for aesthetic cheek surgery. Some patients have used temporary soft tissue fillers in the past to achieve full cheeks, and are seeking a permanent solution. Patients undergoing cheek augmentation should be of good health, with a normally functioning immune system.

      Cheek Implants Standard Procedure Techniques

      Aesthetic cheek surgery can be performed alone, or in combination with other surgical procedures. Multiple shapes and sizes of implants are available to fit your particular anatomy and desired change. Depending on the areas that are being addressed, the implants can be placed through the mouth with a small incision at the gum line, or through a lower eyelid incision if eyelid rejuvenation is being performed at the same time. Depending on the approach and your surgeon's preference, the cheek implants can be made of solid silicone or other non-reactive materials such as Medpor. Surgically, a pocket is made for the implant directly over the cheek bone, and the implant placed. The implant is secured either by designing a well fitting pocket, or affixing it to soft tissue or bone. The incision is closed, completing the cheek augmentation. Usually the whole operation takes about 30 to 45 minutes to complete, unless other procedures are being performed in addition to the cheek augmentation.

      Cheek Implants Benefits / Advantages / Options

      Permanent way to achieve full cheeks (as opposed to temporary fillers)
      May easily be preformed at the time of other facial surgery
      Intra-oral or eyelid approach
      Multiple implant choices to achieve desired look

      Other Considerations regarding Cheek Implants

      If you are bothered by weak cheeks and are not sure if implants are right for you, it is best to seek consultation with a knowledgeable Plastic surgeon. Implants add volume to the cheek, and in doing so provide a lift. A similar effect can be achieved with soft tissue fillers, and these can be used as a temporary way to see if you would be happy with cheek implants. A midface-lift may be the procedure of choice for middle aged patients who previously were happy with their midface appearance, but have noted a drop of the cheek rather than loss of volume. With more advanced facial aging, there can be a combination of factors yielding the aging appearance, including bone resorption, loss of skin elasticity, and loss of volume with fat atrophy. The cheek region may appear deflated and jowling can be present along the jawline. In these cases, aesthetic cheek surgery combined with a facelift procedure may yield the ideal result in such cases.

      Cheek Implants Risks / Complications / Patient Safety

      Sensation to the cheek may be temporarily or permanently changed by the implants.
      Implants can become shifted, especially in the early stages after surgery. Avoid contact sports until you are fully healed.

      With the eyelid approach for surgery, retraction of the lower eyelid is possible, which may create dry eye sensation.

      If cheek implants become infected, removal may be necessary to clear the infection.

      Cheek Surgery Recovery Process

      The usual recovery after aesthetic cheek surgery depends on the type of surgical approach utilized and if other procedures are performed at the same time. In general, from a cheek augmentation alone, you should be active the day of surgery, but your upper lip will be "asleep" similar to a visit to the dentist. This sensation returns overnight, and the cheeks will feel mildly sore and swollen. Prescriptions for antibiotics and pain medicines may be provided, and you should maintain light activities. Keeping your head elevated helps the swelling resolve sooner. If your cheek augmentation was performed through the mouth, you will be restricted to a soft diet for a few days until the gums have healed. You will rinse your mouth after eating to keep the sutures clean, and these will dissolve on their own after several weeks. If the eyelid approach was utilized, your surgeon will instruct you on how to rest your eyes, and utilize lubricants to prevent dryness during the post-surgery swelling phase. During follow-up visits, skin sutures will be removed.

      Will cheek surgery be painful?

      Most patients do not consider aesthetic cheek surgery to be a painful surgery. There is a period of "tightness" associated with the increased volume from the cheek implant, which is worse right after surgery due to the body's normal swelling response. Pain medications are usually only needed for a few days, and then only at night to help with sleep.

      Will there be scarring from cheek surgery?

      With the intra-oral approach for cheek augmentation, no visible external scars should be present. If an eyelid approach is utilized for your aesthetic cheek surgery, scars will be present under the eyelash margin. Scars in this location are usually very hard to identify, even when you are searching for them.

      What are some typical short-term side-effects of cheek surgery?

      It is normal to have a change in cheek sensation after aesthetic cheek surgery. Right after surgery, your cheek will be "asleep" due to the local anesthetics utilized. After your cheek "wakes up", sensations maybe heightened until sensory nerves near the implant get used to their new, tighter surroundings.

      Why type of anesthesia, if any, will be used for cheek surgery?

      Cheek augmentation surgery can be performed under sedation anesthesia, or general anesthesia, depending on the technique utilized and the preferences of the patient and surgeon. Contact and consult your Plastic surgeon to see what they suggest for your individual case.

  • Chin Augmentation
    • Chin Implants Procedure Description:
      Aesthetic chin surgery is performed to improve the balance of your facial profile and correct a "weak" chin. Chin augmentation with implants is the procedure of choice for most patients with normally functioning teeth and jaw development. A biocompatible implant is placed over the bone structure of the lower jaw, augmenting the dimensions of your jaw. Depending on the region augmented, you can create a stronger and/or wider chin, and even lengthen your face.

      Am I a good candidate for aesthetic chin surgery?

      In one approach, the lower section of bone is moved forward and wired into position.
      If you have a mildly weak chin and normal function of your jaw, chin augmentation with implants may be the procedure of choice for you. Perhaps you have used temporary soft tissue fillers in the past to achieve a stronger chin, and are seeking a permanent solution. As with any implant surgery, you should be of good health with a normally functioning immune system.

      Chin Implants Standard Procedure Techniques

      There are several options available for aesthetic chin surgery. Aesthetic chin surgery augments the bony structure of your jaw, and can create a stronger chin, make the chin wider, or even slightly lengthen your face. Implants of multiple shapes, sizes, and materials are available, and are chosen depending on the changes desired and the technique utilized. To perform aesthetic chin surgery, the incision is made and a pocket designed to accommodate the implant directly over the bone along the lower jaw. Solid silicon implants can be placed through a small incision under the chin. When other rigid biocompatible materials (such as Medpor) are used for chin augmentation, an incision inside the mouth is utilized. The chin implant is secured in place either by designing a well-fitting pocket, or affixing it to soft tissue or bone. The incision is closed, completing the chin augmentation. Usually the entire operation takes about 30 to 45 minutes to complete, unless other procedures are being performed in addition to the aesthetic chin surgery. Tape is often applied to the skin to assist in holding the implant in place during the normal swelling after surgery.

      An alternative approach involves inserting an implant between the bone and chin tissue through a short external incision under your chin or through an incision made inside your mouth between the lower lip and gum. Similarly, your cheekbones may be built up by placing an implant over them.

      Chin Implants Benefits / Advantages / Options

      Permanent way to achieve a strong chin (as opposed to temporary fillers)
      May easily be preformed with other procedures (eg: nose surgery/rhinoplasty)
      Multiple chin implant choices are available to achieve your desired look
      Intra-oral or direct surgical approaches available

      Other Considerations for Chin Implants

      When considering aesthetic chin surgery with a chin implant, you should be aware that certain patients are better served with other surgical approaches. If you have a severely weak chin, or abnormally functioning jaw, a genioplasty or mandibular advancement surgery maybe appropriate. Although these procedures involve cutting the bone of your jaw, and have a longer recovery than chin surgery with chin implants, they can achieve results not attainable with implants alone. To decide which procedure is right for you, it is best to seek consultation with a knowledgeable Plastic surgeon.

      Chin Implants Risks / Complications / Patient Safety

      Sensation to the chin may be temporarily or permanently changed by the implant
      The chin implant can be shifted, especially in the early stages after surgery
      Avoid contact sports until you are fully healed
      If the chin implant becomes infected, removal may be necessary to clear the infection

      Chin Surgery Recovery Process

      After surgery, you will have a more balanced profile and pleasing facial contour.
      The usual recovery after aesthetic chin surgery depends on the surgical approach utilized and if other procedures are performed at the same time. In general, from a chin augmentation alone, you will be active around the house the evening of surgery, but your lower lip will be "asleep" similar to after a visit to the dentist. This sensation returns overnight, and your chin will feel mildly sore and swollen. Prescriptions for antibiotics and pain medicines may be provided, and you should maintain light activities. You may be given a garment or your chin may be taped to help maintain the chin implant position during the swelling phase after surgery. Keeping your head elevated helps swelling resolve sooner. If your chin augmentation was performed through the mouth, you will be restricted to a liquid or soft diet for a few days until the gums have healed. You will rinse your mouth after eating to keep the sutures clean, and these will dissolve on their own after several weeks. If your cosmetic chin surgery was performed with a small incision under your chin, sutures are normally removed after 4 to 7 days.

      Will chin surgery be painful?

      The majority of patients do not consider cosmetic chin surgery to be painful surgery. There is a period of "tightness" associated with the increased volume from the chin implant, which is worse right after surgery due to the body's normal swelling response. Discomfort responds rapidly to oral pain medications, which are usually only needed for a few days.

      Will there be scarring undergoing chin surgery?

      If the intra-oral approach for chin augmentation is used, no visible external scars will be present. If your surgeon places the implant through an incision under your chin, a very small scar will be present in a well-concealed region. With usual social encounters, this scar is not visible.

      What are some typical short-term side-effects of undergoing chin surgery?

      It is normal to have a change in chin sensation after aesthetic chin surgery. Right after surgery, your chin will be "asleep" due to the local anesthetics utilized. After your chin "wakes up", sensations maybe heightened until sensory nerves near the implant get used to their new, tighter surroundings.

      Why type of anesthesia, if any, will be used for chin surgery?

      Chin augmentation surgery can be performed under light sedation anesthesia or under general anesthesia. The choice of anesthetic is up to yourself and your surgeon to decide.

  • Ear Pinning
    • Patients who benefit from ear surgery include those who may have:
      Protruding ear(s)- Majority of the cosmetic surgery performed on ears.
      Large ear(s)
      Abnormally shaped ear(s)
      Ear surgery often is recommended for children as they near total ear development at age five or six. Correction of the ears prior to the child entering school helps eliminate potential psychological trauma from the teasing of classmates. Adults may also have their ears reshaped. As long as you are in good health, there is no upper age limit for this surgery.

      Results of Your Ear Surgery

      Usually the final results of the ear surgery are very long lasting.

      Your Personal Consultation-- How will my Plastic surgeon evaluate me for aesthetic ear surgery?

      During the initial consultation, you may be asked to look in a mirror and point out exactly what you would like to see improved. This will help your Plastic surgeon to understand your expectations and determine whether they can realistically be achieved.
      You should come to the consultation prepared to discuss your medical history including previous surgeries, past and present medical conditions and current medications. It is important for you to provide complete information. High blood pressure, thyroid problems, diabetes, etc. should be reviewed as these medical conditions may increase some risks associated with ear surgery. Your Plastic surgeon will want to know if you have allergies.

      How is Aesthetic Ear Surgery Performed

      One of many surgical techniques may be suggested to improve the appearance of your ear(s). The particular technique that your Plastic surgeon recommends will depend on the nature of the problem and many other factors including your desires. Because of individual factors, not everyone will achieve the same results from ear surgery. Your Plastic surgeon will select the surgical technique that he or she feels will obtain the best outcome for you.

      If your problem is protruding ears, the supporting tissue of the ears, called cartilage, is reshaped in order to position your ears closer to your head. This usually is accomplished through incisions placed behind the ears. Subsequent scars will be concealed in the natural skin crease. In some cases, especially in ears that need to be reduced in size or are protruding in the middle 1/3 of the ear, external incision of the front (outside surface) of the ear will be necessitated. Usually these are placed in areas where they will heal in a more inconspicuous manner. In ear reductions, skin as well as cartilage will most often need to be removed.

      Understanding Risks of Ear Surgery

      Fortunately, significant complications from aesthetic ear surgery are infrequent. Every year, many successful cosmetic ear surgeries are performed, without experiencing any major problem.

      The subject of risks and potential complications of surgery is best discussed on a personal basis between you and your surgeon, or with a staff member in your surgeon's office. The risks in most surgeries are similar. Some of the potential complications that may be discussed with you include hematoma (an accumulation of blood under the skin that may require removal), infection, changes in sensation, scarring, allergic reactions, damage to underlying structures, need for revisions, unsatisfactory results possibly necessitating additional procedures and medical risks. Sutures may be visible or may even break allowing for partial or complete recurrence of the protrusion and / or loss of the ear fold. Irregularities, sharp folds and other shape abnormalities may ensue.

      You can help minimize certain risks by following the advice and instructions of your Plastic surgeon, both before and after your ear surgery.

      Your Surgical Experience (Preoperative Preparation and Recovery)

      Pre-Operative
      The goal of your Plastic surgeon and the entire staff is to make your surgical experience as easy and comfortable for you as possible.

      If you are a smoker, it is recommended to stop smoking well in advance of surgery since smoking can impair the healing process. Aspirin and certain anti-inflammatory drugs can cause increased bleeding, so you should avoid taking these medications for a period of time before surgery. Your surgeon will provide you with additional preoperative instructions.

      Aesthetic ear surgery is usually performed on an outpatient basis. If this is the case, be sure to arrange for someone to drive you home after surgery and to stay with you for the next 24 hours.

      The Day of Ear Surgery
      Your ear surgery may be performed in a hospital, free-standing ambulatory facility or office-based surgical suite.

      Medications are administered for your comfort during the surgical procedure. Frequently, local anesthesia and intravenous sedation are used for patients undergoing ear surgery, although general anesthesia may be desirable in some instances (especially young children). For your safety during the operation, various monitors are used to check your heart, blood pressure, pulse and the amount of oxygen circulating in your blood.

      When surgery is completed, you will be taken into a recovery area where you will continue to be closely monitored. You will be instructed to inform your caretaker if the dressings feel too tight. There is surprisingly little discomfort, however, from the surgery, especially if the ears are in a head dressing.

      You probably will be permitted to go home after a short period of observation, although some patients may stay overnight in the hospital or surgical facility.

      Recovery from Ear Surgery
      It is important to realize that the amount of time it takes for recovery varies greatly among individuals.

      The first several days you should maintain head elevation as much as possible. Remember, you must not take aspirin or certain anti-inflammatory medications.
      Initially, pain is usually controlled with oral medication. Some patients find that mild swelling persist for many weeks. Bruising typically disappears within seven to ten days. Stitches are usually removed within a week of surgery.

      After surgery, you may be instructed to wear gauze dressing or bandage for a few days or up to several weeks to ensure that your ears heal in their new, corrected position. Often a ski band to cover the ears is worn at night to prevent the ears from bending during sleep.

      Straining, bending and lifting should be avoided during the early postoperative period. In many instances, you will be able to resume most of your normal activities within ten days or less. Most people return to work at 7- 10 days.

      How much will ear surgery cost?

      Cost is always a consideration in elective surgery. Prices for ear surgery vary widely, and are often dependent on the surgeon's experience and the geographical location.

      The fees are often broken down into several components:

      Surgeon's professional fee
      Facility fee
      Anesthesia fee
      Medications
      Surgical garments
      Medical tests

  • Eyelid Surgery (blepharoplasty)
    • Any one or combination of the following conditions may indicate that you may be considered a good candidate for eyelid surgery:
      Excess skin obscuring the natural fold of the upper eyelids
      Loose skin hanging down from the upper eyelids, perhaps impairing vision
      A puffy appearance to the upper eyelids, making the eyes look tired
      Excess skin and fine, "crepe paper type" wrinkles of the lower eyelids
      Bags and dark circles under the eyes
      Lower eyelid droopiness

      Aesthetic eyelid surgery can usually correct these problems, though other treatments may also need to be considered. Some examples follow. If the upper eyelid condition is accompanied by sagging of the eyebrows, then a forehead lift may be recommended. Smoothing of crow's feet may be accomplished with Botox®, chemical peeling or laser resurfacing procedures. Circles beneath the eyes caused by dark pigmentation may be treated with fillers such as Hyaluronic Acid or fat as well as bleaching solution or chemical peel. Your Plastic surgeon can provide further information if you have an interest in any of these additional procedures.

      Results of Your Eyelid Surgery

      Aesthetic eyelid surgery has the effect of making you look more rested, refreshed and alert. Since the healing process is gradual, you should expect to wait at least several weeks to get an accurate picture of the results of your eyelid surgery. Incisions will fade over a number of months usually becoming barely visible. The results of aesthetic eyelid surgery are usually long-lasting, but they may be affected by heredity and lifestyle factors. Removal of fat from your eyelids, which is usually the cause of puffiness and bags, is permanent, and these conditions generally will not recur. The skin continues to age, however, and skin laxity along with the fine wrinkling of the eyelid area may, at some point, return. Sometimes loss of tone in the forehead causes additional sagging of the eyebrows which mimics a recurrence of drooping upper eyelids. If this happens, correction may require a forehead lift or a secondary eyelid procedure. Even though the aging process continues, patients are usually happy with their appearance for many years following eyelid surgery. Some patients find that they want to make additional improvements at a later time.

      Your Personal Consultation

      How will my Plastic surgeon evaluate me for aesthetic eyelid surgery?

      During the initial consultation, you may be asked to look in a mirror and point out exactly what you would like to see improved. This will help your Plastic surgeon to understand your expectations and determine whether they can realistically be achieved.

      You should come to the consultation prepared to discuss your medical history including previous surgeries, past and present medical conditions and current medications. It is important for you to provide complete information. High blood pressure, thyroid problems, diabetes, etc. should be reviewed as these medical conditions may increase some risks associated with eyelid surgery.

      Your Plastic surgeon will want to know if you have allergies, especially if they affect your eyes. He or she may ask whether you have ever tried and were unable to wear contact lenses.
      It will be necessary for your surgeon to know if you were ever told by an ophthalmologist that you have a condition called "dry eye" or if you have any other problems with your eyes.

      How Aesthetic Eyelid Surgery is Performed

      One of several surgical techniques may be suggested to improve the appearance of your eyelids. The particular technique that your Plastic surgeon recommends will depend on many factors such as the amount of excess fat and skin in the eyelid areas, the position of your eyebrows, and the condition of muscles around your eyelids. Because of individual factors, not everyone will achieve the same results from eyelid surgery. Your Plastic surgeon will select the surgical technique that he or she feels will obtain the best outcome for you.

      Upper Eyelids

      For upper eyelid surgery, generally an incision is hidden within the natural fold of the upper eyelid and extends slightly beyond the outside corner into the laugh lines or other existing creases. Through this incision, excess skin and fatty tissue are removed. Because the incision follows the natural contour of the upper eyelid, it usually is inconspicuous.

      Lower Eyelids

      For lower eyelid surgery, often an incision is hidden just below the lower lashes. Through this incision, excess skin, muscle and fat are removed, or fat may be redistributed to eliminate puffiness or bulges. Other adjustments to correct special problems such as muscle laxity may be performed. As in upper eyelid surgery, placement of the incision in natural crease lines allows for the scar to usually heal in an inconspicuous fashion. In some cases, you and your surgeon may decide that the best approach for removing excess fat is through an incision placed inside the lower eyelid. This technique requires no external incision, but it cannot be used to remove excess skin. A laser may sometimes be used in conjunction with this method to tighten the lower eyelid skin.

      Understanding Risks

      Fortunately, significant complications from aesthetic eyelid surgery are infrequent. Every year, many thousands of people undergo eyelid surgery successfully, without experiencing any major problem.

      The subject of risks and potential complications of surgery is best discussed on a personal basis between you and your surgeon, or with a staff member in your surgeon's office. The risks in most surgeries are similar. Some of the potential complications that may be discussed with you include hematoma (an accumulation of blood under the skin that may require removal), infection, changes in sensation, scarring, allergic reactions, damage to underlying structures, need for revisions, unsatisfactory results possibly necessitating additional procedures and medical risks. Following the surgery, there can be a feeling of dryness or irritation in the eye that requires treatment. There is a possibility of impaired eyelid function that sometimes may need to be corrected by additional surgery.

      You can help minimize certain risks by following the advice and instructions of your Plastic surgeon, both before and after your eyelid surgery.

      Your Surgical Experience (Preoperative Preparation and Recovery) for Eyelid Surgery Pre-Operative

      The goal of your Plastic surgeon and the entire staff is to make your surgical experience as easy and comfortable for you as possible.

      If you are a smoker, it is highly recommended to stop smoking well in advance of surgery. Smoking can impair your ability to heal. Aspirin and certain anti-inflammatory drugs can cause increased bleeding, so you should avoid taking these medications for a period of time before surgery. Your surgeon will provide you with additional preoperative instructions.

      Aesthetic eyelid surgery is usually performed on an outpatient basis. If this is the case, be sure to arrange for someone to drive you home after surgery and to stay with you for the next 24 hours.

      The Day of Eyelid Surgery

      Your eyelid surgery may be performed in a hospital, free-standing ambulatory facility or office-based surgical suite. Medications are administered for your comfort during the surgical procedure. Frequently, local anesthesia and intravenous sedation are used for patients undergoing eyelid surgery, although general anesthesia may be desirable in some instances. For your safety during the operation, various monitors are used to check your heart, blood pressure, pulse and the amount of oxygen circulating in your blood.

      When surgery is completed, you will be taken into a recovery area where you will continue to be closely monitored. Your vision will be blurry as a result of ointment used to soothe and protect the eye during surgery as well as from the swelling that is a normal aftermath of eyelid procedures. There should be surprisingly little discomfort, however, from the surgery.

      You probably will be permitted to go home after a short period of observation, although some patients may stay overnight in the hospital or surgical facility.

      Eyelid Surgery Recovery

      It is important to realize that the amount of time it takes for recovery varies greatly among individuals.

      The first few days after surgery, you should rest quietly with your head elevated. Your surgeon may instruct you to apply cold compresses to your eyelids. Remember, you must not take aspirin or certain anti-inflammatory medications. Initially, you may feel a "tight" sensation around the eyes and some mild discomfort that can be controlled with oral medication. During the first 48 hours following surgery, patients experience varying degrees of swelling and bruising. Some patients find that mild swelling persist for several weeks, while others may see swelling resolve in as little as one week. Bruising typically disappears within seven to ten days. Within the first week or so, you will be permitted to use makeup, if desired, to conceal any discoloration. Stitches are usually removed within a week of surgery.

      Your vision may continue to be somewhat blurry for a few days or longer. Your eyes may be temporarily sensitive to light, and you may experience excess tearing or dryness. Some Plastic surgeons recommend eye drops to help relieve any burning or itching. You may want to wear dark sunglasses for a couple of weeks to protect your eyes from wind and sun irritation.
      Straining, bending and lifting should be avoided during the early postoperative period. In many instances, you will be able to resume most of your normal activities within ten days or less. Although you might feel like going back to work just a few days after surgery, your vision may still be slightly blurry which could make reading or other paperwork more difficult.

      How much will eyelid surgery cost?

      Cost is always a consideration in elective surgery. Prices for eyelid surgery vary widely, and are often dependent on the surgeon's experience and the geographical location.
      The fees are often broken down into several components:

      Surgeon's professional fee
      Facility fee
      Anesthesia fee
      Medications Surgical garments
      Medical tests

  • Facelift
    • The face usually portrays the first visible signs of aging. Both gravity and diminished volume result in the facial features of aging. Most patients requesting evaluation for facelift feel that their facial features do not reflect their youthful spirit and energy level. They are looking for ways to refresh and rejuvenate their appearance. There are many different variations of the facelift procedure that smooth the skin of the face and neck, tighten the underlying tissues and muscle, and remove excess skin. Ultimately, the facelift will allow you to turn back the hands of time to better reflect your youthful spirit.

      How will my Plastic surgeon evaluate me for a facelift?

      During the pre-operative consultation, your surgeon will perform a history and physical examination. During your physical examination, your facial bone structure, underlying skin structure, skin thickness, texture, and elasticity as well as the extent of facial wrinkles and folds will be assessed. This information will be used to formulate a surgical plan and the goals of the procedure will be discussed. Generally, a facelift is a very versatile procedure, and your surgeon will explain the technique that he or she feels most comfortable with and that offers the lowest risk. Your Plastic surgeon will select the surgical technique that he or she feels will obtain the best outcome for you based on your discussions regarding the outcome you wish to achieve.

      How is a facelift performed?

      The facelift procedure continues to evolve. Over the years, the procedure has changed from simple skin lifting to more complex deeper plane lifting techniques. Today, many different techniques exist, with outcomes that are consistently reliable and durable. The facelift procedure usually involves incisions in front of and behind the ear. The incisions may extend into the scalp. Once the incisions are made, various degrees of undermining of the skin are performed, and the deeper layers of the face are 'lifted'. Muscle tightening as well as liposuction of the neck and jowls may be performed, and excess skin is either removed or repositioned. The results are a reversal of the effects of gravity and tightening of soft tissues of the face to restore a more youthful contour to the face.

      Understanding Risks

      Fortunately, significant complications from facelifts are infrequent. Every year, thousands of people undergo successful facelift surgery and are pleased with the results. However, anyone considering surgery should be aware of both the benefits and risks. These are best discussed on a personal basis with your surgeon or one of their qualified staff members.
      Some of the potential complications that may occur include hematoma (an accumulation of blood under the skin), infection, and reactions to anesthesia. While Plastic surgeons are trained in techniques for safely manipulating facial skin and tissues, injury to underlying structures is possible, though usually temporary. Facelift incisions are usually quite inconspicuous; however, this is not entirely predictable due to individual variations in healing. You can help minimize certain risks by following the advice and instructions given to you by your Plastic surgeon both before and after surgery.

      Your Surgical Experience

      The goal of your Plastic surgery team is to make your surgical experience as easy and as comfortable as possible.

      Pre-Operative

      If you are a smoker, you will be asked to stop smoking well in advance of the surgery. Certain medications that increase the risk of bleeding such as Aspirin, non-steroidal anti-inflammatory medications, and some vitamins/homeopathic regimens should be discontinued prior to surgery. If your hair is short, you may want it to grow out enough to cover your incisions while they heal. Any chemical processing of your hair should be performed prior to surgery since you cannot have any of these procedures for a month of more after surgery. If your facelift will be performed on an outpatient basis, be sure to arrange for someone to drive you home and stay with you for at least the first night following surgery.

      Day of Surgery

      Your facelift may be performed in an accredited hospital, free-standing ambulatory facility, or office-based surgical suite.

      Medications are administered for your comfort during the procedure. You and your Plastic surgeon will have decided in advance what type of anesthesia is to be used – either intravenous sedation (twilight) or general anesthesia. For your safety during and after the operation, various monitors are used to check your heart, blood pressure, pulse and the amount of oxygen circulating in your blood.

      When surgery is completed, you will be taken into a recovery area. A bandage may be wrapped around your face. Sometimes small tubes will be inserted beneath the skin to drain away fluid that might otherwise accumulate. There is surprisingly very little discomfort experienced after facelift surgery. However, any discomfort you may experience will be controlled with pain medication as needed.
      You may be permitted to go home after a few hours, although some patients may stay overnight in a hospital or surgical facility.

      Recovery

      It is important to realize that the amount of time it takes to recover from Facelift surgery varies greatly between individuals. Elevation of the head is extremely helpful in reducing the initial post-operative swelling. Your surgeon may also advise you to use ice packs intermittently.
      You should avoid Aspirin and non-steroidal anti-inflammatory medications for the first few days after your surgery. Smoking and exposure to second-hand smoke should be avoided to prevent delays in the healing process.

      Once the dressings and drains are removed, puffiness and discoloration may be more pronounced in some portions of the face than others. Do not be alarmed by any unevenness or temporary asymmetry – this is normal. Most swelling is usually noted in the first 24 to 48 hours, and most bruising resolves within 2 weeks. Concealing makeup is usually permitted after the first week. You may experience numbness to the face post-operatively, which usually resolves within several months.

      Some patients find that mild swelling persists for many weeks. Most stitches are removed within a week of the surgery.

      Straining, bending, and lifting should be avoided during the early post-operative period as these activities may predispose you to bleeding.

      Your surgeon will give you specific instructions that may include caring for the dressings and incisions, directions for your analgesics and other medications, specific concerns to look for, and when to follow up in the office to monitor your healing process. It may take several months for the swelling to fully resolve, and up to 6 months for the incision scars to fully fade. Avoidance of factors that could reduce the benefits of the surgery, such as excessive unprotected sun exposure and cigarette use, is vital.

      Results of Your Facelift

      The results of your facelift may be subtle or dramatic, depending on your appearance prior to the surgery as well as the specific goals that you and your Plastic surgeon have established. Since the healing process is gradual, you should expect to wait several weeks for an accurate picture of your "new look". Additional minor changes or settling may occur over several months following your Facelift surgery.

      How much will a facelift cost?

      Cost is always a consideration in elective surgery. Prices for facelifts vary widely, and are often dependent on the surgeon's experience and the geographical location.
      The fees are often broken down into several components:
      Surgeon's professional fee
      Facility fee
      Anesthesia fee
      Medications
      Surgical garments
      Medical tests

  • Facial Implants
    • Facial implants are designed for augmentative, reconstructive or rejuvenative purposes. Available in a wide range of sizes and styles for the chin, jaw, nose and cheek, implants add or restore contour and/or proportion to the face.\

      Technique:
      The procedure follows a similar pattern for all facial areas. The surgeon makes a small incision near where the implant will be placed, either in a crease or inside the mouth at the gum/lip junction. Then a pocket is made in the facial tissue, the implant inserted, and the incision is stitched. The process generally takes 1-2 hours, usually with general anesthesia. The incision is bandaged or taped, and stitches are removed in 5-10 days (sutures placed inside the mouth will dissolve in a similar period of time). Sometimes facial implants are inserted at the same time as a facelift, nose or eyelid procedure is performed.

      Benefits:
      Return to work and other normal activity within a week.
      Generally performed in the surgeon's office or an outpatient surgical center.
      Adds aesthetically pleasing contour to the face.
      Results are essentially permanent.

      Other Considerations:
      As with any surgical procedure, infection may occur. If the infection persists, the implant may have to be removed and replaced at a later time.

      Shifting of the implant is another possibility. Should the implant become slightly misaligned, a second procedure might be necessary to reposition it.

      Postoperative bruising and swelling. Mild/moderate discomfort for 1 to 2 days.
      Strenuous activity and rough contact to the implant area must be avoided for 4 to 6 weeks.
      Patients with gum or dental problems will want to confer with their dentist.

  • Forehead Lift (brow lift)
    • A forehead lift is often performed to treat conditions associated with aging. It may be done in conjunction with other cosmetic procedures to achieve a more harmonious facial appearance. A forehead lift is also appropriate for treatment of certain inherited traits. Younger adults who have a low brow or who already have deep frown lines due to stress or over activity of muscles may benefit from the Forehead Lift procedure.

      Am I a good candidate for forehead lift surgery?

      Any one or combination of the following conditions may indicate that you are a good candidate for a Forehead Lift:

      sagging or low position of the eyebrows, creating a tired or sad appearance
      deep horizontal creases across the forehead
      frown lines, or furrows, between the eyebrows and sometimes across the top of the nose

      The face usually portrays the first visible signs of aging. Gravity and changes in eyebrow shape and position results in the brow area looking aged. Most patients requesting evaluation for a Forehead Lift or Facelift feel that their facial features do not reflect their youthful spirit and energy level. They are looking for ways to refresh and rejuvenate their appearance. There are many different variations of the Forehead Lift procedure that improve the position and shape of the eyebrow and forehead areas. Ultimately, the Brow Lift will allow you to turn back the hands of time to better reflect your youthful spirit.

      How will my Plastic surgeon evaluate me for a forehead lift?

      During the pre-operative consultation, your surgeon will perform a history and physical examination. During your physical examination, your facial bone structure, underlying skin structure, brow position, eyelid and eye aesthetics, skin thickness, texture, and elasticity will be assessed. This information will be used to formulate a surgical plan and the goals of the procedure will be discussed. Generally, a Forehead Lift procedure is a very versatile procedure, and your surgeon will explain the technique that he or she feels most comfortable with and that offers the lowest risk. Your Plastic surgeon will select the surgical technique that he or she feels will obtain the best outcome for you based on your discussions regarding the outcome you wish to achieve.

      How is a forehead lift performed?

      The Forehead Lift procedure continues to evolve. Over the years, the procedure has changed from open techniques to more complex short incision and endoscopic techniques. The Forehead Lift procedure usually involves incisions in the hair-bearing scalp. Occasionally, incisions may be performed in the forehead, and/ or the upper eyelids. Once the incisions are made, various degrees of undermining of the skin are performed, and the deeper layers of the forehead are 'lifted'. Muscles that depress the eyebrows may be disrupted. The skin and deeper layers are often then 'fixed' or attached to the bone. The results are a reversal of the effects of gravity and tightening of soft tissues of the forehead to restore a more youthful contour to the upper face.

      How is my Plastic surgeon able to improve my frown lines and the position of my eyebrows?

      In many instances, an incision is made across the top of the scalp, beginning above the ears and hidden within the hair. Sometimes, the incision may be placed at the front of the hairline or, in some cases, toward the middle of the scalp. The incision is designed to be inconspicuous when healed. Through the Forehead Lift incision, your Plastic surgeon can modify or remove parts of the muscles that cause wrinkling and frown lines, remove excess skin, and lift your eyebrows to a more pleasing level.

      Sometimes, if your main concern is frown lines between your eyebrows or across the top of your nose, a limited endoscopic procedure to correct these problems can be done.

      Understanding Risks of Forehead Lift Surgery

      Fortunately, significant complications from Forehead Lifts are infrequent. Every year, thousands of people undergo successful Brow Lift surgery and are pleased with the results. However, anyone considering surgery should be aware of both the benefits and risks. These are best discussed on a personal basis with your surgeon or one of their qualified staff members.

      Some of the potential complications that may occur include hematoma (an accumulation of blood under the skin), infection, and reactions to anesthesia. While Plastic surgeons are trained in techniques for safely manipulating facial skin and tissues, injury to underlying structures is possible, though usually temporary. Forehead Lift incisions are usually quite inconspicuous; however, this is not entirely predictable due to individual variations in healing. You can help minimize certain risks by following the advice and instructions given to you by your Plastic surgeon both before and after surgery.

      Your Forehead Lift Surgical Experience

      In many instances, an incision is made across the top of the scalp, beginning above the ears and hidden within the hair.

      The goal of your Plastic surgery team is to make your surgical experience as easy and as comfortable as possible.

      Pre-Operative

      If you are a smoker, it is highly recommended to stop smoking well in advance of the surgery. Certain medications that increase the risk of bleeding such as Aspirin, non-steroidal anti-inflammatory medications, and some vitamins/homeopathic regimens should be discontinued prior to surgery. If your hair is short, you may want it to grow out enough to cover your incisions while they heal. Any chemical processing of your hair should be performed prior to surgery since you cannot have any of these procedures for a month of more after surgery. If your Forehead Lift will be performed on an outpatient basis, be sure to arrange for someone to drive you home and stay with you for at least the first night of following surgery.

      Day of Surgery

      Another Forehead Lift technique uses an endoscope, a long, thin tube with a light on the end, attached to a video camera. The endoscope is inserted through several tiny incisions in the scalp and allows the Plastic surgeon to see and work on the various internal structures of the forehead. The endoscopic technique has the advantage of requiring very minimal incisions, but it may not be equally beneficial for all patients. In some instances, alternate methods may be preferable, or a combination of endoscopic and other techniques may be used.
      Your Forehead Lift may be performed in a hospital, free-standing ambulatory facility, or office-based surgical suite.

      Medications are administered for your comfort during the procedure. You and your Plastic surgeon will have decided in advance what type of anesthesia is to be used – either intravenous sedation (twilight) or general anesthesia. For your safety during and after the operation, various monitors are used to check your heart, blood pressure, pulse and the amount of oxygen circulating in your blood.

      When surgery is completed, you will be taken into a recovery area. A bandage may be wrapped around your forehead or face. Sometimes small tubes will be inserted beneath the skin to drain away fluid that might otherwise accumulate. There is surprisingly very little discomfort experienced after Forehead Lift surgery. However, any discomfort you may experience will be controlled with pain medication as needed.

      You may be permitted to go home after a few hours, although some patients may stay overnight in a hospital or surgical facility.

      Recovery

      It is important to realize that the amount of time it takes varies greatly between individuals. Elevation of the head is extremely helpful in reducing the initial post-operative swelling. Your surgeon may also advise you to use ice packs intermittently.
      You should avoid Aspirin and non-steroidal anti-inflammatory medications for the first few days after your surgery. Smoking and exposure to second-hand smoke should be avoided to prevent delays in the healing process.

      A hybrid technique of the above two procedures is the non-endoscopic, limited incision technique. This procedure requires a small portion of the ends of the coronal incision technique incision to elevate the outside part of the eyebrows under direct vision without the use of the endoscope. The resultant scars are hidden in the temporal hairline, even in balding men who have some temporal hair remaining. Since almost all forehead lift procedures are done in conjunction with at least an upper blepharoplasty, the upper eyelid incisions are used to complete the forehead lift procedure by treating the "frown" lines between the eyebrows and raising the inside part of the eyebrows.

      TOP

      How will I look and feel initially?

      Once the dressings and drains are removed, puffiness and discoloration may be more pronounced in some portions of the face than others. Do not be alarmed by any unevenness or temporary asymmetry – this is normal. Most swelling is usually noted in the first 24 to 48 hours, and most bruising resolves within 2 weeks. Concealing makeup is usually permitted after the first week. You may experience numbness to the forehead post-operatively, which usually resolves within several months.

      Some patients find that mild swelling persists for many weeks. Most stitches are removed within a week of the surgery.

      Straining, bending, and lifting should be avoided during the early post-operative period as these activities may predispose you to bleeding.

      Your surgeon will give you specific instructions that may include caring for the dressings and incisions, directions for your analgesics and other medications, specific concerns to look for, and when to follow up in the office to monitor your healing process. It may take several months for the swelling to fully resolve, and up to 6 months for the incision scars to fully fade. Avoidance of factors that could reduce the benefits of the surgery, such as excessive unprotected sun exposure and cigarette use, is vital.

      Results of Your Forehead Lift

      The results of your Brow Lift may be subtle or dramatic, depending on your appearance prior to the surgery as well as the specific goals that you and your Plastic surgeon have established. Since the healing process is gradual, you should expect to wait several weeks for an accurate picture of your "new look". Additional minor changes or settling may occur over several months following your surgery.

      How much will a forehead lift cost?

      Cost is always a consideration in elective surgery. Prices for Brow Lifts vary widely, and are often dependent on the surgeon's experience and the geographical location.
      The fees are often broken down into several components:

      Surgeon's professional fee
      Facility fee
      Anesthesia fee
      Medications
      Surgical garments
      Medical tests

  • Breast
  • Breast Augmentation
    • Breast augmentation Plastic surgery is one of the most common procedures performed annually by members of the American Society for Aesthetic Plastic Surgery. Women may choose to under go breast enlargement surgery for various reasons. These personal reasons may center around breasts that are perceived to be under developed, or because of differences in the sizes of the breasts or from changes after pregnancy or breast feeding. Some women may be happy with their breasts but just want them made fuller. Often after weight loss, aging or childbirth a woman's breast volume and shape may change. This too can lead to a woman to seek a breast augmentation. Breast implant surgery performed by cosmetic Plastic surgeons is the most popular way to improve breast shape and size. Breast enhancement using breast implants can give a woman more proportional shape and may improve self esteem.

      Am I a good candidate for breast augmentation?

      One or more of the following feelings or conditions may indicate that you are a good candidate for breast augmentation:
      you are bothered by the feeling that your breasts are too small
      clothes that fit well around your hips are often too large at the bustline
      you feel self-conscious wearing a swimsuit or form-fitting top
      your breasts have become smaller and lost their firmness after having children
      weight loss has changed the size and shape of your breasts
      one of your breasts is noticeably smaller than the other

      Your Personal Consultation

      During the consultation, you will be asked about your desired breast size and anything else related to the appearance of your breasts that you feel is important. This will help your surgeon to understand your expectations and determine whether they realistically can be achieved.

      How will my ASAPS Plastic surgeon evaluate me for breast augmentation surgery?

      Your Plastic surgeon will examine your breasts and perhaps take photographs for your medical record. He or she will consider such factors as the size and shape of your breasts, the quality of your skin and the placement of your nipples and areolas (the pigmented skin surrounding the nipples). If your breasts are sagging, a breast lift may be recommended in conjunction with augmentation.

      You should come to the consultation prepared to discuss your medical history. This will include information about any medical conditions, drug allergies, medical treatments you have received, previous surgeries including breast biopsies, and medications that you currently take. You will be asked whether you have a family history of breast cancer and about results of any mammograms. It is important for you to provide complete information.

      There is no scientific evidence that breast augmentation increases the risk of breast cancer. The presence of breast implants, however, makes it more technically difficult to take and read mammograms. This may be a special consideration for women who perhaps are at higher risk for breast cancer because of their family history or other reasons. Placement of the implant underneath the pectoral muscle may interfere less with mammographic examination, but other factors may also need to be considered with regard to implant placement. Your Plastic surgeon will discuss this with you.

      If you are planning to lose a significant amount of weight, be sure to tell your Plastic surgeon. He or she may recommend that you stabilize your weight prior to undergoing surgery.
      If you think that you may want to become pregnant in the future, you should mention this to your surgeon. Pregnancy can alter breast size in an unpredictable way and could affect the long-term results of your breast augmentation. There is no evidence that breast implants will affect pregnancy or your ability to breast-feed, but if you have questions about these matters, you should ask your Plastic surgeon.

      Your Surgical Experience

      The goal of your Plastic surgeon and the entire staff is to make your surgical experience as easy and comfortable for you as possible.

      How should I prepare for breast augmentation Plastic surgery?

      In some instances, your Plastic surgeon may recommend a baseline mammogram before surgery and another mammographic examination some months after surgery. This will help to detect any future changes in your breast tissue. Following breast augmentation, you will still be able to perform breast self-examination.

      If you are a smoker, you will be asked to stop smoking well in advance of surgery. Aspirin and certain anti-inflammatory drugs can cause increased bleeding, so you should avoid taking these medications for a period of time before surgery. Your surgeon will provide you with additional preoperative instructions.

      Breast augmentation is usually performed on an outpatient basis. If this is the case, be sure to arrange for someone to drive you home after surgery and to stay with you at least the first night following surgery.

      What will the day of breast implant surgery be like?

      Your breast augmentation surgery may be performed in a hospital, free-standing ambulatory facility or office-based surgical suite.

      Medications are administered for your comfort during the surgical procedure. Frequently, local anesthesia and intravenous sedation are used for patients undergoing breast augmentation, although general anesthesia may be desirable in some instances.

      When surgery is completed, you will be taken into a recovery area where you will continue to be closely monitored. Your breasts will be wrapped in gauze dressings or a surgical bra.

      You may be permitted to go home after a few hours, unless you and your Plastic surgeon have determined that you will stay in the hospital or surgical facility overnight.

      How will my breasts look and feel after the breast implants have been placed?

      A day or two after surgery, you should be up and about. Any dressings will be removed within several days, and you may be instructed to wear a support bra. Your Plastic surgeon will probably permit you to shower between three and seven days following surgery. Stitches will be removed in about a week.

      Some discoloration and swelling will occur initially, but this will disappear quickly. Most residual swelling will resolve within a month.

      What should I expect during the recovery process?


      Recovery
      At the conclusion of your breast augmentation procedure, you may be placed in a surgical dressing that may include a support bra or garment. You should follow your Plastic surgeon's directions as prescribed. Prior to your discharge, you and your caregiver will be given detailed instructions about your post-surgical care including drains if they have been placed, the normal symptoms you will experience, and any potential signs of complication.

      Options for your recovery after undergoing breast augmentation include:
      Home: When discharged, you will be released to the care of a responsible adult with safe, licensed transportation home. The adult may be a family member, friend or hired caregiver and must be competent to understand your recovery instructions and to monitor your health. Your caregiver must commit to stay with you at all times for a minimum of 24 hours after surgery.
      Licensed Recovery Facility: You will be released to the care of a licensed post-surgical recovery facility where nurses or specially trained medical professionals will monitor your health and comfort until you are able to return home and capably care for yourself.
      Hotel or spa: You may wish to recover at a hotel or spa location, where licensed healthcare professionals will monitor your recovery around the clock as recommended by your Plastic surgeon.

      Overnight Hospital Stay: An overnight hospital stay may be offered to you or may be recommended. In this case your surgery will be performed at the hospital where you will stay overnight. You will be released from the hospital to a capable caregiver to continue your recovery at home, or to a licensed recovery facility.

      You should be walking under your own strength immediately after your breast augmentation surgery. It is very important that you walk a few minutes every few hours to reduce the risk of blood clot formation in your legs.

      The first 2-5 days following your breast augmentation surgery you may feel stiff and sore in the chest region. Any dressings will be removed within several days, and you may be instructed to wear a support bra. Your breasts may feel tight and sensitive to the touch, and your skin may feel warm or itchy. You may experience difficulty raising your arms. You should not lift, push or pull anything, or engage in any strenuous activity or twisting of the upper body. Some discoloration and swelling will occur initially, but this will disappear quickly. Most residual swelling will resolve within a month.

      It is important to follow all patient care instructions as directed.

      When can I expect to resume my normal activities after my breast augmentation?

      While it will take several days to return to more normal activities after your breast augmentation, it is important to your recovery that you get up and move around. After breast augmentation, it is often possible to return to work within just a few days or a week, depending on the type of activities that are required at your job.

      Physical activity should be avoided for at least the first couple of weeks following surgery. After that, care must be taken to be extremely gentle with your breasts for at least the next month.

      How Breast Augmentation is Performed

      Individual factors and personal preferences will help you and your Plastic surgeon to determine your appropriate breast size, the location of incisions, and whether the implants will be placed on top of or underneath the chest muscle.

      Breast Implant Options for the 21st Century

      Breast augmentation is designed to increase the size of small or underdeveloped breasts. Breast surgery can also restore and enhance your breast volume if it has decreased as a result of pregnancy and breast feeding. In addition, breast implants can serve one or more of a number of purposes; breast cancer victims can use breast implants for reconstructive purposes after mastectomy, or women with asymmetrical breasts may use a single breast implant to balance the difference in size.

      The availability of FDA-approved silicone gel implants will create new options for women considering breast surgery for the first time and for those who have had previous surgeries but are seeking new replacements or revision. Now, all women over 22 years old seeking cosmetic breast augmentation and women seeking breast reconstruction surgery will be able to select silicone breast implants.

      What type of breast implants can be used for breast augmentation?

      The implant is placed in a pocket either directly behind the breast tissue (right) or underneath the pectoral muscle which is located between the breast tissue and chest wall.

      The size and type of breast implant recommended for you will be determined by your goals for breast enhancement, your existing body frame, and mass, your existing breast tissue, and the preferences you and your Plastic surgeon discuss. All breast implants include a solid silicone rubber outer shell, called a lumen.

      Breast implant options include:


      Saline breast implants:
      Filled with sterile salt water. Saline implants may be pre-filled to a predetermined size. Saline may also be filled at the time of surgery to allow for minor modifications in implant size.

      Silicone filled breast implants:
      Filled with soft, elastic gel. All silicone breast implants are pre-filled and may require a longer incision for implant placement.

      New scientific data on the safety of breast implants is rapidly being collected. In the future, it is possible that additional types of filler materials may become available as advancements take place. Surgical techniques for breast augmentation and breast implants themselves are continuously being refined, increasing the safety and reliability of the procedure. Your Plastic surgeon will be able to provide you with the latest information.

      Where are the incisions made for the placement of breast implants?

      An incision can be made either underneath the breast, just above the crease, around the lower edge of the areola or within the armpit.

      One of the advantages of a saline-filled implant is that, because it is filled with saltwater after being inserted, only a small incision is needed. Often, an incision of less than one inch is made underneath the breast, just above the crease, where it is usually quite inconspicuous.
      Another possible location for the incision is around the lower edge of the areola. A third alternative is to make a small incision within the armpit.

      Once the incision is made, the surgeon creates a pocket into which the implant will be inserted. This pocket is made either directly behind the breast tissue or underneath the pectoral muscle which is located between the breast tissue and chest wall.

      Understanding Risks

      Every year, many thousands of women undergo successful breast augmentation surgery; however, anyone considering surgery should be aware of both the benefits and risks.
      I understand that every Plastic surgical procedure has risks, but how will I learn more so that I can make an informed decision?

      The subject of risks and potential complications of surgery is best discussed on a personal basis between you and your Plastic surgeon, or with a staff member in your surgeon's office.
      Some of the potential complications that may be discussed with you include reactions to anesthesia, blood accumulation that may need to be drained surgically and infection. Although rare, an infection that does not subside with appropriate treatment may require temporary removal of the implant. Changes in nipple or breast sensation may result from breast augmentation surgery, although they usually are temporary.

      When a breast implant is inserted, a scar capsule forms around it as part of the natural healing process. The capsule may sometimes tighten and compress the implant, causing the breast to feel firmer than normal. Capsular contracture can occur to varying degrees. If it is severe, it can cause discomfort or changes in the breast's appearance. In such cases, more surgery may be needed to modify or remove the scar tissue, or perhaps remove or replace the implant.

      Breast implants are not lifetime devices and cannot be expected to last forever. If a saline-filled implant breaks, its contents are harmlessly absorbed by the body within hours. A definite change in the size of the breast is clearly noticed. Rupture can occur as a result of trauma to the chest, but more commonly it occurs spontaneously with no apparent cause. Surgery will be required to replace the implant, if desired.

      If you are at an age when mammographic examinations should be conducted on a periodic basis, it will be important for you to select a radiology technician who is experienced in taking x-rays of augmented breasts. Additional views of your breasts will be required. Your Plastic surgeon, in some instances, may recommend other types of examinations such as ultrasound or magnetic resonance imaging. It is possible that the presence of breast implants could delay or hinder the early detection of breast cancer.

      Some women with breast implants have reported problems including certain connective tissue and immune-related diseases. Women without implants also have these disorders, so the key question is whether breast implants increase the risk of developing the conditions. Several large studies have been completed that provide reassurance that women with breast implants do not have a significantly increased risk for these diseases.

      Results of Breast Augmentation

      Breast augmentation will make your breasts fuller and enhance their shape. You will find it easier to wear certain styles of clothing. Like many women who have had breast augmentation, you may have a boost in self-confidence.

      How long will the results last after a breast augmentation?

      Except in the event of implant deflation requiring surgical replacement with a new implant, the results of your breast augmentation surgery will be long-lasting. However, gravity and the effects of aging will eventually alter the size and shape of virtually every woman's breasts. If, after a period of years, you become dissatisfied with the appearance of your breasts, you may choose to undergo a breast "lifting" to restore their more youthful contour.

  • Breast Implants
    • Augmentation mammoplasty, or breast augmentation, is typically performed to enlarge small, underdeveloped breasts or breasts that have decreased in size after a woman has had children. Breast augmentation is accomplished by surgically inserting an implant behind each breast.

      Many women consider undergoing breast implant surgery to enhance the size and shape of the natural bustline. Breast implants are also commonly used to restore a breast that has been removed or disfigured as a result of a mastectomy. A feminine body image is important to many women, and that includes the appearance of the breasts. In fact, breast implants come in a variety of sizes, shapes and profiles to achieve a natural-looking physique. Other important features include the texture of an implant's shell and the substance that fills the shell. Implants approved the U.S. Food and Drug Administration (FDA) are filled with saline or silicone which impact the look and feel of a breast implant, which affect the overall appearance of your breasts.

      Am I a good candidate for breast implants?

      One or more of the following feelings or conditions may indicate that you are a good candidate for breast implants:
      you have a sense of low self-esteem that your breasts are too small
      apparel that fit well around your hips is often too large at the bustline
      you feel self-conscious wearing form-fitting clothing or a swimsuit
      your breasts have decreased in size and lost their firmness after having children
      fluctuation in weight has changed the size and shape of your breasts
      asymmetry exists where one of your breasts is noticeably smaller than the other

      Breast Implants Standard Procedure Techniques


      Individual factors and personal preferences will help you and your Plastic surgeon to determine your appropriate breast size, the location of incisions, and whether breast implants will be placed on top of or underneath the chest muscle.

      The size, type, and location of your breast implant may be determined by your goals for breast enhancement, your existing body frame, and mass, your existing breast tissue, and the preferences you and your Plastic surgeon discuss.

      A patient education video features a real patient who talks about her real breast implant surgery to help you make an informed decision and safely achieve a satisfied outcome. (Video)

      Saline Implants vs. Silicone Implants

      Saline breast implants: Solid silicone rubber outer shell filled with sterile salt water. .Saline implants are filled at the time of surgery; thus may be inserted via a smaller incision than silicone implants. Saline implants allow for minor modifications in implant size at the time of the operation. If saline implants deflate, it is obvious in short time.

      Silicone filled breast implants: Solid silicone rubber outer shell filled with cohesive silicone gel. Silicone is a naturally occurring element found in sand, quartz and rock. Silicone can be manufactured in a variety of ways, including oils, gels and solids. Silicone products have been shown to be bio-compatible, reliable, flexible and easy to sterilize. All silicone breast implants are pre-filled and may require a longer incision for implant placement. Patients tend to think that silicone implants feel more natural. If silicone implants rupture, it may not be obvious immediately. Current FDA recommendations include getting an MRI every other year starting with the third year to look for silent ruptures. With the recent FDA approval, all women over 22 years of age seeking cosmetic breast augmentation and women seeking breast reconstruction surgery will be able to select silicone breast implants.

      Textured Implants vs. Smooth Implants

      Textured implants: implants with a rough surface. Textured implants are intended to stay in one place and not move. Shaped implants should be textured so that they are more likely to stay in the appropriate location and orientation. Round implants may also be textured. The idea being that a rough surface may help to decrease capsular contracture.

      Smooth implants: implants with a smooth surface. Smooth implants are intended to move within the pocket. Some patients think that smooth implants are less palpable.

      Round Implants vs. Shaped Implants


      Round implants: round implants. Does not have an orientation.
      Shaped implants: various shapes available. In the United States currently, limited to saline implants.

      Options for Breast Implant Surgery Incisions

      Inframammary (under the breast)
      Periareolar (around the nipple)
      Transaxillary (in the armpit region)
      Transumbilical (through the belly button)
      Options for Breast Implant Pocket Location

      Subpectoral – under the pectoralis major muscle
      Subglandular – over the pectoralis major muscle
      Breast Implants Benefits / Advantages / Options
      Increases fullness of the breasts
      Increases the size of the breasts
      If different sizes are used in each side, breast size asymmetry may improve
      May improve sagging breasts, depending on how large the implant and how much your breasts sag
      May improve the proportion of breast size to match the rest of the body
      May improve the fit of clothing
      May improve self–confidence
      Other Considerations for Breast Implant Surgery

      After having breast implants, it may be recommended that you take prophylactic antibiotics when any dental work is done to protect the implant from infection for a short period of time.
      Check with your insurance carrier to see if getting breast implants will affect your coverage or premiums.

      Breast implants do not last forever. Expect to have another breast operation in the future.

      Breast Implant Surgery Risks / Complications / Patient Safety


      Every year, many thousands of women undergo successful breast implant surgery; however, anyone considering breast surgery should be aware of both the benefits and risks.
      The subject of risks and potential complications of breast implant surgery is best discussed on a personal basis between you and your Plastic surgeon, or with a staff member in your surgeon's office.

      General risks of breast implant surgery: Some of the potential complications from breast implant surgery that may be discussed with you include reactions to anesthesia, blood accumulation that may need to be drained surgically and infection. Although rare, an infection that does not subside with appropriate treatment may require temporary removal of the implant.
      Capsular contracture: When a breast implant is inserted, a scar capsule forms around it as part of the natural healing process. The capsule may sometimes tighten and compress the implant, causing the breast to feel firmer than normal. Capsular contracture can occur to varying degrees. If it is severe, it can cause discomfort or changes in the breast's appearance. In such cases, more surgery may be needed to modify or remove the scar tissue, or perhaps remove or replace the implant.

      Implant rupture: Breast implants are not lifetime devices and cannot be expected to last forever. If a saline-filled implant breaks, its contents are harmlessly absorbed by the body within hours. A definite change in the size of the breast is clearly noticed. The implant may be removed and replaced if desired. If a silicone implant is used, a rupture may not be immediately obvious. Your may notice that your breasts seem to change shape, feel different, or start to have capsular contracture. A ruptured silicone implant should be removed and if desired, replaced. Rupture can occur as a result of trauma to the chest, but more commonly it occurs spontaneously with no apparent cause. Surgery will be required to replace the implant, if desired.

      Breast cancer screening: If you are at an age when mammographic examinations should be conducted on a periodic basis, it will be important for you to select a radiology technician who is experienced in taking x-rays of augmented breasts. Additional views of your breasts will be required. Your Plastic surgeon, in some instances, may recommend other types of examinations such as ultrasound or magnetic resonance imaging. An implant may obscure some of the mammogram. It is possible that the presence of breast implants could delay or hinder the early detection of breast cancer.

      Other risks of breast implants: Other risks include changes in sensation of the nipple or breast and changes in the ability to breastfeed. Changes in sensation may either be increased or decreased or altered sensation. These changes may be temporary or permanent. Also, implant visibility, rippling, and asymmetry may also occur.

      Other considerations of breast implants: Some women with breast implants have reported problems including certain connective tissue and immune-related diseases. Women without implants also have these disorders, so the key question is whether breast implants increase the risk of developing the conditions. Several large studies have been completed that provide reassurance that women with breast implants do not have a significantly increased risk for these diseases.

      Breast Implants Recovery Process

      At the conclusion of your breast implant procedure, you may be placed in a surgical dressing that may include a support bra or garment. You should follow your Plastic surgeon's directions as prescribed. Prior to your discharge, you and your caregiver will be given detailed instructions about your post-surgical care including drains if they have been placed, the normal symptoms you will experience, and any potential signs of complication.

      You should be walking under your own strength immediately after your breast implant surgery. It is very important that you walk a few minutes every few hours to reduce the risk of blood clot formation in your legs.

      The first 2-5 days following your breast implant surgery you may feel stiff and sore in the chest region. Any dressings will be removed within several days, and you may be instructed to wear a support bra. Your breasts may feel tight and sensitive to the touch, and your skin may feel warm or itchy. You may experience difficulty raising your arms. You should not lift, push or pull anything, or engage in any strenuous activity or twisting of the upper body. Some discoloration and swelling will occur initially, but this will disappear quickly. Most residual swelling will resolve within a month.

      Your surgeon may instruct you to do displacement exercises/implant massage. This is usually recommended when round smooth implants are used, and are done to try to keep the breast pocket open. The idea is to allow room for the implant to move and try to keep the breast soft and more natural looking.

      It is important to follow your surgeon's instructions as directed.

      Breast Implants Frequently Asked Questions:

      Will breast implant surgery be painful?

      Usually, pain after the breast implant operation is controlled by pain pills. Patients may feel stiff and sore in the chest region. They may feel tight, numb, itchy, or sensitive to the touch. Some patients may feel discomfort when raising their arms. However, the amount and duration of pain varies. Some patients have only minor discomfort. Others may have more severe pain or pain for a longer time.

      Will there be scarring from breast implant surgery?

      Anytime the layers of the skin are cut through, a scar forms. Thus there will be a scar along the incision that will not be able to be erased. Your surgeon will make it as thin and least noticeable as he/she can; however, the ultimate healing will be determined by your body's healing potential.

      What are some typical short-term side-effects from breast implant surgery?

      Soreness, pain (see Will it be painful?), swelling are to be expected. A collection of fluid (seroma) may occur that may need to be drained either with a needle or with another operation. A collection of blood (hematoma) or bleeding may occur that may need another operation. Implant asymmetry, rippling, contracture, rupture, may also occur. Poor healing, poor scarring, alterations in sensation may also occur. Breast implant infection that may need antibiotics or even removal may occur.

      What type of anesthesia, if any, will be used during breast implant surgery?

      Breast augmentation may be done under sedation or general anesthesia. Speak to your surgeon regarding his/her preferences and your options. Many surgeons also use numbing medication (local anesthetic) during the operation to help with pain after the operation.

      How long will my implants last?

      Implants will not last forever and will likely need to be replaced with a subsequent operation. The length of time varies in each patient. However, if your breast implants do not give you problems, there is no set time at which "old" implants need to be replaced.

  • Breast Lift
    • Loss of skin elasticity, gravity and other factors such as weight loss, pregnancy and breast-feeding ultimately affect the shape and firmness of your breasts. Patients who are generally satisfied with the size of their breasts can have a breast lift to raise and firm them, resulting in a more youthful breast contour. Some patients may be unhappy that they have lost a significant amount of breast volume over time. In such cases, implants inserted in conjunction with a breast lift can increase breast size at the same time as the shape and position of the breasts are enhanced.

      Am I a good candidate for a breast lift?

      You may be a good candidate for breast lift surgery if you have one or more of the following conditions:
      breasts that are pendulous, but of satisfactory size
      breasts that lack substance or firmness
      nipples and areolas that point downward, especially if they are positioned below the breast crease

      Sometimes these conditions may be inherited traits. In certain cases, the breasts may have developed differently so that one breast is firm and well positioned while the other is not. There may be differences in the size of your breasts as well as their shape. Breasts that are large and heavy can be lifted, but the results may not be as long-lasting as when the procedure is done on smaller breasts.

      A breast lift can be performed at any age, but Plastic surgeons usually recommend waiting until breast development has stopped. Pregnancy and breast-feeding may have significant and unpredictable effects on the size and shape of your breasts. Nevertheless, many women decide to undergo breast lift surgery before having children and feel that they can address any subsequent changes later. Since the milk ducts and nipples are left intact, breast lift surgery usually will not affect your ability to breast-feed; however, you should discuss this with your Plastic surgeons.

      Your Personal Consultation

      During the consultation, you will be asked about your desired breast shape and size. Your Plastic surgeon will discuss with you how your nipples and areolas will be repositioned. You should mention anything else about your breasts that you would like to see improved. This will help your surgeon to understand your expectations and determine whether they realistically can be achieved.

      How will my Plastic surgeon evaluate me for breast lift surgery?

      Your Plastic surgeon will examine your breasts, taking measurements and perhaps photographs for your medical record. The size and shape of your breasts, the quality of your skin, and the placement of the nipples and areolas will be carefully evaluated.

      You should come to the consultation prepared to discuss your medical history. This will include information about any medical conditions, drug allergies, medical treatments you have received, previous surgeries including breast biopsies, and medications that you currently take. It is important for you to provide complete information.

      You should tell your Plastic surgeon if you plan to lose a significant amount of weight, particularly if you have noticed that your breasts sag or become smaller with weight loss. Your surgeon may recommend that you stabilize your weight before having surgery.

      Will my insurance help cover the cost of surgery?

      Breast lift surgery, as an aesthetic (cosmetic) procedure, generally is not covered by insurance.
      Under certain circumstances, however, insurance coverage may be available. For example, if a breast reconstruction after mastectomy is performed, the opposite breast may need to be modified for symmetry. Many factors determine your eligibility for coverage, including the specific terms of your insurance policy. A letter of predetermination may be required by your insurance company prior to surgery. Your Plastic surgeon or a staff member in your surgeon's office will discuss these matters with you.

      How a Breast Lift Is Performed

      Individual factors and personal preferences will determine the specific technique selected to lift your breasts.

      Incisions following the breast's natural contour define the area of excision and the new location for the nipple and areola. Skin in the shaded area is removed, and the nipple and areola are moved to a higher position.

      Where are the incisions placed?

      A common method of lifting the breasts involves three incisions. One incision is made around the areola. Another runs vertically from the bottom edge of the areola to the crease underneath the breast. The third incision is horizontal beneath the breast and follows the natural curve of the breast crease.

      After the Plastic surgeon has removed excess breast skin, the nipple and areola are shifted to a higher position. The areola, which in a sagging breast may have been stretched, can be reduced in size. Skin that was formerly located above the areola is brought down and together beneath it to reshape the breast.

      The nipples and areolas remain attached to underlying mounds of tissue, and this usually allows for the preservation of sensation and the ability to breast-feed.
      Skin formerly located above the areola is brought down and together beneath it to reshape the breast.

      What are some variations to the common breast lifting technique?

      There are many variations to the design of the incisions for breast lift surgery. The size and shape of your breasts, size of your areolas, and extent of sagging are factors that will help your Plastic surgeon determine the best technique for you.

      In some instances, it may be possible to avoid the horizontal incision beneath the breast. Sometimes a technique may be used that avoids this horizontal incision as well as the vertical incision that runs from the bottom edge of the areola to the breast crease.

      If you are a good candidate for a modified technique, your Plastic surgeon will discuss this with you.

      If you and your Plastic surgeon have decided that it is desirable to enlarge your breasts at the same time as they are lifted, this will require insertion of breast implants. If this is an option that you wish to consider, your surgeon will review the necessary information with you and may provide you with a brochure on breast augmentation.

      Understanding Risks

      Fortunately, significant complications from breast lifts are infrequent. Every year, many thousands of women undergo successful breast lift surgery, experience no major problems and are pleased with the results. Anyone considering surgery, however, should be aware of both the benefits and risks.

      I understand that every surgical procedure has risks, but how will I learn more so that I can make an informed decision?

      The subject of risks and potential complications of surgery is best discussed on a personal basis between you and your Plastic surgeon, or with a staff member in your surgeon's office.
      Some of the potential complications that may be discussed with you include bleeding, infection and reactions to anesthesia. Following a breast lift, sometimes the breasts may not be perfectly symmetrical or the nipple height may vary slightly. Minor adjustments often can be made at a later time. Permanent loss of sensation in the nipples or areas of breast skin may occur rarely. Revisionary surgery may sometimes be helpful in certain instances where incisions may have healed poorly.

      You can help to lessen certain risks by following the advice and instructions of your Plastic surgeon, both before and after surgery.

      Your Surgical Experience

      How should I prepare for surgery?

      The goal of your Plastic surgeon and the entire staff is to make your surgical experience as easy and comfortable for you as possible.

      Depending on your age, or if you have a history of breast cancer in your family, your Plastic surgeon may recommend a baseline mammogram before surgery and another mammographic examination some months after surgery. This will help to detect any future changes in your breast tissue. Following a breast lift, you will still be able to perform breast self-examination. Breast lift surgery will not increase your risk of developing breast cancer.

      If you are a smoker, you will be asked to stop smoking well in advance of surgery. Aspirin and certain anti-inflammatory drugs can cause increased bleeding, so you should avoid taking these medications for a period of time before surgery. Your surgeon will provide you with additional preoperative instructions.

      Breast lift surgery is usually performed on an outpatient basis. If this is the case, be sure to arrange for someone to drive you home after surgery and to stay with you at least the first night.

      What will the day of surgery be like?

      Your breast lift surgery may be performed in a hospital, free-standing ambulatory facility or office-based surgical suite.

      Medications are administered for your comfort during the surgical procedure. Often, a general anesthetic is administered, so that you will be asleep throughout the procedure.

      Alternatively, a breast lift may be performed using local anesthesia and intravenous sedation. When surgery is completed, you will be taken into a recovery area where you will continue to be closely monitored. Sometimes, small drain tubes will have been placed in your breasts to help avoid the accumulation of fluids. Gauze or other dressings may be placed on your breasts and covered with an elastic bandage or surgical bra.

      You may be permitted to go home after a few hours, unless you and your Plastic surgeon have determined that you will stay in the hospital or surgical facility overnight.

      How will I look and feel initially?

      The day after surgery, you will be encouraged to get out of bed for short periods of time. After several days, you should be able to move about more comfortably. Straining, bending and lifting must be avoided, however, since these activities might cause increased swelling or even bleeding. You may be instructed to sleep on your back to avoid pressure on your breasts.
      Any surgical drains will be removed within a few days of surgery, at which time your dressings may also be changed or removed. You may be instructed to wear a support bra for a few weeks, until the swelling and discoloration of your breasts diminish. Generally, stitches will be removed in stages over a period of approximately three weeks, beginning about one week after surgery.

      You may notice that you feel less sensation in the nipple and areola areas. This is usually temporary. It may, however, take weeks, months or even more than a year before sensation returns to normal. Your breasts may also require some time to assume a more natural shape. Incisions will initially be red or pink in color. They will remain this way for many months following surgery.

      When can I resume my normal activities?

      After breast lift surgery, it is often possible to return to work within a week or so, depending on your job. In many instances, you can resume most of your normal activities, including some form of mild exercise, after several weeks. You may continue to experience some mild, periodic discomfort during this time, but such feelings are normal. Severe pain should be reported to your doctor.

      Any sexual activity should be avoided for a minimum of one or two weeks, and your Plastic surgeon may advise you to wait longer. After that, care must be taken to be extremely gentle with your breasts for at least the next several weeks.

      Results of a Breast Lift

      Breast lift surgery will make your breasts firmer and more uplifted. The position of your areolas and nipples will be enhanced, and the size of your areolas will be aesthetically pleasing.
      The incisions from your breast lift surgery will heal and fade over time. It is important to realize, however, that the incision lines will be permanently visible. In some instances, they will eventually be only faint lines. Certain individuals may have incision lines that are more noticeable. Fortunately, the incisions for your breast lift are in locations easily concealed by clothing, even low-cut necklines.

      How long will the results last?

      Unless you gain or lose a significant amount of weight or become pregnant, your new breast shape should remain fairly constant. However, gravity and the effects of aging will eventually alter the size and shape of virtually every woman's breasts. If, after a period of years, you again become dissatisfied with the appearance of your breasts, you may choose to undergo a second breast lift procedure to restore their more youthful contour and appearance.

  • Breast Reduction
    • Patients who undergo breast reduction surgery frequently are seeking relief from physical symptoms caused by the excessive weight of large breasts. Breast reduction usually can solve these problems as well as improve the size and shape of your breasts. Following breast reduction, your breasts will be more proportional to the rest of your body, and clothes will fit you better.

      Am I a good candidate for breast reduction?

      You may be a good candidate for breast reduction if you have one or more of the following conditions:
      breasts that are too large in proportion to your body frame
      heavy, pendulous breasts with nipples and areolas that point downward
      one breast is much larger than the other
      back, neck or shoulder pain caused by the weight of your breasts
      skin irritation beneath your breasts
      indentations in your shoulders from tight bra straps
      restriction of physical activity due to the size and weight of your breasts
      dissatisfaction or self-consciousness about the largeness of your breasts

      Breast reduction can be performed at any age, but Plastic surgeons usually recommend waiting until breast development has stopped. Childbirth and breast-feeding may have significant and unpredictable effects on the size and shape of your breasts. Nevertheless, many women decide to undergo breast reduction before having children and feel that they can address any subsequent changes later. If you plan to breast-feed in the future, you should discuss this with your Plastic surgeon.

      During the consultation, you will be asked about your desired breast size as well as anything else about your breasts that you would like to see improved. This will help your Plastic surgeon to understand your expectations and determine whether they realistically can be achieved.

      How will my Plastic surgeon evaluate me for breast reduction surgery?

      Your Plastic surgeon will examine your breasts, taking measurements and perhaps photographs for your medical record. The size and shape of your breasts, the quality of your skin, and the placement of the nipples and areolas will be carefully evaluated.

      You should come to the consultation prepared to discuss your medical history. This will include information about any medical conditions, drug allergies, medical treatments you have received, previous surgeries including breast biopsies, and medications that you currently take. It is important for you to provide complete information.

      You should tell your Plastic surgeon if you plan to lose a significant amount of weight, particularly if you have noticed that your breasts become smaller with weight loss. Your surgeon may recommend that you stabilize your weight before having surgery.

      Will my insurance help cover the cost of surgery?

      Insurance coverage is sometimes available for breast reduction surgery. Many factors determine your eligibility, including the specific terms of your insurance policy and the amount of breast tissue to be removed. A letter of predetermination may be required by your insurance company prior to surgery. Your Plastic surgeon or a staff member in your surgeon's office will discuss these matters with you.

      Where are the incisions placed?

      Individual factors and personal preferences will determine the specific technique selected to reduce the size of your breasts.

      The most common method of reducing the breasts involves three incisions. One incision is made around the areola. Another runs vertically from the bottom edge of the areola to the crease underneath the breast. The third incision follows the natural curve of the breast crease.
      After the surgeon has removed excess breast tissue, fat and skin, the nipple and areola are shifted to a higher position. The areola, which in large breasts usually has been stretched, also is reduced in size. Skin that was formerly located above the nipple is brought down and together to reshape the breast. Liposuction may be used to improve the contour under the arm.
      One common breast reduction technique removes excess breast tissue, fat and skin through the incisions shown. The nipple and areola remain attached to the underlying tissue but are shifted to a higher position. The size of the areola is often reduced at the same time.
      Usually, the nipples and areolas remain attached to underlying mounds of tissue, and this allows for the preservation of sensation. The ability to breast-feed may also be preserved by this method, although this cannot be guaranteed.

      Skin that formerly was located above the nipple is brought down and together to reshape the breast.

      What are some variations to the common breast reduction technique?

      There are many variations to the design of the incisions for breast reduction. The size and shape of your breasts, as well as the desired amount of reduction, are factors that will help your Plastic surgeon determine the best technique for you.

      In some instances, it may be possible to avoid the vertical incision that runs from the bottom edge of the areola to the breast crease or the horizontal incision underneath the breast.
      Rarely, if your breasts are extremely large, the nipples and areolas may need to be completely detached before they are shifted to a higher level. In such a case, you will need to have made the decision to sacrifice sensation and the possibility of breast-feeding in order to achieve your desired breast size.

      Understanding Risks

      Fortunately, significant complications from breast reduction are infrequent. Every year, many thousands of women undergo successful breast reduction surgery, experience no major problems and are pleased with the results. Anyone considering surgery, however, should be aware of both the benefits and the risks.

      I understand that every surgical procedure has risks, but how will I learn more so that I can make an informed decision?

      The subject of risks and potential complications of surgery is best discussed on a personal basis between you and your Plastic surgeon, or with a staff member in your surgeon's office.
      Some of the potential complications that may be discussed with you include bleeding, infection and reactions to anesthesia. Rarely, a patient may require a blood transfusion during the operation. This usually can be anticipated in advance, and your Plastic surgeon may, under certain circumstances, advise you to donate your own blood in preparation for surgery.
      Following reduction, sometimes the breasts may not be perfectly symmetrical or the nipple height may vary slightly. If desired, minor adjustments can be made at a later time. Permanent loss of sensation in the nipples or breasts may occur rarely. Revisionary surgery is sometimes helpful in certain instances where incisions may have healed poorly. In the unlikely event of injury to or loss of the nipple and areola, they usually can be satisfactorily reconstructed using skin grafts.

      You can help to lessen certain risks by following the advice and instructions of your Plastic surgeon, both before and after surgery.

      How should I prepare for surgery?

      Depending on your age, or if you have a history of breast cancer in your family, your Plastic surgeon may recommend a baseline mammogram before surgery and another mammographic examination some months after surgery. This will help to detect any future changes in your breast tissue. Following breast reduction, you will still be able to perform breast self-examination. Breast reduction surgery will not increase your risk of developing breast cancer.
      If you are a smoker, you will be asked to stop smoking well in advance of surgery. Aspirin and certain anti-inflammatory drugs can cause increased bleeding, so you should avoid taking these medications for a period of time before surgery. Your surgeon will provide you with additional preoperative instructions.

      Breast reduction surgery may be performed on an inpatient or outpatient basis. If you are to stay in the hospital or surgical facility, it will most likely be for only one night. Whether you are released the day of surgery or the following day, you will need someone to drive you home and to stay with you for the next day or two.

      Your Surgical Experience

      The goal of your Plastic surgeon and the entire staff is to make your surgical experience as easy and comfortable for you as possible.

      What will the day of surgery be like?

      Your breast reduction surgery may be performed in a hospital, free-standing ambulatory facility or office-based surgical suite.

      Usually, a general anesthetic is administered, so that you will be asleep throughout the procedure. When surgery is completed, you will be taken into a recovery area where you will continue to be closely monitored. In many instances, small drain tubes will have been placed in your breasts to help avoid the accumulation of fluids. Gauze dressings will be placed on your breasts and covered with an elastic bandage or surgical bra.

      How will I look and feel initially?

      The day after surgery, you will be encouraged to get out of bed for short periods of time. After several days, you will be able to move about more comfortably. Straining, bending and lifting must be avoided, however, since these activities might cause increased swelling or even bleeding. You may be instructed to sleep on your back to avoid pressure on your breasts.
      Any surgical drains will be removed a day or two after surgery, at which time your dressings may also be changed or removed. You will be instructed to wear a support bra for a few weeks, until the swelling and discoloration of your breasts diminishes. Generally, stitches will be removed in stages over a period of approximately three weeks, beginning about one week after surgery.

      You may notice that you feel less sensation in the nipple and areola areas. This usually is temporary. It may, however, take weeks, months or even more than a year before sensation returns to normal. Your breasts may also require some time to assume a more natural shape. Incisions will initially be red or pink in color. They will remain this way for many months following surgery.

      When can I resume my normal activities?

      After breast reduction surgery, it is often possible to return to work within just a couple of weeks, depending on your job. In many instances, you can resume most of your normal activities, including some form of mild exercise, after several weeks. You may continue to experience some mild, periodic discomfort during this time, but such feelings are normal. Severe pain should be reported to your doctor.

      Any sexual activity should be avoided for a minimum of one week, and your Plastic surgeon may advise you to wait longer. After that, care must be taken to be extremely gentle with your breasts for at least the next six weeks.

      How long will the results last?

      Unless you gain or lose a significant amount of weight or become pregnant, your breast size should remain fairly constant. However, gravity and the effects of aging will eventually alter the size and shape of virtually every woman's breasts. If, after a period of years, you become dissatisfied with the appearance of your breasts, you may choose to undergo a breast "lifting" procedure to restore their more youthful contour.

      Results of Breast Reduction

      Breast reduction surgery will make your breasts smaller and firmer. Without the excessive weight of large breasts, you may find greater enjoyment in playing sports and engaging in physical activity.

      The incisions from your breast reduction surgery will heal and fade over time. It is important to realize, however, that the incision lines will be permanently visible, more so in some individuals than others. Fortunately, the incisions for breast reduction are in locations easily concealed by clothing, even low-cut necklines.

      Breast reduction often makes a dramatic change in your appearance. For this reason, it may take some time to adjust to your new body image. Most women, however, eventually become comfortable with their smaller breasts and feel very pleased with the results of surgery. In fact, the level of patient satisfaction resulting from breast reduction is among the highest of any Plastic surgery procedure.

  • Male Breast Reduction
    • Gynecomastia is a medical term that originates from the Greek words for "women-like breasts." This condition is far more common than many realize. Gynecomastia affects an estimated 40 to 60 percent of the male population. It may affect only one breast or both. Although certain drugs such as anabolic steroids, medications containing estrogen, alcohol, marijuana, etc., and medical conditions including cancer, impaired liver function, to name a few, may cause or contribute to enlarged male breasts, it is widely accepted that a large percentage of cases derive from unknown sources.

      Men of any age who are healthy and emotionally stable are considered good candidates for male breast reduction surgery. The best candidates are those who have firm, elastic skin that will reshape to the body's new contours. In some instances, surgery may be discouraged for overweight men who have not first tried an exercise and diet regimen.

      Enlarged male breasts can be reduced by liposuction and/or by cutting out excess glandular tissue. The procedure for male breast reduction takes an average of two hours, usually on an outpatient basis, using general or local anesthesia. If excessive glandular tissue, fat and skin is present, it will be removed.

      Surgery may be performed alone or in conjunction with lipoplasty, where the suction device will typically be inserted through the existing incisions. For the removal of excess fatty tissue alone, liposuction may be all that is needed; in such cases, scars will be small and barely visible.
      Results are permanent, although subsequent obesity can create a gynecomastia-like effect. Some of the benefits of surgery include a firmer, flatter, more contoured chest which may give the male patient a boost in self-confidence. There is little downtime, and you may return to work within one week usually, unless you are involved in strenuous activities.
      There will be scarring around the nipple of the breast (areola) from this procedure but will fade over a period of time and be less visible. There will be some post-operative bruising, swelling, and burning sensation. To assist with the healing process, the patient will wear an elastic pressure garment for 3-6 weeks and must avoid exposing scarred areas to the sun for at least 6 months.

      Other considerations include temporary numbness or lack of sensation that could last up to a year. Infrequent complications may include infection, skin damage, fluid accumulation, bleeding, scarring or pigment changes. Post-operative asymmetry, while rare, is possible; a second procedure may be needed to remove additional tissue.

  • Skin
  • Chemical Peels
    • A deep chemical skin peel, or phenol peel, is the strongest of chemical peels, and is reserved for individuals with deep wrinkles from sun exposure or is used to treat skin wrinkling around the lips and chin area. The procedure diminishes imperfections in sun-damaged, unevenly pigmented, or coarsely wrinkled facial areas by peeling away the skin's top layers.

      Technique:

      A full-face deep chemical peel takes 1 to 2 hours to perform. A more limited procedure (such as treatment of wrinkling above the lip) will generally take less than a half-hour. A solution is applied to the area to be treated (avoiding the eyes, brows and lips). There is a slight burning sensation, but it is minimal since the solution also acts as an anesthetic. After the peel solution has worked on the skin, it is neutralized with water. Approximately one hour later, a thick coating of petroleum jelly is layered over the patient's face, covering the protective crust which develops rapidly over the area. This stays in place for 1 to 2 days. In an alternative technique, the patient's face is covered by a "mask," composed of strips of adhesive tape, with openings for the eyes and mouth (this is particularly effective in cases of severe wrinkling).

      Some patients experience discomfort after a deep chemical peel, but this can be controlled with medication. A few days after the procedure, new skin with a bright pink color akin to sunburn will emerge; the pinkness will fade within a few days. Post-operative puffiness will also subside in a few days, but the skin will remain sensitive. Patients should avoid exposure to sunlight and continue to use sun block.

      Benefits:

      Effects of a phenol chemical peel are long lasting, and in some cases are still readily apparent up to 20 years following the procedure. Improvements in the patient's skin can be quite dramatic.

      Normal work schedule and other activities can be resumed after 1 to 2 weeks.
      Variants in the phenol peel formula can create a milder solution for broader use.

      Other Considerations:

      Possible postoperative complications can include scarring, infection or abnormal pigmentation. Tends to have a bleaching effect, and patient may need to wear make-up to match treated and untreated areas.
      EKG monitoring is advised.
      Cannot be used on the neck or other parts of the patient's body.
      Not as effective in treating individuals with dark, oily complexions.
      Some facial skin disorders do not respond to chemical peeling.
      Skin pores may appear larger, and the skin may not tan properly.
      Can activate latent cold sore infections.
      All forms of deep skin peels include the risk of delayed healing and scarring.

      ASAPS Position:

      The effectiveness of phenol chemical peeling has been proven in clinical studies over the last 30 years. Because they are serious procedures, it is ASAPS' position that phenol chemical peels should only be performed under the direction of a qualified physician.

  • Fat Injection
    • Description of Procedure

      Fat injection or grafting has broad applications in cosmetic surgery. Fat injected into areas requiring volume-enhancement produces safe, long-lasting, and natural-appearing results as volume is replaced to tissues where fat is diminished. Fat grafting usually involves harvesting fat from one part of the body, washing/ purifying it, and the carefully re-injecting it with specially designed needles into the areas requiring augmentation. The procedure may need to be repeated several times to achieve the desired result.

      Swelling, which is commonly seen after fat injection, usually resolves within 2-3 weeks. The degree of swelling is most dependent on the area injected.

      Am I a good candidate for fat grafting?

      Patients who benefit from fat grafting are people who desire augmentation or filling of volume-deficient areas. The most commonly grafted areas include the hands, face (including the lips), and depressions in the skin contour such as those that have developed following liposuction and scarring.

      Generally, patients who are considered for fat injection are in good health. If you have a history of abnormal bleeding or swelling following a procedure you should notify your surgeon. A smoking history should be disclosed to your surgeon. Each patient's anatomy and proportions vary, and the decision to utilize fat injection techniques depends on the goals of the patient as well as the surgeon.

      Fat Injection Standard Procedure Techniques

      All patients requesting consideration for fat injection require a thorough pre-procedure evaluation. This may require several visits to your surgeon before the procedure. A full history and physical examination will be performed prior to the procedure. Your surgeon may take pre-procedure photographs, an informed consent will be obtained, and your skin may be marked. Either local ('twilight') or general anesthesia may be used, depending on your surgeon's preference.

      Fat is harvested using a special suction cannula using sterile technique. Once enough fat is obtained from the donor area, it is then purified. This often requires the use of a centrifuge which spins the fat and removes impurities. The fat is then placed into the areas requiring augmentation. The injection needle is usually passed in and out of the areas to be augmented multiple times. This creates a 'grid' of threads of fat graft. The areas that were injected may then be massaged by the surgeon to create a satisfactory contour. A dressing may then be placed.

      Fat Injection Benefits/ Advantages

      Fat injection or grafting is a technique that is growing in popularity. Fat is one of most well-tolerated fillers available to aesthetic surgeons, and thus has broad applications. It is natural-appearing, lasts a long time, and is safe. It is an effective filler used for changing body contour, revising scars, filling depressions created by liposuction, and rejuvenating the hands and face. Perhaps most importantly, it spares the patient the inherent risks associated with fillers derived from animals or cadavers.

      Fat Injection Risks/Complications/Patient Safety

      Swelling is the most common post-operative side effect. Most of the swelling settles down within several weeks.

      Bruising in both the donor and recipient areas as a result of bleeding. It is unusual to require a transfusion.

      Numbness of the skin overlying the donor and injected areas. This is usually temporary.
      Slight asymmetry or contour irregularity. This usually improves as the swelling resolves.
      Under or over correction of the defect
      Infection
      Loss of fat viability, with resultant failure of the desired augmentation

      Fat Injection Recovery Process

      Dressings may be placed on the injected areas. These dressings may include the use of tapes or compressive-type dressings. Your surgeon may request that you don't sit or lie on injected areas for a prescribed period. Your surgeon may also instruct you regarding a massage program after the procedure. Swelling and bruising usually resolve within 2 to 3 weeks.

  • Injectables
    • Cosmetic surgical procedures can produce profound, long lasting changes in facial appearance, but are invasive and have an associated recovery period. Many patients who are just beginning to show signs of facial aging desire improvement, but cannot justify the cost or time investment required for surgical intervention. For these patients, the rapidly expanding repertoire of injectable treatments is perfect to suit their needs. Injectables can be utilized during an office visit, rather than requiring a trip to the operating room. With some treatments, no anesthetic is necessary, as the needles utilized are so small that discomfort is minimal. With others, topical anesthetic agents or nerve blocks may be utilized, depending on the patient's preference and the sensitivity of the region being treated.

      From the standpoint of using minimally invasive techniques to treat facial wrinkles, there are two general classes of injectables:

      Neuromuscular Toxins

      The first option, which is most appropriate for active lines or age associated wrinkles that are just starting to appear, is to temporarily weaken or paralyze the muscle that is causing the wrinkle. Botulinum Toxin type A is a family of neurotoxins that block nerve signals that cause muscles to contract. The toxin works directly where it is placed, and thus can be artistically used to alter facial expressions. Botox Cosmetic® is widely recognized, and was the first neurotoxin to be approved for cosmetic use in the United States. Other manufactures are producing variant toxins that will likely be approved for use in the near future, including Reloxin and PurTox. These toxins will be differentiated by their time to onset, duration of effect (the clinical effects of Botox Cosmetic® are typically 3 to 4 months), and the distance of effect from the injection site. Risks include bruising at the injection site, rare chance of an infection, and the possibility of unintentionally affecting nearby muscle groups. Specific risks should be discussed with your injector when considering treatment.

      Soft Tissue Fillers

      The second class of injectable treatments are the soft tissue fillers. This group is rapidly expanding, and many options are available. These injectables are more useful for treatment of firmly established wrinkles or larger lines of facial aging (such as the nasolabial folds). Fillers restore volume to the face and can add structure as well. Depending on the type of filler and the depth at which it is injected, you can smooth out fine lines on the surface of the skin, fill out deep lines (eg: nasolabial folds), augment soft tissues (such as the lips), or even effectively augment facial bone structure. All of these injectable fillers are placed by an injection, so the group carries usual risks of bruising, lumpiness, redness, product specific adverse reactions, and in rare cases local infections.

      Many options are available in the filler class, with clinical differences being predominantly governed by how long the effects last, as well as how the filler "feels". Generally speaking, very soft fillers (that are best for locations such as the lips) tend to have a shorter duration of effect, while fillers that last longer tend to have more structure and are better suited in regions where they will not be palpable (such as the nasolabial folds). In the past, the most widely used fillers were based on collagen, with sources ranging from bovine to human. For some collagen formulations, skin testing before injection is necessary to confirm that you will not have an allergic response to the filler. Collagen based fillers tend to last 3 to 6 months, and for some indications have a very natural feel.

      A more recent class of fillers is based on hyaluronic acid (HA), which is a sugar found naturally in human skin. When first introduced, a major benefit of this filler class is that allergic reactions are extremely rare, and no pre-treatment skin testing is necessary. These compounds bind water similar to the way a sponge absorbs water. Because of this, they hydrate the skin in the treated region and act as a cushion. Several manufacturers are coming out with versions of HA fillers, and formulations vary with the size of molecules (governed by the amount of crosslinking) and other components of the injectate (such as local anesthetic to help decrease the discomfort associated with injections). The various formulations expand the repertoire of options available to your injector, as certain products are better suited for different anatomical regions. Formulations with smaller particle sizes tend to be softer and smoother, and work well in regions such as the lips. Larger particles have more structure, and are best suited for deep folds such as the nasolabial creases. Hyaluronic acids are eventually absorbed by your body, and the length of time is dependent on a multitude of factors including the patient, the location of injection, and the particular product used. Results last from 3 months in high mobility areas (such as the lips), and up to 1 year in regions such as the nasolabial folds, with most patients experiencing the desired effects for 6 months.

      A newer class of fillers has been introduced that is based on microsphere technology. Microspheres are tiny round particles of solid material that are relatively uniform in size. Two formulations are FDA approved for use, differing in design and expected longevity of results. These products are used for volume replacement and for deep facial wrinkles (such as the nasolabial folds.) They are not approved for use in the lips.

      Radiesse contains mirospheres are made of calcium hydroxylapatite suspended in a gel carrier. The filler is broken down by the body in two phases, first the carrier and then the spheres. During this process, collagen ingrowth occurs, which is expected to provide a long lasting effect. This prolonged degradation process makes Radiesse a longer lasting filler than those previously discussed, with expected results lasting a year or more.

      Artefill is a filler made of a mixture of collagen gel (similar to classical dermal fillers) and tiny microspheres of non-resorbable polymethylmethacrylate (a biocompatable compound that has been used for years in orthopedic surgery). The collagen component has resorption characteristics similar to other collagen based fillers, but the microspheres cannot be degraded by the body, and should provide permanent support to the regions treated. Since this type of filler is permanent, the margin for error in placement is less than for resorbable fillers, and it is important to seek treatment by an injector with experience using this class of product.

      Recommendations:

      Although there are many options available, there is no "one best product" for any particular use. Our recommendation is to consult with an ASAPS member physician to discuss your areas of concern, and to hear the options they suggest. If you are considering soft tissue fillers, it is a reasonable practice to first try short acting agents to be certain that you enjoy the effects of treatment before utilizing longer acting agents. Your physician will have their personal preference regarding a filler or neuromuscular agent that gives good results in their hands, and together you should be able to choose a treatment regime that matches your desires.

  • Microdermabrasion
    • Microdermabrasion is effective in reducing fine lines, "crow's feet," age spots and acne scars. It stimulates the production of skin cells and collagen. It has proven to be a very popular nonsurgical cosmetic procedure; see current American Society for Aesthetic Plastic Surgery (ASAPS) statistics.

      Technique:

      The hand piece emits crystals onto the surface of the skin, resulting in a gentle abrasion or "polishing" process. Each treatment takes from 30 minutes to an hour. The number of treatments recommended for maximal results can range between 5 and 12, spaced from 2 to 3 weeks apart. Maintenance of results requires periodic repeat treatments after the initial regimen is completed. Microdermabrasion may be combined with a light chemical peel to increase the effect.

      Benefits:

      Virtually no side effects.
      Gives the skin an overall fresh, healthy-looking glow.
      Nonsurgical, safe, effective "lunch hour" procedure.
      Effective on all skin colors and types.
      No anesthetic required.
      Excellent for skin sensitive to chemical procedures.
      Normal activities can be resumed immediately.

      Other Considerations:

      Requires multiple sessions and maintenance treatments.
      Patients with good skin tone will show best results.
      An individualized skin care program may be recommended to maximize results.