To Enhance the Body Contour of a Woman Who, for Personal Reasons, Feels Her Breast Size Is Too Small.
To Restore Breast Volume Lost Due to Weight Loss or Following Pregnancy
To Achieve Better Symmetry When Breasts Are Moderately Disproportionate in Size and Shape
To Improve the Shape of Breasts That Are Sagging or Have Lost Firmness, Often Used with a Breast Lift Procedure
To Provide the Foundation of a Breast Contour When a Breast Has Been Removed or Disfigured by Surgery to Treat Breast Cancer
To Improve Breast Appearance or Create the Appearance of a Breast That Is Missing or Disfigured Due to Trauma, Heredity, or Congenital Abnormalities
The Best Candidates for Breast Augmentation
Breast Augmentation Can Enhance Your Appearance and Your Self-Confidence, but It Won't Necessarily Change Your Looks to Match Your Ideal, or Cause Other People to Treat You Differently. Before You Decide to Have Surgery, Think Carefully About Your Expectations and Discuss Them with Your Surgeon.
The Best Candidates for Breast Augmentation Are Women Who Are Looking for Improvement, Not Perfection, in the Way They Look. If You're Physically Healthy and Realistic in Your Expectations, You May Be a Good Candidate.
Types of Implants
The Choice of Implant Filler, Implant Size, Shape and Other Features Will Be Determined Based on Your Breast Anatomy, Body Type and Your Desired Increase in Size. Your Lifestyle, Goals and Personal Preferences, as Well Your Plastic Surgeon's Recommendations and Sound Surgical Judgment Are Also Determining Factors. Implant Manufacturers Occasionally Introduce New Styles and Types of Implants, and Therefore There May Be Additional Options Available to You.
Breast Implants Are Medical Devices with a Solid Silicone, Rubber Shell. The Implant Shell May Be Filled with Either Saline Solution (Sterile Salt Water) or Elastic Silicone Gel. Both Saline and Silicone Gel Breast Implants Are Approved by the U.S. Food and Drug Administration (Fda). Approval Means That an Implant Has Been Rigorously Researched and Tested, and Reviewed by an Independent Panel of Physicians for Safety.
The Size of a Breast Implant Is Measured in Cubic Centimeters (Ccs) Based on the Volume of the Saline or Silicone Filler. Breast Implants Vary Both by Filler and in Size, but There Are Additional Features to Consider:
Texture: The Implant Shell May Be Smooth or Textured
Shape: The Implant May Have a Round Profile or One That Is Anatomic (Teardrop or Tapered Shape)
Profile: The Implant May Have a Low, Medium or High Projection (the Depth of the Implant From the Base to the Highest Point of the Implant Curve)
Diameter: The Width of the Implant Measured Across It's Base (the Side of the Implant That Will Be Positioned Over the Chest Wall)
Adult Women of Any Age Can Benefit Greatly From the Enhancement Breast Implants Provide. It Is Usually Recommended, However, That a Woman's Breasts Are Fully Developed Prior to Placement of Breast Implants. Saline Implants Are Fda Approved for Augmentation in Women 18 Years of Age and Older. Silicone Implants Are Fda Approved for Augmentation in Women Age 22 and Older. Saline or Silicone Implants May Be Recommended at a Younger Age if Used for Reconstruction Purposes.
Breast Augmentation Is Relatively Straightforward. But as with Any Operation, There Are Risks Associated with Surgery and Specific Complications Associated with This Procedure.
The Most Common Problem, Capsular Contracture, Occurs if the Scar or Capsule Around the Implant Begins to Tighten. This Squeezing of the Soft Implant Can Cause the Breast to Feel Hard. Capsular Contracture Can Be Treated in Several Ways, and Sometimes Requires Either Removal or "Scoring" of the Scar Tissue, or Perhaps Removal or Replacement of the Implant.
As with Any Surgical Procedure, Excessive Bleeding Following the Operation May Cause Some Swelling and Pain. If Excessive Bleeding Continues, Another Operation May Be Needed to Control the Bleeding and Remove the Accumulated Blood.
A Small Percentage of Women Develop an Infection Around an Implant. This May Occur at Any Time, but Is Most Often Seen Within a Week After Surgery. In Some Cases, the Implant May Need to Be Removed for Several Months Until the Infection Clears. A New Implant Can Then Be Inserted.
Some Women Report That Their Nipples Become Oversensitive, Under Sensitive, or Even Numb. You May Also Notice Small Patches of Numbness Near Your Incisions. These Symptoms Usually Disappear Within Time, but May Be Permanent in Some Patients.
Breast Implants Do Not Generally Interfere with a Woman's Ability to Breast Feed, or Present a Health Hazard During Pregnancy to a Woman or Her Baby. However, Pregnancy and the Associated Changes to a Woman's Body May Alter the Results of Any Breast Surgery, Including Surgery to Place Breast Implants. Therefore, It Is Important to Discuss the Options of Breast Implant Surgery with Your Plastic Surgeon if You Are Interested in Becoming Pregnant and Breast Feeding in the Future.
Occasionally, Breast Implants May Break or Leak. Rupture Can Occur as a Result of Injury or Even From the Normal Compression and Movement of Your Breast and Implant, Causing the Man-Made Shell to Leak.
Planning Your Surgery
In Your Initial Consultation, Your Surgeon Will Evaluate Your Health and Explain Which Surgical Techniques Are Most Appropriate for You, Based on the Condition of Your Breasts and Skin Tone. If Your Breasts Are Sagging, Your Doctor May Also Recommend a Breast Lift.
Be Sure to Discuss Your Expectations Frankly with Your Surgeon. He or She Should Be Equally Frank with You, Describing Your Alternatives and the Risks and Limitations of Each. You May Want to Ask Your Surgeon for a Copy of the Manufacturer's Insert That Comes with the Implant He or She Will Use -- Just So You Are Fully Informed About It. And, Be Sure to Tell Your Surgeon if You Smoke, and if You're Taking Any Medications, Vitamins, or Other Drugs.
Your Surgeon Should Also Explain the Type of Anesthesia to Be Used, the Type of Facility Where the Surgery Will Be Performed, and the Costs Involved. Because Most Insurance Companies Do Not Consider Breast Augmentation to Be Medically Necessary, Carriers Generally Do Not Cover the Cost of This Procedure.
Preparing for Your Surgery
Your Surgeon Will Give You Instructions to Prepare for Surgery, Including Guidelines on Eating and Drinking, Smoking, and Taking or Avoiding Certain Vitamins and Medications. A Mammogram May Be Recommended Prior to Your Procedure to Ensure Breast Health and Serve as a Baseline for Future Comparison.
In Addition to Explaining Your Surgical Procedure, You Plastic Surgeon Will Discuss Anesthesia, the Recovery Process and Your Obligations as a Patient. You Will Also Discuss Where Your Procedure Will Be Performed. You Will Be Asked to Sign Consent Forms to Ensure That You Fully Understand the Procedure You Will Undergo and Any Risks and Potential Complications of Your Surgery. There May Be a Waiting Period of Several Days to Weeks From the Time of Your Consent to the Day of Surgery.
While Making Preparations, Be Sure to Arrange for Someone to Drive You Home After Your Surgery and to Help You Out for a Few Days, if Needed.
Where Your Surgery Will Be Performed
Your Surgeon May Prefer to Perform the Operation in an Office Facility, a Freestanding Surgery Center, or a Hospital Outpatient Facility. Occasionally, the Surgery May Be Done as an Inpatient in a Hospital, in Which Case You Can Plan on Staying for a Day or Two.
Types of Anesthesia
Breast Augmentation Can Be Performed with a General Anesthesia, So You'll Sleep Through the Entire Operation. Some Surgeons May Use a Local Anesthesia, Combined with a Sedative to Make You Drowsy, So You'll Be Relaxed but Awake, and May Feel Some Discomfort.
The Surgery
The Method of Inserting and Positioning Your Implant Will Depend on Your Anatomy and Your Surgeon's Recommendation. The Incision Can Be Made Either in the Crease Where the Breast Meets the Chest, Around the Areola (the Dark Skin Surrounding the Nipple), or in the Armpit. In Addition, a Saline Implant May Be Placed Through an Incision at the Navel. Every Effort Will Be Made to Assure That the Incision Is Placed So Resulting Scars Will Be as Inconspicuous as Possible.
Working Through the Incision, the Surgeon Will Lift Your Breast Tissue and Skin to Create a Pocket, Either Directly Behind the Breast Tissue (Submammary or Subglandular Placement) or May Be Placed Beneath the Pectoral Muscle and on Top of the Chest Wall (Submuscular Placement). Once the Implant Is Positioned Within This Pocket, the Incisions Are Closed with Sutures, Skin Adhesive and/or Surgical Tape. A Gauze Bandage May Be Applied Over Your Breasts to Help with Healing. The Surgery Usually Takes One to Two Hours to Complete. You'll Want to Discuss the Pros and Cons of These Alternatives with Your Doctor Before Surgery to Make Sure You Fully Understand the Implications of the Procedure He or She Recommends for You.
After Your Surgery
You're Likely to Feel Tired and Sore for a Few Days Following Your Surgery, but You'll Be Up and Around in 24 to 48 Hours. Most of Your Discomfort Can Be Controlled by Medication Prescribed by Your Doctor.
Within Several Days, the Gauze Dressings, if You Have Them, Will Be Removed, and You May Be Given a Surgical Bra. You Should Wear It as Directed by Your Surgeon. You May Also Experience a Burning Sensation in Your Nipples for About Two Weeks, but This Will Subside as Bruising Fades.
Your Stitches Will Come Out in a Week to 10 Days, but the Swelling in Your Breasts May Take Three to Five Weeks to Disappear.
Getting Back to Normal
You Should Be Able to Return to Work Within a Few Days, Depending on the Level of Activity Required for Your Job.
Follow Your Surgeon's Advice on When to Begin Exercises and Normal Activities. Your Breasts Will Probably Be Sensitive to Direct Stimulation for Two to Three Weeks, So You Should Avoid Much Physical Contact. After That, Breast Contact Is Fine Once Your Breasts Are No Longer Sore, Usually Three to Four Weeks After Surgery.
Your Scars Will Be Firm and Pink for at Least Six Weeks. Then They May Remain the Same Size for Several Months, or Even Appear to Widen. After Several Months, Your Scars Will Begin to Fade, Although They Will Never Disappear Completely.
Routine Mammograms Should Be Continued After Breast Augmentation for Women Who Are in the Appropriate Age Group, Although the Mammography Technician Should Use a Special Technique to Assure That You Get a Reliable Reading, as Discussed Earlier.
Your New Look
For Many Women, the Result of Breast Augmentation Can Be Satisfying, Even Exhilarating, as They Learn to Appreciate Their Fuller Appearance.
Even if You Believe Your Implants Are Functioning Well, It Is Important That You Follow-Up as Directed with Your Plastic Surgeon to Assess the Condition of Your Breast Implants. In Addition, Whether You Choose to Have Breast Implants or Not, It Is Essential to Your Health That You Practice a Monthly Breast Self-Exam and Schedule Regular Diagnostic Breast Screenings.
Your Decision to Have Breast Augmentation Is a Highly Personal One That Not Everyone Will Understand. The Important Thing Is How You Feel About It. If You've Met Your Goals, Then Your Surgery Is a Success.
Breast Lift
Over Time, a Woman's Breasts Begin to Sag and the Areolas Become Larger.
Incisions Outline the Area of Skin to Be Removed and the New Position for the Nipple.
Skin Formerly Located Above the Nipple Is Brought Down and Together to Reshape the Breast. Sutures Close the Incisions, Giving the Breast Its New Contour.
After Surgery, the Breasts Are Higher and Firmer, with Sutures Usually Located Around the Areola, Below It, and in the Crease Under the Breast.
If Your Expectations Are Realistic, Chances Are You'll Be Satisfied with Your Breast Lift.
If You're Considering a Breast Lift...
Over the Years, Factors Such as Pregnancy, Nursing, and the Force of Gravity Take Their Toll on a Woman's Breasts. As the Skin Loses Its Elasticity, the Breasts Often Lose Their Shape and Firmness and Begin to Sag. Breast Lift, or Mastopexy, Is a Surgical Procedure to Raise and Reshape Sagging Breasts--at Least, for a Time. (No Surgery Can Permanently Delay the Effects of Gravity.) Mastopexy Can Also Reduce the Size of the Areola, the Darker Skin Surrounding the Nipple. If Your Breasts Are Small or Have Lost Volume--for Example, After Pregnancy--Breast Implants Inserted in Conjunction with Mastopexy Can Increase Both Their Firmness and Their Size. If You're Considering a Breast Lift, This Brochure Will Give You a Basic Understanding of the Procedure--When It Can Help, How It's Performed, and What Results You Can Expect. It Can't Answer All of Your Questions, Since a Lot Depends on Your Individual Circumstances. Please Be Sure to Ask Your Doctor if There Is Anything About the Procedure You Don't Understand.
The Best Candidates for Breast Lift
A Breast Lift Can Enhance Your Appearance and Your Self-Confidence, but It Won't Necessarily Change Your Looks to Match Your Ideal, or Cause Other People to Treat You Differently. Before You Decide to Have Surgery, Think Carefully About Your Expectations and Discuss Them with Your Surgeon.
The Best Candidates for Mastopexy Are Healthy, Emotionally-Stable Women Who Are Realistic About What the Surgery Can Accomplish. The Best Results Are Usually Achieved in Women with Small, Sagging Breasts. Breasts of Any Size Can Be Lifted, but the Results May Not Last as Long in Heavy Breasts.
Many Women Seek Mastopexy Because Pregnancy and Nursing Have Left Them with Stretched Skin and Less Volume in Their Breasts. However, if You're Planning to Have More Children, It May Be a Good Idea to Postpone Your Breast Lift. While There Are No Special Risks That Affect Future Pregnancies (for Example, Mastopexy Usually Doesn't Interfere with Breast-Feeding), Pregnancy Is Likely to Stretch Your Breasts Again and Offset the Results of the Procedure.
All Surgery Carries Some Uncertainty and Risk
A Breast Lift Is Not a Simple Operation, but It's Normally Safe When Performed by a Qualified Plastic Surgeon. Nevertheless, as with Any Surgery, There Is Always a Possibility of Complications or a Reaction to the Anesthesia. Bleeding and Infection Following a Breast Lift Are Uncommon, but They Can Cause Scars to Widen. You Can Reduce Your Risks by Closely Following Your Physician's Advice Both Before and After Surgery.
Mastopexy Does Leave Noticeable, Permanent Scars, Although They'll Be Covered by Your Bra or Bathing Suit. (Poor Healing and Wider Scars Are More Common in Smokers.) the Procedure Can Also Leave You with Unevenly Positioned Nipples, or a Permanent Loss of Feeling in Your Nipples or Breasts.
Planning Your Surgery
In Your Initial Consultation, It's Important to Discuss Your Expectations Frankly with Your Surgeon, and to Listen to His or Her Opinion. Every Patient--and Every Physician, as Well--Has a Different View of What Is a Desirable Size and Shape for Breasts.
The Surgeon Will Examine Your Breasts and Measure Them While You're Sitting or Standing. He or She Will Discuss the Variables That May Affect the Procedure--Such as Your Age, the Size and Shape of Your Breasts, and the Condition of Your Skin--and Whether an Implant Is Advisable. You Should Also Discuss Where the Nipple and Areola Will Be Positioned; They'll Be Moved Higher During the Procedure, and Should Be Approximately Even with the Crease Beneath Your Breast.
Your Surgeon Should Describe the Procedure in Detail, Explaining Its Risks and Limitations and Making Sure You Understand the Scarring That Will Result. He or She Should Also Explain the Anesthesia to Be Used, the Type of Facility Where the Surgery Will Be Performed, and the Costs Involved.
Don't Hesitate to Ask Your Doctor Any Questions You May Have, Especially Those Regarding Your Expectations and Concerns About the Results.
Preparing for Your Surgery
Depending on Your Age and Family History, Your Surgeon May Require You to Have a Mammogram (Breast X-Ray) Before Surgery. You'll Also Get Specific Instructions on How to Prepare for Surgery, Including Guidelines on Eating and Drinking, Smoking, and Taking or Avoiding Certain Vitamins and Medications.
While You're Making Preparations, Be Sure to Arrange for Someone to Drive You Home After Your Surgery and to Help You Out for a Few Days if Needed.
Where Your Surgery Will Be Performed
Your Breast Lift May Be Performed in a Hospital, an Outpatient Surgery Center, or a Surgeon's Office-Based Facility. It's Usually Done on an Outpatient Basis, for Cost Containment and Convenience. If You're Admitted to the Hospital as an Inpatient, You Can Expect to Stay One or Two Days.
Types of Anesthesia
Breast Lifts Are Usually Performed Under General Anesthesia, Which Means You'll Sleep Through the Operation. In Selected Patients--Particularly When a Smaller Incision Is Being Made--the Surgeon May Use Local Anesthesia, Combined with a Sedative to Make You Drowsy. You'll Be Awake but Relaxed, and Will Feel Minimal Discomfort.
The Surgery
Mastopexy Usually Takes One and a Half to Three and a Half Hours. Techniques Vary, but the Most Common Procedure Involves an Anchor-Shaped Incision Following the Natural Contour of the Breast.
The Incision Outlines the Area From Which Breast Skin Will Be Removed and Defines the New Location for the Nipple. When the Excess Skin Has Been Removed, the Nipple and Areola Are Moved to the Higher Position. The Skin Surrounding the Areola Is Then Brought Down and Together to Reshape the Breast. Stitches Are Usually Located Around the Areola, in a Vertical Line Extending Downwards From the Nipple Area, and Along the Lower Crease of the Breast.
Some Patients, Especially Those with Relatively Small Breasts and Minimal Sagging, May Be Candidates for Modified Procedures Requiring Less Extensive Incisions. One Such Procedure Is the Doughnut (or Concentric) Mastopexy, in Which Circular Incisions Are Made Around the Areola, and a Doughnut-Shaped Area of Skin Is Removed.
If You're Having an Implant Inserted Along with Your Breast Lift, It Will Be Placed in a Pocket Directly Under the Breast Tissue, or Deeper, Under the Muscle of the Chest Wall.
After Your Surgery
After Surgery, You'll Wear an Elastic Bandage or a Surgical Bra Over Gauze Dressings. Your Breasts Will Be Bruised, Swollen, and Uncomfortable for a Day or Two, but the Pain Shouldn't Be Severe. Any Discomfort You Do Feel Can Be Relieved with Medications Prescribed by Your Surgeon.
Within a Few Days, the Bandages or Surgical Bra Will Be Replaced by a Soft Support Bra. You'll Need to Wear This Bra Around the Clock for Three to Four Weeks, Over a Layer of Gauze. The Stitches Will Be Removed After a Week or Two.
If Your Breast Skin Is Very Dry Following Surgery, You Can Apply a Moisturizer Several Times a Day. Be Careful Not to Tug at Your Skin in the Process, and Keep the Moisturizer Away From the Suture Areas.
You Can Expect Some Loss of Feeling in Your Nipples and Breast Skin, Caused by the Swelling After Surgery. This Numbness Usually Fades as the Swelling Subsides Over the Next Six Weeks or So. In Some Patients, However, It May Last a Year or More, and Occasionally It May Be Permanent.
Getting Back to Normal
Healing Is a Gradual Process. Although You May Be Up and About in a Day or Two, Don't Plan on Returning to Work for a Week or More, Depending on How You Feel. And Avoid Lifting Anything Over Your Head for Three to Four Weeks. If You Have Any Unusual Symptoms, Don't Hesitate to Call Your Surgeon.
Your Surgeon Will Give You Detailed Instructions for Resuming Your Normal Activities. You May Be Instructed to Avoid Sex for a Week or More, and to Avoid Strenuous Sports for About a Month. After That, You Can Resume These Activities Slowly. If You Become Pregnant, the Operation Should Not Affect Your Ability to Breast-Feed, Since Your Milk Ducts and Nipples Will Be Left Intact.
Your New Look
Your Surgeon Will Make Every Effort to Make Your Scars as Inconspicuous as Possible. Still, It's Important to Remember That Mastopexy Scars Are Extensive and Permanent. They Often Remain Lumpy and Red for Months, Then Gradually Become Less Obvious, Sometimes Eventually Fading to Thin White Lines. Fortunately, the Scars Can Usually Be Placed So That You Can Wear Even Low-Cut Tops.
You Should Also Keep in Mind That a Breast Lift Won't Keep You Firm Forever--the Effects of Gravity, Pregnancy, Aging, and Weight Fluctuations Will Eventually Take Their Toll Again. Women Who Have Implants Along with Their Breast Lift May Find the Results Last Longer.
Your Satisfaction with a Breast Lift Is Likely to Be Greater if You Understand the Procedure Thoroughly and if Your Expectations Are Realistic.
Breast Reduction Surgery
Heavy Breasts Can Lead to Physical Discomfort, a Variety of Medical Problems, Shoulder Indentations Due to Tight Bra Straps, and Extreme Self-Consciousness.
Incisions Outline the Area of Skin, Breast Tissue, and Fat to Be Removed and the New Position for the Nipple.
Skin Formerly Located Above the Nipple Is Brought Down and Together to Reshape the Breast. Sutures Close the Incisions, Giving the Breast Its New Contour.
Scars Around the Areola, Below It, and in the Crease Under the Breast Are Permanent, but Can Be Easily Concealed by Clothing.
With Smaller, Better Proportioned Breasts, You'll Feel More Comfortable and Your Clothes Will Fit Better.
If You're Considering Breast Reduction...
Women with Very Large, Pendulous Breasts May Experience a Variety of Medical Problems Caused by the Excessive Weight-From Back and Neck Pain and Skin Irritation to Skeletal Deformities and Breathing Problems. Bra Straps May Leave Indentations in Their Shoulders. And Unusually Large Breasts Can Make a Woman-or a Teenage Girl-Feel Extremely Self-Conscious.
Breast Reduction, Technically Known as Reduction Mammaplasty, Is Designed for Such Women. The Procedure Removes Fat, Glandular Tissue, and Skin From the Breasts, Making Them Smaller, Lighter, and Firmer. It Can Also Reduce the Size of the Areola, the Darker Skin Surrounding the Nipple. The Goal Is to Give the Woman Smaller, Better-Shaped Breasts in Proportion with the Rest of Her Body.
If You're Considering Breast Reduction, This Will Give You a Basic Understanding of the Procedure- When It Can Help, How It's Performed, and What Results You Can Expect. It Can't Answer All of Your Questions, Since a Lot Depends on Your Individual Circumstances. Please Be Sure to Ask Your Doctor if There Is Anything About the Procedure You Don't Understand.
The Best Candidates for Breast Reduction
Breast Reduction Is Usually Performed for Physical Relief Rather Than Simply Cosmetic Improvement. Most Women Who Have the Surgery Are Troubled by Very Large, Sagging Breasts That Restrict Their Activities and Cause Them Physical Discomfort.
In Most Cases, Breast Reduction Isn't Performed Until a Woman's Breasts Are Fully Developed; However, It Can Be Done Earlier if Large Breasts Are Causing Serious Physical Discomfort. The Best Candidates Are Those Who Are Mature Enough to Fully Understand the Procedure and Have Realistic Expectations About the Results. Breast Reduction Is Not Recommended for Women Who Intend to Breast-Feed.
All Surgery Carries Some Uncertainty and Risk
Breast Reduction Is Not a Simple Operation, but It's Normally Safe When Performed by a Qualified Plastic Surgeon. Nevertheless, as with Any Surgery, There Is Always a Possibility of Complications, Including Bleeding, Infection, or Reaction to the Anesthesia. Some Patients Develop Small Sores Around Their Nipples After Surgery; These Can Be Treated with Antibiotic Creams. You Can Reduce Your Risks by Closely Following Your Physician's Advice Both Before and After Surgery.
The Procedure Does Leave Noticeable, Permanent Scars, Although They'll Be Covered by Your Bra or Bathing Suit. (Poor Healing and Wider Scars Are More Common in Smokers.) the Procedure Can Also Leave You with Slightly Mismatched Breasts or Unevenly Positioned Nipples. Future Breast-Feeding May Not Be Possible, Since the Surgery Removes Many of the Milk Ducts Leading to the Nipples.
Some Patients May Experience a Permanent Loss of Feeling in Their Nipples or Breasts. Rarely, the Nipple and Areola May Lose Their Blood Supply and the Tissue Will Die. (the Nipple and Areola Can Usually Be Rebuilt, However, Using Skin Grafts From Elsewhere on the Body.)
Planning Your Surgery
In Your Initial Consultation, It's Important to Discuss Your Expectations Frankly with Your Surgeon, and to Listen to His or Her Opinion. Every Patient-and Every Physician, as Well-Has a Different View of What Is a Desirable Size and Shape for Breasts.
The Surgeon Will Examine and Measure Your Breasts, and Will Probably Photograph Them for Reference During Surgery and Afterwards. (the Photographs May Also Be Used in the Processing of Your Insurance Coverage.) He or She Will Discuss the Variables That May Affect the Procedure-Such as Your Age, the Size and Shape of Your Breasts, and the Condition of Your Skin. You Should Also Discuss Where the Nipple and Areola Will Be Positioned; They'll Be Moved Higher During the Procedure, and Should Be Approximately Even with the Crease Beneath Your Breasts.
Your Surgeon Should Describe the Procedure in Detail, Explaining Its Risks and Limitations and Making Sure You Understand the Scarring That Will Result. The Surgeon Should Also Explain the Anesthesia He or She Will Use, the Facility Where the Surgery Will Be Performed, and the Costs. (Some Insurance Companies Will Pay for Breast Reduction if It's Medically Necessary; However, They May Require That a Certain Amount of Breast Tissue Be Removed. Check Your Policy, and Have Your Surgeon Write a Predetermination Letter if Required.)
Preparing for Your Surgery
Your Surgeon May Require You to Have a Mammogram (Breast X-Ray) Before Surgery. You'll Also Get Specific Instructions on How to Prepare for Surgery, Including Guidelines on Eating and Drinking, Smoking, and Taking or Avoiding Certain Vitamins and Medications. Some Surgeons Suggest That Their Patients Diet Before the Operation.
Breast Reduction Doesn't Usually Require a Blood Transfusion. However, if a Large Amount of Breast Tissue Will Be Removed, Your Physician May Advise You to Have a Unit of Blood Drawn Ahead of Time. That Way, if a Transfusion Should Be Needed, Your Own Blood Can Be Used.
While You're Making Preparations, Be Sure to Arrange for Someone to Drive You Home After Your Surgery and to Help You Out for a Few Days if Needed.
Where Your Surgery Will Be Performed
Breast Reduction Surgery May Be Performed in a Hospital, an Outpatient Surgery Center or an Office-Based Surgical Suite. If You Are Admitted to the Hospital, Your Stay Will Be a Short One. The Surgery Itself Usually Takes Two to Four Hours, but May Take Longer in Some Cases.
Type of Anesthesia
Breast Reduction Is Nearly Always Performed Under General Anesthesia. You'll Be Asleep Through the Entire Operation.
The Surgery
Techniques for Breast Reduction Vary, but the Most Common Procedure Involves an Anchor-Shaped Incision That Circles the Areola, Extends Downward, and Follows the Natural Curve of the Crease Beneath the Breast. The Surgeon Removes Excess Glandular Tissue, Fat, and Skin, and Moves the Nipple and Areola Into Their New Position. He or She Then Brings the Skin From Both Sides of the Breast Down and Around the Areola, Shaping the New Contour of the Breast. Liposuction May Be Used to Remove Excess Fat From the Armpit Area.
In Most Cases, the Nipples Remain Attached to Their Blood Vessels and Nerves. However, if the Breasts Are Very Large or Pendulous, the Nipples and Areolas May Have to Be Completely Removed and Grafted Into a Higher Position. (This Will Result in a Loss of Sensation in the Nipple and Areolar Tissue.)
Stitches Are Usually Located Around the Areola, in a Vertical Line Extending Downward, and Along the Lower Crease of the Breast. In Some Cases, Techniques Can Be Used That Eliminate the Vertical Part of the Scar. And Occasionally, When Only Fat Needs to Be Removed, Liposuction Alone Can Be Used to Reduce Breast Size, Leaving Minimal Scars.
After Your Surgery
After Surgery, You'll Be Wrapped in an Elastic Bandage or a Surgical Bra Over Gauze Dressings. A Small Tube May Be Placed in Each Breast to Drain Off Blood and Fluids for the First Day or Two.
You May Feel Some Pain for the First Couple of Days-Especially When You Move Around or Cough-and Some Discomfort for a Week or More. Your Surgeon Will Prescribe Medication to Lessen the Pain.
The Bandages Will Be Removed a Day or Two After Surgery, Though You'll Continue Wearing the Surgical Bra Around the Clock for Several Weeks, Until the Swelling and Bruising Subside. Your Stitches Will Be Removed in One to Three Weeks.
If Your Breast Skin Is Very Dry Following Surgery, You Can Apply a Moisturizer Several Times a Day, but Be Sure to Keep the Suture Area Dry.
Your First Menstruation Following Surgery May Cause Your Breasts to Swell and Hurt. You May Also Experience Random, Shooting Pains for a Few Months. You Can Expect Some Loss of Feeling in Your Nipples and Breast Skin, Caused by the Swelling After Surgery. This Usually Fades Over the Next Six Weeks or So. In Some Patients, However, It May Last a Year or More, and Occasionally It May Be Permanent.
Getting Back to Normal
Although You May Be Up and About in a Day or Two, Your Breasts May Still Ache Occasionally for a Couple of Weeks. You Should Avoid Lifting or Pushing Anything Heavy for Three or Four Weeks.
Your Surgeon Will Give You Detailed Instructions for Resuming Your Normal Activities. Most Women Can Return to Work (if It's Not Too Strenuous) and Social Activities in About Two Weeks. But You'll Have Much Less Stamina for Several Weeks, and Should Limit Your Exercises to Stretching, Bending, and Swimming Until Your Energy Level Returns. You'll Also Need a Good Athletic Bra for Support.
You May Be Instructed to Avoid Sex for a Week or More, Since Sexual Arousal Can Cause Your Incisions to Swell, and to Avoid Anything but Gentle Contact with Your Breasts for About Six Weeks.
A Small Amount of Fluid Draining From Your Surgical Wound, or Some Crusting, Is Normal. If You Have Any Unusual Symptoms, Such as Bleeding or Severe Pain, Don't Hesitate to Call Your Doctor.
Your New Look
Although Much of the Swelling and Bruising Will Disappear in the First Few Weeks, It May Be Six Months to a Year Before Your Breasts Settle Into Their New Shape. Even Then, Their Shape May Fluctuate in Response to Your Hormonal Shifts, Weight Changes, and Pregnancy.
Your Surgeon Will Make Every Effort to Make Your Scars as Inconspicuous as Possible. Still, It's Important to Remember That Breast Reduction Scars Are Extensive and Permanent. They Often Remain Lumpy and Red for Months, Then Gradually Become Less Obvious, Sometimes Eventually Fading to Thin White Lines. Fortunately, the Scars Can Usually Be Placed So That You Can Wear Even Low-Cut Tops.
Of All Plastic Surgery Procedures, Breast Reduction Results in the Quickest Body-Image Changes. You'll Be Rid of the Physical Discomfort of Large Breasts, Your Body Will Look Better Proportioned, and Clothes Will Fit You Better.
However, as Much as You May Have Desired These Changes, You'll Need Time to Adjust to Your New Image-as Will Your Family and Friends. Be Patient with Yourself, and with Them. Keep in Mind Why You Had This Surgery, and Chances Are That, Like Most Women, You'll Be Pleased with the Results.
Revision Breast Augmentation
Why Undergo Revision Breast Augmentation?Women choose revision breast augmentation for a variety of reasons. Some decide that breast implants no longer fit into their lifestyle, while others desire a correction or aesthetic improvement. Some of the common goals in revision breast augmenation include:
Change in Implant Size
Switch From Saline to Silicone
Decision to Remove Implants
Capsular Contracture
Implant Displacement
Visible Implant Rippling
Ruptured Implant
Nipple Malposition
What to Expect During Revision Surgery
The Procedure May Involve a Simple Technique, Such as Adjustment of the Implant Fill Volume, or It May Involve Removal and Replacement of the Implants. Breast Implant Removal Is a Relatively Straightforward Procedure. The Implant Is Typically Approached Through the Same Surgical Incisions as Your Original Breast Augmentation. Surgery May Be as Short as One Hour, but This Will Vary Depending on Your Particular Condition.
Body
Liposuction
Liposuction Is a Procedure That Can Help Sculpt the Body by Removing Unwanted Fat From Specific Areas, Including the Abdomen, Hips, Buttocks, Thighs, Knees, Upper Arms, Chin, Cheeks and Neck. During the Past Decade, Liposuction, Which Is Also Known as Lipoplasty or Suction Lipectomy, Has Benefited From Several New Refinements. Today, a Number of New Techniques, Including Ultrasound-Assisted Lipoplasty (Ual), the Tumescent Technique, and the Super-Wet Technique, Are Helping Many Plastic Surgeons to Provide Selected Patients with More Precise Results and Quicker Recovery Times. Although No Type of Liposuction Is a Substitute for Dieting and Exercise, Liposuction Can Remove Stubborn Areas of Fat That Don't Respond to Traditional Weight-Loss Methods.
If You're Considering Liposuction, This Brochure Will Give You a Basic Understanding of the Procedure -- When It Can Help, How It Is Performed and How You Might Look and Feel After Surgery. It Won't Answer All of Your Questions, Since Much Depends on Your Individual Circumstances. Please Ask Your Doctor if There Is Anything About the Procedure You Don't Understand.
The Best Candidates for Liposuction
To Be a Good Candidate for Liposuction, You Must Have Realistic Expectations About What the Procedure Can Do for You. It's Important to Understand That Liposuction Can Enhance Your Appearance and Self Confidence, but It Won't Necessarily Change Your Looks to Match Your Ideal or Cause Other People to Treat You Differently. Before You Decide to Have Surgery, Think Carefully About Your Expectations and Discuss Them with Your Surgeon.
The Best Candidates for Liposuction Are Normal-Weight People with Firm, Elastic Skin Who Have Pockets of Excess Fat in Certain Areas. You Should Be Physically Healthy, Psychologically Stable and Realistic in Your Expectations. Your Age Is Not a Major Consideration; However, Older Patients May Have Diminished Skin Elasticity and May Not Achieve the Same Results as a Younger Patient with Tighter Skin.
Liposuction Carries Greater Risk for Individuals with Medical Problems Such as Diabetes, Significant Heart or Lung Disease, Poor Blood Circulation, or Those Who Have Recently Had Surgery Near the Area to Be Contoured.
Planning Your Surgery
In Your Initial Consultation, Your Surgeon Will Evaluate Your Health, Determine Where Your Fat Deposits Lie and Assess the Condition of Your Skin. Your Surgeon Will Explain the Body-Contouring Methods That May Be Most Appropriate for You. For Example, if You Believe You Want Liposuction in the Abdominal Area, You May Learn That an Abdominoplasty or Tummy Tuck May More Effectively Meet Your Goals; Or That a Combination of Traditional Liposuction and Ual Would Be the Best Choice for You.
Be Frank in Discussing Your Expectations with Your Surgeon. He or She Should Be Equally Frank with You, Describing the Procedure in Detail and Explaining Its Risks and Limitations.
Getting the Answers You Need
Individuals Considering Liposuction Often Feel a Bit Overwhelmed by the Number of Options and Techniques Being Promoted Today. However, Your Plastic Surgeon Can Help. In Deciding Which Is the Right Treatment Approach for You, Your Doctor Will Consider Effectiveness, Safety, Cost and Appropriateness for Your Needs. This Is Called Surgical Judgment, a Skill That Is Developed Through Surgical Training and Experience. Your Doctor Also Uses This Judgment to Prevent Complications; To Handle Unexpected Occurrences During Surgery; And to Treat Complications When They Occur.
Your Surgeon's Education and Training Have Helped to Form His or Her Surgical Judgement, So Take the Time to Do Some Background Checking. Patients Are Encouraged to Consider a Doctor Certified by the American Board of Plastic Surgery (Abps). By Choosing a Plastic Surgeon Who Is Certified by the Abps, a Patient Can Be Assured That the Doctor Has Graduated From an Accredited Medical School and Completed at Least Five Years of Additional Residency - Usually Three Years of General Surgery (or Its Equivalent) and Two Years of Plastic Surgery. To Be Certified by the Abps, a Doctor Must Also Practice Surgery for Two Years and Pass Comprehensive Written and Oral Exams.
Preparing for Your Surgery
Your Surgeon Will Give You Specific Instructions on How to Prepare for Surgery, Including Guidelines on Eating and Drinking, Smoking, and Taking or Avoiding Vitamins, Iron Tablets and Certain Medications. If You Develop a Cold or an Infection of Any Kind, Especially a Skin Infection, Your Surgery May Have to Be Postponed.
Though It Is Rarely Necessary, Your Doctor May Recommend That You Have Blood Drawn Ahead of Time in Case It Is Needed During Surgery.
Also, While You Are Making Preparations, Be Sure to Arrange for Someone to Drive You Home After the Procedure and, if Needed, to Help You at Home for a Day or Two.
Where Your Surgery Will Be Performed
Liposuction May Be Performed in a Surgeon's Office-Based Facility, in an Outpatient Surgery Center, or in a Hospital. Smaller-Volume Liposuction Is Usually Done on an Outpatient Basis for Reasons of Cost and Convenience. However, if a Large Volume of Fat Will Be Removed, or if the Liposuction Is Being Performed in Conjunction with Other Procedures, a Stay in a Hospital or Overnight Nursing Facility May Be Required.
Anesthesia for Liposuction
Various Types of Anesthesia Can Be Used for Liposuction Procedures. Together, You and Your Surgeon Will Select the Type of Anesthesia That Provides the Most Safe and Effective Level of Comfort for Your Surgery.
If Only a Small Amount of Fat and a Limited Number of Body Sites Are Involved, Liposuction Can Be Performed Under Local Anesthesia, Which Numbs Only the Affected Areas. However, if You Prefer, the Local Is Usually Used Along with Intravenous Sedation to Keep You More Relaxed During the Procedure. Regional Anesthesia Can Be a Good Choice for More Extensive Procedures. One Type of Regional Anesthesia Is the Epidural Block, the Same Type of Anesthesia Commonly Used in Childbirth.
However, Some Patients Prefer General Anesthesia, Particularly if a Large Volume of Fat Is Being Removed. If This Is the Case, a Nurse Anesthetist or Anesthesiologist Will Be Called in to Make Sure You Are Completely Asleep During the Procedure.
The Surgery
The Time Required to Perform Liposuction May Vary Considerably, Depending on the Size of the Area, the Amount of Fat Being Removed, the Type of Anesthesia and the Technique Used.
There Are Several Liposuction Techniques That Can Be Used to Improve the Ease of the Procedure and to Enhance Outcome.
Liposuction Is a Procedure in Which Localized Deposits of Fat Are Removed to Recontour One or More Areas of the Body. Through a Tiny Incision, a Narrow Tube or Cannula Is Inserted and Used to Vacuum the Fat Layer That Lies Deep Beneath the Skin. The Cannula Is Pushed Then Pulled Through the Fat Layer, Breaking Up the Fat Cells and Suctioning Them Out. The Suction Action Is Provided by a Vacuum Pump or a Large Syringe, Depending on the Surgeon's Preference. If Many Sites Are Being Treated, Your Surgeon Will Then Move on to the Next Area, Working to Keep the Incisions as Inconspicuous as Possible.
Fluid Is Lost Along with the Fat, and It's Crucial That This Fluid Be Replaced During the Procedure to Prevent Shock. For This Reason, Patients Need to Be Carefully Monitored and Receive Intravenous Fluids During and Immediately After Surgery.
Technique Variations
The Basic Technique of Liposuction, as Described Above, Is Used in All Patients Undergoing This Procedure. However, as the Procedure Has Been Developed and Refined, Several Variations Have Been Introduced.
Fluid Injection, a Technique in Which a Medicated Solution Is Injected Into Fatty Areas Before the Fat Is Removed, Is Commonly Used by Plastic Surgeons Today. The Fluid -- a Mixture of Intravenous Salt Solution, Lidocaine (a Local Anesthetic) and Epinephrine (a Drug That Contracts Blood Vessels) -- Helps the Fat Be Removed More Easily, Reduces Blood Loss and Provides Anesthesia During and After Surgery. Fluid Injection Also Helps to Reduce the Amount of Bruising After Surgery.
The Amount of Fluid That Is Injected Varies Depending on the Preference of the Surgeon.
Large Volumes of Fluid -- Sometimes as Much as Three Times the Amount of Fat to Be Removed -- Are Injected in the Tumescent Technique. Tumescent Liposuction, Typically Performed on Patients Who Need Only a Local Anesthetic, Usually Takes Significantly Longer Than Traditional Liposuction (Sometimes as Long as 4 to 5 Hours). However, Because the Injected Fluid Contains an Adequate Amount of Anesthetic, Additional Anesthesia May Not Be Necessary. The Name of This Technique Refers to the Swollen and Firm or Tumesced State of the Fatty Tissues When They Are Filled with Solution.
The Super-Wet Technique Is Similar to the Tumescent Technique, Except That Lesser Amounts of Fluid Are Used. Usually the Amount of Fluid Injected Is Equal to the Amount of Fat to Be Removed. This Technique Often Requires Iv Sedation or General Anesthesia and Typically Takes One to Two Hours of Surgery Time.
Ultrasound-Assisted Lipoplasty (Ual). This Technique Requires the Use of a Special Cannula That Produces Ultrasonic Energy. As It Passes Through the Areas of Fat, the Energy Explodes the Walls of the Fat Cells, Liquefying the Fat. The Fat Is Then Removed with the Traditional Liposuction Technique.
Ual Has Been Shown to Improve the Ease and Effectiveness of Liposuction in Fibrous Areas of the Body, Such as the Upper Back or the Enlarged Male Breast. It Is Also Commonly Used in Secondary Procedures, When Enhanced Precision Is Needed. In General, Ual Takes Longer to Perform Than Traditional Liposuction.
Liposuction Is Normally Safe, as Long as Patients Are Carefully Selected, the Operating Facility Is Properly Equipped and the Physician Is Adequately Trained.
As a Minimum, Your Surgeon Should Have Basic (Core) Accredited Surgical Training with Special Training in Body Contouring. Also, Even Though Many Body-Contouring Procedures Are Performed Outside the Hospital Setting, Be Certain That Your Surgeon Has Been Granted Privileges to Perform Liposuction at an Accredited Hospital.
Your Doctor Must Have Advanced Surgical Skills to Perform Procedures That Involve the Removal of a Large Amount of Fat (More Than 5 Liters or 5,000 Ccs); Ask Your Doctor About His or Her Other Patients Who Have Had Similar Procedures and What Their Results Were. Also, More Extensive Liposuction Procedures Require Attentive After-Care. Find Out How Your Surgeon Plans to Monitor Your Condition Closely After the Procedure.
However, It's Important to Keep in Mind That Even Though a Well-Trained Surgeon and a State-of-the Art Facility Can Improve Your Chance of Having a Good Result, There Are No Guarantees. Though They Are Rare, Complications Can and Do Occur. Risks Increase if a Greater Number of Areas Are Treated at the Same Time, or if the Operative Sites Are Larger in Size. Removal of a Large Amount of Fat and Fluid May Require Longer Operating Times Than May Be Required for Smaller Operations.
The Combination of These Factors Can Create Greater Hazards for Infection; Delays in Healing; The Formation of Fat Clots or Blood Clots, Which May Migrate to the Lungs and Cause Death; Excessive Fluid Loss, Which Can Lead to Shock or Fluid Accumulation That Must Be Drained; Friction Burns or Other Damage to the Skin or Nerves or Perforation Injury to the Vital Organs; And Unfavorable Drug Reactions.
There Are Also Points to Consider with the Newer Techniques. For Example, in Ual, the Heat From the Ultrasound Device Used to Liquefy the Fat Cells May Cause Injury to the Skin or Deeper Tissues. Also, You Should Be Aware That Even Though Ual Has Been Performed Successfully on Several Thousand People Worldwide, the Long-Term Effects of Ultrasound Energy on the Body Are Not Yet Known.
In the Tumescent and Super-Wet Techniques, the Anesthetic Fluid That Is Injected May Cause Lidocaine Toxicity (if the Solution's Lidocaine Content Is Too High), or the Collection of Fluid in the Lungs (if Too Much Fluid Is Administered).
The Scars From Liposuction Are Small and Strategically Placed to Be Hidden From View. However, Imperfections in the Final Appearance Are Not Uncommon After Lipoplasty. The Skin Surface May Be Irregular, Asymmetric or Even Baggy, Especially in the Older Patient. Numbness and Pigmentation Changes May Occur. Sometimes, Additional Surgery May Be Recommended.
After Your Surgery
After Surgery, You Will Likely Experience Some Fluid Drainage From the Incisions. Occasionally, a Small Drainage Tube May Be Inserted Beneath the Skin for a Couple of Days to Prevent Fluid Build-Up. To Control Swelling and to Help Your Skin Better Fit Its New Contours, You May Be Fitted with a Snug Elastic Garment to Wear Over the Treated Area for a Few Weeks. Your Doctor May Also Prescribe Antibiotics to Prevent Infection.
Don't Expect to Look or Feel Great Right After Surgery. Even Though the Newer Techniques Are Believed to Reduce Some Post-Operative Discomforts, You May Still Experience Some Pain, Burning, Swelling, Bleeding and Temporary Numbness. Pain Can Be Controlled with Medications Prescribed by Your Surgeon, Though You May Still Feel Stiff and Sore for a Few Days.
It Is Normal to Feel a Bit Anxious or Depressed in the Days or Weeks Following Surgery. However, This Feeling Will Subside as You Begin to Look and Feel Better.
Getting Back to Normal
Healing Is a Gradual Process. Your Surgeon Will Probably Tell You to Start Walking Around as Soon as Possible to Reduce Swelling and to Help Prevent Blood Clots From Forming in Your Legs. You Will Begin to Feel Better After About a Week or Two and You Should Be Back at Work Within a Few Days Following Your Surgery. The Stitches Are Removed or Dissolve on Their Own Within the First Week to 10 Days.
Activity That Is More Strenuous Should Be Avoided for About a Month as Your Body Continues to Heal. Although Most of the Bruising and Swelling Usually Disappears Within Three Weeks, Some Swelling May Remain for Six Months or More.
Your Surgeon Will Schedule Follow-Up Visits to Monitor Your Progress and to See if Any Additional Procedures Are Needed.
If You Have Any Unusual Symptoms Between Visits -- for Example, Heavy Bleeding or a Sudden Increase in Pain -- or Any Questions About What You Can and Can't Do, Call Your Doctor.
Your New Look
You Will See a Noticeable Difference in the Shape of Your Body Quite Soon After Surgery. However, Improvement Will Become Even More Apparent After About Four to Six Weeks, When Most of the Swelling Has Subsided. After About Three Months, Any Persistent Mild Swelling Usually Disappears and the Final Contour Will Be Visible.
If Your Expectations Are Realistic, You Will Probably Be Very Pleased with the Results of Your Surgery. You May Find That You Are More Comfortable in a Wide Variety of Clothes and More at Ease with Your Body. And, by Eating a Healthy Diet and Getting Regular Exercise, You Can Help to Maintain Your New Shape.
Tummy Tuck
An Incision Just Above the Pubic Area Is Used to Remove Excess Skin and Fat From the Middle and Lower Abdomen.
Skin Is Separated From the Abdominal Wall All the Way Up to the Ribs.
The Surgeon Draws Underlying Muscle and Tissue Together and Stitches Them, Thereby Narrowing the Waistline and Strengthening the Abdominal Wall.
Abdominal Skin Is Drawn Down and Excess Is Removed. With Complete Abdominoplasty, a New Opening Is Cut for the Navel. Both Incisions Are Stitched Closed.
After Surgery, the Patient Has a Flatter, Trimmer Abdomen. Scars Are Permanent, but Will Fade with Time.
If You're Considering Abdominoplasty...
Abdominoplasty, Known More Commonly as a Tummy Tuck, Is a Major Surgical Procedure to Remove Excess Skin and Fat From the Middle and Lower Abdomen and to Tighten the Muscles of the Abdominal Wall. The Procedure Can Dramatically Reduce the Appearance of a Protruding Abdomen. But Bear in Mind, It Does Produce a Permanent Scar, Which, Depending on the Extent of the Original Problem and the Surgery Required to Correct It, Can Extend From Hip to Hip.
If You're Considering Abdominoplasty, This Will Give You a Basic Understanding of the Procedure-When It Can Help, How It's Performed, and What Results You Can Expect. It Can't Answer All of Your Questions, Since a Lot Depends on the Individual Patient and the Surgeon. Please Ask Your Surgeon About Anything You Don't Understand.
The Best Candidates for Abdominoplasty
The Best Candidates for Abdominoplasty Are Men or Women Who Are in Relatively Good Shape but Are Bothered by a Large Fat Deposit or Loose Abdominal Skin That Won't Respond to Diet or Exercise. The Surgery Is Particularly Helpful to Women Who, Through Multiple Pregnancies, Have Stretched Their Abdominal Muscles and Skin Beyond the Point Where They Can Return to Normal. Loss of Skin Elasticity in Older Patients, Which Frequently Occurs with Slight Obesity, Can Also Be Improved.
Patients Who Intend to Lose a Lot of Weight Should Postpone the Surgery. Also, Women Who Plan Future Pregnancies Should Wait, as Vertical Muscles in the Abdomen That Are Tightened During Surgery Can Separate Again During Pregnancy. If You Have Scarring From Previous Abdominal Surgery, Your Doctor May Recommend Against Abdominoplasty or May Caution You That Scars Could Be Unusually Prominent.
Abdominoplasty Can Enhance Your Appearance and Your Self-Confidence, but It Won't Necessarily Change Your Looks to Match Your Ideal, or Cause Other People to Treat You Differently. Before You Decide to Have Surgery, Think Carefully About Your Expectations and Discuss Them with Your Surgeon.
Thousands of Abdominoplasties Are Performed Successfully Each Year. When Done by a Qualified Plastic Surgeon Who Is Trained in Body Contouring, the Results Are Generally Quite Positive. Nevertheless, There Are Always Risks Associated with Surgery and Specific Complications Associated with This Procedure.
Post-Operative Complications Such as Infection and Blood Clots Are Rare, but Can Occur. Infection Can Be Treated with Drainage and Antibiotics, but Will Prolong Your Hospital Stay. You Can Minimize the Risk of Blood Clots by Moving Around as Soon After the Surgery as Possible.
Poor Healing, Which Results in Conspicuous Scars, May Necessitate a Second Operation. Smokers Should Be Advised to Stop, as Smoking May Increase the Risk of Complications and Delay Healing.
You Can Reduce Your Risk of Complications by Closely Following Your Surgeon's Instructions Before and After the Surgery, Especially with Regard to When and How You Should Resume Physical Activity.
Planning Your Surgery
In Your Initial Consultation, Your Surgeon Will Evaluate Your Health, Determine the Extent of Fat Deposits in Your Abdominal Region, and Carefully Assess Your Skin Tone. Be Sure to Tell Your Surgeon if You Smoke, and if You're Taking Any Medications, Vitamins, or Other Drugs.
Be Frank in Discussing Your Expectations with Your Surgeon. He or She Should Be Equally Frank with You, Describing Your Alternatives and the Risks and Limitations of Each.
If, for Example, Your Fat Deposits Are Limited to the Area Below the Navel, You May Require a Less Complex Procedure Called a Partial Abdominoplasty, Also Know as a Mini-Tummy Tuck, Which Can Often Be Performed on an Outpatient Basis. You May, on the Other Hand, Benefit More From Partial or Complete Abdominoplasty Done in Conjunction with Liposuction to Remove Fat Deposits From the Hips, for a Better Body Contour. Or Maybe Liposuction Alone Would Create the Best Result.
In Any Case, Your Surgeon Should Work with You to Recommend the Procedure That Is Right for You and Will Come Closest to Producing the Desired Body Contour.
During the Consultation, Your Surgeon Should Also Explain the Anesthesia He or She Will Use, the Type of Facility Where the Surgery Will Be Performed, and the Costs Involved. In Most Cases, Health Insurance Policies Do Not Cover the Cost of Abdominoplasty, but You Should Check Your Policy to Be Sure.
Preparing for Your Surgery
Your Surgeon Will Give You Specific Instructions on How to Prepare for Surgery, Including Guidelines on Eating and Drinking, Smoking, and Taking or Avoiding Certain Vitamins, and Medications.
If You Smoke, Plan to Quit at Least One to Two Weeks Before Your Surgery and Not to Resume for at Least Two Weeks After Your Surgery. Avoid Overexposure to the Sun Before Surgery, Especially to Your Abdomen, and Do Not Go on a Stringent Diet, as Both Can Inhibit Your Ability to Heal. If You Develop a Cold or Infection of Any Kind, Your Surgery Will Probably Be Postponed.
Whether Your Surgery Is Done on an Outpatient or Inpatient Basis, You Should Arrange for Someone to Drive You Home After Your Surgery, and to Help You Out for a Day or Two After You Leave the Hospital, if Needed.
Where Your Surgery Will Be Performed
Many Surgeons Perform Both Partial and Complete Abdominoplasties in an Outpatient Surgical Center or an Office-Based Facility. Others Prefer the Hospital, Where Their Patients Can Stay for Several Days.
Types of Anesthesia
Your Doctor May Select General Anesthesia, So You'll Sleep Through the Operation.
Other Surgeons Use Local Anesthesia, Combined with a Sedative to Make You Drowsy. You'll Be Awake but Relaxed, and Your Abdominal Region Will Be Insensitive to Pain. (However, You May Feel Some Tugging or Occasional Discomfort.)
The Surgery
Complete Abdominoplasty Usually Takes Two to Five Hours, Depending on the Extent of Work Required. Partial Abdominoplasty May Take an Hour or Two.
Most Commonly, the Surgeon Will Make a Long Incision From Hipbone to Hipbone,, Just Above the Pubic Area. A Second Incision Is Made to Free the Navel From Surrounding Tissue. With Partial Abdominoplasty, the Incision Is Much Shorter and the Navel May Not Be Moved, Although It May Be Pulled Into an Unnatural Shape as the Skin Is Tightened and Stitched.
Next, the Surgeon Separates the Skin From the Abdominal Wall All the Way Up to Your Ribs and Lifts a Large Skin Flap to Reveal the Vertical Muscles in Your Abdomen. These Muscles Are Tightened by Pulling Them Close Together and Stitching Them Into Their New Position. This Provides a Firmer Abdominal Wall and Narrows the Waistline.
The Skin Flap Is Then Stretched Down and the Extra Skin Is Removed. A New Hole Is Cut for Your Navel, Which Is Then Stitched in Place. Finally, the Incisions Will Be Stitched, Dressings Will Be Applied, and a Temporary Tube May Be Inserted to Drain Excess Fluid From the Surgical Site.
In Partial Abdominoplasty, the Skin Is Separated Only Between the Incision Line and the Navel. This Skin Flap Is Stretched Down, the Excess Is Removed, and the Flap Is Stitched Back Into Place.
After Your Surgery
For the First Few Days, Your Abdomen Will Probably Be Swollen and You're Likely to Feel Some Pain and Discomfort Which Can Be Controlled by Medication. Depending on the Extent of the Surgery, You May Be Released Within a Few Hours or You May Have to Remain Hospitalized for Two to Three Days.
Your Doctor Will Give You Instructions for Showering and Changing Your Dressings. And Though You May Not Be Able to Stand Straight at First, You Should Start Walking as Soon as Possible.
Surface Stitches Will Be Removed in Five to Seven Days, and Deeper Sutures, with Ends That Protrude Through the Skin, Will Come Out in Two to Three Weeks. The Dressing on Your Incision May Be Replaced by a Support Garment.
Getting Back to Normal
It May Take You Weeks or Months to Feel Like Your Old Self Again. If You Start Out in Top Physical Condition with Strong Abdominal Muscles, Recovery From Abdominoplasty Will Be Much Faster. Some People Return to Work After Two Weeks, While Others Take Three or Four Weeks to Rest and Recuperate.
Exercise Will Help You Heal Better. Even People Who Have Never Exercised Before Should Begin an Exercise Program to Reduce Swelling, Lower the Chance of Blood Clots, and Tone Muscles. Vigorous Exercise, However, Should Be Avoided Until You Can Do It Comfortably.
Your Scars May Actually Appear to Worsen During the First Three to Six Months as They Heal, but This Is Normal. Expect It to Take Nine Months to a Year Before Your Scars Flatten Out and Lighten in Color. While They'll Never Disappear Completely, Abdominal Scars Will Not Show Under Most Clothing, Even Under Bathing Suits.
Your New Look
Abdominoplasty, Whether Partial or Complete, Produces Excellent Results for Patients with Weakened Abdominal Muscles or Excess Skin. And in Most Cases, the Results Are Long Lasting, if You Follow a Balanced Diet and Exercise Regularly.
If You're Realistic in Your Expectations and Prepared for the Consequences of a Permanent Scar and a Lengthy Recovery Period, Abdominoplasty May Be Just the Answer for You.
Upper Arm Lift
Fluctuations in Weight, Aging and Even Heredity Can Cause Changes in Appearance That You Might Not Expect. One Such Change That Can Occur in the Upper Arm Results in a Droopy, Sagging, Batwing-Like Appearance. Fitness May Strengthen and Improve Underlying Muscle Tone of the Upper Arm, but It Cannot Address Excess Skin That Has Lost Elasticity or Underlying Weakened Tissues and Localized Fat Deposits.
If the Underside of Your Upper Arms Has Developed Sagging, Droopy Skin, or Appears Loose and Full Due to Excess Skin and Fat, an Arm Lift May Be Right for You. In General, an Arm Lift Reduces Excess Skin and Underlying Fat That Occurs Between Underarm Region in the Elbow, Reshaping the Arm to Result in Smoother Skin and More Normal Contours. An Arm Lift Results in a More Toned and Proportionate Appearance, Enhancing Your Self-Confidence and Expanding Your Fashion Choices. The Trade-Off to Your Improved Image Is a Resulting Scar on the Inside of Your Upper Arm.
This Webpage Presents an Overview of Arm Lift, Technically Called Brachioplasty. The Best Way to Learn How an Arm Lift and Help Fulfill Your Personal Goals Is a Consultation with a Plastic Surgeon Certified by the American Board of Plastic Surgery.
What Is an Arm Lift?An arm lift is a surgical procedure that reshapes the under portion of the upper arm, and the underarm region to the elbow. This procedure is performed to:
Reduce Excess Sagging Skin That Droops Downward When Arms Are Extended Away From the Body
Tighten and Smooth the Underlying Supportive Tissue That Defines the Shape of the Upper Arm in Addition, Any Localized Pockets of Fat in the Upper Arm Region May Be Reduced Through Brachioplasty, Most Commonly in Conjunction with Liposuction Techniques.
The Conditions Treated with an Arm Lift May Develop in Both Men and Women, Most Often Due to a Loss of Elasticity in the Skin and Underlying Tissue of the Upper Arm. This May Be the Result of Significant Weight Loss and Skin That Has Been So Stretched It Loses the Ability to Retract. Conditions May Also Result From the Natural Changes That Occur with Aging, Heredity or a Combination of These Conditions.
An Arm Lift Cannot Correct Weakened Muscles of the Upper Arm; In Fact Many Individuals Who Seek Surgery Are Relatively Fit Individuals Who Are Bothered by a Condition That Cannot Be Corrected Through Exercise. In General, Good Candidates for an Arm Lift Are:
Adults of Any Age Whose Weight Is Relatively Stable and Who Are Not Significantly Overweight
Healthy Individuals Who Do Not Have Medical Conditions That Can Impair Healing or Increase Risk of Surgery
Non-Smokers
Individuals with a Positive Outlook and Realistic Goals for What an Arm Lift Can Accomplish
Individuals Committed to Leading a Healthy Lifestyle of Proper Nutrition and Fitness
Where Do I Begin?
A Consultation with Your Plastic Surgeon Is the First Step to Learn How and on What Can Help You Achieve a Smoother and More Normal Contour of the Arm. A Consultation Is Designed to Fully Educate You About Brachioplasty in a Non-Pressured Environment, and Will Include:
A Discussion of Your Goals and an Evaluation of the Individual Case
The Options Available for an Arm LeftThe likely outcomes of brachioplasty and any associated risks or potential complications the course of treatment recommended by your plastic surgeon
Evaluation
Overall Health and Personal Outlook Can Greatly Impact the Outcome of Arm Lift Surgery. These Will Be Carefully Evaluated in a Consultation with Your Plastic Surgeon. The Success of Your Procedure, Safety and Overall Satisfaction Require That You:
Honestly Share Your ExpectationsFully disclose health history, current medications, the use of vitamins, herbal supplements, alcohol, tobacco and drugs commit to precisely following all of your plastic surgeon's instructions
Your Arm Lift
An Arm Lift Is a Safe and Satisfying Procedure That Can Greatly Improve the Appearance of Your Upper Arm. The Procedure Begins with an Incision Placed in the Inside of the Upper Arm. The Incision May Extend From the Underarm to the Elbow, or Be More Limited in Length. Incision Length and Pattern Depend on the Amount and Location of Excess Skin to Be Removed, as Well as the Preferences and Surgical Judgment of Your Plastic Surgeon.
If Fat Will Be Reduced During Your Arm Lift, It Will Be Excised or Treated with Liposuction Techniques. The Underlying Supportive Tissues Are Tightened and Reshaped with Internal Sutures. Overlying Skin Is Then Smoothed Over the New Contour of Your Arm, with Excess Skin Reduced. Your Incisions Will Be Closed with Absorbable Sutures, or Stitches That Will Be Removed Within One to Two Weeks Following Your Arm Lift.
The Trade Off to an Improved Body Contour and Image Through an Arm Lift Is a Resulting Scar on the Inside Portion of Your Upper Arm. In Addition, Uneven Contours Can Develop in the Arm After Surgery. In Some Cases, Skin Elasticity Is So Poor That Relapse of the Skin Is Possible.
Preparing for Surgery
Your Plastic Surgeon Will Carefully Explain the Technique for Your Arm Lift. Prior to Any Surgery, You Will Be Given Specific Instructions That May Include:
Pre-Surgical Considerations, Diagnostic Testing and Medications
Day of Surgery Instructions and Medications
Specific Information Related to the Use of Anesthesia
Postoperative Care and Follow Up
In Addition, You Will Be Asked to Sign Consent Forms to Assure Your Plastic Surgeon That You Full Understand the Procedure or Procedures You Will Undergo and Any Associated Risks and Potential Complications.
Possible Risks of an Arm Lift Include Bleeding, Infection, Fluid Accumulation, Delayed or Poor Healing, Skin Loss, Blood Clots, Excessive or Widened Scars, Numbness and Other Changes in Skin Sensation and Irregular or Asymmetric Contour or Scars. Any Surgery Carries Risks Associated with Anesthesia. These Risks and Others Will Be Fully Disclosed Prior to Your Consent.
It Is Important That You Address All Your Questions Directly with Your Plastic Surgeon. It Is Natural to Feel Some Anxiety, Whether Excitement for the Anticipated Outcomes or Preoperative Stress. Discuss These Feelings with Your Plastic Surgeon.
What to Expect
Brachioplasty May Be Performed in Your Surgeon's Accredited Office-Based Surgical Facility, an Ambulatory Surgical Facility or a Hospital, Possibly with an Overnight Hospital Stay. Procedures Are Most Commonly Performed Under General Anesthesia, Although Local Anesthesia with Sedation May Be Used. These Decisions Will Be Based on the Requirements of Your Specific Procedure and Considerations of Patient and Surgeon Preference.
Following Surgery
Once Your Arm Lift Is Completed, Dressing or Bandages Will Be Applied to Your Incisions, and Your Arms May Be Wrapped in an Elastic Bandage to Minimize Swelling and to Support Your New Contours as You Heal. Small, Thin Tubes May Be Temporarily Placed Under the Skin to Drain Excess Fluid or Blood That May Collect. Before You Are Released Following Surgery, You and an Accompanying Responsible Family Member, Friend or Caregiver Will Be Given Specific Instructions That May Include:
• How to Care for the Surgical Site and Drains
• Medications to Apply or Take Orally to Aid Healing and Reduce the Potential for Infection
• Specific Concerns to Look for at the Surgical Site or in Overall Health
• When to Follow-Up with Your Plastic Surgeon
Progress and Healing
Following Your Arm Lift, Your Arms Will Be Swollen and Bruised, and You Will Experience Some Discomfort. Discomfort Is Common and Can Be Controlled with Medication. You Will Be Instructed to Keep Your Arms Elevated for Several Days Following Surgery and Return to Light Walking as Soon as Possible to Minimize the Potential for Blood Clots and Other Complications.
You Will Also Be Instructed to Avoid Lifting or Bearing Any Weight on Your Arms for Several Days to Weeks. Your Surgeon May Also Advise You to Limit Your Range of Motion Until Internal Healing Is Complete. You Will Be Ready to Return to Work and Light, Normal Activities Within a Few Days, as Long as You Do Not Engage in Any Lifting or Vigorous Exercise. Follow All Instructions Carefully - This Is Essential to the Success of Your Outcome.
Your Incisions Will Heal Within 7 to 14 Days, After Which Time Sutures Will Be Removed if Necessary. Additional Healing Will Continue for Many Weeks as Swelling Resolves and Incision Lines Continue to Improve. Numbness and a Firm Feeling Over the Skin's Surface Will Resolve Over Time. You Must Practice Diligent Sun Protection Until the Healing Process Is Fully Completed or Skin in the Treated Area May Develop Irregular Pigmentation and Scars May Become Raised, Red or Dark. It May Take a Year or More Following a Given Procedure for Incision Lines to Refine and Fade to Some Degree. Continue to Follow Your Plastic Surgeon's Instructions and Attend Follow-Up Visits as Scheduled.
Results and Outlook
The Dramatic Improvement in Arm Contour Following Arm Lift Surgery Can Greatly Enhance Your Body Image. A Smooth, Toned Arm That Matches Your Body Image and Personal Goals Does, However, Come with Visible Scars. This Is a Fair Trade-Off to Achieving a Body Contour That Matches Your Body Weight and Proportion.
The Results of Arm Lift Will Be Long-Lasting, Provided That You Maintain a Stable Weight and General Fitness. As Your Body Ages, It Is Natural to Lose Some Firmness. However, Most of Your Improvement Should Be Relatively Permanent.
Body Lift
A Well-Toned Body with Smooth Contours Often Is a Sign of Fitness Achieved by Healthy Diet and Exercise. But Exercise Cannot Always Achieve Results for Individuals Who Have Loose, Sagging Skin and Uneven Contours. Aging, Sun Damage, Pregnancy and Fluctuations in Body Weight as Well as Genetic Factors Contribute to Poor Tissue Elasticity and May Result in Sagging of the Abdomen, Buttocks, Thighs, and Upper Arms.
If You Desire a Firmer, More Youthful Looking Body Contour, Then a Surgical Body Lift May Help Achieve Your Goals. In General, a Body Lift Reduces Excess Fat and Skin Resulting in Smoother Skin and Contours. These Physical Changes to the Body Can Improve Your Body Image and Enhance Your Self-Confidence.
This Web Page Presents an Overview of Body Lift Procedures. The Best Way to Learn How Body Contouring Through Body Lifts Can Help Fulfill Your Personal Goals Is a Consultation with a Plastic Surgeon.
What Are Body Lifts?
A Body Lift Is Surgery Performed to Correct Excess Loose and Sagging Skin and Irregular Contours of The:
Abdominal Area, Locally or Extending Around the Sides and Into the Lower Back Area
Buttocks, That May Be Low, Flat or Shaped Unevenly
Groin That May Sag Into the Inner Thigh
Thigh, Including the Inner, Outer, or Posterior Thigh, or Circumferentially
Upper Arms, Including the Armpit Region
Surgical Body Lifting Improves the Shape and Tone of the Underlying Tissue That Supports Fat and Skin. Excess Sagging Fat and Skin Is Removed to Treat Conditions Caused in Part by Poor Tissue Elasticity. In Addition, a Body Lift Can Improve a Dimpled, Irregular Skin Surface, Commonly Known as Cellulite.
Body Lifts Are Not Intended Strictly for the Removal of Excess Fat. Liposuction Alone Can Remove Excess Fat Deposits Where Skin Has Good Elasticity and Is Able to Naturally Conform to New Body Contours. In Cases Where Skin Elasticity Is Poor, a Combination of Liposuction and Body Lift Techniques May Be Recommended.
Body Lifting Procedures May Be Appropriate for Individuals Who Are of Stable Weight That Is Reasonably Proportionate to Their Height and Body Frame. In Addition, It Is Recommended That Women Considering Future Pregnancies Postpone and Abdominal Body Lift Since Pregnancy May Diminish Results. Body Lift Procedures May Be Performed on Adults of Any Age Who Have Realistic Goals in Mind for Improvement of Their Body Contour.
Good Candidates Are:
Individuals with Significant Soft Tissue Looseness in One or Multiple Body Areas
Healthy Individuals Who Do Not Have Medical Conditions That Can Impair Healing or Increase Risk of Surgery
Non-SmokersIndividuals with a positive outlook and specific goals in mind for body contouring
Where Do I Begin?
A Consultation with Your Plastic Surgeon Is the First Step to Learn How Body Lifting Procedures Can Improve Your Body Contours. A Consultation Is Designed to Fully Educate You About Your Body Lift in a Non-Pressured Environment, and Will Include:
A Discussion of Your Goals and an Evaluation of Your Individual Case
The Options Available in Body Lift Surgery
The Likely Outcomes of Body Lifting Procedures and Any Risks or Potential Complications
The Course of Treatment Recommended by Your Plastic Surgeon
Evaluation
Overall Health and Personal Outlook Can Greatly Impact the Outcome of Body Contouring Surgery, Including Body Lifts. These Will Be Carefully Evaluated in Your Consultation. The Success of Your Procedure, Safety and Overall Satisfaction Require That You:
Honestly Share Your Expectations
Fully Disclose Health History, Current Medications, Use of Vitamins, Herbal Supplements, Alcohol, Tobacco and Drugs
Commit to Precisely Following All of Your Plastic Surgeon's Instructions
Your Body Lift
Your Body Lift Will Be Individualized to Your Specific Conditions and the Regions to Be Treated. Conditions That May Be Improved by a Body Lift Include:
Dimpled or Uneven Soft Tissue
Lax, Loose Skin
Excess Fat and Tissue
Sagging Body ContoursMany conditions can contribute to tissue that is weak and lacking in tone and firmness, and to uneven or sagging body contours. These most commonly include:
Weight Changes, Especially Substantial Weight Loss, Such as Occurs Following Gastric Bypass Surgery
Stress on the Skin and Underlying Tissue That May Result From Pregnancy
The Natural Aging Process Causing Skin and Tissue to Lose Elasticity and Tone Over Time
Sun Damage and Other Environmental Factors That Cause Premature Skin Aging
Heredity or the Genetic Make-Up That Determines One's Body Type and Skin Qualities Including Cellulite
Childhood and Teenage Obesity Resulting in Premature Loss of Youthful Skin Tone
There Is No Other Method of Body Contouring That Can Restore Body Shape, Skin Appearance, and Skin Tone as Effectively as a Body Lift. Body Lifts Are Surgical Procedures and They Require Incisions; In Some Cases, Incisions May Be Extensive. Incision Length and Pattern Depend on the Amount and Location of Skin to Be Removed, as Well as Personal Preference and Surgical Judgment. Advanced Techniques Usually Allow Incisions to Be Placed in Locations Where They Can Be Hidden by Most Types of Clothing and Swimsuits.
Other Body Contouring Procedures May Be Performed Separately or in the Same Surgical Session as a Body Lift, Including Liposuction and Tummy Tuck, Breast Lift or Male or Female Breast Reduction. However, Not All Patients Are Good Candidates for Combined Procedures. Your Case Will Be Evaluated on an Individual Basis.
Preparing for Surgery
Your Plastic Surgeon Will Carefully Explain Your Body Lift Procedure. Prior to Surgery, You Will Be Given Specific Instructions That May Include:
Pre-Surgical Considerations, Diagnostic Testing and Medications
Day of Surgery Instructions and Medications
Specific Information Related to the Use of Anesthesia
Postoperative Care and Follow UpIn addition, you will be asked to sign consent forms to assure your plastic surgeon that you full understand the procedure or procedures you will undergo and any associated risks and potential complications.
Possible Risks of a Body Lift Include Bleeding, Infection, Fluid Accumulation, Delayed or Poor Healing, Skin Loss, Blood Clots, Excessive or Widened Scars, Numbness and Other Changes in Skin Sensation and Irregular or Asymmetric Contour or Scars. Any Surgery Carries Risks Associated with Anesthesia. These Risks and Others Will Be Fully Disclosed Prior to Your Consent.
It Is Important That You Address All Your Questions Directly with Your Plastic Surgeon. It Is Natural to Feel Some Anxiety, Whether Excitement for the Anticipated Outcomes or Preoperative Stress. Discuss These Feelings with Your Plastic Surgeon.
What to Expect
A Body Lift May Be Performed in Your Plastic Surgeon's Accredited Office-Based Surgical Facility, an Ambulatory Surgical Facility or a Hospital, Possibly with an Overnight Hospital Stay. Procedures Are Most Commonly Performed Under General Anesthesia, Although Local Anesthesia with Sedation May Be Used. These Decisions Will Be Based on the Requirements of Your Specific Procedure and Considerations of Patient and Surgeon Preference. Your Plastic Surgeon and the Assisting Staff Will Fully Attend to Your Comfort and Safety.
Following Surgery
Once Your Procedure Is Completed, Dressings or Bandages May Be Applied to Your Incisions, and You May Be Wrapped in an Elastic Bandage to Minimize Swelling and Support Your New Contours as You Heal. One or More Small, Thin Tubes May Be Temporarily Placed Under the Skin to Drain Excess Fluid or Blood That May Collect. Before You Are Released Following Surgery, You and an Accompanying Family Member, Friend or Caregiver Will Be Given Specific Instructions That May Include:
How to Care for the Surgical Site and Drains
Medications to Apply or Take Orally to Aid Healing and Reduce Potential for Infection
Specific Concerns to Look for at the Surgical Site or in the Overall Health
When to Follow-Up with Your Plastic Surgeon
Progress and Healing
Initial Healing Will Include Swelling at the Incision Sites. Discomfort Is Common and Can Be Controlled with Medication. You Will Be Instructed to Return to Light Walking as Soon as Possible to Minimize the Potential for Blood Clots and Other Complications.
You Must Avoid Bending, Straining or Lifting for Several Days. Where Tightening of the Abdomen or Thighs Is Involved, Your Plastic Surgeon May Also Instruct You to Avoid Standing Fully Upright and Stressing Any Internal Sutures as They Heal, and to Sleep with Pillows Elevating Your Knees. Follow All Instructions Carefully – This Is Essential to the Success of Your Outcome. A Return to Light, Normal Activity Is Possible as Soon as You Feel Ready, Usually Within 2-3 Weeks Following Surgery.
Initial Wound Healing May Take 7 to 14 Days, After Which Time Sutures Will Be Removed if Necessary. You Will Be Ready to Return to Work and Normal Activity in a Few Weeks, So Long as You Do Not Engage in Any Heavy Lifting or Vigorous Exercise.
Healing Will Continue for Several Weeks as Swelling Dissipates and Incision Lines Continue to Improve. You Must Practice Diligent Sun Protection Until the Healing Process Is Fully Complete. Continue to Follow Your Plastic Surgeons Instructions and Attend Follow-Up Visits as Scheduled.
Results and Outlook
The Results of a Body Lift Are Visible Almost Immediately, However It May Take Several Months for Your Final Results to Fully Develop. Numbness and a Firm Feeling Over the Skin's Surface Will Resolve Over Time. It May Take a Year or More for Incisions Lines to Refine and Fade to Some Degree. Although Permanent, These Lines Can Usually Be Hidden by Most Clothing and Swimsuits.
Your New Uplifted Body Contours Should Be Long Lasting Provided That You Maintain Your Weight and General Fitness. As Your Body Ages, It Is Natural to Lose Some Firmness. However, Most of Your Improvement Should Be Relatively Permanent.
Thigh Lift
Reshaping of the Thighs Is Achieved Through Incisions in the Groin That Can Extend Downward to the Knee Along the Inner Portion of the Thigh.
Improving Contours of the Outer Thigh May Require an Incision Extending From the Groin Around the Hip. Through These Incisions Your Plastic Surgeon Will Tighten Tissues for a Smoother, Better Toned Thigh.
Breast Reduction for Men
Many Men Have Gynecomastia-- Enlarged, Female-Like Breasts-- Caused by Excess Glandular Tissue or Fat (or Both).
Glandular Tissue Must Be Cut Out, Usually Through a Small Incision Near the Edge of the Areola.
Fatty Tissue Can Be Removed by Liposuction. A Small, Hollow Tube Is Inserted Through a Tiny Incision, Leaving a Nearly Imperceptible Scar.
Following Surgery for Gynecomastia, the Patient Has a More Masculine Chest Contour.
A Word About Breast Reduction in Men...
Gynecomastia Is a Medical Term That Comes From the Greek Words for Women-Like Breasts. Though This Oddly Named Condition Is Rarely Talked About, It's Actually Quite Common. Gynecomastia Affects an Estimated 40 to 60 Percent of Men. It May Affect Only One Breast or Both. Though Certain Drugs and Medical Problems Have Been Linked with Male Breast Overdevelopment, There Is No Known Cause in the Vast Majority of Cases.
For Men Who Feel Self-Conscious About Their Appearance, Breast-Reduction Surgery Can Help. The Procedure Removes Fat and or Glandular Tissue From the Breasts, and in Extreme Cases Removes Excess Skin, Resulting in a Chest That Is Flatter, Firmer, and Better Contoured.
If You're Considering Surgery to Correct Gynecomastia, This Brochure Will Give You a Basic Understanding of the Procedure--When It Can Help, How It's Performed, and What Results You Can Expect. It Can't Answer All of Your Questions, Since a Lot Depends on Your Individual Circumstances. Please Be Sure to Ask Your Doctor if There Is Anything About the Procedure You Don't Understand.
The Best Candidates for Gynecomastia Correction
Surgery to Correct Gynecomastia Can Be Performed on Healthy, Emotionally Stable Men of Any Age. The Best Candidates for Surgery Have Firm, Elastic Skin That Will Reshape to the Body's New Contours.
Surgery May Be Discouraged for Obese Men, or for Overweight Men Who Have Not First Attempted to Correct the Problem with Exercise or Weight Loss. Also, Individuals Who Drink Alcohol Beverages in Excess or Smoke Marijuana Are Usually Not Considered Good Candidates for Surgery. These Drugs, Along with Anabolic Steroids, May Cause Gynecomastia. Therefore, Patients Are First Directed to Stop the Use of These Drugs to See if the Breast Fullness Will Diminish Before Surgery Is Considered an Option.
All Surgery Carries Some Uncertainty and Risk
When Male Breast-Reduction Surgery Is Performed by a Qualified Plastic Surgeon, Complications Are Infrequent and Usually Minor. Nevertheless, as with Any Surgery, There Are Risks. These Include Infection, Skin Injury, Excessive Bleeding, Adverse Reaction to Anesthesia, and Excessive Fluid Loss or Accumulation. The Procedure May Also Result in Noticeable Scars, Permanent Pigment Changes in the Breast Area, or Slightly Mismatched Breasts or Nipples. If Asymmetry Is Significant, a Second Procedure May Be Performed to Remove Additional Tissue.
The Temporary Effects of Breast Reduction Include Loss of Breast Sensation or Numbness, Which May Last Up to a Year.
Planning Your Surgery
The Initial Consultation with Your Surgeon Is Very Important. Your Surgeon Will Need a Complete Medical History, So Check Your Own Records Ahead of Time and Be Ready to Provide This Information. First, Your Surgeon Will Examine Your Breasts and Check for Causes of the Gynecomastia, Such as Impaired Liver Function, Use of Estrogen-Containing Medications, or Anabolic Steroids. If a Medical Problem Is the Suspected Cause, You'll Be Referred to an Appropriate Specialist.
Your Plastic Surgeon May, in Extreme Cases, Also Recommend a Mammogram, or Breast X-Ray. This Will Not Only Rule Out the Very Small Possibility of Breast Cancer, but Will Reveal the Breast's Composition. Once Your Surgeon Knows How Much Fat and Glandular Tissue Is Contained Within the Breasts, He or She Can Choose a Surgical Approach to Best Suit Your Needs.
Don't Hesitate to Ask Your Surgeon Any Questions You May Have During the Initial Consultation- Including Your Concerns About the Recommended Treatment or the Costs Involved. Treatment of Gynecomastia May Be Covered by Medical Insurance--but Policies Vary Greatly. Check Your Policy or Call Your Carrier to Be Sure. If You Are Covered, Make Certain You Get Written Pre-Authorization for the Treatment Recommended by Your Surgeon.
Preparing for Your Surgery
Your Surgeon Will Give You Specific Instructions on How to Prepare for Surgery, Including Guidelines on Eating, Drinking, and Taking Certain Vitamins and Medications.
Smokers Should Plan to Stop Smoking for a Minimum of One or Two Weeks Before Surgery and During Recovery. Smoking Decreases Circulation and Interferes with Proper Healing. Therefore, It Is Essential to Follow All Your Surgeon's Instructions.
Where Your Surgery Will Be Performed
Surgery for Gynecomastia Is Most Often Performed as an Outpatient Procedure, but in Extreme Cases, or Those Where Other Medical Conditions Present Cause for Concern, an Overnight Hospital Stay May Be Recommended. The Surgery Itself Usually Takes About an Hour and a Half to Complete. However, More Extensive Procedures May Take Longer.
Type of Anesthesia
Correction of Enlarged Male Breasts May Be Performed Under General, or in Some Cases, Under Local Anesthesia Plus Sedation. You'll Be Awake, but Very Relaxed and Insensitive to Pain. More Extensive Correction May Be Performed Under General Anesthesia, Which Allows the Patient to Sleep Through the Entire Operation. Your Surgeon Will Discuss Which Option Is Recommended for You, and Why This Is the Option of Choice.
The Surgery
If Excess Glandular Tissue Is the Primary Cause of the Breast Enlargement, It Will Be Excised, or Cut Out, with a Scalpel. The Excision May Be Performed Alone or in Conjunction with Liposuction. In a Typical Procedure, an Incision Is Made in an Inconspicuous Location--Either on the Edge of the Areola or in the Under Arm Area. Working Through the Incision, the Surgeon Cuts Away the Excess Glandular Tissue, Fat and Skin From Around the Areola and From the Sides and Bottom of the Breast. Major Reductions That Involve the Removal of a Significant Amount of Tissue and Skin May Require Larger Incisions That Result in More Conspicuous Scars. If Liposuction Is Used to Remove Excess Fat, the Cannula Is Usually Inserted Through the Existing Incisions.
If Your Gynecomastia Consists Primarily of Excessive Fatty Tissue, Your Surgeon Will Likely Use Liposuction to Remove the Excess Fat. A Small Incision, Less Than a Half-Inch in Length, Is Made Around the Edge of the Areola--the Dark Skin That Surrounds the Nipple. Or, the Incision May Be Placed in the Underarm Area. A Slim Hollow Tube Called a Cannula Which Is Attached to a Vacuum Pump, Is Then Inserted Into the Incision. Using Strong, Deliberate Strokes, the Surgeon Moves the Cannula Through the Layers Beneath the Skin, Breaking Up the Fat and Suctioning It Out. Patients May Feel a Vibration or Some Friction During the Procedure, but Generally No Pain.
In Extreme Cases Where Large Amounts of Fat or Glandular Tissue Have Been Removed, Skin May Not Adjust Well to the New Smaller Breast Contour. In These Cases, Excess Skin May Have to Be Removed to Allow the Removing Skin to Firmly Re-Adjust to the New Breast Contour.
Sometimes, a Small Drain Is Inserted Through a Separate Incision to Draw Off Excess Fluids. Once Closed, the Incisions Are Usually Covered with a Dressing. The Chest May Be Wrapped to Keep the Skin Firmly in Place.
After Your Surgery
Whether You've Had Excision with a Scalpel or Liposuction, You Will Feel Some Discomfort for a Few Days After Surgery. However, Discomfort Can Be Controlled with Medications Prescribed by Your Surgeon. In Any Case, You Should Arrange to Have Someone Drive You Home After Surgery and to Help You Out for a Day or Two if Needed.
You'll Be Swollen and Bruised for Awhile--in Fact, You May Wonder if There's Been Any Improvement at All. To Help Reduce Swelling, You'll Probably Be Instructed to Wear an Elastic Pressure Garment Continuously for a Week or Two, and for a Few Weeks Longer at Night. Although the Worst of Your Swelling Will Dissipate in the First Few Weeks, It May Be Three Months or More Before the Final Results of Your Surgery Are Apparent.
In the Meantime, It Is Important to Begin Getting Back to Normal. You'll Be Encouraged to Begin Walking Around on the Day of Surgery, and Can Return to Work When You Feel Well Enough--Which Could Be as Early as a Day or Two After Surgery. Any Stitches Will Generally Be Removed About 1 to 2 Weeks Following the Procedure.
Your Surgeon May Advise You to Avoid Sexual Activity for a Week or Two, and Heavy Exercise for About Three Weeks. You'll Be Told to Stay Away From Any Sport or Job That Risks a Blow to the Chest Area for at Least Four Weeks. In General, It Will Take About a Month Before You're Back to All of Your Normal Activities.
You Should Also Avoid Exposing the Resulting Scars to the Sun for at Least Six Months. Sunlight Can Permanently Affect the Skin's Pigmentation, Causing the Scar to Turn Dark. If Sun Exposure Is Unavoidable, Use a Strong Sunblock.
Your New Look
Gynecomastia Surgery Can Enhance Your Appearance and Self-Confidence, but It Won't Necessarily Change Your Looks to Match Your Ideal. Before You Decide to Have Surgery, Think Carefully About Your Expectations and Discuss Them Frankly with Your Plastic Surgeon.
The Results of the Procedure Are Significant and Permanent. If Your Expectations Are Realistic, Chances Are Good That You'll Be Very Satisfied with Your New Look.
Body Contouring After Major Weight Loss
Dramatic Weight Loss, Whether Achieved by Proper Nutrition and Exercise, as the Result of Bariatric Surgery, or From Other Forms of Medical Treatment, Has Many Benefits. However, Once You Reach Your Weight Loss Goals, You May Find That You Still Don’T Have the Fit and Healthy Body Image You Desire. Skin May Be Loose, Sagging and in Many Cases, Your Body Contours May Appear Irregular and Disharmonious.
If You Have Undergone Dramatic Weight Loss That Has Resulted in Excess Sagging Skin, Surgical Body Contouring May Be Right for You. In General, Body Contouring Following Major Weight Loss Reduces Excess Fat and Skin That Has Developed in Multiple Body Areas. The Result of Surgery Is a Smoother, More Attractive Body Contour. Body Contouring After Major Weight Loss Is an Important and Rewarding Phase of Your Challenge to Have a Healthier, More Proportionate Body, and Can Help You Further Enhance Your Body Image and Self-Confidence.
This Web Page Presents an Overview of Body Contouring Procedures That Follow Major Weight Loss. The Best Way to Learn How Body Contouring Can Help Fulfill Your Personal Goals Is a Consultation with a Plastic Surgeon Certified by the American Board of Plastic Surgery or the Royal College of Physicians and Surgeons of Canada.
What Is Body Contouring Following Major Weight Loss?
The Condition of Being Significantly Overweight Can Cause Stress on Your Health in Many Ways. If Your Physical Activity Has Been Limited Due to Your Overweight Condition, You May Have Weak Muscle and Poor Skin Tone, and Your Skin May Be Severely Stretched.
Bariatric Surgery, in Its Various Forms, Is One Method of Major Weight Loss for Individuals Clinically Defined as Obese. Following Weight Reduction Surgery, or Any Substantial Weight Loss, the Skin and Tissues Often Lack Elasticity and Cannot Conform to the Reduced Body Size. As a Result, Skin That Has Been Severely Stretched Now Is Unsupported, and Begins to Sag in Pockets That Most Commonly Develop Around These Areas:
Face, Neck and Jowls, Resulting in a Droopy, Sad Appearance
Upper Arms, Resulting in a “Bat-Wing” Appearance
Breasts, Causing Them to Flatten and Hang with Nipples Pointing Down
Abdominal Area, Extending Around the Sides and Into the Lower Back, Resulting in an Apron-Like Overhang
Buttocks, Groin and Thighs, Causing Hanging Pockets of Skin
Weak and Sagging Skin That Becomes Macerated (Wet or Infected) Is Not Only Unattractive, It Is Also a Serious Threat to Your Health That Should Be Treated.
Surgical Body Contouring After Major Weight Loss Improves the Shape and Tone of the Underlying Tissue That Supports Fat and Skin, and Removes Excess Sagging Fat and Skin. The Result Is a More Normal Body Appearance with Smoother Contours. This Is, in Essence, the Final Phase of Your Total Weight Loss Experience.
However, Before You Decide to Undergo Body-Contouring Surgery, It Is Important to Understand That Your Weight Loss Must Have Stabilized. If You Continue to Lose Weight, Sagging Pockets Will Redevelop. If You Rapidly Regain the Weight You Have Lost, You Will Traumatically Stress Your Already Weakened and Thin Skin, Causing Further Stress to the Skin, Visible Stretch Marks and Wide Scars.
If You Have Weight Reduction Surgery, Your Plastic Surgeon Will Work Closely with Your Physician to Determine When It Is Appropriate for You to Begin Body Contouring.
In General, Good Candidates for Body Contouring Are:
Adults of Any Age Whose Weight Loss Has Stabilized
Healthy Individuals Who Do Not Have Medical Conditions That Can Impair Healing or Increase Surgery Risks
Non-Smokers
Individuals with Positive Outlook and Realistic Goals
Individuals Committed to Leading a Healthy Lifestyle
Where Do I Begin?
A Consultation with Your Plastic Surgeon Is the First Step to Learn How Body Contouring Can Help You Achieve Better Health and an Improved Appearance. A Consultation Is Designed to Fully Educate You About Surgery in a Non-Pressured Environment, and Will Include:
A Discussion of Your Goals and an Evaluation of Your Individual Case
The Options Available in Body Contouring
The Likely Outcomes of Body Contouring and Any Associated Risks
The Course of Treatment Recommended by Your Plastic Surgeon
Evaluation
Overall Health and Personal Outlook Can Greatly Impact the Outcome of Your Surgery. These Will Be Carefully Evaluated in Your Consultation with Your Plastic Surgeon. The Success of Your Procedure, Safety and Overall Satisfaction Require That You Honestly Share Your Expectations, Fully Disclose Your Medical History and Commit to Following Your Surgeons Instructions.
Preparing for Surgery
Your Plastic Surgeon Will Carefully Explain Your Body-Contouring Plan. Prior to Any Surgery, You Will Be Given Specific Instructions That May Include Information About Diagnostic Testing, Medications, Day of Surgery Instructions, Anesthesia and Post-Operative Care.
In Addition, You Will Be Asked to Sign Consent Forms to Assure Your Plastic Surgeon That You Fully Understand the Procedure(S) and Any Associated Risks or Potential Complications. Possible Risks of Body Contouring Include Bleeding, Infection, Fluid Accumulation, Delayed or Poor Healing, Skin Loss, Blood Clots, Excessive or Widened Scars, Numbness and Other Changes in Skin Sensation, and Irregular or Asymmetric Scars. Any Surgery Carries Risks Associated with Anesthesia. These Risks and Others Will Be Fully Discussed Prior to Your Consent. It Is Important That You Address All Your Questions Directly with Your Plastic Surgeon. It Is Natural to Feel Some Anxiety, Whether Excitement for the Anticipated Outcomes or Preoperative Stress. Discuss These Feelings with Your Plastic Surgeon.
Where Is Surgery Performed?
Body Contouring Procedures May Be Performed in Your Surgeon's Accredited Office-Based Surgical Facility, an Ambulatory Surgical Facility or Hospital, Possibly with an Overnight Hospital Stay. Procedures Are Most Commonly Performed Under General Anesthesia, Although Local Anesthesia with Sedation May Also Be Used. These Decisions Will Be Based on the Requirements of Your Specific Procedure and Considerations of Patient and Surgeon Preference. Your Surgeon and the Assisting Staff Will Fully Attend to Your Comfort and Safety.
Procedural Steps
What Happens During Body Contouring Surgery?
The Procedures Necessary to Achieve Your Goals Will Be Defined Along with a Plan for the Timing of These Procedures. Plastic Surgery Procedures That May Be Recommended by Your Physician Include:
Lower Body Lift: To Correct Sagging of the Abdomen, Buttocks, Groin and Outer Thighs
Arm Lift: To Correct Sagging of the Upper Arms
Thigh Lift: To Correct Sagging of the Inner, Outer and Mid Thigh
Step 1 - Anesthesia
Medications Are Administered for Your Comfort During the Surgical Procedures. The Choices Include Intravenous Sedation and General Anesthesia. Your Doctor Will Recommend the Best Choice for You.
Step 2 - the Incision
All Body Contouring Procedures Require Incisions to Remove Excess Skin. In Many Cases, These Incisions May Be Extensive.
Incision Length and Pattern Depend on the Amount and Location of Excess Skin to Be Removed, as Well as Personal Preference and Your Doctor's Surgical Judgment.
Advanced Techniques Usually Allow Incisions to Be Placed in Strategic Locations Where They Can Be Hidden by Most Types of Clothing, but This Is Not Always the Case.
Body Contouring Is Often Performed in Stages. Your Particular Condition and Goals, as Well as Your Plastic Surgeon's Best Judgment, Will All Influence How Your Doctor Defines a Surgical Plan. While It May Have Taken You Two Years or More to Lose All the Excess Weight, It May Take Equally as Long for the Results of Your Body Contouring to Be Complete.
Body Lift
A Complete Lower Body Lift Treats Sagging Buttocks, Abdomen, Waist, Hips and Outer Thighs in One Procedure or in Staged Procedures. Incision Patterns Vary, and May Include a Circumferential Incision Around the Body to Remove the "Belt" of Excess Skin and Fat.
Breast Lift
The Incision Patterns for Lifting a Woman's Sagging Breasts Will Be Determined Based on the Amount of Excess Skin to Be Removed.
These May Include One or a Combination of Incisions in a Circular Pattern Around the Areola, in a Line Extending From the Areola to the Breast Crease, and Horizontally Along the Breast Crease.
A Breast Implant Also May Be Recommended to Enhance Breast Shape and Size.
Arm Lift
Sagging Skin in the Upper Arms Is Treated with an Incision From the Underarm Area Extending Along the Inside or Back of the Upper Arm. Additional Incisions on the Arms May Be Necessary Anywhere Excess Skin Has Formed Sagging Pockets.
The Smoother, Tighter Contours That Result From Upper Arm Contouring Are Apparent Almost Immediately, Although Initially Obscured by Swelling and Bruising. In Addition, Skin Quality Is Dramatically Improved in Both Appearance and Texture.
Thigh Lift
Reshaping of the Thighs Is Achieved Through Incisions in the Groin That Can Extend Downward to the Knee Along the Inner Portion of the Thigh.
Improving Contours of the Outer Thigh May Require an Incision Extending From the Groin Around the Hip. Through These Incisions Your Plastic Surgeon Will Tighten Tissues for a Smoother, Better Toned Thigh.
Following Surgery
Once Your Procedures Are Completed, Dressing or Bandages May Be Applied to Your Incisions. Areas of the Body That Have Been Treated May Be Wrapped in an Elastic Bandage to Minimize Swelling and Support Your New Contours as You Heal. Small, Thin Tubes May Be Temporarily Placed Under the Skin to Drain Excess Fluid or Blood That May Collect. Before You Are Released, You and Your Accompanying Caregiver Will Be Given Specific Instructions That May Include:
How to Care for the Surgical Site and Drains
Medications to Apply or Take Orally to Aid Healing and Reduce Infection Risk
Specific Concerns to Look for at the Surgical Site or in Your General Health
When to Follow Up with Your Plastic Surgeon
Progress and Healing
Initial Healing Will Include Swelling at the Incision Sites. Discomfort Is Common and Can Be Controlled with Medication. You Will Be Instructed to Return to Light Walking as Soon as Possible to Minimize the Potential for Blood Clots and Other Complications.
You May Be Instructed to Avoid Bending, Straining or Lifting for Several Days to Weeks. Where Tightening of the Abdomen or Thighs Is Involved, Your Plastic Surgeon May Also Instruct You to Avoid Standing Fully Upright and Stressing Any Internal Sutures as They Heal, and to Sleep with Pillows Elevating Your Knees. Follow All Instructions Carefully – This Is Essential to the Success of Your Outcome.
Initial Wound Healing May Take 7 to 14 Days, After Which Time Sutures Will Be Removed if Necessary. You Will Be Ready to Return to Work and Normal Activity in a Few Weeks, So Long as You Do Not Engage in Any Heavy Lifting or Vigorous Exercise.
Healing Will Continue for Many Weeks as Swelling Resolves and Incision Lines Continue to Improve. Numbness and a Firm Feeling Over the Skin's Surface Will Improve Over Time. Once You Have Completely Recovered From One Series of Procedures, It May Be Time to Begin Preparation for Additional Procedures in Other Body Areas.
Results and OutlookThe results of a body contouring following major weight loss are visible almost immediately; however, it may take as long as one to two years or more for the final results of all the recommended procedures to be fully appreciated. Visible scars are something you must accept in your goals to achieving a body contour that matches your new body weight and proportion. The results are long lasting, provided that you maintain a stable weight and general fitness. As your body ages, it is natural to lose some firmness, but most of your initial improvement should be relatively permanent.
Tumescent Technique
The Tumescent Technique Is a Relatively New Liposuction Method That Can Reduce Post Operative Bruising, Swelling and Pain. Because Blood Loss Is Minimized During Tumescent Liposuction, Use of the Technique Reduces the Chance That a Blood Transfusion Will Be Needed.
In the Tumescent Technique, Areas of Excess Fat Are Injected with a Large Amount of Anesthetic Liquid Before Liposuction Is Per-Formed. 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.
Candidates for Tumescent LiposuctionAny person who is a candidate for traditional liposuction is also a good candidate for the tumescent technique. Although the technique can be used on any area of the body, it is commonly used on areas that require enhanced precision, such as the face, neck, arms, calves and ankles. Individuals who have large areas of excess fat may also be good candidates for tumescent liposuction.
Understanding the Risk
Although the Anesthesia Requirements Are Lessened and Blood Loss Is Minimized with Tumescent Liposuction, Patients Undergoing the Procedure Still Face the Same Risks and Cosmetic Complications Associated with Tradi-Tional Liposuction Surgery.
There Are Also Risks Specifically Associated with the Tumescent Technique. These Rare Complications Include Pulmonary Edema (the Collection of Fluid in the Lungs), Which May Occur if Too Much Fluid Is Administered; And Lidocaine Toxicity, Which Occurs if the Solution's Lidocaine Content Is Too High.
You Can Reduce Your Risks by Choosing a Board-Certified Plastic Surgeon Who Has Adequate Experience with the Technique.
AnesthesiaFor many patients, general anesthesia is the best option. For others, the anesthetic contained in the solution combined with sedation may provide sufficient comfort during the procedure. Or, if your doctor feels it's appropriate, the tumescent solution itself may serve as the sole means of anesthesia.
The SurgeryIn tumescent liposuction, the warmed tumescent liquid -- a dilute solution containing lidocaine, epinephrine and intravenous fluid -- is injected into the area to be treated. As the liquid enters the fat, it becomes swollen, firm and blanched. Liposuction is then performed on the tumesced areas.
After Surgery
The Long-Acting Effects of the Anesthetic Solution Help to Provide Pain Relief After the Procedure and Decrease the Need for Additional Pain Medication.
For the First Day or Two After Surgery, Most Patients Experience Swelling in the Treated Areas, as Well as Some Fluid Drainage From the Incision Sites.
Light Activity Is Usually Resumed Within the First Few Days After Tumescent Liposuction; Normal Activity Can Be Resumed Within a Few Weeks.
Your New Look
Patients Are Usually Able to See a Noticeable Difference Almost Immediately After Surgery. However, More Improvement Can Be Seen After Three Weeks, When Most of the Swelling Has Subsided. After About Three Months, Any Persistent Mild Swelling Will Disappear and the Final Contour Will Be Visible.
Patients Are Usually Very Pleased with the Results of the Procedure. By Eating a Healthy Diet and Getting Regular Exercise, You Can Help to Maintain Your Slimmer Figure or Leaner Physique.
Cosmetic Plastic Surgery
Procedures at a GlanceThis page offers a general overview of cosmetic surgery procedures. For more in-depth information on these procedures, please follow the links in the left column.
Abdominoplasty
Procedure:Flatten abdomen by removing excess fat and skin and tightening muscles of abdominal wall.
Length:2 To 5 hours.
Anesthesia:General, or local with sedation.
In/Outpatient:Either depending on individual circumstances and extent of surgery.
Side Effects:Temporary pain. Swelling, soreness, numbness of abdominal skin, bruising, tiredness for several weeks or months.
Risks:Blood clots. Infection. Bleeding under the skin flap. Poor healing resulting in conspicuous scarring or skin loss. Need for a second operation.
Recovery:Back to work: 2 to 4 weeks. More strenuous activity: 4 to 6 weeks or more. Fading and flattening of scars: 3 months to 2 years.
Breast Enlargement
Procedure:Enhance the size of breasts using inflatable implants filled with saline.
Length:1 To 2 hours.
Anesthesia:Local with sedation, or general.
In/Outpatient:Usually outpatient.
Side Effects:Temporary soreness, swelling, change in nipple sensation, bruising. Breast sensitive to stimulation for a few weeks.
Risks:Lack of implant permanence -- surgical removal or replacement of the implants may be required to treat problems, including: deflation; the formation of scar tissue around the implant (capsular contracture), which may cause the breast to feel tight or hard; bleeding or infection. Increase or decrease in sensitivity of nipples or breast skin, occasionally permanent. Mammography requires a special technique. (Note: some women have reported symptoms similar to those of immune disorders. Ask your doctor about these and other fda concerns. )
Recovery:Back to work: a few days. Physical contact with breasts: 3 to 4 weeks. Fading of scars: several months to a year or more.
Duration of Results:Variable. Implants may require removal or replacement.
Breast Lift
Procedure:Raise and reshape sagging breasts by removing excess skin and repositioning remaining tissue and nipples.
Length:1 To 3 hours.
Anesthesia:Local with sedation, or general.
In/Outpatient:Usually outpatient. Sometimes inpatient.
Side Effects:Temporary bruising, swelling, discomfort, numbness, dry breast skin. Permanent scars.
Risks:Thick, wide scars; skin loss; infection. Unevenly positioned nipples. Permanent loss of feeling in nipples or breast.
Recovery:Back to work: 1 week or more. Strenuous activities: 1 month. Fading of scars: several months to a year.
Duration of Results:Variable; gravity, pregnancy, aging, and weight changes may cause new sagging. Results may last longer or be enhanced when breast implants are inserted as part of the procedure.
Chemical Peel
Procedure:Restore wrinkled, blemished, unevenly pigmented, or sun-damaged facial skin, using a chemical solution to peel away skin's top layers. Works best on fair, thin skin with superficial wrinkles.
Length:1 To 2 hours for full face.
Anesthesia:None; sedation and ekg monitoring may be used.
In/Outpatient:Usually outpatient. Full-face phenol peel may require admission for 1 to 2 days.
Side Effects:Both: temporary throbbing, tingling, swelling, redness; acute sensitivity to sun. Phenol: permanent lightening of treated skin; permanent loss of ability to tan.
Recovery:Phenol: formation of new skin: 7 to 21 days. Normal activities: 2 to 4 weeks. Full healing and fading of redness: 3 to 6 months tca: new skin within 5 to 10 days.
Duration of Results:Phenol: permanent, although new wrinkles may form as skin ages. Tca: variable (temporary).
Collagen / Fat Injections
Procedure:Plump up creased, furrowed, or sunken facial skin; add fullness to lips and backs of hands. Works best on thin, dry, light-colored skin.
Length:15 Minutes to 1 hour per session.
Anesthesia:Collagen: usually none; local may be included with the injection. Fat: local.
In/Outpatient:Outpatient.
Side Effects:Temporary stinging, throbbing, or burning sensation. Faint redness, swelling, excess fullness.
Risks:Collagen: allergic reaction including rash, hives, swelling, or flu-like symptoms; possible triggering of connective-tissue or autoimmune diseases. (A skin test is required before collagen treatment to determine whether an allergy exists. ) Both: contour irregularities, infection.
Duration of Results:Variable; a few months to 1 year.
Dermabrasion
Procedure:Mechanical scraping of the top layers of skin using a high-speed rotary wheel. Softens sharp edges of surface irregularities, including acne and other scars and fine wrinkles, especially around the mouth.
Length:A few minutes to 1 hour. May require more than 1 session.
Anesthesia:Local, numbing spray, or general.
In/Outpatient:Usually outpatient.
Side Effects:Temporary tingling, burning, itching, swelling, redness. Lightening of treated skin. Acute sensitivity to sun; loss of ability to make pigment (tan).
Recovery:Back to work: 2 weeks. More strenuous activities: 4 to 6 weeks. Fading of redness: about 3 months. Return of pigmentation/sun exposure: 6 to 12 months.
Duration of Results:Permanent, although new wrinkles may form as skin ages.
Ear Surgery
Procedure:Set prominent ears back closer to the head, or reduce the size of large ears. Most often done on children between the ages of 4 and 14 years. (Occasionally covered by insurance. )
Length:2 To 3 hours.
Anesthesia:Young children: usually general. Older children or adults: general or local, with sedation.
In/Outpatient:Usually outpatient.
Side Effects:Temporary throbbing, aching, swelling, redness, numbness.
Risks:Infection of cartilage. Excessive scarring. Blood clot that may need to be drained. Mismatched or artificial- looking ears. Recurrence of the protrusion, requiring repeat surgery.
Recovery:Back to work or school: 5 to 7 days.Strenuous activity, contact sports: 1 to 2 months.
Duration of Results:Usually permanent.
Eyelid Surgery
Procedure:Correct drooping upper eyelids and puffy bags below the eyes by removing excess fat, skin, and muscle. (Upper-eyelid surgery may be covered by insurance if used to correct visual field defects)
Length:1 To 3 hours.
Anesthesia:Usually locally with sedation or general.
In/Outpatient:Usually outpatient.
Side Effects:Temporary discomfort, tightness of lids, swelling, bruising. Temporary dryness, burning, itching of eyes. Excessive tearing, sensitivity to light for first few weeks.
Risks:Temporary blurred or double vision. Infection, bleeding. Swelling at the corners of the eyelids. Dry eyes. Formation of whiteheads. Slight asymmetry in healing or scarring. Difficulty in closing eyes completely (rarely permanent). Pulling down of the lower lids (may require further surgery). Blindness (extremely rare).
Recovery: Reading: 2 or 3 Days. Back to Work: 7 to 10 Days. Contact Lenses: Two Weeks or More. Strenuous Activities, Alcohol: About 3 Weeks. Bruising and Swelling Gone: Several Weeks.
Duration of Results:Several years. Sometimes permanent.
Facelift
Procedure:Improving sagging facial skin, jowls, and loose neck skin by removing excess fat, tightening muscles, redraping skin. Most often done on men and women over 40.
Length:Several hours.
Anesthesia:Local with sedation, or general.
In/Outpatient:Usually outpatient. Some patients may require short inpatient stay.
Side Effects:Temporary bruising, swelling, numbness and tenderness of skin; tight feeling, dry skin. For men, permanent need to shave behind ears, where beard-growing skin is repositioned.
Risks:Injury to the nerves that control facial muscles or feeling (usually temporary but may be permanent). Infection, bleeding. Poor healing; excessive scarring. Asymmetry or change in hairline.
Recovery:Back to work: 10 to 14 days. More strenuous activity: 2 weeks or more. Bruising: 2 to 3 weeks. Must limit exposure to sun for several months.
Duration of Results:Usually 5 to 10 years.
Facial Implants
Procedure:Change the basic shape and balance of the face using carefully shaped implants to build up a receding chin, add prominence to cheekbones, or reshape the jawline.
Side Effects:Temporary discomfort, swelling, bruising, numbness and/or stiffness. In jaw surgery, inability to open mouth fully for several weeks.
Risks:Shifting or imprecise positioning of implant, or infection around it, requiring a second operation or removal. Excess tightening and hardening of scar tissue around an artificial implant ("capsular contracture"), causing unnatural shape.
Recovery:Back to work: about 1 week. Normal appearance: 2 to 4 weeks. Activity that could jar or bump face: 6 weeks or more.
Duration of Results:Permanent.
Forehead Lift
Browlift
Procedure:Minimize forehead creases, drooping eyebrows, hooding over eyes, furrowed forehead and frown lines by removing excess tissue, altering muscles and tightening the forehead skin. May be done using the traditional technique, with an incision across the top of the head just behind the hairline; or with the use of an endoscope, which requires 3 to 5 short incisions. Most often done on people over 40.
Length:1 To 2 hours.
Anesthesia:Local with sedation, or general.
In/Outpatient:Usually outpatient.
Side Effects:Temporary swelling, numbness, headaches, bruising. Traditional method: possible itching and hair loss.
Risks:Injury to facial nerve, causing loss of motion, muscle weakness, or asymmetrical look. Infection. Broad or excessive scarring.
Recovery:Back to work: 7 to 10 days, usually sooner for endoscopic forehead lift. More strenuous activity: several weeks. Full recovery from bruising: 2 to 3 weeks. Limit sun exposure for several months.
Duration of Results:Usually 5 to 10 years.
Hair Replacement Surgery
Procedure:Fill in balding areas with a patient's own hair using a variety of techniques including scalp reduction, tissue expansion, strip grafts, scalp flaps, or clusters of punch grafts (plugs, miniplugs and microplugs). Works best on men with male pattern baldness after hair loss has stopped.
Length:1 To 3 hours. Some techniques may require multiple procedures over 18 months or more.
Anesthesia:Usually local with sedation. Flaps and tissue expansion may be done with general anesthesia.
In/Outpatient:Usually outpatient.
Side Effects:Temporary achy, tight scalp. Unnatural look in early stages.
Risks:Unnatural look. Infection. Excessive scarring. Failure to "take. " Loss of scalp tissue and/or transplanted hair.
Recovery:Back to work: usually 2 to 5 days. More strenuous activities: 10 days to 3 weeks. Final look: may be 18 months or more, depending on procedure.
Duration of Results:Permanent.
Laser Facial Resurfacing
Procedure:Smooth the face and smooth fine wrinkles using a carbon dioxide (co 2 ) laser device that treats layers of damaged skin. Softens lines around the eyes and mouth and minimizes facial scars and unevenly pigmented areas.
Length:A few minutes to 1 hour. May require more than 1 session.
Anesthesia:Local with sedation, or general.
In/Outpatient:Usually outpatient, unless combined with other surgical procedures that require hospitalization.
Side Effects:Temporary swelling, discomfort. Lightening of treated skin. Acute sun sensitivity. Increased sensitivity to makeup. Pinkness or redness in skin that may persist for up to 6 months.
Risks:Burns or injuries caused by laser heat. Scarring. Abnormal changes in skin color. Flare-up of viral infections ("cold sores") and other infections (rare).
Recovery:Back to work: 2 weeks. More strenuous activities: 4-6 weeks. Complete fading of redness: 6 months or less. Return of pigmentation/light sun exposure: 6-12 months.
Duration of Results:Long-lasting, but does not stop aging. New wrinkles, expression lines may form as skin ages.
Liposuction
Procedure:Improve body shape by removing exercise-resistant fat deposits with a tube and vacuum device. Can be performed using the tumescent technique, in which targeted fat cells are infused with saline containing solution with a local anesthetic before liposuction to reduce post-operative bruising and swelling. Common locations for liposuction include chin, cheeks, neck, upper arms, above breasts, abdomen, buttocks, hips, thighs, knees, calves, ankles.
Length:1 To 2 hours or more. Ual: 20-40 percent longer than traditional liposuction.
Anesthesia:Local, epidural, or general.
In/Outpatient:Usually outpatient. Extensive procedures may require short inpatient stay.
Side Effects:Temporary bruising, swelling, numbness, soreness, burning sensation. Tumescent: temporary fluid drainage from incision sites. Ual: larger incisions for cannula.
Risks:Asymmetry. Rippling or bagginess of skin. Pigmentation changes. Skin injury. Fluid retention. Excessive fluid loss leading to shock. Infection. Ual: thermal burn injury caused by the heat from the ultrasound device.
Recovery:Back to work: 1 to 2 weeks. More strenuous activity: 2 to 4 weeks. Full recovery from swelling and bruising: 1 to 6 months or more. Use of tumescent technique or ual may decrease post-operative bruising and swelling.
Duration of Results:Permanent, with sensible diet and exercise.
Male Breast Reduction
Procedure:Reduce enlarged, female-like breast in men using liposuction and/or cutting out excess glandular tissue. (Sometimes covered by medical insurance. )
Length:1 Hour or more.
Anesthesia:General or local.
In/Outpatient:Usually outpatient.
Side Effects:Temporary bruising, swelling, numbness, soreness, burning sensation.
Risks:Infection. Fluid accumulation. Injury to the skin. Rippling or bagginess of skin. Asymmetry. Pigmentation changes (may become permanent if exposed to sun). Excessive scarring if tissue was cut away. Need for second procedure to remove additional tissue.
Recovery:Back to work: 3 to 7 days. More strenuous activity: 2 to 3 weeks. Swelling and bruising: 3 to 6 months.
Duration of Results:Permanent
Nose Surgery
Procedure:Reshape nose by reducing or increasing size, removing hump, changing shape of tip or bridge, narrowing span of nostrils, or changing angle between nose and upper lip. May also relieve some breathing problems. (May be covered by insurance. )
Length:1 To 2 hours or more.
Anesthesia:Local with sedation, or general.
In/Outpatient:Usually outpatient.
Side Effects:Temporary swelling, bruising around eyes, nose and headaches. Some bleeding and stiffness.
Risks:Infection. Small burst blood vessels resulting in tiny, permanent red spots. Incomplete improvement, requiring additional surgery.
Recovery:Back to work: 1 to 2 weeks. More strenuous activities: 2 to 3 weeks. Avoid hitting nose or sunburn: 8 weeks. Final appearance: 1 year or more.
Duration of Results:Permanent.
Mommy Makeover
Moms Sacrifice So Much for the Family. At Surgical Renewal and Aesthetics We Understand That Not All Moms Are Lucky Enough to Bounce Back to Their Pre-Pregnancy Appearance. We Offer Special Mommy Makeover Packages to Help Regain That Youthful Contour.
We Understand the Frustration Many Mothers Go Through with Their Bodies After Childbirth. We Offer Personalized and Affordable Procedures to Help You on Your Road to Renewal.
You Are Key to Keeping Your Family on Track. We Will Help You Get Your Body Back on Track with Procedures Specifically Targeting the Changes Brought on by Motherhood:
Breast Lift or Breast Augmentation
Tummy Tuck
Liposuction of the Abdomen, Hips and Thighs
Reconstructive Surgery
Breast Reconstruction
A Tissue Expander Is Inserted Following the Mastectomy to Prepare for Reconstruction.
The Expander Is Gradually Filled with Saline Through an Integrated or Separate Tube to Stretch the Skin Enough to Accept an Implant Beneath the Chest Muscle.
After Surgery, the Breast Mound Is Restored. Scars Are Permanent, but Will Fade with Time. The Nipple and Areola Are Reconstructed at a Later Date.
With Flap Surgery, Tissue Is Taken From the Back and Tunneled to the Front of the Chest Wall to Support the Reconstructed Breast.
The Transported Tissue Forms a Flap for a Breast Implant, or It May Provide Enough Bulk to Form the Breast Mound Without an Implant.
Tissue May Be Taken From the Abdomen and Tunneled to the Breast or Surgically Transplanted to Form a New Breast Mound.
After Surgery, the Breast Mound, Nipple, and Areola Are Restored.
Scars at the Breast, Nipple, and Abdomen Will Fade Substantially with Time, but May Never Disappear Entirely.
If You're Considering Breast Reconstruction...
Reconstruction of a Breast That Has Been Removed Due to Cancer or Other Disease Is One of the Most Rewarding Surgical Procedures Available Today. New Medical Techniques and Devices Have Made It Possible for Surgeons to Create a Breast That Can Come Close in Form and Appearance to Matching a Natural Breast. Frequently, Reconstruction Is Possible Immediately Following Breast Removal (Mastectomy), So the Patient Wakes Up with a Breast Mound Already in Place, Having Been Spared the Experience of Seeing Herself with No Breast at All.
But Bear in Mind, Post-Mastectomy Breast Reconstruction Is Not a Simple Procedure. There Are Often Many Options to Consider as You and Your Doctor Explore What's Best for You.
This Information Will Give You a Basic Understanding of the Procedure -- When It's Appropriate, How It's Done, and What Results You Can Expect. It Can't Answer All of Your Questions, Since a Lot Depends on Your Individual Circumstances. Please Be Sure to Ask Your Surgeon if There Is Anything You Don't Understand About the Procedure.
The Best Candidates for Breast Reconstruction
Most Mastectomy Patients Are Medically Appropriate for Reconstruction, Many at the Same Time That the Breast Is Removed. The Best Candidates, However, Are Women Whose Cancer, as Far as Can Be Determined, Seems to Have Been Eliminated by Mastectomy.
Still, There Are Legitimate Reasons to Wait. Many Women Aren't Comfortable Weighing All the Options While They're Struggling to Cope with a Diagnosis of Cancer. Others Simply Don't Want to Have Any More Surgery Than Is Absolutely Necessary. Some Patients May Be Advised by Their Surgeons to Wait, Particularly if the Breast Is Being Rebuilt in a More Complicated Procedure Using Flaps of Skin and Underlying Tissue. Women with Other Health Conditions, Such as Obesity, High Blood Pressure, or Smoking, May Also Be Advised to Wait.
In Any Case, Being Informed of Your Reconstruction Options Before Surgery Can Help You Prepare for a Mastectomy with a More Positive Outlook for the Future.
All Surgery Carries Some Uncertainty and Risk
Virtually Any Woman Who Must Lose Her Breast to Cancer Can Have It Rebuilt Through Reconstructive Surgery. But There Are Risks Associated with Any Surgery and Specific Complications Associated with This Procedure.
In General, the Usual Problems of Surgery, Such as Bleeding, Fluid Collection, Excessive Scar Tissue, or Difficulties with Anesthesia, Can Occur Although They're Relatively Uncommon. And, as with Any Surgery, Smokers Should Be Advised That Nicotine Can Delay Healing, Resulting in Conspicuous Scars and Prolonged Recovery. Occasionally, These Complications Are Severe Enough to Require a Second Operation.
If an Implant Is Used, There Is a Remote Possibility That an Infection Will Develop, Usually Within the First Two Weeks Following Surgery. In Some of These Cases, the Implant May Need to Be Removed for Several Months Until the Infection Clears. A New Implant Can Later Be Inserted.
The Most Common Problem, Capsular Contracture, Occurs if the Scar or Capsule Around the Implant Begins to Tighten. This Squeezing of the Soft Implant Can Cause the Breast to Feel Hard. Capsular Contracture Can Be Treated in Several Ways, and Sometimes Requires Either Removal or Scoring of the Scar Tissue, or Perhaps Removal or Replacement of the Implant.
Reconstruction Has No Known Effect on the Recurrence of Disease in the Breast, Nor Does It Generally Interfere with Chemotherapy or Radiation Treatment, Should Cancer Recur. Your Surgeon May Recommend Continuation of Periodic Mammograms on Both the Reconstructed and the Remaining Normal Breast. If Your Reconstruction Involves an Implant, Be Sure to Go to a Radiology Center Where Technicians Are Experienced in the Special Techniques Required to Get a Reliable X-Ray of a Breast Reconstructed with an Implant.
Women Who Postpone Reconstruction May Go Through a Period of Emotional Readjustment. Just as It Took Time to Get Used to the Loss of a Breast, a Woman May Feel Anxious and Confused as She Begins to Think of the Reconstructed Breast as Her Own.
Planning Your Surgery
You Can Begin Talking About Reconstruction as Soon as You're Diagnosed with Cancer. Ideally, You'll Want Your Breast Surgeon and Your Plastic Surgeon to Work Together to Develop a Strategy That Will Put You in the Best Possible Condition for Reconstruction.
After Evaluating Your Health, Your Surgeon Will Explain Which Reconstructive Options Are Most Appropriate for Your Age, Health, Anatomy, Tissues, and Goals. Be Sure to Discuss Your Expectations Frankly with Your Surgeon. He or She Should Be Equally Frank with You, Describing Your Options and the Risks and Limitations of Each. Post-Mastectomy Reconstruction Can Improve Your Appearance and Renew Your Self-Confidence -- but Keep in Mind That the Desired Result Is Improvement, Not Perfection.
Your Surgeon Should Also Explain the Anesthesia He or She Will Use, the Facility Where the Surgery Will Be Performed, and the Costs. In Most Cases, Health Insurance Policies Will Cover Most or All of the Cost of Post-Mastectomy Reconstruction. Check Your Policy to Make Sure You're Covered and to See if There Are Any Limitations on What Types of Reconstruction Are Covered.
Preparing for Your Surgery
Your Oncologist and Your Plastic Surgeon Will Give You Specific Instructions on How to Prepare for Surgery, Including Guidelines on Eating and Drinking, Smoking, and Taking or Avoiding Certain Vitamins and Medications.
While Making Preparations, Be Sure to Arrange for Someone to Drive You Home After Your Surgery and to Help You Out for a Few Days, if Needed. Breast Reconstruction Usually Involves More Than One Operation. The First Stage, Whether Done at the Same Time as the Mastectomy or Later on, Is Usually Performed in a Hospital.
Follow-Up Procedures May Also Be Done in the Hospital. Or, Depending on the Extent of Surgery Required, Your Surgeon May Prefer an Outpatient Facility.
Types of Anesthesia
The First Stage of Reconstruction, Creation of the Breast Mound, Is Almost Always Performed Using General Anesthesia, So You'll Sleep Through the Entire Operation.
Follow-Up Procedures May Require Only a Local Anesthesia, Combined with a Sedative to Make You Drowsy. You'll Be Awake but Relaxed, and May Feel Some Discomfort.
Types of Implants
If Your Surgeon Recommends the Use of an Implant, You'll Want to Discuss What Type of Implant Should Be Used. A Breast Implant Is a Silicone Shell Filled with Either Saline or Elastic Silicone Gel.
While There Are Many Options Available in Post-Mastectomy Reconstruction, You and Your Surgeon Should Discuss the One That's Best for You.
Skin Expansion
The Most Common Technique Combines Skin Expansion and Subsequent Insertion of an Implant.
Following Mastectomy, Your Surgeon Will Insert a Balloon Expander Beneath Your Skin and Chest Muscle. Through a Tiny Valve Mechanism Buried Beneath the Skin, He or She Will Periodically Inject a Salt-Water Solution to Gradually Fill the Expander Over Several Weeks or Months. After the Skin Over the Breast Area Has Stretched Enough, the Expander May Be Removed in a Second Operation and a More Permanent Implant Will Be Inserted. Some Expanders Are Designed to Be Left in Place as the Final Implant. The Nipple and the Dark Skin Surrounding It, Called the Areola, Are Reconstructed in a Subsequent Procedure.
Some Patients Do Not Require Preliminary Tissue Expansion Before Receiving an Implant. For These Women, the Surgeon Will Proceed with Inserting an Implant as the First Step.
Flap Reconstruction
An Alternative Approach to Implant Reconstruction Involves Creation of a Skin Flap Using Tissue Taken From Other Parts of the Body, Such as the Back, Abdomen, or Buttocks.
In One Type of Flap Surgery, the Tissue Remains Attached to Its Original Site, Retaining Its Blood Supply. The Flap, Consisting of the Skin, Fat, and Muscle with Its Blood Supply, Are Tunneled Beneath the Skin to the Chest, Creating a Pocket for an Implant or, in Some Cases, Creating the Breast Mound Itself, Without Need for an Implant.
Another Flap Technique Uses Tissue That Is Surgically Removed From the Abdomen, Thighs, or Buttocks and Then Transplanted to the Chest by Reconnecting the Blood Vessels to New Ones in That Region. This Procedure Requires the Skills of a Plastic Surgeon Who Is Experienced in Microvascular Surgery as Well.
Regardless of Whether the Tissue Is Tunneled Beneath the Skin on a Pedicle or Transplanted to the Chest as a Microvascular Flap, This Type of Surgery Is More Complex Than Skin Expansion. Scars Will Be Left at Both the Tissue Donor Site and at the Reconstructed Breast, and Recovery Will Take Longer Than with an Implant. On the Other Hand, When the Breast Is Reconstructed Entirely with Your Own Tissue, the Results Are Generally More Natural and There Are No Concerns About a Silicone Implant. In Some Cases, You May Have the Added Benefit of an Improved Abdominal Contour.
Follow-Up Procedures
Most Breast Reconstruction Involves a Series of Procedures That Occur Over Time. Usually, the Initial Reconstructive Operation Is the Most Complex. Follow-Up Surgery May Be Required to Replace a Tissue Expander with an Implant or to Reconstruct the Nipple and the Areola. Many Surgeons Recommend an Additional Operation to Enlarge, Reduce, or Lift the Natural Breast to Match the Reconstructed Breast. But Keep in Mind, This Procedure May Leave Scars on an Otherwise Normal Breast and May Not Be Covered by Insurance.
After Your Surgery
You Are Likely to Feel Tired and Sore for a Week or Two After Reconstruction. Most of Your Discomfort Can Be Controlled by Medication Prescribed by Your Doctor.
Depending on the Extent of Your Surgery, You'll Probably Be Released From the Hospital in Two to Five Days. Many Reconstruction Options Require a Surgical Drain to Remove Excess Fluids From Surgical Sites Immediately Following the Operation, but These Are Removed Within the First Week or Two After Surgery. Most Stitches Are Removed in a Week to 10 Days.
Getting Back to Normal
It May Take You Up to Six Weeks to Recover From a Combined Mastectomy and Reconstruction or From a Flap Reconstruction Alone. If Implants Are Used Without Flaps and Reconstruction Is Done Apart From the Mastectomy, Your Recovery Time May Be Less.
Reconstruction Cannot Restore Normal Sensation to Your Breast, but in Time, Some Feeling May Return. Most Scars Will Fade Substantially Over Time, Though It May Take as Long as One to Two Years, but They'll Never Disappear Entirely. The Better the Quality of Your Overall Reconstruction, the Less Distracting You'll Find Those Scars.
Follow Your Surgeon's Advice on When to Begin Stretching Exercises and Normal Activities. As a General Rule, You'll Want to Refrain From Any Overhead Lifting, Strenuous Sports, and Sexual Activity for Three to Six Weeks Following Reconstruction.
Your New Look
Chances Are Your Reconstructed Breast May Feel Firmer and Look Rounder or Flatter Than Your Natural Breast. It May Not Have the Same Contour as Your Breast Before Mastectomy, Nor Will It Exactly Match Your Opposite Breast. But These Differences Will Be Apparent Only to You. For Most Mastectomy Patients, Breast Reconstruction Dramatically Improves Their Appearance and Quality of Life Following Surgery.
Hand Surgery
Carpel Tunnel Syndrome Can Cause Tingling, Numbness, or a Dull Ache in the Shaded Area Shown in This Illustration.
The Surgeon Makes an Incision From the Palm to the Wrist, Providing Access to the Tissue That's Causing Pressure on the Nerve.
A Section of Tissue Is Cut, Relieving Pressure on the Nerve and Restoring Feeling and Function to the Hand.
In Dupuytren's Contracture, Scar-Like Tissue in the Palm Pulls Fingers Into an Abnormal Position. The Surgeon May Make Zig-Zag Incisions Across This Band of Tissue, Creating Small Skin Flaps.
After Surgery the Repositioned Flaps Expand Like an Accordion, Allowing Freer Finger Motion.
In a Typical Syndactyly, Two Fingers Are Fused Together. The Surgeon Often Uses Zig-Zag Incisions to Separate the Fingers, Creating Triangular Skin Flaps.
Skin Flaps Cover Most of the Exposed Areas Between the Fingers. Skin Grafts Are Used to Fill the Shaded Areas at the Base of the Fingers.
Dramatic Advances Have Been Made in Recent Years in Treating Patients with Hand Injuries, Degenerative Disorders, and Birth Defects of the Hand. At the Forefront of These Advances Have Been Plastic Surgeons-Specialists Whose Major Interest Is Improving Both Function and Appearance. Plastic Surgeons Undergo Intensive Training in Hand Surgery, and They (Along with Orthopedic Surgeons and General Surgeons) Treat Patients with a Wide Range of Hand Problems.
This Information Is Designed to Give You a Basic Understanding of the Most Common Hand Problems-What They Are, What Plastic Surgeons Can Do for Them, and the Results You Can Expect. It Can't Answer All of Your Questions, Since Each Problem Is Unique and a Great Deal Depends on Your Individual Circumstances. Please Be Sure to Ask Your Doctor if There Is Anything About the Procedure You Don't Understand.
If You're Considering Hand Surgery
If You're Considering Hand Surgery, a Consultation with a Plastic Surgeon Is a Good Place to Start. The Surgeon Will Examine You, Discuss the Possible Methods of Treatment for Your Problem, and Let You Know if Surgery Is Warranted. If It Is, the Surgeon Will Discuss the Procedure in Detail, Including Where the Surgery Will Be Performed (in the Surgeon's Office, an Outpatient Surgery Center, or a Hospital), the Anesthesia and Surgical Techniques That Will Be Used, Possible Risks and Complications, the Recovery and Rehabilitation Period, and the Probable Outcome in Terms of Function and Appearance.
Don't Hesitate to Ask Your Surgeon Any Questions You May Have During the Initial Consultation-Including Any Concerns You Have About the Recommended Treatment and the Costs Involved. (Since Hand Surgery Is Performed Primarily to Correct Physical Abnormalities, It Usually Is Covered by Insurance. Check Your Policy or Call Your Carrier to Be Sure.)
All Surgery Carries Some Uncertainty and Risk
Thousands of Successful Hand Operations Are Performed Each Year. While the Procedures Are Generally Safe When Performed by a Qualified and Experienced Plastic Surgeon, Complications Can Arise.
In All Types of Hand Surgery, the Possible Complications Include Infection, Poor Healing, Loss of Feeling or Motion, Blood Clots, and Adverse Reactions to the Anesthesia. These Complications Are Infrequent, However, and They Can Generally Be Treated. You Can Reduce Your Risks by Choosing a Qualified Surgeon and by Closely Following His or Her Advice.
Hand Injuries
The Most Common Procedures in Hand Surgery Are Those Done to Repair Injured Hands, Including Injuries to the Tendons, Nerves, Blood Vessels, and Joints; Fractured Bones; And Burns, Cuts, and Other Injuries to the Skin. Modern Techniques Have Greatly Improved the Surgeon's Ability to Restore Function and Appearance, Even in Severe Injuries.
Among the Techniques Now Used by Plastic Surgeons:
GraftingThe transfer of skin, bone, nerves, or other tissue from a healthy part of the body to repair the injured part;
Flap SurgeryMoving the skin along with its underlying fat, blood vessels, and muscle from a healthy part of the body to the injured site;
Replantation or Transplantation - Restoring Accidentally Amputated Fingers or Hands Using Microsurgery, an Extremely Precise and Delicate Surgery Performed Under Magnification. Some Injuries May Require Several Operations Over an Extended Period of Time. In Many Cases, Surgery Can Restore a Significant Degree of Feeling and Function to Injured Hands. However, Recovery May Take Months, and a Period of Hand Therapy Will Most Often Be Needed (See Recovery and Rehabilitation Below.)
Carpal Tunnel Syndrome
The Carpal Tunnel Is a Passageway Through the Wrist Carrying Tendons and One of the Hand's Major Nerves. Pressure May Build Up Within the Tunnel Because of Disease (Such as Rheumatoid Arthritis), Injury, Fluid Retention During Pregnancy, Overuse, or Repetitive Motions. The Resulting Pressure on the Nerve Within the Tunnel Causes a Tingling Sensation in the Hand, Often Accompanied by Numbness, Aching, and Impaired Hand Function. This Is Known as Carpal Tunnel Syndrome.
In Some Cases, Splinting of the Hand and Anti-Inflammatory Medications Will Relieve the Problem. If This Doesn't Work, However, Surgery May Be Required.
In the Operation, the Surgeon Makes an Incision From the Middle of the Palm to the Wrist. He or She Will Then Cut the Tissue That's Pressing on the Nerve, in Order to Release the Pressure. A Large Dressing and Splint Are Used After Surgery to Restrict Motion and Promote Healing. The Scar Will Gradually Fade and Become Barely Visible.
The Results of the Surgery Will Depend in Part on How Long the Condition Has Existed and How Much Damage Has Been Done to the Nerve. For That Reason, It's a Good Idea to See a Doctor Early if You Think You May Have Carpal Tunnel Syndrome.
Rheumatoid Arthritis
Rheumatoid Arthritis, an Inflammation of the Joints, Is a Disabling Disease That Can Affect the Appearance and the Function of the Hands and Other Parts of the Body. It Often Deforms Finger Joints and Forces the Fingers Into a Bent Position That Hampers Movement.
Disabilities Caused by Rheumatoid Arthritis Can Often Be Managed Without Surgery-for Example, by Wearing Special Splints or Using Physical Therapy to Strengthen Weakened Areas. For Some Patients, However, Surgery Offers the Best Solution. Whether or Not to Have Surgery Is a Decision You Should Make in Consultation with Your Surgeon and Your Rheumatologist.
Surgeons Can Repair or Reconstruct Almost Any Area of the Hand or Wrist by Removing Tissue From Inflamed Joints, Repositioning Tendons, or Implanting Artificial Joints. While Your Hand May Not Regain Its Full Use, You Can Generally Expect a Significant Improvement in Function and Appearance. Still, It's Important to Remember That Surgical Repair Doesn't Eliminate the Underlying Disease. Rheumatoid Arthritis Can Continue to Cause Damage to Your Hand, Sometimes Requiring Further Surgery, and You'll Still Need to See Your Rheumatologist for Continuing Care.
Dupuytren's Contracture
Dupuytren's Contracture Is a Disorder of the Skin and Underlying Tissue on the Palm Side of the Hand. Thick, Scar-Like Tissue Forms Under the Skin of the Palm and May Extend Into the Fingers, Pulling Them Toward the Palm and Restricting Motion. The Condition Usually Develops in Mid-Life and Has No Known Cause (Though It Has a Tendency to Run in Families).
Surgery Is the Only Treatment for Dupuytren's Contracture. The Surgeon Will Cut and Separate the Bands of Thickened Tissue, Freeing the Tendons and Allowing Better Finger Movement. The Operation Must Be Done Very Precisely, Since the Nerves That Supply the Hand and Fingers Are Often Tightly Bound Up in the Abnormal Tissue. In Some Cases, Skin Grafts Are Also Needed to Replace Tightened and Puckered Skin.
The Results of the Surgery Will Depend on the Severity of the Condition. You Can Usually Expect Significant Improvement in Function, Particularly After Physical Therapy (See Recovery and Rehabilitation.), and a Thin, Fairly Inconspicuous Scar.
Congenital Deformities
Congenital Deformities of the Hand-That Is, Deformities a Child Is Born with-Can Interfere with Proper Hand Growth and Cause Significant Problems in the Use of the Hand. Fortunately, with Modern Surgical Techniques Most Defects Can Be Corrected at a Very Early Age-in Some Cases During Infancy, in Others at Two or Three Years-Allowing Normal Development and Functioning of the Hand.
One of the Most Common Congenital Defects Is Syndactyly, in Which Two or More Fingers Are Fused Together. Surgical Correction Involves Cutting the Tissue That Connects the Fingers, Then Grafting Skin From Another Part of the Body. (the Procedure Is More Complicated if Bones Are Also Fused.) Surgery Can Usually Provide a Full Range of Motion and a Fairly Normal Appearance, Although the Color of the Grafted Skin May Be Slightly Different From the Rest of the Hand.
Other Common Congenital Defects Include Short, Missing, or Deformed Fingers, Immobile Tendons, and Abnormal Nerves or Blood Vessels. In Most Cases, These Defects Can Be Treated Surgically and Significant Improvement Can Be Expected.
Recovery and Rehabilitation
Since the Hand Is a Very Sensitive Part of the Body, You May Have Mild to Severe Pain Following Surgery. Your Surgeon Can Prescribe Injections or Oral Medication to Make You More Comfortable. How Long Your Hand Must Remain Immobilized and How Quickly You Resume Your Normal Activities Depends on the Type and Extent of Surgery and on How Fast You Heal.
To Enhance Your Recovery and Give You the Fullest Possible Use of Your Hand, Your Surgeon May Recommend a Course of Rehabilitation (Physical and Occupational Therapy) Under the Direction of a Trained Hand Therapist. Your Therapy May Include Hand Exercises, Heat and Massage Therapy, Electrical Nerve Stimulation, Splinting, Traction, and Special Wrappings to Control Swelling. Keep in Mind That Surgery Is Just the Foundation for Recovery. It's Crucial That You Follow the Therapist's Instructions and Complete the Entire Course of Therapy if You Want to Regain the Maximum Use of Your Hand.
Skin Cancer
Basal Cell Carcinoma May Come in Many Forms. It Often Begins as a Small, Pearly Nodule.
Squamous Cell Carcinoma May Begin as a Red, Scaly Patch, a Group of Crusted Nodules, or a Sore That Doesn't Heal.
Malignant Melanoma Is Often Asymmetrical, with Blurred or Ragged Edges and Mottled Colors.
Small Skin Cancers Can Often Be Excised Quickly and Easily in the Physician's Office.
Simple Excision Usually Leaves a Thin Barely Visible Scar.
A Bone/Soft Tissue Flap Is Used to Reconstruct the Nose Following Skin Cancer Excision.
The Incision Lines of the Flap Are Hidden Within the Natural Creases of the Nose and Face.
Skin Cancer Is the Most Common Form of Cancer in the United States. More Than 500,000 New Cases Are Reported Each Year and the Incidence Is Rising Faster Than Any Other Type of Cancer. While Skin Cancers Can Be Found on Any Part of the Body, About 80 Percent Appear on the Face, Head, or Neck, Where They Can Be Disfiguring as Well as Dangerous.
The Purpose of This Web Page Is to Educate You About the Different Types of Skin Cancer, Their Causes, and Preventive Measures You Can Take; To Help You Know When to Consult a Doctor; And to Explain the Role of the Plastic Surgeon in the Diagnosis and Treatment of Skin Cancer and Other Skin Growths.
The Primary Cause of Skin Cancer Is Ultraviolet Radiation, Most Often From the Sun, but Also From Artificial Sources Like Sunlamps and Tanning Booths. In Fact, Researchers Believe That Our Quest for the Perfect Tan, an Increase in Outdoor Activities, and Perhaps the Thinning of the Earth's Protective Ozone Layer Are Behind the Alarming Rise We're Now Seeing in Skin Cancers.
Anyone Can Get Skin Cancer, No Matter What Your Skin Type, Race or Age, No Matter Where You Live or What You Do. But Your Risk Is Greater if...
Your Skin Is Fair and Freckles Easily.
You Have Light-Colored Hair and Eyes.
You Have a Large Number of Moles, or Moles of Unusual Size or Shape.
You Have a Family History of Skin Cancer or a Personal History of Blistering Sunburn.
You Spend a Lot of Time Working or Playing Outdoors.
You Live Closer to the Equator, at a Higher Altitude, or in Any Place That Gets Intense, Year-Round Sunshine.
You Received Therapeutic Radiation Treatments for Adolescent Acne.
Types of Skin Cancer
By Far the Most Common Type of Skin Cancer Is Basal Cell Carcinoma. Fortunately, It's Also the Least Dangerous Kind; It Tends to Grow Slowly and Rarely Spreads Beyond Its Original Site. Though Basal Cell Carcinoma Is Seldom Life-Threatening, if Left Untreated It Can Grow Deep Beneath the Skin and Into the Underlying Tissue and Bone, Causing Serious Damage (Particularly if It's Located Near the Eye).
Squamous Cell Carcinoma Is the Next Most Common Kind of Skin Cancer, Frequently Appearing on the Lips, Face, or Ears. It Sometimes Spreads to Distant Sites, Including Lymph Nodes and Internal Organs. Squamous Cell Carcinoma Can Become Life Threatening if It's Not Treated.
A Third Form of Skin Cancer, Malignant Melanoma, Is the Least Common, but Its Incidence Is Increasing Rapidly, Especially in the Sunbelt States. Malignant Melanoma Is the Most Dangerous Type of Skin Cancer. If Discovered Early Enough, It Can Be Completely Cured. If It's Not Treated Quickly, However, Malignant Melanoma May Spread Throughout the Body and Is Often Deadly.
Other Skin Growths You Should Know About
Two Other Common Types of Skin Growths Are Moles and Keratoses.
Moles Are Clusters of Heavily Pigmented Skin Cells, Either Flat or Raised Above the Skin Surface. While Most Pose No Danger, Some-Particularly Large Moles Present at Birth, or Those with Mottled Colors and Poorly Defined Borders-May Develop Into Malignant Melanoma. Moles Are Frequently Removed for Cosmetic Reasons, or Because They're Constantly Irritated by Clothing or Jewelry (Which Can Sometimes Cause Pre-Cancerous Changes).
Solar or Actinic Keratoses Are Rough, Red or Brown, Scaly Patches on the Skin. They Are Usually Found on Areas Exposed to the Sun, and Sometimes Develop Into Squamous Cell Cancer.
Recognizing Skin Cancer
Basal and Squamous Cell Carcinomas Can Vary Widely in Appearance. The Cancer May Begin as Small, White or Pink Nodule or Bumps; It Can Be Smooth and Shiny, Waxy, or Pitted on the Surface. Or It Might Appear as a Red Spot That's Rough, Dry, or Scaly...a Firm, Red Lump That May Form a Crust...a Crusted Group of Nodules...a Sore That Bleeds or Doesn't Heal After Two to Four Weeks...or a White Patch That Looks Like Scar Tissue.
Malignant Melanoma Is Usually Signaled by a Change in the Size, Shape, or Color of an Existing Mole, or as a New Growth on Normal Skin. Watch for the "Abcd" Warning Signs of Melanoma: Asymmetry-a Growth with Unmatched Halves; Border Irregularity-Ragged or Blurred Edges; Color-a Mottled Appearance, with Shades of Tan, Brown, and Black, Sometimes Mixed with Red, White, or Blue; And Diameter- a Growth More Than 6 Millimeters Across (About the Size of a Pencil Eraser), or Any Unusual Increase in Size.
If All These Variables Sound Confusing, the Most Important Thing to Remember Is This: Get to Know Your Skin and Examine It Regularly, From the Top of Your Head to the Soles of Your Feet. (Don't Forget Your Back.) if You Notice Any Unusual Changes on Any Part of Your Body, Have a Doctor Check It Out.
Choosing a Doctor
If You're Concerned About Skin Cancer, Your Family Physician Is a Good Place to Start. He or She Should Examine Your Skin at Your Annual Physical, and Can Refer You to a Specialist if Necessary.
If You Notice an Unusual Growth Yourself, Consult a Plastic Surgeon or a Dermatologist. Both Are Skilled at Diagnosing and Treating Skin Cancer and Other Skin Growths. A Plastic Surgeon Can Surgically Remove the Growth in a Manner That Maintains Function and Offers the Most Pleasing Final Appearance, a Consideration That May Be Especially Important if the Cancer Is in a Highly Visible Area. If a Treatment Other Than Surgical Excision Is Called for, the Plastic Surgeon Can Refer You to the Appropriate Specialist.
Diagnosis and Treatment
Skin Cancer Is Diagnosed by Removing All or Part of the Growth and Examining Its Cells Under a Microscope. It Can Be Treated by a Number of Methods, Depending on the Type of Cancer, Its Stage of Growth, and Its Location on Your Body.
Most Skin Cancers Are Removed Surgically, by a Plastic Surgeon or a Dermatologist. If the Cancer Is Small, the Procedure Can Be Done Quickly and Easily, in an Outpatient Facility or the Physician's Office, Using Local Anesthesia. The Procedure May Be a Simple Excision, Which Usually Leaves a Thin, Barely Visible Scar. Or Curettage and Desiccation May Be Performed. In This Procedure the Cancer Is Scraped Out with an Electric Current to Control Bleeding and Kill Any Remaining Cancer Cells. This Leaves a Slightly Larger, White Scar. In Either Case, the Risks of the Surgery Are Low.
If the Cancer Is Large, However, or if It Has Spread to the Lymph Glands or Elsewhere in the Body, Major Surgery May Be Required. Other Possible Treatments for Skin Cancer Include Cryosurgery (Freezing the Cancer Cells), Radiation Therapy (Using X-Rays), Topical Chemotherapy (Anti-Cancer Drugs Applied to the Skin), and Mohs Surgery, a Special Procedure in Which the Cancer Is Shaved Off One Layer at a Time. (Mohs Surgery Is Performed Only by Specially Trained Physicians and Often Requires a Reconstructive Procedure as Follow-Up.)
Discussing Your Options and Concerns
All of the Treatments Mentioned Above, When Chosen Carefully and Appropriately, Have Good Cure Rates for Most Basal Cell and Squamous Cell Cancers, and Even for Malignant Melanoma if It's Caught Early Enough.
You Should Discuss These Choices Thoroughly with Your Doctor Before Beginning Treatment. Find Out Which Options Are Available to You, How Effective They're Likely to Be for Your Particular Cancer, the Possible Risks and Side Effects, Who Can Best Perform Them, and the Cosmetic and Functional Results You Can Expect. If You Have Any Doubts About the Outcome, Get a Second Opinion From a Plastic Surgeon Before You Begin Treatment.
A Word About Reconstruction
The Different Techniques Used in Treating Skin Cancers Can Be Life Saving, but They May Leave a Patient with Less Than Pleasing Cosmetic or Functional Results. Depending on the Location and Severity of the Cancer, the Consequences May Range From a Small but Unsightly Scar to Permanent Changes in Facial Structures Such as Your Nose, Ear, or Lip.
In Such Cases, No Matter Who Performs the Initial Treatment, the Plastic Surgeon Can Be an Important Part of the Treatment Team. Reconstructive Techniques, Ranging From a Simple Scar Revision to a Complex Transfer of Tissue Flaps From Elsewhere on the Body, Can Often Repair Damaged Tissue, Rebuild Body Parts, and Restore Most Patients to Acceptable Appearance and Function.
Preventing a Recurrence
After You've Been Treated for Skin Cancer, Your Doctor Should Schedule Regular Follow-Up Visits to Make Sure the Cancer Hasn't Recurred.
Your Physician, However, Can't Prevent a Recurrence. It's Up to You to Reduce Your Risks by Changing Old Habits and Developing New Ones. (These Preventive Measures Apply to People Who Have Not Had Skin Cancer as Well.)
Avoid Prolonged Exposure to the Sun, Especially Between 10 a.M. And 2 P.M. And During the Summer Months. Remember, Ultraviolet Rays Pass Right Through Water and Clouds, and Reflect Off Sand and Snow.
When You Do Go Out for an Extended Period of Time, Wear Protective Clothing Such as Wide Brimmed Hats and Long Sleeves.
On Any Exposed Skin, Use a Sunscreen with an Spf (Sun Protection Factor) of at Least 15. Reapply It Frequently, Especially After You've Been Swimming or Sweating.
Finally, Examine Your Skin Regularly. If You Find Anything Suspicious, Consult a Plastic Surgeon or a Dermatologist as Soon as Possible.
Tissue Expansion
Tissue Expansion Is a Relatively Straightforward Procedure That Enables the Body to "Grow" Extra Skin for Use in Reconstructing Almost Any Part of the Body. A Silicone Balloon Expander Is Inserted Under the Skin Near the Area to Be Repaired and Then Gradually Filled with Salt Water Over Time, Causing the Skin to Stretch and Grow. Although Tissue Expansion Is Most Commonly Used for Breast Reconstruction, It Also May Be Used to Repair Skin Damaged by Birth Defects, Accidents or Surgery, and in Certain Cosmetic Procedures.
If Your Doctor Is Recommending Tissue Expansion, This Will Give You a Basic Understanding of the Procedure. It Can't Answer All of Your Questions, Since a Lot Depends on Your Individual Circumstances. Please Be Sure to Ask Your Surgeon if There Is Anything You Don't Understand About the Procedure.
The Best Candidates for Tissue Expansion
Almost Anyone in Need of Additional Skin Can Benefit From Tissue Expansion, From Infants to Elderly Men and Women.
The Procedure Is Used Widely in Breast Reconstruction When There Is Not Enough Skin to Accommodate a Permanent Implant to Restore a Woman's Natural Appearance. It Is Also an Option for Repairing or Replacing Areas of the Scalp, Where Hair Growth Makes It Difficult to Replace Lost Tissue with Skin From Other Areas of the Body. Tissue Expansion Generally Produces Excellent Results When Reconstructing Some Areas of the Face and Neck, the Hands, Arms, and Legs.
Expansion May Be More Difficult on the Back, Torso, or Other Areas Where Skin Is Thick. If the Affected Area Is Severely Damaged or Scarred, Expansion Is Probably Not an Option, Since Healthy Skin Is the First Requirement.
Advantages and Disadvantages
Until Recently, Surgeons Were Limited to Skin Flaps and Skin Grafts to Reconstruct Damaged Tissue. Tissue Expansion, However, Provides an Added Technique with Several Advantages.
First, Expansion Offers a Near-Perfect Match of Color, Texture, and Hair-Bearing Qualities. Second, Because the Skin Remains Connected to the Donor Area's Blood and Nerve Supply, There Is a Smaller Risk That It Will Die. In Addition, Because the Skin Doesn't Have to Be Moved From One Area to Another, Scars Are Often Less Apparent.
On the Other Hand, Skin Expansion Has One Significant Drawback: The Length of Time Required to Grow Additional Skin. Depending on the Area to Be Reconstructed, Tissue Expansion Can Take as Long as 3 - 4 Months. During This Time, the Expander Creates What Can Be an Unsightly Bulge, Which Is Desirable in Breast Reconstruction, but Can Be Quite Noticeable for Someone Requiring Repair of the Scalp or Other Areas of the Body. Furthermore, the Procedure Requires Repeated Visits to the Surgeon for Injection of the Salt Water That Inflates the Balloon. For Some People, the Inconvenience and Obvious Appearance of an Expander Are Enough for Them to Consider Other Options.
All Surgery Carries Some Uncertainty and Risk
Skin Expansion Can Produce Some Remarkable Results. But as with Any Operation, There Are Risks Associated with Surgery and Specific Complications Associated with This Procedure.
The Most Common Concern Is That the Silicone Expander Used in the Procedure Will Break or Leak While It Is in the Body. While Expanders Are Rigorously Tested and Placed with Care, Leaks Do Occur. If the Expander Should Leak, the Salt-Water Solution, Also Known as Saline, Used to Fill the Expander Is Harmlessly Absorbed by Your System and the Expander Is Replaced in a Relatively Minor Surgical Procedure.
A Small Percentage of Patients Develop an Infection Around the Expander. While This May Occur at Any Time, It's Most Often Seen Within a Few Weeks After the Expander Is Inserted. In Some Cases, the Expander May Need to Be Removed for Several Months Until the Infection Clears. A New Expander Can Then Be Inserted.
You May Have Concerns About the Use of a Silicone Tissue Expander in This Procedure Because of the Food and Drug Administration's (Fda) Limitations on Silicone Breast Implants. At This Time, the Fda Ruling Does Not Affect Tissue Expanders Because They Are Filled with Salt Water, Not Silicone Gel, and Are Left in Place for Only Six to 10 Weeks, Not Permanently. Be Sure to Ask Your Doctor if You Want to Know More About the Fda Recommendations.
Planning Your Surgery
During Your Initial Consultation, Your Surgeon Will Evaluate Your Condition. Your Age, Skin Condition, Medical History and Other Factors Will Help Your Surgeon Determine if You'll Benefit From Tissue Expansion. Your Flexibility and Tolerance for the Inconvenience Associated with This Procedure Will Help You Determine if You Want to Pursue It. Before Proceeding with Tissue Expansion, Discuss Your Expectations and Your Understanding of It with Your Surgeon.
Preparing for Your Surgery
Your Surgeon Will Give You Specific Instructions on How to Prepare for Surgery, Including Guidelines on Eating and Drinking, Smoking, and Taking or Avoiding Certain Medications.
If You Smoke, Your Surgeon Will Probably Ask You to Quit for at Least Two Weeks Before and After Your Surgery, Since Smoking May Have an Effect on How Well You Heal.
Whether Your Surgery Is Done on an Outpatient or Inpatient Basis, You Should Arrange for Someone to Drive You Home After Your Surgery, and to Help You Out for a Day or Two, if Needed.
Where Your Surgery Will Be Performed
While Most Tissue Expansion Is Done in an Outpatient Surgical Facility, the Size and Location of the Expansion, as Well as the Preference of the Patient and Surgeon, Will Dictate Where the Surgery Takes Place.
Your Surgeon May Begin Tissue Expansion Immediately at the Time of Breast Removal. If You've Had an Injury, on the Other Hand, Your Surgeon Will Probably Recommend That Tissue Expansion Be Performed in an Outpatient Surgical Facility After the Wound Has Healed.
More and More Frequently, Surgeons Are Performing Tissue Expansions on an Out Patient Basis for Cost Savings and Convenience.
Types of Anesthesia
Your Surgeon May Use Local Anesthesia, Combined with a Sedative to Make You Drowsy. You'll Be Awake but Relaxed, and Should Feel Little Discomfort. Or, Your Surgeon May Recommend the Use of a General Anesthesia, in Which Case You'll Sleep Through the Entire Operation.
The Surgery
In Most Cases, the Initial Operation Will Take One to Two Hours, Depending on the Size and Area of Skin to Be Expanded. Your Surgeon Will Begin by Making a Small Incision Next to the Area of Skin to Be Repaired, and Will Do Everything Possible to Make the Incision as Inconspicuous as Possible.
He or She Will Then Insert the Silicone Balloon Expander in a Pocket Created Beneath the Skin. The Expander Includes a Tiny Tube and a Self-Sealing Valve That Allows the Surgeon to Gradually Fill the Expander with Saline Solution. The Valve Is Usually Left Just Beneath the Surface of the Skin.
Once the Incision Has Healed, You'll Be Asked to Return to Your Surgeon's Office Periodically So That the Expander Can Be Injected with Additional Saline. As the Expander Enlarges, Your Skin Will Stretch. In Some People, This Procedure Causes Some Minor Discomfort.
When the Skin Has Stretched Enough to Cover the Affected Area, You'll Have a Second Operation to Remove the Expander and Reposition the New Tissue. In Breast Reconstruction, the Surgery Required to Remove the Expander and Insert the Permanent Implant Is Relatively Brief. More Complex Surgery to Repair Skin on the Face or Scalp Will Take Longer, and May Require More Than One Expansion Sequence to Complete.
After Your Surgery
How You Feel After Surgery Depends on the Extent and Complexity of the Procedure. The Initial Surgery to Insert the Expander Causes Most Patients Only Temporary Discomfort Which Can Be Controlled with Medication Prescribed by Your Physician.
You May Feel Some Minor Discomfort Each Time Saline Is Injected Into the Expander, but This Usually Lasts Only an Hour or Two. The Follow-Up Procedure to Remove the Expander and Put the New Tissue in Place May Create Some Temporary Discomfort, but This, Too, Can Be Controlled with Medication.
Getting Back to Normal
Again, How Soon You Resume Your Normal Routine Depends on the Length, Complexity and Type of Surgery You've Had. For Breast Reconstruction Patients, if Tissue Expansion Is Separate From Breast Removal, Normal Activity Can Resume in Two to Four Days.
Most Tissue Expansion Patients Find They Can Keep Up with Their Normal Routine While the Expander Is in Place. Following the Second Surgery, Most Patients Are Up and About Within a Week.
Your New Look
Generally, the Results of Tissue Expansion Are Superior to Other Methods Used to Reconstruct or Repair Damaged Skin. But Keep in Mind, the Goal Is Improvement, Not Perfection. For Most Tissue Expansion Patients, the Procedure Dramatically Improves Their Appearance and Quality of Life Following Surgery.
If You're Physically Healthy, Psychologically Stable, and Realistic in Your Expectations, You'll Probably Be Quite Pleased with Your Results.
Scar Revision
This Thick, Over-Grown Cluster of Scar Tissue on the Earlobe Is a Keloid. Here It Has Been Removed and the Incision Closed with Stitches, Leaving a Thin Scar.
This Hypertrophic Scar Has Formed a Contracture, Restricting Finger Motion.
Using Z-Plasty, the Scar Is Removed and Several Incisions Are Made on Each Side, Creating Small Triangular Flaps of Skin. Then the Flaps Are Rearranged and Interlocked to Cover the Affected Area.
The Incision Is Closed with a Z-Shaped Line of Sutures. The New Scar Is Thinner and Less Visible, and Allows the Finger to Be Extended.
The Scar Crossing the Natural Line, or Crease, Between the Nose and Mouth Is Removed and Repositioned Using Z-Plasty. The Forehead Scar, Located in the Natural Lines, Is Excised with Tapered Ends. The Skin Is Then Loosened and Brought Together with Stitches.
The Repaired Scars Now Lie Partly Within the Natural Skin Crease, Where They Are Less Visible.
If You're Considering Scar Revision...
Scars, Whether They're Caused by Accidents or by Surgery, Are Unpredictable. The Way a Scar Develops Depends as Much on How Your Body Heals as It Does on the Original Injury or on the Surgeon's Skills.
Many Variables Can Affect the Severity of Scarring, Including the Size and Depth of the Wound, the Blood Supply to the Area, the Thickness and Color of Your Skin, and the Direction of the Scar. How Much the Appearance of a Scar Bothers You Is, of Course, a Personal Matter.
While No Scar Can Be Removed Completely, Plastic Surgeons Can Often Improve the Appearance of a Scar, Making It Less Obvious Through the Injection or Application of Certain Steroid Medications or Through Surgical Procedures Known as Scar Revisions.
If You're Considering Scar Revision, This Will Give You a Basic Understanding of the Most Common Types of Scars, the Procedures That Treat Them, and the Results You Can Expect. It Can't Answer All of Your Questions, Since a Lot Depends on Your Individual Circumstances. Please Be Sure to Ask Your Doctor if There Is Anything About the Procedure You Don't Understand.
Making the Decision
Many Scars That Appear Large and Unattractive at First May Become Less Noticeable with Time. Some Can Be Treated with Steroids to Relieve Symptoms Such as Tenderness and Itching. For These Reasons, Many Plastic Surgeons Recommend Waiting as Long as a Year or More After an Injury or Surgery Before You Decide to Have Scar Revision.
If You're Bothered by a Scar, Your First Step Should Be to Consult a Board-Certified Plastic Surgeon. The Surgeon Will Examine You and Discuss the Possible Methods of Treating Your Scar, the Risks and Benefits Involved, and the Possible Outcomes. Be Frank in Discussing Your Expectations with the Surgeon, and Make Sure They're Realistic. Don't Hesitate to Ask Any Questions or Express Any Concerns You May Have.
Insurance Usually Doesn't Cover Cosmetic Procedures. However, if Scar Revision Is Performed to Minimize Scarring From an Injury or to Improve Your Ability to Function, It May Be at Least Partially Covered. Check Your Policy or Call Your Carrier to Be Sure.
All Surgery Carries Some Uncertainty and Risk
While Scar Revision Is Normally Safe, There Is Always the Possibility of Complications. These May Include Infection, Bleeding, a Reaction to the Anesthesia, or the Recurrence of an Unsightly Scar.
You Can Reduce Your Risks by Choosing a Qualified Plastic Surgeon and Closely Following His or Her Advice, Both Before Surgery and in Follow-Up Care.
Keloid Scars
Keloids Are Thick, Puckered, Itchy Clusters of Scar Tissue That Grow Beyond the Edges of the Wound or Incision. They Are Often Red or Darker in Color Than the Surrounding Skin. Keloids Occur When the Body Continues to Produce the Tough, Fibrous Protein Known as Collagen After a Wound Has Healed.
Keloids Can Appear Anywhere on the Body, but They're Most Common Over the Breastbone, on the Earlobes, and on the Shoulders. They Occur More Often in Dark-Skinned People Than in Those Who Are Fair. The Tendency to Develop Keloids Lessens with Age.
Keloids Are Often Treated by Injecting a Steroid Medication Directly Into the Scar Tissue to Reduce Redness, Itching, and Burning. In Some Cases, This Will Also Shrink the Scar.
If Steroid Treatment Is Inadequate, the Scar Tissue Can Be Cut Out and the Wound Closed with One or More Layers of Stitches. This Is Generally an Outpatient Procedure, Performed Under Local Anesthesia. You Should Be Back at Work in a Day or Two, and the Stitches Will Be Removed in a Few Days. A Skin Graft Is Occasionally Used, Although the Site From Which the Graft Was Taken May Then Develop a Keloid.
No Matter What Approach Is Taken, Keloids Have a Stubborn Tendency to Recur, Sometimes Even Larger Than Before. To Discourage This, Your Surgeon May Combine the Scar Removal with Steroid Injections, Direct Application of Steroids During Surgery, or Radiation Therapy. Or You May Be Asked to Wear a Pressure Garment Over the Area for as Long as a Year. Even So, the Keloid May Return, Requiring Repeated Procedures Every Few Years.
Hypertrophic Scars
Hypertrophic Scars Are Often Confused with Keloids, Since Both Tend to Be Thick, Red, and Raised. Hypertrophic Scars, However, Remain Within the Boundaries of the Original Incision or Wound. They Often Improve on Their Own (Though It May Take a Year or More) or with the Help of Steroid Applications or Injections.
If a Conservative Approach Doesn't Appear to Be Effective, Hypertrophic Scars Can Often Be Improved Surgically. Your Plastic Surgeon Will Remove Excess Scar Tissue, and May Reposition the Incision So That It Heals in a Less Visible Pattern. This Surgery May Be Done Under Local or General Anesthesia, Depending on the Scar's Location and What You and Your Surgeon Decide. You May Receive Steroid Injections During Surgery and at Intervals for Up to Two Years Afterward to Prevent the Thick Scar From Reforming.
Contractures
Burns or Other Injuries Resulting in the Loss of a Large Area of Skin May Form a Scar That Pulls the Edges of the Skin Together, a Process Called Contraction. The Resulting Contracture May Affect the Adjacent Muscles and Tendons, Restricting Normal Movement.
Correcting a Contracture Usually Involves Cutting Out the Scar and Replacing It with a Skin Graft or a Flap. In Some Cases a Procedure Known as Z-Plasty May Be Used. And New Techniques, Such as Tissue Expansion, Are Playing an Increasingly Important Role. If the Contracture Has Existed for Some Time, You May Need Physical Therapy After Surgery to Restore Full Function.
Facial Scars
Because of Its Location, a Facial Scar Is Frequently Considered a Cosmetic Problem, Whether or Not It Is Hypertrophic. There Are Several Ways to Make a Facial Scar Less Noticeable. Often It Is Simply Cut Out and Closed with Tiny Stitches, Leaving a Thinner, Less Noticeable Scar.
If the Scar Lies Across the Natural Skin Creases (or "Lines of Relaxation") the Surgeon May Be Able to Reposition It to Run Parallel to These Lines, Where It Will Be Less Conspicuous.
Some Facial Scars Can Be Softened Using a Technique Called Dermabrasion, a Controlled Scraping of the Top Layers of the Skin Using a Hand-Held, High-Speed Rotary Wheel. Dermabrasion Leaves a Smoother Surface to the Skin, but It Won't Completely Erase the Scar.
Z-Plasty
Z-Plasty Is a Surgical Technique Used to Reposition a Scar So That It More Closely Conforms to the Natural Lines and Creases of the Skin, Where It Will Be Less Noticeable. It Can Also Relieve the Tension Caused by Contracture. Not All Scars Lend Themselves to Z-Plasty, However, and It Requires an Experienced Plastic Surgeon to Make Such Judgments.
In This Procedure, the Old Scar Is Removed and New Incisions Are Made on Each Side, Creating Small Triangular Flaps of Skin. These Flaps Are Then Rearranged to Cover the Wound at a Different Angle, Giving the Scar a "Z" Pattern. The Wound Is Closed with Fine Stitches, Which Are Removed a Few Days Later. Z-Plasty Is Usually Performed as an Outpatient Procedure Under Local Anesthesia.
While Z-Plasty Can Make Some Scars Less Obvious, It Won't Make Them Disappear. A Portion of the Scar Will Still Remain Outside the Lines of Relaxation.
Skin Grafting and Flap Surgery
Skin Grafts and Flaps Are More Serious Than Other Forms of Scar Surgery. They're More Likely to Be Performed in a Hospital as Inpatient Procedures, Using General Anesthesia. The Treated Area May Take Several Weeks or Months to Heal, and a Support Garment or Bandage May Be Necessary for Up to a Year.
Grafting Involves the Transfer of Skin From a Healthy Part of the Body (the Donor Site) to Cover the Injured Area. The Graft Is Said to "Take" When New Blood Vessels and Scar Tissue Form in the Injured Area. While Most Grafts From a Person's Own Skin Are Successful, Sometimes the Graft Doesn't Take. In Addition, All Grafts Leave Some Scarring at the Donor and Recipient Sites.
Flap Surgery Is a Complex Procedure in Which Skin, Along with the Underlying Fat, Blood Vessels, and Sometimes the Muscle, Is Moved From a Healthy Part of the Body to the Injured Site. In Some Flaps, the Blood Supply Remains Attached at One End to the Donor Site; In Others, the Blood Vessels in the Flap Are Reattached to Vessels at the New Site Using Microvascular Surgery.
Skin Grafting and Flap Surgery Can Greatly Improve the Function of a Scarred Area. The Cosmetic Results May Be Less Satisfactory, Since the Transferred Skin May Not Precisely Match the Color and Texture of the Surrounding Skin. In General, Flap Surgery Produces Better Cosmetic Results Than Skin Grafts.
After Scar Revision
With Any Kind or Scar Revision, It's Very Important to Follow Your Surgeon's Instructions After Surgery to Make Sure the Wound Heals Properly. Although You May Be Up and About Very Quickly, Your Surgeon Will Advise You on Gradually Resuming Your Normal Activities.
As You Heal, Keep in Mind That No Scar Can Be Removed Completely; The Degree of Improvement Depends on the Size and Direction of Your Scar, the Nature and Quality of Your Skin, and How Well You Care for the Wound After the Operation. If Your Scar Looks Worse at First, Don't Panic; The Final Results of Your Surgery May Not Be Apparent for a Year or More.
General Reconstruction
Tissue Expansion Is Ideal for Scalp Repair Because the Stretched Skin on the Scalp Retains Normal Hair Growth. Most Other Body Tissue Does Not Grow Hair to the Same Degree.
Following Tissue Expansion, the Repaired Scalp Restores a More Natural Appearance.
With Flap Surgery, Tissue, Sometimes Including Underlying Fat and Muscle, Is Taken From the Back and Tunneled to the Front of the Chest Wall to Support the Reconstructed Breast.
The Transported Tissue Forms a Flap to Cover a Breast Implant, or It May Provide Enough Bulk to Form the Breast Mound Without an Implant.
In a Typical Syndactyly, Two Fingers Are Fused Together. The Surgeon Often Uses Zig-Zag Incisions to Separate the Fingers, Creating Triangular Skin Flaps.
Skin Flaps Cover Most of the Exposed Areas Between the Fingers. Skin Grafts Are Used to Fill the Shaded Areas at the Base of the Fingers.
Reconstructive Surgery: Procedures at a Glance
We Bring Back, Refashion and Restore to Wholeness the Features That Nature Gave but Chance Destroyed, Not That They May Be an Advantage to the Living Soul, Not as a Mean Artifice but as an Alleviation of Illness, Not as Becomes Charlatans but as Becomes Good Physicians and Followers of the Great Hippocrates. For Though the Original Beauty Is Indeed Restored . . . The End for Which the Physician Is Working Is That the Features Should Fulfill Their Offices According to Nature's Decree.
Gaspare Tagliacozzi, 1597
What Is Reconstructive Surgery?
It's Estimated That More Than One Million Reconstructive Procedures Are Performed by Plastic Surgeons Every Year. Reconstructive Surgery Helps Patients of All Ages and Types - Whether It's a Child with a Birth Defect, a Young Adult Injured in an Accident, or an Older Adult with a Problem Caused by Aging.
The Goals of Reconstructive Surgery Differ From Those of Cosmetic Surgery. Reconstructive Surgery Is Performed on Abnormal Structures of the Body, Caused by Birth Defects, Developmental Abnormalities, Trauma or Injury, Infection, Tumors, or Disease. It Is Generally Performed to Improve Function, but May Also Be Done to Approximate a Normal Appearance.
Cosmetic Surgery Is Performed to Reshape Normal Structures of the Body to Improve the Patient's Appearance and Self-Esteem.
Although No Amount of Surgery Can Achieve Perfection, Modern Treatment Options Allow Plastic Surgeons to Achieve Improvements in Form and Function That Were Thought to Be Impossible 10 Years Ago.
Who Has Reconstructive Surgery?
Patients May Be Divided Into Two Basic Categories: Those Who Have Congenital Deformities, Otherwise Known as Birth Defects, and Those with Developmental Deformities, Acquired as a Result of Accident, Infection, Disease, or Aging.
Some Common Examples of Congenital Abnormalities Are Birthmarks; Cleft-Lip and Palate Deformities; Hand Deformities Such as Syndactyly (Webbed Fingers), or Extra or Absent Fingers; And Abnormal Breast Development.
Burn Wounds, Lacerations, Growths, and Aging Problems Are Considered Acquired Deformities. In Some Cases, Patients May Find That a Procedure Commonly Thought to Be Aesthetic in Nature May Be Performed to Achieve a Reconstructive Goal. For Example, Some Older Adults with Redundant or Drooping Eyelid Skin Blocking Their Field of Vision Might Have Eyelid Surgery. Or an Adult Whose Face Has an Asymmetrical Look Because of Paralysis Might Have a Balancing Facelift. Although Appearance Is Enhanced, the Main Goal of the Surgery Is to Restore Function.
Large, Sagging Breasts Are One Example of a Deformity That Develops as a Result of Genetics, Hormonal Changes, or Disease. Breast Reduction, or Reduction Mammaplasty, Is the Reconstructive Procedure Designed to Give a Woman Smaller, More Comfortable Breasts in Proportion with the Rest of Her Body.
In Another Case, a Young Child Might Have Reconstructive Otoplasty (Outer-Ear Surgery) to Correct Overly-Large or Deformed Ears. Usually, Health Insurance Policies Will Consider the Cost of Reconstructive Surgery a Covered Expense. Check with Your Carrier to Make Sure You're Covered and to See if There Are Any Limitations on the Type of Surgery You're Planning. Work with Your Doctor to Get Pre-Authorization From the Insurer for the Procedure.
All Surgery Carries Some Uncertainty and Risk
When Reconstructive Surgery Is Performed by a Qualified Plastic Surgeon, Complications Are Infrequent and Usually Minor. However, Individuals Vary Greatly in Their Anatomy and Healing Ability and the Outcome Is Never Completely Predictable.
As with Any Surgery, Complications Can Occur. These May Include Infection; Excessive Bleeding, Such as Hematomas (Pooling of Blood Beneath the Skin); Significant Bruising and Wound-Healing Difficulties; And Problems Related to Anesthesia and Surgery.
There Are a Number of Factors That May Increase the Risk of Complications in Healing. In General, a Patient Is Considered to Be a Higher Risk if He or She Is a Smoker; Has a Connective-Tissue Disease; Has Areas of Damaged Skin From Radiation Therapy; Has Decreased Circulation to the Surgical Area; Has Hiv or an Impaired Immune System; Or Has Poor Nutrition. If You Regularly Take Aspirin or Some Other Medication That Affects Blood Clotting, It's Likely That You'll Be Asked to Stop a Week or Two Before Surgery.
Planning Your Surgery
In Evaluating Your Condition, a Plastic Surgeon Will Be Guided by a Set of Rules Known as the Reconstructive Ladder. The Least-Complex Types of Treatments, Such as Simple Wound Closure, Are at the Lower Part of the Ladder. Any Highly Complex Procedure-Like Microsurgery to Reattach Severed Limbs-Would Occupy One of the Ladder's Highest Rungs. A Plastic Surgeon Will Almost Always Begin at the Bottom of the Reconstructive Ladder in Deciding How to Approach a Patient's Treatment, Favoring the Most Direct, Least-Complex Way of Achieving the Desired Result.
The Size, Nature and Extent of the Injury or Deformity Will Determine What Treatment Option Is Chosen and How Quickly the Surgery Will Be Performed. Reconstructive Surgery Frequently Demands Complex Planning and May Require a Number of Procedures Done in Stages.
Because It's Not Always Possible to Predict How Growth Will Affect Outcome, a Growing Child May Have to Plan for Regular Follow-Up Visits on a Long-Term Basis to Allow Additional Surgery as the Child Matures.
Everyone Heals at a Different Rate-and Plastic Surgeons Cannot Pinpoint an Exact "Back-to-Normal" Date Following Surgery. They Can, However, Give You a General Idea of When You Can Expect to Notice Improvement.
Options in Wound Treatment
In Deciding How to Treat a Wound, a Plastic Surgeon Must Carefully Assess Its Size, Severity, and Features: Is Skin Missing? Have Nerves or Muscles Been Damaged? Has Skeletal Support Been Affected?
As You and Your Plastic Surgeon Form Your Surgical Plan, It's Important to Have a Clear Understanding of What Will Happen During the Procedure. Asking Questions Is Key to Making an Informed Decision.
Direct Closure Is Usually Performed on Skin-Surface Wounds That Have Straight Edges, Such as a Simple Cut. Maximum Attention Is Given to the Aesthetic Result, Taking Extra Care to Minimize Noticeable Stitch Marks.
Skin Grafts
A Wound That Is Wide and Difficult or Impossible to Close Directly May Be Treated with a Skin Graft. A Skin Graft Is Basically a Patch of Healthy Skin That Is Taken From One Area of the Body, Called the "Donor Site," and Used to Cover Another Area Where Skin Is Missing or Damaged.
There Are Three Basic Types of Skin Grafts.
A Split-Thickness Skin Graft, Commonly Used to Treat Burn Wounds, Uses Only the Layers of Skin Closest to the Surface. When Possible, Your Plastic Surgeon Will Choose a Less Conspicuous Donor Site. Location Will Be Determined in Part by the Size and Color of the Skin Patch Needed. The Skin Will Grow Back at the Donor Site, However, It May Be a Bit Lighter in Color.
A Full-Thickness Skin Graft Might Be Used to Treat a Burn Wound That Is Deep and Large, or to Cover Jointed Areas Where Maximum Skin Elasticity and Movement Are Needed. As Its Name Implies, the Surgeon Lifts a Full-Thickness (All Layers) Section of Skin From the Donor Site. A Thin Line Scar Usually Results From a Direct Wound Closure at the Donor Site.
A Composite Graft Is Used When the Wound to Be Covered Needs More Underlying Support, as with Skin Cancer on the Nose. A Composite Graft Requires Lifting All the Layers of Skin, Fat, and Sometimes the Underlying Cartilage From the Donor Site. A Straight-Line Scar Will Remain at the Site Where the Graft Was Taken. It Will Fade with Time.
Tissue Expansion
Tissue Expansion Is a Procedure That Enables the Body to "Grow" Extra Skin by Stretching Adjacent Tissue. A Balloon-Like Device Called an Expander Is Inserted Under the Skin Near the Area to Be Repaired and Then Gradually Filled with Salt Water Over Time, Causing the Skin to Stretch and Grow. The Time Involved in Tissue Expansion Depends on the Individual Case and the Size of the Area to Be Repaired.
The Advantages of Tissue Expansion Are Many-It Offers a Near-Perfect Match of Skin Color, Sensation, and Texture; The Risk of Tissue Loss Is Decreased Because the Skin Remains Connected to Its Original Blood and Nerve Supply; And Scars Are Less Apparent Than Those in Flaps or Grafts. The Expander Temporarily Creates What Can Be an Unsightly Bulge, Making This Option Undesirable for Some Patients.
Advanced Wound Care: Flap Surgery and Microsurgery
Though Success Will Largely Depend on the Extent of a Patient's Injury, Flap Surgery and Microsurgery Have Vastly Improved a Plastic Surgeon's Ability to Help a Severely Injured or Disfigured Patient. Using Advanced Techniques That Often Take Many Hours and May Require the Use of an Operating Microscope, Plastic Surgeons Can Now Replant Amputated Fingers or Transplant Large Sections of Tissue, Muscle or Bone From One Area of the Body to Another with the Original Blood Supply in Tact.
A Flap Is a Section of Living Tissue That Carries Its Own Blood Supply and Is Moved From One Area of the Body to Another. Flap Surgery Can Restore Form and Function to Areas of the Body That Have Lost Skin, Fat, Muscle Movement, and/or Skeletal Support.
A Local Flap Uses a Piece of Skin and Underlying Tissue That Lie Adjacent to the Wound. The Flap Remains Attached at One End So That It Continues to Be Nourished by Its Original Blood Supply, and Is Repositioned Over the Wounded Area.
A Regional Flap Uses a Section of Tissue That Is Attached by a Specific Blood Vessel. When the Flap Is Lifted, It Needs Only a Very Narrow Attachment to the Original Site to Receive Its Nourishing Blood Supply From the Tethered Artery and Vein.
A Musculocutaneous Flap, Also Called a Muscle and Skin Flap, Is Used When the Area to Be Covered Needs More Bulk and a More Robust Blood Supply. Musculocutaneous Flaps Are Often Used in Breast Reconstruction to Rebuild a Breast After Mastectomy. This Type of Flap Remains "Tethered" to Its Original Blood Supply.
In a Bone/Soft Tissue Flap, Bone, Along with the Overlying Skin, Is Transferred to the Wounded Area, Carrying Its Own Blood Supply.
A Microvascular Free Flap Is a Section of Tissue and Skin That Is Completely Detached From Its Original Site and Reattached to Its New Site by Hooking Up All the Tiny Blood Vessels.
Other Reconstructive Procedures
In Addition to Correcting Cuts and Other Surface Wounds, Plastic Surgeons Also Regularly Treat Both Cancerous and Non-Cancerous Growths and Problems with the Supporting Structures Beneath the Skin.
Tumors, Both Cancerous and Benign, Vary Widely in Type, Severity and Recurrence. The Removal Method Chosen Will Depend Largely on the Type of Growth, What Stage It's in, and Its Location on the Body.
Skin Cancers and Growths Are Usually Removed by Excision and Closure, in Which the Growth Is Simply Removed Completely with a Scalpel, Leaving a Small Thin Scar. If the Cancer Is Large or Spreading, Major Surgery May Be Necessary, Using Flaps to Reconstruct the Affected Area.
Hand Surgery
Whether the Defect Is Congenital or Acquired, Plastic Surgeons Can Usually Restore Comfort, Mobility, and Normal Appearance to Patients with Hand Problems. Acquired Defects Include Carpal Tunnel and Other Painful Conditions Caused by Pressure on the Nerves (Usually at the Wrist or Elbow); Trigger Fingers, a Condition Caused by Swelling of a Flexor Tendon in the Hand; Ganglion Cysts, a Benign Cystic Growth and Scar Contracture Which Occurs When a Wound or Burn on the Hand Heals Poorly and Forms Scar Tissue That Curls the Fingers or Restricts Mobility. Dupuytren's Disease Causes a Similar Problem of Hand Contracture.
Children Born with Syndactyly (Webbed Fingers) Can Benefit From Finger Separation, Where a Zig-Zag-Type Incision Separates the Fingers and Rearranges the Tissue Between Them, Preventing Growth Deformities. If a Child Had Polydactyly (Extra Fingers), Correction Is Often More Than Simply Removing the Extra Digits. The Surgeon May Also Need to Balance the Tendons of the Hand and Stabilize the Remaining Finger Joints So That the Hand Functions as Normally as Possible. Plastic Surgeons Also Reconstruct Missing Digits, Including the Thumb, Which Supplies Half of the Hand's Function.
Laser Surgery
In the Past Decade, Laser Technology Has Revolutionized Many Areas of Plastic Surgery. The Laser's Allure Comes From Its Ability to "Blast" Away or Diminish Imperfections or Growths with Minimum Bleeding, Bruising, and Scarring. Currently, There Are Many Types of Lasers Available, with Many More Under Development. Therefore, It's Important to Understand That Not All Lasers Are Alike. If You're Planning to Have Laser Surgery, It's Best to Find a Doctor Who Is Well Experienced with, and Has Access to, a Variety of Lasers.
The Yellow Pulsed-Dye Laser Uses a Type of Dye as Its Active Medium. It Has a Pulsing Beam That Is Heavily Absorbed by Hemoglobin, Which Gives Blood Its Red Color. This Laser Is Often Used for Performing Surgery on Children Who Have Pinkish Birthmarks Called Port-Wine Stains. The Laser Destroys the Abnormal Blood Vessels, Lightening the Birthmark to the Point of Being Barely Noticeable. Scarring, Which Was a Problem with Earlier Laser Models, Is Minimal with the Yellow Pulsed-Dye Laser.
The "Pigment-Blasting" Laser Family, the Q-Switch Ruby, the Q-Switch Yag, and the Alexandrite Is a Group of Lasers That Are Effective in Eliminating the Black and Blue Pigments of Tattoos, Pigmented Lesions and the Brown Patches and Spots That Often Occur with Aging. Though the Removal of Decorative Tattoos Is Considered a Cosmetic Procedure, the Removal of "Traumatic Tattoos" Is a Reconstructive Process. Traumatic Tattoos Occur When Material Particles Are Forced Under the Skin Through an Accident Such as an Explosion or Collision.
The Carbon Dioxide Laser, Sometimes Called the "Workhorse" of Lasers, Is an Invisible Light Absorbed by Water, the Primary Component of Human Skin. When the Beam Is Focused, It Can Cut Tissue and Seal Blood Vessels Simultaneously. When Defocused, It Vaporizes. These Characteristics Make It the Treatment of Choice for Removing Warts and Many Types of Skin Growths.
The Yag Laser Has Been Shown to Be Effective in the Surgery of Various Types of Hemangiomas, Which Are Skin Growths with Heavy Concentrations of Blood Vessels. It Delivers Highly-Focused Energy and-Unlike Other Lasers-Its Tip Can Be Placed Directly on the Skin, Mimicking a Scalpel.
The Argon Laser Is Similar to the Yellow Pulsed-Dye Laser. The Argon Laser Emits a Blue-Green Light That Is Absorbed Heavily by the Color Red. It Is Particularly Effective in Treating Abnormalities That Have a Proliferation of Blood Vessels, Such as Blood Blisters, "Spider" Blood Vessels on the Face, "Strawberry" Birthmarks, Hemangiomas, and Bulky Vascular Tumors.
The Copper Vapor Laser Is a Newer Type of Laser That Emits a Yellowish Light. Its Uses Include Treating Brown or Red Pigmented Areas.
The Number of Laser Treatments You'll Need Depends Largely Upon the Size and Severity of the Defect. A Child with a Large Birthmark May Need Six to Ten Laser Treatments to Achieve Satisfactory Results. Only One Treatment May Be Needed to Remove Some Small Spider Veins on the Face.
Lasers Have a Number of Valuable Uses, but a Laser Should Not Be Viewed as a "Magic Wand" That Improves the Results of Any Type of Surgery. For Traditional Kinds of Surgery and Most Plastic Surgery, the Scalpel Is Still the Proven Instrument of Choice.
Botox & Injectables
Botox Cosmetic
Botox® Injections
The Cosmetic Form of Botulinum Toxin, Often Referred to by Its Product Name Botox®, Is a Popular Non-Surgical Injection That Temporarily Reduces or Eliminates Frown Lines, Forehead Creases, Crow's Feet Near the Eyes and Thick Bands in the Neck. The Toxin Blocks the Nerve Impulses, Temporarily Paralyzing the Muscles That Cause Wrinkles While Giving the Skin a Smoother, More Refreshed Appearance. Studies Have Also Suggested That Botox Is Effective in Relieving Migraine Headaches, Excessive Sweating and Muscle Spasms in the Neck and Eyes.
Who Should Consider Botox?
Botox Cosmetic Is Indicated for the Temporary Correction of Moderate to Severe Glabellar Lines (Frown Lines) Associated with Corrugator and/or Procerus Muscle Activity in Patients 18 to 65 Years of Age. If You Exhibit Lines on the Smooth Part of Your Forehead Above and Between the Brows (the Glabella), You Should Consider Treatment with Botox Cosmetic.
Botox Cosmetic Is Contraindicated if the Patient Exhibits an Infection at the Proposed Injection Site(S) and or Has a Known Hypersensitivity to Any Botulinum Toxin Preparation or to Any of the Components in the Formulation. Do Not Undergo Botox Treatment if You Are Allergic to Any of the Ingredients or if You Have Experienced an Allergic Reaction to Another Product Containing Botulinum Toxin. Ask Your Plastic Surgeon About the Possible Side Effects of Botox.
IndicationBotox® cosmetic is indicated for the temporary improvement in the appearance of moderate to severe glabellar lines associated with corrugator and/or procerus muscle activity in patients 18 to 65 years of age.
Distant Spread of Toxin EffectPostmarketing reports indicate that the effects of botox® cosmetic and all botulinum toxin products may spread from the area of injection to produce symptoms consistent with botulinum toxin effects. These may include asthenia, generalized muscle weakness, diplopia, blurred vision, ptosis, dysphagia, dysphonia, dysarthria, urinary incontinence, and breathing difficulties. These symptoms have been reported hours to weeks after injection. Swallowing and breathing difficulties can be life threatening, and there have been reports of death. The risk of symptoms is probably greatest in children treated for spasticity, but symptoms can also occur in adults treated for spasticity and other conditions, particularly in those patients who have underlying conditions that would predispose them to these symptoms. In unapproved uses, including spasticity in children and adults, and in approved indications, cases of spread of effect have occurred at doses comparable to those used to treat cervical dystonia and at lower doses.
ContraindicationsBotox® cosmetic is contraindicated in the presence of infection at the proposed injection site(s) and in individuals with known hypersensitivity to any botulinum toxin preparation or to any of the components in the formulation.
WarningsThe recommended dosage and frequency of administration for botox® cosmetic should not be exceeded. Risks resulting from administration at higher dosages are not known.
Lack of Interchangeability Between Botulinum Toxin Products
The Potency Units of Botox® Cosmetic Are Specific to the Preparation and Assay Method Utilized. They Are Not Interchangeable with Other Preparations of Botulinum Toxin Products and, Therefore, Units of Biological Activity of Botox® Cosmetic Cannot Be Compared to or Converted Into Units of Any Other Botulinum Toxin Products Assessed with Any Other Specific Assay Method.
Spread of Toxin Effect
Please Refer to Boxed Warning for Distant Spread of Toxin Effect.
No Definitive, Serious Adverse Event Reports of Distant Spread of Toxin Effect Associated with Dermatologic Use of Botox® Cosmetic at the Labeled Dose of 20 Units (for Glabellar Lines) Have Been Reported.
Hypersensitivity Reactions
Serious and/or Immediate Hypersensitivity Reactions Have Been Reported. These Reactions Include Anaphylaxis, Urticaria, Soft-Tissue Edema, and Dyspnea. If Such Reactions Occur, Further Injection of Botox® Cosmetic Should Be Discontinued and Appropriate Medical Therapy Immediately Instituted. One Fatal Case of Anaphylaxis Has Been Reported in Which Lidocaine Was Used as the Diluent and, Consequently, the Causal Agent Cannot Be Reliably Determined.
Pre-Existing Neuromuscular Disorders
Individuals with Peripheral Motor Neuropathic Diseases, Amyotrophic Lateral Sclerosis, or Neuromuscular Junctional Disorders (Eg, Myasthenia Gravis or Lambert-Eaton Syndrome) Should Be Monitored Particularly Closely When Given Botulinum Toxin. Patients with Neuromuscular Disorders May Be at Increased Risk of Clinically Significant Effects Including Severe Dysphagia and Respiratory Compromise From Typical Doses of Botox® Cosmetic.
Precautions
Caution Should Be Used When Botox® Cosmetic Treatment Is Used in Patients Who Have an Inflammatory Skin Problem at the Injection Site, Marked Facial Asymmetry, Ptosis, Excessive Dermatochalasis, Deep Dermal Scarring, Thick Sebaceous Skin, or the Inability to Substantially Lessen Glabellar Lines by Physically Spreading Them Apart.
Information for Patients
Patients Should Be Counseled That if Loss of Strength, Muscle Weakness, or Impaired Vision Occur, They Should Avoid Driving a Car or Engaging in Other Potentially Hazardous Activities.
Pregnancy
Administration of Botox® Cosmetic Is Not Recommended During Pregnancy. There Are No Adequate and Well-Controlled Studies of Botox® Cosmetic in Pregnant Women.
Nursing Mothers
It Is Not Known Whether Botox® Cosmetic Is Excreted in Human Milk. Because Many Drugs Are Excreted in Human Milk, Caution Should Be Exercised When Botox® Cosmetic Is Administered to a Nursing Woman.
Adverse Reactions
General
The Most Serious Adverse Events Reported After Treatment with Botulinum Toxin Include Spontaneous Reports of Death, Sometimes Associated with Anaphylaxis, Dysphagia, Pneumonia, and/or Other Significant Debility.
There Have Also Been Reports of Adverse Events Involving the Cardiovascular System, Including Arrhythmia and Myocardial Infarction, Some with Fatal Outcomes. Some of These Patients Had Risk Factors Including Pre-Existing Cardiovascular Disease.
The Most Frequently Reported Adverse Events Following Injection of Botox® Cosmetic Include Blepharoptosis and Nausea.
OverdosageExcessive doses of botox® cosmetic may be expected to produce neuromuscular weakness with a variety of symptoms. Respiratory support may be required where excessive doses cause paralysis of respiratory muscles. In the event of overdose, the patient should be medically monitored for symptoms of excessive muscle weakness or muscle paralysis.
Latisse
Solution Is an Actual Growth Treatment. In Fact, It's the Only Fda-Approved Treatment Clinically Proven to Grow Lashes. And It's the Only Lash Growth Product of Its Kind Available by Prescription.
How to UseLatisse® solution is a once-a-day treatment you apply topically to the base of your upper eyelashes, as instructed by your doctor. Then, gradually, the results come in. You may start to see more length in as little as 4 weeks and you should achieve full growth in 16 weeks. It’s not an illusion of growth. It’s your own eyelashes — only better.
How It WorksLatisse® makes lash growth possible because of its active ingredient: bimatoprost. Although the precise mechanism of action is unknown, latisse® is believed to affect the growth (anagen) phase of the eyelash hair cycle in two ways: first, it increases the length of this phase, and second, it increases the number of hairs in this growth phase.
Chemical-Peel
Chemical Peel Is Especially Useful for the Fine Wrinkles on Cheeks, Forehead, and Around the Eyes, and the Vertical Wrinkles Around the Mouth.
The Chemical Solution Can Be Applied to the Entire Face, or to a Specific Area -for Example, Around the Mouth - Sometimes in Conjunction with a Facelift.
At the End of a Phenol Peel, a Thick Layer of Petroleum Jelly May Be Applied to the Treated Area.
A Protective Crust May Be Allowed to Form Over the New Skin. When It's Removed, the Skin Underneath Will Be a Bright Pink.
After Healing, the Skin Is Lighter in Color, Tighter, Smoother, and Younger Looking.
If You're Considering Chemical Peel...
A Chemical Peel Uses a Chemical Solution to Improve and Smooth the Texture of the Facial Skin by Removing Its Damaged Outer Layers. It Is Helpful for Those Individuals with Facial Blemishes, Wrinkles and Uneven Skin Pigmentation. Phenol, Trichloroacetic Acid (Tca) and Alpha Hydroxy Acids (Ahas) Are Used for This Purpose.
The Precise Formula Used May Be Adjusted to Meet Each Patient's Needs. Although Chemical Peel May Be Performed in Conjunction with a Facelift, It Is Not a Substitute for Such Surgery, Nor Will It Prevent or Slow the Aging Process. This Brochure Provides Basic Information About Certain Types of Chemical Peel Treatments and the Results You Might Expect. It Won't Answer All Your Questions, Since a Lot Depends on Your Individual Circumstances. Once You and Your Plastic Surgeon Have Decided on a Specific Peel Program, Be Sure to Ask About Any Details That You Do Not Understand.
Deciding if Chemical Peel Is Right for You
A Chemical Peel Is Typically Performed for Cosmetic Reasons -- to Enhance Your Appearance and Your Self Confidence. The Procedure May Also Remove Pre-Cancerous Skin Growths Soften Acne Facial Scars and Help Control Acne.
In Certain Cases, Health Insurance May Cover the Peel Procedure. Be Sure to Check Your Policy and Contact Your Insurance Company Before the Procedure Is Performed.
Alpha Hydroxy Acids (Ahas), Such as Glycolic, Lactic, or Fruit Acids Are the Mildest of the Peel Formulas and Produce Light Peels. These Types of Peels Can Provide Smoother, Brighter-Looking Skin for People Who Can't Spare the Time to Recover From a Phenol or Tca Peel. Aha Peels May Be Used to Treat Fine Wrinkling, Areas of Dryness, Uneven Pigmentation and Acne. Various Concentrations of an Aha May Be Applied Weekly or at Longer Intervals to Obtain the Best Result. Your Doctor Will Make This Decision During Your Consultation and as the Treatment Proceeds. An Alpha Hydroxy Acid, Such as Glycolic Acid, Can Also Be Mixed with a Facial Wash or Cream in Lesser Concentrations as Part of a Daily Skin-Care Regimen to Improve the Skin's Texture.
Trichloroacetic Acid (Tca) Can Be Used in Many Concentrations, but It Is Most Commonly Used for Medium-Depth Peeling. Fine Surface Wrinkles, Superficial Blemishes and Pigment Problems Are Commonly Treated with Tca. The Results of Tca Peel Are Usually Less Dramatic Than and Not as Long-Lasting as Those of a Phenol Peel. In Fact, More Than One Tca Peel May Be Needed to Achieve the Desired Result. The Recovery From a Tca Peel Is Usually Shorter Than with a Phenol Peel.
Phenol Is the Strongest of the Chemical Solutions and Produces a Deep Peel. It Is Used Mainly to Treat Patients with Coarse Facial Wrinkles, Areas of Blotchy or Damaged Skin Caused by Sun Exposure, or Pre-Cancerous Growths. Since Phenol Sometimes Lightens the Treated Areas, Your Skin Pigmentation May Be a Determining Factor as to Whether or Not This Is an Appropriate Treatment for You. Phenol Is Primarily Used on the Face; Scarring May Result if It's Applied to the Neck or Other Body Areas.
All Chemical Peels Carry Some Uncertainty and Risk
A Chemical Peel Is Normally a Safe Procedure When It Is Performed by a Qualified, Experienced Plastic Surgeon. However, Some Unpredictability and Risks Such as Infection and Scarring, While Infrequent, Are Possible.
Aha Peels May Cause Stinging, Redness, Irritation and Crusting. However, as the Skin Adjusts to the Treatment Regimen, These Problems Will Subside.
With a Tca Peel, Your Healed Skin Will Be Able to Produce Pigment as Always; The Peel Will Not Bleach the Skin. However, Tca-Peel Patients Are Advised to Avoid Sun Exposure for Several Months After Treatment to Protect the Newly Formed Layers of Skin. Even Though Tca Is Milder Than Phenol, It May Also Produce Some Unintended Color Changes in the Skin.
With a Phenol Peel, the New Skin Frequently Loses Its Ability to Make Pigment (That Is, Tan). This Means That Not Only Will the Skin Be Lighter in Color, but You'll Always Have to Protect It From the Sun. Phenol May Pose a Special Risk for Patients with a History of Heart Disease. It's Important That You Make Your Surgeon Aware of Any Heart Problems When Your Medical History Is Taken.
It Is Also Possible That Phenol Will Cause Some Undesired Cosmetic Results, Such as Uneven Pigment Changes. Certain Modified Phenol Peels Are Gentler and May Be Preferred in Some Circumstances.
Peel Formulas at a Glance
Alpha Hydroxy Acids (Ahas)
Uses:
Smooths Rough, Dry Skin
Improves Texture of Sun-Damaged Skin
Aids in Control of Acne
Can Be Mixed with Bleaching Agent to Correct Pigment Problems
Can Be Used as Tca Pre-Treatment
Considerations:
A Series of Peels May Be Needed
As with Most Peel Treatments, Sunblock Use Is Recommended
Trichloroacetic Acid (Tca)
Uses:
Smooths Out Fine Surface Wrinkles
Removes Superficial Blemishes
Corrects Pigment Problems
Considerations:
Can Be Used on Neck or Other Body Areas
May Require Pre-Treatment with Retin-a or Aha Creams
Treatment Takes Only 10-15 Minutes
Preferred for Darker-Skinned Patients
Peel Depth Can Be Adjusted
Repeat Treatment May Be Needed to Maintain Results
Sunblock Must Be Used for Several Months
Healing Is Usually Quick, Much Quicker Than with a Phenol Peel
Phenol
Uses:
Corrects Blotches Caused by: Sun Exposure, Birth-Control Pills, Aging
Smooths Out Coarse Wrinkles
Removes Pre-Cancerous Growths
Considerations:
Used on the Face Only
Not Recommended for Dark-Skinned Individuals
Procedure May Pose Risk for Patients with Heart Problems
Full-Face Treatment May Take One Hour or More
Recovery May Be Slow - Complete Healing May Take Several Months
May Permanently Remove Facial Freckles
Sun Protection, Including Sunblock, Must Always Be Used
Results Are Dramatic and Long-Lasting
Permanent Skin Lightening and Lines of Demarcation May Occur
Planning for a Chemical Peel
In Some States, No Medical Degree Is Required to Perform a Chemical Peel - Even the Strongest Phenol Peels. Many States Have Laws That Permit Non-Physicians to Administer Certain Peel Solutions, but Regulate the Strengths Which They Are Permitted to Apply. You Should Be Warned That Phenol and Tca Peels Have Been Offered by Inadequately Trained Practitioners Claiming "Miracle Techniques" to Rejuvenate the Skin.
It Is Very Important That You Find a Physician Who Has Adequate Training and Experience in Skin Resurfacing. Your Plastic Surgeon May Offer You a Choice of Peel Techniques or Suggest a Combination of Peels to Obtain the Best Result for You.
During Your Initial Consultation, It Is Important That You Discuss Your Expectations with Your Plastic Surgeon. Don't Hesitate to Ask Any Questions or Express Any Concerns That You May Have. Expect Your Plastic Surgeon to Explain the Planned Procedure in Detail, Including Its Risks and Benefits, the Recovery Period and the Costs. If You Have a History of Herpes, You Should Inform Your Physician Prior to the Procedure. Remember, Chemical Peel Treatments Are Usually Not Covered by Medical Insurance Unless They Are Performed for Medically Related Problems.
Preparing for Your Chemical Peel
Your Plastic Surgeon Will Instruct You on How to Prepare for Your Peel Treatment.
Sometimes Retin-a, a Prescription Medication Derived From Vitamin a, Is Used to Pre-Treat the Skin. This Thins Out the Skin's Surface Layer, Allowing the Tca Solution to Penetrate More Deeply and Evenly. If Your Skin Won't Tolerate Retin-a Pre-Treatment, an Aha Cream May Be Used Instead. Hydroquinone, a Bleaching Agent, Is Sometimes Used in Conjunction with Retin-a or Aha Pre-Treatment, Especially if You Have Blotchy Skin Areas or Pigmentation Problems. You May Have to Spend a Month or More in the Pre-Treatment Phase Before the Doctor Will Schedule Your Actual Peel.
You Will Need to Arrange for Someone to Drive You Home and Help You Out for a Day or Two if You Are Having a Phenol or Deeper Tca Peel. You Probably Won't Need Any Extra Assistance if You're Having an Aha Peel or Superficial Tca Peel.
Where Your Peel Will Be Performed
Most Chemical Peels May Be Safely Performed in a Plastic Surgeon's Office, Office-Based Surgical Facility or Outpatient Surgical Center. Your Plastic Surgeon May Want You to Stay Overnight in a Facility or Hospital if Other Cosmetic Procedures Are Performed Simultaneously.
Types of Anesthesia
Anesthesia Isn't Required for Phenol or Tca Peels Because the Chemical Solution Acts as an Anesthetic. However, Sedation May Be Used Before and During the Procedure to Relax You and Keep You Comfortable.
No Anesthesia Is Needed for Aha Peels Since They Cause Only a Slight Stinging Sensation During Application.
How the Peel Works
Aha Peels/Treatments: Your Doctor Will Apply the Aha Solution to Your Cleansed Facial Skin, a Process That Usually Takes No More Than 10 Minutes. No "After-Peel" Ointment or Covering Is Required. Depending on the Strength of the Peel, Periodic Treatments May Be Necessary Until the Desired Effects Are Achieved.
For Some Patients, the Application of an Aha-Based Face Wash or Cream Once or Twice a Day at Home Will Be Sufficient to Accomplish the Desired Goal. Your Plastic Surgeon May Add Retin-a or a Bleaching Agent to Your at-Home Treatment Schedule. After Several Weeks of at-Home Use, Your Doctor Will Examine Your Skin to Determine if Your Regimen Needs Adjustment.
Phenol and Tca Peels: Typically, the Skin Is First Thoroughly Cleansed. Then, the Surgeon Will Carefully Apply the Phenol or Tca Solution. You May Feel a Stinging Sensation as the Peel Solution Is Applied, but This Feeling Will Quickly Pass.
A Full-Face Tca Peel Usually Takes No More Than 15 Minutes. Two or More Tca Peels May Be Needed to Obtain the Desired Result, and Those May Be Spaced Out Over Several Months. Mild Tca Peels May Be Repeated as Often as Every Month.
If Phenol Solution Has Been Used, Your Plastic Surgeon May Coat the Treated Area with Petroleum Jelly or a Waterproof Adhesive Tape. With Lighter Peels, No Covering Is Necessary.
A Full-Face Phenol Peel Generally Takes One or Two Hours to Perform, While a Phenol Peel to a Smaller Facial Region (Perhaps the Skin Above the Upper Lip) May Take Only 10 or 15 Minutes. A Single Treatment Usually Suffices.
After Your Treatment
After an Aha Peel, It Is Common to Experience Some Temporary Flaking or Scaling, Redness and Dryness of the Skin. However, These Conditions Will Disappear as the Skin Adjusts to Treatment.
After a Phenol or Tca Peel, Your Doctor May Prescribe a Mild Pain Medication to Relieve Any Tingling or Throbbing You May Feel. If Tape Was Used to Cover Your Face, It Will Be Removed After a Day or Two. A Crust or Scab Will Form on the Treated Area. To Help Your Face Heal Properly, It Is Essential That You Follow Your Doctor's Specific Post-Operative Instructions.
A Tca Peel May Also Cause Significant Swelling, Depending on the Strength of the Peel Used.
If You've Had a Phenol Peel, Your Face May Become Quite Swollen. Your Eyes May Even Be Swollen Shut Temporarily. You Will Need Someone to Help Care for You for a Day or Two. You May Also Be Limited to a Liquid Diet and Advised Not to Talk Very Much During the First Few Days of Recovery.
Getting Back to Normal
With an Aha Peel, the Temporary Redness, Flaking and Dryness That You Experience Will Not Prevent You From Working or Engaging in Your Normal Activities. A Fresher and Improved Skin Texture Will Result with Continued Aha Treatments. Remember, Protecting Your Skin From the Sun Is Also Important Following These Mild Acid Peels. Ask Your Doctor to Recommend a Sunblock with Adequate Uva and Uvb Protection and Use It Every Day.
With a Tca Peel, the Moderate Discomfort and Mild Swelling You May Experience Will Subside Within the First Week. In About a Week to Ten Days, Your New Skin Will Be Apparent and You Should Be Healed Sufficiently to Return to Your Normal Activities. It Is Best to Avoid Sun Exposure Unless You Are Adequately Protected.
With a Phenol Peel, New Skin Will Begin to Form in About Seven to Ten Days. Your Face Will Be Very Red at First, Gradually Fading to a Pinkish Color Over the Following Weeks to Months. During This Time, It Is Especially Important That You Use a Sunblock or Blotchy, Irregular Skin Coloring May Result.
About Two Weeks After Treatment, You May Return to Work and Resume Some of Your Normal Activities. Your Skin Will Be Healed Enough for You to Wear Makeup. (for Makeup Tips, Ask Your Plastic Surgeon for the Asps Brochure on Camouflage Cosmetics.)
Your New Look
Improvements From Aha Peels May Be Very Subtle at First. You May Detect a Healthier Glow to Your Skin. With Continued Treatments, You Will Notice a General Improvement in the Texture of Your Skin.
The Results of a Tca Peel Are Usually Not as Long-Lasting as Those of Phenol Peel. However, Your Skin Will Be Noticeably Smoother and Fresher-Looking.
If You're Planning a Phenol Peel, You Can Expect Dramatic Improvement in the Surface of Your Skin - Fewer Fine Wrinkles, Fewer Blemishes and More Even-Toned Skin. Your Results Will Be Long-Lasting, Although Not Immune to the Effects of Aging and Sun Exposure.
Injectable Fillers
Injectable Fillers Can Help Improve the Skin's Texture by Filling in the Laugh Lines and Facial Creases That Often Occur with Aging.
Years of Squinting and Other Facial Muscle Movements Can Take Their Toll on the Eye Area, Leaving Crow's Feet and Other Noticeable Lines
After Treatment, the Skin Around the Eye Area Appears Smoother and Tauter.
Lines and Creases That Form Around the Mouth Are Usually Caused by Gravity and a Breakdown of Tissues Beneath the Skin.
The Lower Face Appears Firmer and Smoother After Treatment with Injectables. Lines Around the Mouth Are Filled in and Nearly Imperceptible.
With Regular Follow-Up Treatments, Your Refreshed Look Can Be Easily Maintained.
If You're Considering Injectables...
As We Age, Our Faces Begin to Show the Effects of Gravity, Sun Exposure and Years of Facial Muscle Movement, Such as Smiling, Chewing and Squinting. The Underlying Tissues That Keep Our Skin Looking Youthful and Plumped Up Begin to Break Down, Often Leaving Laugh Lines, Smile Lines, Crow's Feet or Facial Creases Over the Areas Where This Muscle Movement Occurs.
Soft-Tissue Fillers, Most Commonly Injectable Collagen, Hyaluronic Acid, or Fat, Can Help Fill in These Lines and Creases, Temporarily Restoring a Smoother, More Youthful-Looking Appearance. When Injected Beneath the Skin, These Fillers Plump Up Creased and Sunken Areas of the Face. They Can Also Add Fullness to the Lips and Cheeks. Injectable Fillers May Be Used Alone or in Conjunction with a Resurfacing Procedure, Such as a Laser Treatment, or a Recontouring Procedure, Such as a Facelift.
Knowing Your Options
Fillers Are Primarily Used to Improve the Appearance of the Skin's Texture. They Can Help Correct Deep Facial Wrinkles, Creases and Furrows, "Sunken" Cheeks, Skin Depressions and Some Types of Scars. They Can Also Be Used to Add a Fuller, More Sensuous Look to the Lips.
Injectables Are Usually Not Sufficient for Severe Surface Wrinkles on the Face, Such as Multiple Vertical "Lipstick Lines" That Sometimes Form Around the Mouth. Instead, Your Plastic Surgeon May Suggest a Resurfacing Technique, Such as Chemical Peel, Dermabrasion or Laser Treatments. Rather Than Filling in Facial Lines, Resurfacing Methods Strip Away the Outer Layers of the Skin to Produce a Smoother Appearance.
Deep Folds in the Face or Brow Caused by Overactive Muscles or by Loose Skin May Be More Effectively Treated with Cosmetic Surgery, Such as a Facelift or Brow Lift. Injectables Are Sometimes Used in Conjunction with Facial Surgery Procedures; However, Injectables Alone Cannot Change Facial Contour the Way Surgery Can.
Keep in Mind That a Plastic Surgeon Is a Specialist That Can Offer You the Full Gamut of the Most Advanced Treatments Ranging From Cosmetic Surgery, Refinishing Techniques, Laser Therapy, Injectables and the Use of Other Fillers. You and Your Surgeon May Determine That a Single Procedure or a Combination of Procedures Is the Best Choice for You.
A Word About Other Types of FillersThis web page explains commonly used injectable fillers such as hyaluronic acid, collagen and fat. However, to a lesser extent, a number of other filler materials are also being used for facial rejuvenation purposes. They include agents such as polymers, porcine collagen, or calcium hydroxylapatite. Each of these options has its own set of risks and benefits. If you're considering any of these alternative filler treatments, tell your doctor.
What to Expect From Treatment
The Most Important Fact to Remember About Injectable Fillers Is That the Results Are Not Permanent. Injected Material Is Eventually Metabolized by the Body. You Should Not Expect the Same Long-Lasting Results That May Be Gained From Cosmetic Surgery.
In Some Individuals, the Results May Last Only a Few Weeks; In Others, the Results May Be Maintained Indefinitely. Researchers Believe That Age, Genetic Background, Skin Quality and Lifestyle as Well as the Injected Body Site May All Play a Role in the Injected Material's "Staying Power." However, the Precise Reason for the Variation of Results Among Patients Has Yet to Be Identified.
If You've Had Short-Lived Results From Fat Injections, You Shouldn't Necessarily Assume That Collagen Injections Will Work Better for You. And, Conversely, if You've Had Disappointing Results From Collagen, Don't Assume That Injected Fat Is the Answer. Although It's True That Some Individuals' Bodies Are More Receptive to One Substance Than the Other, Others May Find That Neither Substance Produces Long-Lasting Results. Sometimes One Substance May Work Better Than the Other for a Specific Problem.
Risks Related to Injectables
When Injectables Are Administered by a Qualified Plastic Surgeon, Complications Are Infrequent and Usually Minor in Nature. Still, Individuals Vary Greatly in Their Anatomy, Their Physical Reactions and Their Healing Abilities. The Outcome of Treatment with Injectables Is Never Completely Predictable.
Hyaluronic Acid: Side Effects Are Typically Mild or Moderate in Nature and Last for Less Than 7 Days. Adverse Events Inclde Redness, Pain, Firmness, Swelling, Lumps/Bumps, Bruising, Itching, and Discoloration.
Collagen: Allergic Reaction Is the Primary Risk of Collagen. To Help Determine if You Are Allergic to the Substance, Your Surgeon Will Perform an Allergy Skin Test About a Month Before the Procedure. After the Test Is Performed, the Test Site Should Be Watched Carefully for Three or Four Weeks, or as Long as Your Surgeon Advises. Any Sign of Redness, Itching, Swelling or Other Occurrences at the Test Site Should Be Reported to Your Surgeon.
Risks Not Necessarily Related to Allergies Include Infection, Abscesses, Open Sores, Skin Peeling, Scarring and Lumpiness, Which May Persist Over the Treated Area. Reports of These Problems Are Very Rare.
Fat: Allergic Reaction Is Not a Factor for Fat Because It's Harvested From a Patient's Own Body. However, There Is Still a Small Risk of Infection and Other Infrequent Complications.
Planning for Treatment
Facial Rejuvenation Is Very Individualized. That's Why It's Important to Discuss Your Hopes and Expectations with a Board-Certified Plastic Surgeon Who Has Experience with Many Different Types of Surgical and Non-Surgical Facial Procedures.
In Your Initial Consultation, Your Plastic Surgeon Will Evaluate Your Face - the Skin, the Muscles and the Underlying Bone - and Discuss Your Goals for the Surgery. Your Doctor Will Help You Select a Treatment Option Based on Your Goals and Concerns, Your Anatomy and Your Lifestyle.
Your Surgeon Will Ask You About Your Medical History, Drug Allergies, and Check for Conditions That Could Cause Problems, Such as Active Skin Infections or Non-Healed Sores From Injuries. Collagen Injections Are Generally Off Limits for Pregnant Women, Individuals Who Are Allergic to Beef or Bovine Products, Patients Who Suffer From Autoimmune Diseases, and Those Who Are Allergic to Lidocaine (the Anesthetic Agent Contained in the Syringe with the Collagen Material). For More Specific Information About the Contraindications and Risks of Collagen Use, Ask Your Doctor for the Manufacturer's Brochure for Patients.
Insurance Usually Doesn't Cover Cosmetic Procedures. However, if Your Injectable Treatment Is Being Performed to Treat a Scar or Indentation From an Accident or Injury, You May Be Reimbursed for a Portion of the Cost. Check with Your Insurance Carrier to Be Sure.
Where Your Treatment Will Be PerformedInjectables are usually administered in a surgeon's office-based facility. If, however, you are being hospitalized for a facelift, neck lift, brow lift, or any other procedure, your injections may be administered in the hospital as well.
Types of Anesthesia
Collagen: Because the Anesthetic Agent Lidocaine Is Mixed in with Collagen, Additional Anesthetic Is Usually Not Used. However, if You Are Especially Sensitive to Pain, Your Doctor May Use a Topical Cream Anesthetic or a Freon Spray to Numb the Injected Area. Or, You May Elect to Have an Injected Local Anesthetic or Sedative Drugs.
Fat: Both the Donor and Recipient Sites Are Numbed with Local Anesthesia. Sedation Can Be Used as Well. If You Elect to Use Sedation, Be Sure to Arrange for a Ride Home After Your Treatment.
Collagen Injection
Collagen Is a Naturally Occurring Protein That Supports Tissue of the Skin, Joints, Bones and Ligaments. Injectable Collagen Can Be Derived From Purified Bovine Collagen, Porcine Collagen or Human Sources. The Purification Process Ensures the Product Is Similar to Human Collagen. Injectable Collagen Is Produced in Varying Concentrations to Meet Individual Patient Needs.
Collagen Is Used Primarily to Fill Wrinkles, Lines and Scars on the Face and Sometimes the Neck, Back and Chest. First, a Skin Test Determines if You Are Allergic to the Substance. If You Are Not Allergic, the Collagen Is Injected at Several Points Along the Edge of the Targeted Area. Local Anesthesia Can Be Used to Control Discomfort as the Injections Are Administered. Because Part of Collagen Is Salt Water That Will Be Absorbed Within a Few Days, Your Doctor May Slightly Overfill the Area. You May Be Asked to Hold a Hand Mirror During the Procedure to Help Your Doctor Decide When You've Had Enough.
After Treatment, You May Notice Some Minor Discomfort, Stinging or Throbbing in the Injected Area. Occasionally Some Bruising or Swelling Will Occur, but It Is Usually Minor. Redness That Appears in the Injected Site Usually Disappears Within 24 Hours. However, in Some Individuals, Particularly Fair-Skinned Patients, This Redness May Persist for a Week or More. Tiny Scabs May Also Form Over the Needle-Stick Areas; These Generally Heal Quickly.
No Bandaging Is Needed and You Are Free to Eat, Drink, and Wear Makeup with Sunblock Protection Shortly Thereafter. There May Be Some Temporary Swelling and Redness in the Treated Area Which Should Dissipate Within a Few Days. If These Symptoms Persist, Contact Your Surgeon.
The Duration of Your Results Will Vary. In General, the Injected Material Is Likely to Disappear Faster in Areas That Are More Affected by Muscle Movement. Your Doctor Can Help You Determine How Long You Can Go Between Treatments to Best Maintain Your Results.
Fat Injection
Fat-Injection Procedure Is Also Known as Autologous Fat Transplantation or Micro-Lipoinjection. Fat Cells Are Extracted From the Patient's Abdomen, Thighs, Buttocks or Elsewhere and Reinjected Beneath the Facial Skin. Fat Can Fill in Sunken Cheeks or Lines Between the Nose and Mouth, Correct Skin Depressions, Minimize Forehead Wrinkles or Enhance the Lips.
After Cleansing and Treatment with Local Anesthesia, Fat Is Withdrawn Using a Syringe with a Large-Bore Needle or a Liposuction Cannula. The Fat Is Then Prepared and Injected Into the Recipient Site with a Needle. Sometimes an Adhesive Bandage Is Applied Over the Injection Site. Slight Overfilling May Be Necessary to Allow for Fat Absorption That Occurs. When Fat Is Used to Augment the Cheeks, This Overcorrection May Cause the Face to Appear Abnormally Full.
While Some Treatments Require a Brief Recovery Period, Many Patients Resume Normal Activity Right Away. Expect Some Swelling, Bruising or Redness in Both the Donor and Recipient Sites. The Severity of These Symptoms Depends Upon the Size and Location of the Treated Area. Stay Out of the Sun Until Redness and Bruising Subsides - Usually About 48 Hours. In the Meantime, You May Use Makeup with Sunblock Protection to Help Conceal Your Condition. In Some Cases, Swelling and Puffiness in the Recipient Site Lasts Several Weeks, Especially if a Large Area Was Filled.
While Some Patients Report Results Lasting 1 Year or More, the Majority of Patients Find That at Least Half of the Injected Fullness Disappears Within 3-6 Months. Therefore, Repeated Injections May Be Necessary. Your Doctor Will Advise You on How to Maintain Your Results with Repeat Treatments.
Your New LookIf you're like most patients, you'll be very satisfied with the results of your injectable treatments. You may be surprised at the pleasing results that can be gained from this procedure.
Laser Skin Resurfacing
In Laser Resurfacing, Sometimes Called "Laser Peel," a Carbon Dioxide (Co2) Laser Is Used to Remove Areas of Damaged or Wrinkled Skin, Layer by Layer. The Procedure Is Most Commonly Used to Minimize the Appearance of Fine Lines, Especially Around the Mouth and the Eyes. However, It Is Also Effective in Treating Facial Scars or Areas of Uneven Pigmentation. Laser Resurfacing May Be Performed on the Whole Face or in Specific Regions. Often, the Procedure Is Done in Conjunction with Another Cosmetic Operation, Such as a Facelift or Eyelid Surgery.
Laser Resurfacing Is Still a Very New Procedure. However, It Has Been Shown That in Some Cases, This Surgical Method Produces Less Bleeding, Bruising and Post-Operative Discomfort Than Is Typically Seen with Other Resurfacing Methods.
This Brochure Will Give You a Basic Understanding of the Laser Resurfacing Procedure - When It Can Help, How It's Performed and What Results You Can Expect. It Cannot, However, Provide All the Details Which May Be Relevant to Your Particular Needs. Please Ask Your Plastic Surgeon if There Is Anything About the Procedure You Don't Understand.
A Word About the Laser
Laser Resurfacing Is Performed Using a Beam of Laser Energy Which Vaporizes the Upper Layers of Damaged Skin at Specific and Controlled Levels of Penetration.
It's Clear That Laser Resurfacing May Offer a Number of Advantages Over Other Resurfacing Methods: Precision, Little (if Any) Bleeding and Less Post-Operative Discomfort. However, Laser Resurfacing Isn't for Everyone. In Some Cases, an Alternative Skin Resurfacing Treatment, Such as Dermabrasion or Chemical Peel, May Still Be a Better Choice.
All Resurfacing Treatments Work Essentially the Same Way. First, the Outer Layers of Damaged Skin Are Stripped Away. Then, as New Cells Form During the Healing Process, a Smoother, Tighter, Younger-Looking Skin Surface Appears. Laser Resurfacing Is a New Method Being Used by Plastic Surgeons to Remove Damaged Skin. Because It Is New, There Are No Long-Term Data on This Technique. However, a Number of Studies Using Microscopic Examination Have Shown That the Physical Changes That Occur to Laser-Treated Skin Are Essentially Identical to Those That Occur with Either Dermabrasion or Chemical Peel. Ask Your Plastic Surgeon About the Latest Facts Concerning Long-Term Follow-Up.
For Superficial or Medium Resurfacing, the Laser Can Be Limited to the Epidermis and Papillary Dermis. For Deeper Resurfacing, the Upper Levels of the Reticulas Dermis Can Also Be Removed. Varied Penetration Allows Treatment of Specific Spots or Wrinkles.
It's Also Important to Consider the Length of Recovery When Choosing Among the Skin-Resurfacing Alternatives. In General, the More Aggressive the Resurfacing Procedure Is, the More Prolonged the Recovery Is Likely to Be. "Light" Resurfacing Procedures, Such as Superficial Chemical Peels or Superficial Laser Resurfacing, Offer Shorter Recovery Times. However, These Lighter Procedures May Need to Be Repeated Multiple Times to Achieve Results Comparable to Those Achieved with More Aggressive Techniques.
The Best Candidates for Laser Resurfacing
In Many Cases, Facial Wrinkles Form in Localized Areas, Such as Near the Eyes or Around the Mouth. The Laser Can Be Precisely Controlled So That Only These Specific Areas Are Targeted.
Patients with Olive Skin, Brown Skin or Black Skin May Be at Increased Risk for Pigmentation Changes No Matter What Type of Resurfacing Method Is Recommended. Your Plastic Surgeon Will Evaluate Your Skin Characteristics and Make Recommendations Accordingly.
Also, Individuals Who Have Taken Accutane in the Past 12-18 Months or Are Prone to Abnormal (Keloid-Like) Scarring or Those with Active Skin Infections on the Treatment Area May Not Be Appropriate Candidates for This Procedure.
Remember, Having Laser Resurfacing Can Help Enhance Your Appearance and Your Self-Confidence, but It Won't Completely Remove All Facial Flaws or Prevent You From Aging. Lines That Occur as a Result of Natural Movements of the Face - Smiling, Squinting, Blinking, Talking, Chewing - Will Inevitably Recur. Your Plastic Surgeon Can Suggest Ways to Help You Preserve Your Results by Protecting Yourself From Sun Exposure or Using Maintenance Treatments, Such as Light Chemical Peels or Medicated Facial Creams. Before You Decide to Have Laser Resurfacing, Think Carefully About Your Expectations and Discuss Them with Your Surgeon.
All Surgery Carries Some Uncertainty and Risk
When Laser Resurfacing Is Performed by a Qualified, Experienced Surgeon, Complications Are Infrequent and Usually Minor. However, Because Individuals Vary Greatly in Their Anatomy, Their Physical Reactions and Their Healing Abilities, the Outcome Is Never Completely Predictable.
Risks Associated with Laser Resurfacing Include: Burns or Other Injuries From the Heat of the Laser Energy, Scarring, and Obvious Lightening or Darkening of the Treated Skin. Also, Laser Resurfacing Can Activate Herpes Virus Infections ("Cold Sores") and, Rarely, Other Types of Infection.
Additional Corrective Measures and Treatment May Be Required if Healing Seems Abnormal or Delayed or if There Is Any Evidence of Abnormal Pigmentation or Scarring.
You Can Reduce Your Risks by Choosing a Qualified Plastic Surgeon Who Has Received Special Training in Laser Surgery.
Planning Your Surgery
Not Every Practitioner Who Offers Laser Surgery Has the Same Level of Experience and Skill with Laser Use. That Is Why It Is Especially Important That You Find a Plastic Surgeon Who Is Adequately Trained in the Procedure.
One Safety Measure Is to Find Out Whether Your Surgeon Has Privileges to Perform Laser Resurfacing with a Co2 Laser at an Accredited Hospital. Even if the Operation Is to Be Conducted in Your Doctor's Private Facility, the Fact That He or She Has Privileges to Use That Same Laser in a Hospital Ensures That the Doctor Has Been Reviewed by the Institution's Experts.
In Your Initial Consultation, Be Frank in Discussing Your Expectations with the Surgeon and Don't Hesitate to Ask Any Questions You May Have. Your Surgeon Should Be Equally Frank with You, Explaining the Factors That Could Influence the Procedure and the Results - Such as Any Abnormal Skin Condition Which Has Been Diagnosed or Previously Treated, Medications You Are Taking or Have Taken in the Past, Previous Skin Injuries or Previous Operations.
Your Surgeon Will Discuss Your Medical History, Perform a Routine Examination and Photograph the Area to Be Treated. He or She Should Explain the Procedure in Detail, Along with Its Risks and Benefits, the Recovery Period and the Costs.
Remember, Cosmetic Laser Treatments Can Be Expensive and Are Usually Not Covered by Medical Insurance. On Rare Occasions, the Procedure Can Be Used for Modification of Scars or the Removal of Pre-Cancerous Skin Growths. These Conditions Could Meet the Criteria for "Medical Necessity," Usually Required by Insurance Companies Before Coverage Will Be Provided. Your Plastic Surgeon Can Advise You How to Contact Your Insurance Carrier to Determine Whether Benefits Will Be Allowed in Such Instances.
Preparing for the Laser Procedure
Depending on Your Individual Needs, Your Surgeon May Recommend That You Begin a Pre-Treatment Plan to Prepare the Skin for Resurfacing.
At the Time of the Procedure, You Will Be Given Specific Instructions on How to Care for Your Skin Immediately Following Your Laser Treatment. Your Surgeon May Also Instruct You to Follow a Specific Maintenance Regimen for Long-Term Care of the Skin to Maximize the Benefits of the Procedure.
While You Are Making Plans, Be Sure to Make Arrangements for Someone to Drive You Home if You Will Be Given Tranquilizers or Sedation for Your Laser Treatment.
Where Your Laser Treatment Will Be Performed
Laser Resurfacing May Be Performed in a Hospital, an Outpatient Surgery Center or a Surgeon's Office-Based Facility. For Cost Containment and Convenience, Laser Resurfacing Is Usually Done on an Outpatient Basis. For the More Extensive Resurfacing Procedures or for Resurfacing Combined with Other Surgical Procedures, You May Be Admitted to a Hospital or a Recovery Center.
Types of Anesthesia
Laser Resurfacing Is Most Commonly Performed Under Local Anesthesia with Sedation, Especially When It's Used to Treat Localized Areas of the Face. You'll Be Awake but Relaxed, and Will Feel Minimal Discomfort. For More Extensive Resurfacing, Your Surgeon May Prefer to Use General Anesthesia, in Which Case You'll Sleep Through the Procedure.
The Procedure
Laser Resurfacing Is a Relatively Quick Procedure. It Usually Takes Anywhere From a Few Minutes to 1 1/2 Hours, Depending on How Large of an Area Is Involved.
When the Imperfections Are Especially Deep, Your Surgeon May Recommend That the Resurfacing Be Performed in Two or More Stages.
During the Procedure, the Activated Laser Is Carefully Passed Back and Forth Over the Skin Until the Surgeon Reaches the Level That Will Make the Wrinkle or Scar Less Visible.
When the Procedure Is Over, Your Surgeon May Choose to Treat the Resurfaced Skin with Applications of Protective Creams or Ointments Until Healing Is Complete. Some Surgeons Choose to Apply a Bandage Over the Treated Areas Which Will Cover and Protect the Healing Skin for the First Five to Ten Days.
After Your Treatment
You Are Likely to Experience Some Mild Swelling and Discomfort After Laser Resurfacing. However, This Can Be Controlled with Ice Packs and Medications Prescribed by Your Surgeon.
If a Bandage Was Applied After Your Procedure, It May Be Replaced with a Fresh One After a Day or Two. After About a Week or So, Your Bandage Will Be Removed and a Thin Layer of Ointment May Be Applied to the Skin. Once This Stage Is Reached, Your Surgeon Will Provide Instructions on How to Gently Wash and Care for Your Healing Skin.
During This Phase of Healing, It Is Very Important That You Not Pick the Crusts Off the Treated Area or Scarring May Result. Most Patients Are Free of Crusts by About 10 Days Post-Operatively. Redness May Persist for Several Weeks.
Getting Back to Normal
Your New Skin Will Usually Remain Bright Pink to Red in the Weeks Following the Procedure. Your Surgeon May Prescribe Medications to Make This Color Subside More Rapidly. After About Two Weeks or So, Most Patients Can Safely Apply Makeup to Conceal This Temporary Color Change. However, Some Pinkness May Remain for Up to Six Months.
It Is Rare, Some Patients May Find That Their Healing Skin Is Unusually Sensitive to the Makeup That Was Regularly Used Prior to Treatment. In Such Instances, Makeup Should Be Avoided Until a Substitute Can Be Found or Until the Healing Progresses to a Point at Which the Makeup No Longer Causes a Reaction.
Above All, in the Months Following Treatment, It's Important to Protect the Treated Area From the Sun Until All the Color Has Returned to Normal. Using Sun Protection Regularly Will Help to Maintain Your Results and Reduce the Chance of Any New Sun Damage to Your Skin.
If You Must Be in the Sun, Apply a Strong Sun Block with an Spf of 15 or Higher and Shade Your Face with a Hat or Visor. If Resurfacing Was Performed Around the Eyes, It's Best to Also Wear Good Quality Sunglasses with Uva and Uvb 100 Percent Filters.
Your New Look
The Final Result From Laser Resurfacing May Take Several Months to Fully Appear. However, Once the Pinkness Fades, Patients Usually Notice a Significant Improvement in the Quality of Their Skin and a Fresher, Smoother Appearance.
It's Important to Understand That Your Results Will Be Long-Lasting, but Not Permanent. Remember, Your New Skin Is Not Immune to the Effects of Aging. In the Months and Years Following Your Laser Treatment, Your Natural Facial Movements Will Eventually Cause Any "Expression" Lines to Recur.
As with Other Methods of Skin Rejuvenation, Laser Treatments Can Usually Be Repeated. However, by Protecting Yourself From the Sun and Following a Skin-Care Regimen Recommended by Your Plastic Surgeon, You Can Help Maintain Your Rejuvenated Look
Port Wine Stain
Port Wine StainPort-wine stains are birthmarks often treated by plastic surgeons. Treatment may vary according to the birthmark color, but can typically be done in children as young as 6-months old. Dark red port-wine birthmarks are typically treated with a series of laser treatments. Other birthmarks such as brown patches or red spots, also referred to as hemangiomas, may also be treated with a laser or surgically. Brown patches are sometimes treated with tissue expansion, whereby a silicone balloon expander is inserted under an area of the normal skin and then gradually filled with salt water, causing the skin to stretch and grow. Once the skin has stretched enough to cover the affected area, it is repositioned in place of the brown patch.
Spider Veins
Beauty for Life
Enhancing Your Appearance with Spider Vein Treatment
"If You Sometimes Avoid Showing Your Legs Because You Have Spider Veins — Those Small Clusters of Red, Blue or Purple Veins That Appear on the Thighs, Calves and Ankles — You Are Not Alone. It's Estimated That at Least Half of All Women Are Bothered by This Common Cosmetic Problem.
If You Would Like to Eliminate Your Spider Veins and Improve Your Appearance, Your Plastic Surgeon Can Help. Today There Are Very Effective, Safe and Relatively Painless Methods Available for Eradicating Spider Veins.
In Some Women, Spider Veins Become Noticeable in Their Early 20S. For Others, the Veins May Not Become Obvious Until They Reach Their 40S. Men Get Spider Veins, Too. However, Usually They Are Concealed by Hair Growth on the Leg.
A Number of Factors May Contribute to the Development of Spider Veins in the Legs, Including:
Heredity
Pregnancy
Hormonal Shifts
Weight Gain
Occupations or Activities That Require Prolonged Sitting or Standing
Is It Right for Me?
You Are Bothered by Spider Veins Anywhere on Your Body
You Have a Positive Outlook and Realistic Goals for Your Spider Vein Treatment
You Are Committed to Following Your Plastic Surgeon's Prescribed Course of Treatment
What to Expect During Your Consultation
The Success and Safety of Your Procedure Depends Very Much on Your Complete Candidness During Your Consultation. You’Ll Be Asked a Number of Questions About Your Health, Desires and Lifestyle.
Be Prepared to Discuss:
Why You Want the Procedure, Your Expectations and Desired Outcome
Any Problems You May Have Had in the Area to Be Treated, Such as Pain or Previous Injuries
Any Surgical Procedures That Have Been Performed Near the Area to Be Treated, Including Any Previous Vein Treatments
Medical Conditions, Family History, Drug Allergies, and Medical Treatments
Use of Current Medications, Vitamins, Herbal Supplements, Alcohol, Tobacco and Drugs
Your Surgeon May Also:
Evaluate Your General Health Status and Any Pre-Existing Health Conditions or Risk Factors
Examine Your Veins in Detail
Discuss Your Options and Recommend a Course of Treatment
Discuss Likely Outcomes of Spider Vein Treatment and Any Risks or Potential Complications if Leg Veins Are the Problem, Your Surgeon May Examine You for Signs of More Serious “Deep Vein” Problems, as Well as for Larger, Varicose Veins. These Conditions Are Often Identified by Swelling, Sores, or Skin Changes at the Ankle. A Hand-Held Ultrasound Device Is Sometimes Used to Detect Any Backflow Within the Venous System. If Problems Are Identified, Your Surgeon May Refer You to a Different Specialist for Further Evaluation and Possible Treatment.
Preparing for Surgery
Prior to Your Procedure, You May Be Asked To:
Get Lab Testing or a Medical Evaluation
Take Certain Medications or Adjust Your Current Medications
Stop Smoking
Avoid Taking Aspirin and Certain Anti-Inflammatory Drugs and Herbal Supplements as They Can Increase Bleeding
Special Instructions You Receive Will Cover:
What to Do on the Day of Treatment
Care and Follow-Up
What Happens During Spider Vein Treatment?
Sclerotherapy Requires No Anesthesia and Is Usually Performed in an Outpatient Setting. Two or More Sessions, Each Lasting Less Than an Hour, Are Usually Required to Obtain Optimal Results.
Step 1 - the Treatment
A Common Method of Treating Spider Veins in the Legs and Ankles Is with Sclerotherapy. In This Treatment, Sclerosing Solution Is Injected Into Each Affected Vein, Causing the Vein to Collapse and Fade From View.
Although Everyone Is Different, You Can Generally Expect to Receive One Injection for Every Inch of Spider Vein That Is Treated. Bright Light and Magnification May Be Used to Ensure Maximum Precision While the Skin Is Held Taut to Inject Sclerosing Solution. A Cotton Ball and Compression Tape Is Often Applied to Each Injection Site as It Is Finished.
Leg Veins May Also Be Treated with a Laser. In This Method, an Intense Beam of Light Is Directed at the Spider Vein, Which Obliterates It Through the Skin.
Typically, Two or More Sessions Are Needed to Obtain the Desired Results. Sometimes, Laser Therapy Is Used in Combination with Sclerotherapy.
The Decision to Have Spider Vein Treatment Is Extremely Personal and You’Ll Have to Decide if the Benefits Will Achieve Your Goals and if the Risks and Potential Complications Are Acceptable.
Your Plastic Surgeon and/or Staff Will Explain in Detail the Risks Associated with Treatment. You Will Be Asked to Sign Consent Forms to Ensure That You Fully Understand the Procedure You Will Undergo and Any Risks and Potential Complications.
Important Facts About the Safety and Risks of Spider Vein Treatment
The Decision to Have Spider Vein Treatment Is Extremely Personal and You’Ll Have to Decide if the Benefits Will Achieve Your Goals and if the Risks and Potential Complications Are Acceptable.
Your Plastic Surgeon and/or Staff Will Explain in Detail the Risks Associated with Surgery. You Will Be Asked to Sign Consent Forms to Ensure That You Fully Understand the Procedure You Will Undergo, the Alternatives and the Most Likely Risks and Potential Complications.
Some of the Risks Include:
Unfavorable Scarring
Bleeding (Hematoma)
Infection
Poor Healing of Injection Sites
Change in Skin Sensation
Damage to Deeper Structures — Such as Nerves, Blood Vessels and Muscles — Can Occur and May Be Temporary or Permanent
Allergies to Tape, Suture Materials and Glues, Blood Products, Topical Preparations or Injected Agents
Skin Contour Irregularities
Skin Discoloration and Swelling
Skin Sensitivity
Ulceration
Pain, Which May Persist
Possibility of Revisional Surgery
Need for Further Injection Therapy
Be Sure to Ask Questions: It's Very Important to Ask Your Plastic Surgeon Questions About Your Procedure. It's Natural to Feel Some Anxiety, Whether It's Excitement for Your Anticipated New Look or a Bit of Preoperative Stress. Don’T Be Shy About Discussing These Feelings with Your Plastic Surgeon.
Where Will My Procedure Be Performed?
Spider Vein Treatment Is Usually Performed in Your Plastic Surgeon's Office.
After Your Treatment, You May Be Instructed to Wear Support Hose to Help Your Legs Heal. You May Feel Some Cramping in Your Legs for the First Day or Two After Treatment. This Discomfort Is Temporary and Usually Doesn’T Require Prescription Medication.
You Will Be Given Specific Instructions That May Include: How to Care for Your Legs Following Treatment, Medications to Apply or Take Orally to Aid Healing and Reduce the Risk of Infection, and When to Follow-Up with Your Plastic Surgeon.
When You Go Home
Should Any Complications Occur, Notify Your Plastic Surgeon Who Will Determine if Any Additional Treatment Is Needed.
Be Careful
Following Your Physician's Instructions Is Key to the Success of Your Treatment. It Is Important That the Injection Sites Are Not Subjected to Excessive Force, Abrasion, or Motion During the Time of Healing. Your Doctor Will Give You Specific Instructions on How to Care for Yourself.
My Recovery
Every Patient Heals at a Different Rate. However, You Can Expect That Your Recovery Will Follow This General Time Line:
Within the First Week
You Will Be Encouraged to Walk
The Tape, Cotton Balls or Any Other Dressings (if Used) Will Be Removed From the Treated Areas When Recommended by the Plastic Surgeon
The Treated Sites Will Appear Bruised
You May Be Instructed to Wear Support Stockings for Three to Six Weeks
You Will Be Discouraged From Sitting or Standing in One Place for More Than an Hour or Two
You Should Avoid Squatting, Heavy Lifting and Running
Within One Month
The Bruises at the Treated Sites Will Diminish
You Will Begin to Feel More Comfortable Wearing Leg-Baring Fashions
You Can Resume Most Exercise; However, Your Doctor Should Be Consulted if You Plan to Do Any Weight Lifting or Jogging
One Month After the First Treatment, Spider Veins Are Distinctly Lighter, Yet Still Somewhat Visible
You Will Be Discouraged From Sitting or Standing in One Place for More Than an Hour or Two
After Two or More Treatments, the Leg Appears Noticeably Clearer and More Attractive
The Practice of Medicine and Surgery Is Not an Exact Science. Although Good Results Are Expected, There Is No Guarantee, in Some Situations, It May Not Be Possible to Achieve Optimal Results with a Single Surgical Procedure and Another Procedure May Be Necessary.
Results and Outlook
After About a Month of Healing, You May Be Ready for a Second Vein Treatment. With Each Treatment, You Will Notice Further Improvement of Your Skin's Appearance.
It's Important to Know Treatment May Not Prevent New Spider Veins From Surfacing in the Future. As Time Passes, You May Find That You Need Further Treatments to Take Care of Any New Veins That May Emerge.
How Much Will Spider Vein Treatment Cost?
Cost Is Always a Consideration in Elective Treatment. Prices for Spider Vein Procedures Can Vary Widely. A Surgeon's Cost for May Vary Based on His or Her Experience, the Type of Procedure Used, as Well as Geographic Location. Many Plastic Surgeons Offer Patient Financing Plans, So Be Sure to Ask.
Cost May Include:
Surgeon's Fee
Surgical Facility Costs
Prescriptions for Medication
Post-Treatment Garments, And
Medical TestsMost health insurance plans will not cover spider vein treatment, related complications or another procedure to revise the appearance of your legs. You must carefully review your health insurance policy.
Your Satisfaction Involves More Than a Fee
When Choosing a Plastic Surgeon for Spider Vein Treatment, Remember That the Surgeon's Experience and Your Comfort with Him or Her Are Just as Important as the Final Cost of the Procedure.
Words to Know
Arborizing Veins:Veins that resemble tiny, branch-like shapes in a cartwheel pattern, often seen on the outer thigh.
Hyfrecation:Spider vein treatment in which the vessels are cauterized.
Laser Therapy:An intense beam of light passed over the leg to eliminate spider veins.
Laser Treatment:An intense beam of light directed at the spider vein, which obliterates it through the skin.
Reticular Veins:Larger, darker leg veins that tend to bulge slightly, but are not severe enough to require surgical treatment.
Sclerotherapy:Sclerosing solution injected into a vein, causing it to collapse and fade from view.
Simple Linear Veins:Veins which appear as thin, separate lines, and are commonly seen on the inner knee or on the face.
Spider-Shaped Veins:A group of veins radiating outward from a dark central point.
Spider Veins:Small clusters of red, blue or purple veins that appear in the skin on the thighs, calves and ankles.
Support Hose:Special stockings that compress your legs, typically used for varicose veins and post-surgical conditions.
Ultrasound:A device that uses high-frequency sound waves to create images of organs and systems within the body.
Varicose Veins:Abnormally swollen or dilated veins.
