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When considering plastic surgery, it’s
natural to focus more on the expected
result than on the surgical process. However,
to be fully informed, it’s important
to learn about the safety of the procedure
as well as the expected outcome. Although
thousands of people have plastic surgery
every year without complications, no surgical
procedure is risk-free. To maximize safety,
ensure that:
• Your
surgeon is adequately trained
• The facility where your surgery
will be performed conforms to strict
safety standards;
• Your surgeon is informed of
any drugs you are taking and your full
medical history, especially if you have
had any circulation disorders, heart
or lung ailments or problems with blood
clots;
• The surgical facility will use
an anesthesiologist to administer and
monitor your anesthesia and your recovery
immediately following the procedure;
The American Society of Plastic Surgeons
and the American Society for Aesthetic
Plastic Surgery have issued a statement
to their members that by July 1, 2002
all plastic surgery performed under anesthesia,
other than minor local anesthesia and/or
minimal oral tranquilization, must be
performed in a surgical facility that
meets at least one of the following criteria:
• Accredited
by a national or state recognized accrediting
agency/organization such as the American
Association for Accreditation of Ambulatory
Surgery Facilities (AAAASF), Accreditation
Association for Ambulatory Health Care
(AAAHC), or Joint Commission on Accreditation
of Healthcare Organizations (JCAHO)
• Certified to participate in
the Medicare program under Title XVIII
• Licensed by the state in which
the facility is located
Patients should ensure that the facility
is accredited or is in the process of
being accredited. I perform my surgery
at a JCAHO and Medicare approved facility.
Plastic surgery procedures performed in
accredited surgical facilities by qualified plastic surgeons.
There is always risk with any surgical
procedure. However, as a patient, you
can play an important role in reducing
your risk by providing a full and complete
health history to your surgeon.
Certain elements of your personal or family
health histories may increase your risk
of certain complications. This will be
reviewed by the doctor prior to the surgery.
How can I be sure that the anesthesia
care I receive in my plastic surgeon’s
surgical facility is adequate?
Anesthesia care in an accredited or licensed
facility has reached a level of sophistication
that is absolutely comparable to the care
received in the hospital. For maximum
safety, ASPS recommends that:
Any planned anesthesia should be administered
by an anesthesiologist. I perform my procedures
with a board-certified anesthesiologist
(we can have a link here to my anesthesia
data) on all but the most minor procedures
at the surgery center.
Before any type of
anesthesia is used, the surgeon and anesthesiologist
must take a full medical history. A physical
examination and appropriate lab tests
may also be performed. Your surgeon needs
to know if you have any serious medical
problems or have had previous adverse
reaction to any other type of anesthesia.
Also, you must let the anesthesiologist
know about any medications you are taking
(including herbal supplements), any known
drug allergies, when you last ate and
whether you smoke cigarettes or use alcohol
or illegal drugs.
You should be assured
that you will receive individual monitoring
by skilled, licensed personnel before,
during and after the procedure. Staff
who are familiar with the warning signs
of cardiac or respiratory distress and
are trained in advanced cardiac life support
(ACLS), should be on hand to monitor your
procedure and recovery following your
surgery.
If you are told that
you will be kept overnight at the surgical
facility while you recuperate, make sure
that the facility is accredited by a recognized
agency. In an accredited facility you
will receive around-the-clock care and
monitoring by two or more skilled and
licensed staff members with at least one
trained in ACLS. You will also be assured
that the facility has the necessary equipment
and medications to handle complications
that may arise and an emergency plan in
case you need to be transferred to the
hospital.
Most importantly
you must feel comfortable with your surgeon.
You should also carefully consider
where you surgeon wishes to perform your
procedure. Make sure your surgeon is qualified
to do the procedure you are considering
in a local hospital before allowing it
to take place in an office based surgery
center. Some surgeons operate in office
ORs in order to do procedures they have
not been credentialed to do in the hospital.
Yes. Please ask for
a list of patients if desired.
Consultations are
complimentary.
Yes, it is possible
to stay overnight in our surgery center
with our private duty nurse. Typically,
facelift and abdominoplasty patients will
spend the night.
Yes, once you have
had your consultation, the patient coordinator
will help you submit an application, which
takes a very short time to complete. You
will receive an answer regarding approval
very quickly.
Plastic surgery is named from the Greek
word "plastikos" which means
"to shape", based on the surgeon
re-shaping the form of the patient's form
through surgery. It has nothing to do
with the types of materials used in the
surgery itself. In surgery, many different
materials may be utilized, depending on
the desired results and the type of surgery.
Frequently, the surgeon will make use
of the patient's own tissues, including
tissues from another location of the body,
or by reshaping the existing tissues to
achieve a better appearance. Historically,
many materials have been used in cosmetic
and reconstructive surgery, including
ivory, wood, and others. In modern times,
hard silicone rubber is a popular material.
This should not be confused with the gel
silicone which has sparked so much controversy
through its use as a filler for breast
implants.
Any time a cut or incision is made in
the skin, there is a scar left behind
as part of the normal healing process.
Plastic and Reconstructive Surgeons have
received special training and have extensive
experience with minimizing the size of
these scars, creating the least noticeable
appearance of then, and locating them
in the least conspicuous areas possible.
Often the scars will become undetectable
to all but the most careful examination
over the course of time. In addition,
scars may be hidden in the hair, along
a wrinkle, in the mouth, etc. to minimize
the visibility of the scar. Other times
scars are more visible. The approximate
placement and length of the incisions
will be discussed before surgery. You
can review patients photos with similar
incisions.
If the stretch marks are located in on
the lower abdomen (below the belly button)
then they can usually be removed in the
course of abdominoplasty. Typically all
of the skin from just above the navel
to the pubic area is removed. This skin
usually contains the stretch marks and
well as the less elastic skin. The upper
skin more elastic, better quality, less
or no stretch marks, is stretched across
the entire abdomen. If the stretch marks
extend above
The axillary approach has several advantages
for most patients. First, it does not
invade the breast tissues directly, going
underneath instead. This means that you
have a less chance of permanent numbness.
In addition, the pectoralis muscle is
not divided which gives a stronger support
for the implant over time. Another advantageis
that there is no scar left on the skin
of the breast. Instead the scar is located
in the armpit in a high wrinkle, which
is a much less noticeable location. Typically,
the scar is smaller.
How much can my breasts
be enlarged? Why is it limited? How big
should I go?
The degree of enlargement is based on
the anatomy of the patient's body more
than any other factor. Saline-filled implants
require placement underneath the muscle
layer of the chest to achieve a natural
result in most patients. The implant must
be covered by the muscle layer, and this
coverage determines the maximum volume
of the implant. The width of the patient's
chest, as well as the locations of nerves
in the chest and abdomen limit the maximum
volume of an implant that can be used,
because the total width of the implant
must fit underneath the muscle without
intruding into the nerve bundles, otherwise
numbness of the breast and/or nipples
would result. Your surgeon can help you
determine the best size of implant for
you at the time of your consultation.
Most of my patients desire a full proportional
look. They want something nice but not
too obvious. I prefer to create nice looking
breasts that fit a patient’s body
well rather than very large breasts that
are too large for the frame. In fact,
I do not have any patient that has told
me that I have made them too large.
Breast augmentation (under the muscle
layer) should not affect your ability
to breast feed. For sub-glandular augmentation
(under the breast tissue, but over the
muscle layer), like any other surgery
which disturbs the breast tissue itself,
there is a risk of losing the ability
to breast feed. I do not perform subglandular
(over muscle) primary augmentations.
A loss of volume, often associated with
drooping, is very common after pregnancy
and is called post-partum breast involution.
Volume loss with a small amount of sagging
can be corrected with the breast augmentation
surgery. For an excessive degree of sagging,
a mastopexy or 'breast lift' may be the
solution. I typically perform a minimal
incision breast lift with augmentations.
This means that the lift incision is only
a circle around the areola. Several drooping
may need more lift incision.
With inverted nipples, the problem is
that the ducts are too short and tether
the nipple. This can be corrected in the
office under local anesthesia. The procedure
is very and fairly simple. The incision
is small and located on the underside
of the nipple so that it is difficult
to see.
The areola can be reduced in size or enlarged.
This may be done as a standalone type
of procedure under local anesthesia. Or,
it may be done in conjunction with an
augmentation, reduction or lift.
This type of procedure is called a 'trans-umbilical
approach'. I have trained in this procedure.
I learned it from the surgeon who invented
it. My malpractice carrier, the one with
the most plastic surgeons, refuses to
cover this procedure. They claim that
the procedure is associated with much
litigation. In addition, the implant manufacturers
frown on this technique. I value the opinion
of the largest plastic surgery malpractice
company and implant manufacturer. It is
probably not a good idea to have an augmentation
with this technique.
Mechanical failure of the mammary implants
is possible. The rate of failure is low
and should be discussed with your surgeon,
including the implant manufacturer's limited
warranty.
No. You do not need to change your implants
unless there is a problem. The implants
have a warranty on them (5-10 years depending
on the manufacturer). If they deflate
during the warranty, the manufacturer
will give you an implant and pay towards
replacement.
Nearly everyone I have examined has some
asymmetry in their breasts. Sometimes
these differences are subtle and other
times they are more pronounced. It can
be a difference in size, height of the
nipple, amount of drooping, height of
the breast fold, contour of the ribs,
height of the shoulder tips, etc. Many
times we can attempt to correct or improve
upon the asymmetries. This can be done
by lower a fold, place a slightly more
saline on one side, etc. Most of the time
there are subtle asymmetries before and
after surgery.
No. Breast implants do not cause breast,
or any other cancer. Studies have shown
that women who get breast cancer and have
implants have the same outcome as women
that get breast cancer and do not have
implants. You still should get mammograms
as recommended by your physician. Notify
your mammographer that you have implants
as they will do a few special views to
maximize the mammogram.
I typically put the implant behind or
under the pectoralis major muscle. There
are several reasons for this. I believe
that it looks much more natural. There
is more tissue between the implant and
the outside world. There is less chance
of complications. There is more support
for the implant to protect against drooping.
But, most of all, the mammogram is better
when the implant is under the muscle.
The conventional upper blepharoplasty
utilizes a crescent shaped incision located
along the upper eyelid fold. Excessive
skin and central fatty tissue is removed.
The incision is then closed.
There are multiple option for the lower
lid. Most lower blepharoplasties are of
the conjunctival type. This means that
an incision is made on the back side of
the eyelid and fatty tissue or the bag
is excised. The scar is not seen. If the
patient has a minor skin excess or wrinkles,
the laser can also be used to tighten
the skin or improve/remove wrinkles. Patients
with more significant skin excess will
need the subciliary approach. An incision
is made just below the eyelashes. Fatty
tissue or the bags are removed. Skin excess
is trimmed and the incision closed.
Blepharoplasty surgery only works on the
skin and muscle of the eyelids area --
how your contact lenses fit is based on
the shape of your eye itself. Although
you won't be able to wear contact for
the first few days after surgery (to allow
time for the healing process to begin
without disturbance) blepharoplasty surgery
will not change how your contact lenses
fit or function.
Why must brows be evaluated when considering
upper blepharoplasty?
The upper eyelid and the brow must always
be evaluated together. This is very important.
Lets consider someone with a low brow.
The low brow causes skin to pile up on
the upper lid. This weight causes the
person to unconsciously lift the brow
until this weight is removed. If skin
is removed during an upper blepharoplasty,
this weight is reduced. This allows the
brow elevators to relax and lower the
brow until the skin piles up on the lid
again and obscures the result of the upper
blepharoplasty. This situation can be
avoided by recognition of the brow ptosis
and treatment through a brow lift or browpexy.
When someone doesn’t have brow drooping,
this situation does not occur.
The tumescent technique is a liposuction
method that can reduce post operative
bruising, swelling and pain. Also, blood
loss is minimized during tumescent liposuction
due to the effects of the local anesthetic
which is used. In the tumescent technique,
areas of excess fat are injected with
a large amount of anesthetic liquid before
liposuction is performed. The liquid causes
the compartments of fat to become swollen
and firm or "tumesced." The
expanded fat compartments allow the liposuction
cannula to travel smoothly beneath the
skin as the fat is removed. This can give
multiple benefits -- extra precision for
the surgeon, reduced loss of blood for
the patient, and extended pain relief
after surgery, which can reduce the need
for pain medication immediately after
surgery.
After liposuction, swelling is expected.
A compression garment helps reduce swelling
and helps to reshape the tissue. Many
patients see little difference or are
even larger during the first week after
surgery. The following week, patients
usually begin to see results. After 2
months, the patient will be at about 80%
of the result. Improvement continues until
about 6 months after surgery when all
of the swelling should be gone. I usually
have patients wear there compression garment
for 3 weeks 24/7 and then 3 weeks during
sleep.
We are born with a certain number of fat
cells. During liposuction, fat cells are
removed with the surgery. The remaining
fat cells get bigger when you get bigger
and get smaller when you get smaller.
If you maintain your weight, the fat should
not come back to the liposuctioned areas.
If you put on weight, it will more likely
to be distributed more evenly over the
body and less likely to go to your ‘trouble
zones’.
The aim and goal of surgery is to improve
one's appearance as it relates to shape
and volume. Depending upon the degree
and the magnitude one's cellulite and
rippling prior to surgery, will affect
the post -operative outcome. In mild to
moderate cases, the cellulite and rippling
is usually improved with the surgery.
But, no promises can be made regarding
cellulite. Liposuction improves the overall
shape of the body in addition to making
it smaller.
We do not charge for postop visits –
you are our patient for life.
The good news is that your facelift will
not fall down at the stroke of midnight
on the tenth year! Actually, a facelift
(and other procedures) will turn back
the clock. You will start aging again
from that point forward. You will always
look better than if you did not have the
procedure in the first place.
In younger individuals with good skin
tone, the fat in this area can be removed
with gentle liposuction, and this improves
the contour of the neckline. When skin
tone is poor, it may take a facelift procedure
with liposuction to correct the condition.
We use our facial muscles for smiling,
frowning and other expressions and, over
time, prominent lines may be formed in
the outer layers of skin. A substance
called Botox can be injected into these
overactive muscles to cause temporary
paralysis (3-4 months) and smooth these
problem areas. Botox works best for dynamic
wrinkles or those wrinkles that are caused
be expression or muscle contraction.
Skin and facial tissue that sag along
with aging can give you an appearance
of tiredness or anger even when you are
feeling happy and energetic. A facelift
procedure primarily addresses jowling
and neck laxity. With facial rejuvenation,
you appear rested, healthy and more youthful.
The idea is to look better and/or younger,
not different.
If your concern
is less about jowling and neck and more
about the cheekbone area, then you may
be appropriate for a mid-facelift. This
is a newer procedure that involves incisions
in the hairline and in the mouth which
are not typically visible.
I choose the techniques that I use to
create a natural, non-surgical appearance.
Every effort is made to improve your appearance
in the most natural view.
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