Cosmetic and
Reconstructive Surgery Procedures

Face Lift
Eyelid Lift
Cheek and Chin
Nose Reshaping
Lip Augmentation
Otoplasty
Liposuction/Liposculpture
Thigh Lift/Buttock Lift
Breast Augmentation
Breast Lift

Breast Reduction
Breast Reconstruction
Laser Skin Treatment
Skin Resurfacing
Laser Hair Reduction
Abdominoplasty
Browlift
Gynecomastia
Genioplasty
Vaginoplasty

Face Lift

The face lift procedure may take up to four hours or longer depending on if you are having more than one procedure done. Incisions will be made on each side of your face beginning within the hairline above the temple area and will follow the natural line behind the tragus. It then curves behind the ear. Facial and neck tissue, as well as muscle, may be separated from the skin. Fat may be trimmed or suctioned after the skin has been pulled up and back. Sometimes the deeper tissues may also need to be repositioned in order to restore a more youthful contour to the face.

If you decide to have a neck lift as well, a small incision will be made under your chin. Stitches will be applied to secure and enclose the incisions. Small tubes may be placed under your skin behind the ear to drain any blood that may have been collecting during surgery. Your head will be bandaged to minimize bruising and swelling. After surgery, you will be taken to the recovery room until you wake and are able to go home, which generally takes several hours. Your surgeon may recommend an overnight stay.

Eyelid Lift

Eyelid surgery may take one to two hours depending on the extent of the surgery.

TRANSCONJUNCTIVAL BLEPHAROPLASTY
If you have fat pockets beneath your eyes but don’t want skin removed, your surgeon may perform what is called transconjunctival blepharoplasty. In this case, the incision is made inside your lower eyelid so it will not leave a visible scar. After surgery, your eyes will be lubricated with ointment and a bandage may be applied.

UPPER EYELID SURGERY
An incision will be made along the natural lines of your eyelids, such as the crease of your upper eyelid. The skin will be separated from muscle and fatty tissues, and excess fat will be removed. Sagging skin and muscles will be trimmed if needed before closing the incisions with very fine sutures. After surgery, your eyes will be lubricated with ointment and a bandage may be applied.

LOWER EYELID SURGERY
An incision will be made below the lashes on the lower eyelid. The incision will run along the smile creases under your eye. The skin will be separated from the muscle and fatty tissues, and excess fat will be removed. Sagging skin and muscles will be trimmed if needed and the incisions will be closed with very fine sutures.

Cheek & Chin Implant

CHIN IMPLANT
To begin, a sizer is used to determine the proper size and shape of your implant. Two common methods including making an incision just under the chin or inside the mouth in the gum line where the lower lip and gum meet. The method chosen will be determined based on your individual needs. The appropriate incision is made, a pocket is created, and the implant is inserted. Once the implant is in place and sutured, your chin may be taped to minimize swelling.

Generally the procedure is done under local anesthesia and may take between thirty minutes and one hour. It is not uncommon to combine this procedure with liposuction of the neck and/or chin where excess fatty tissue is removed. You may also consider rhinoplasty, also known as nose reshaping, to improve your profile.

CHEEK IMPLANT
To begin, a sizer is used to determine the proper size and shape of your implant. An incision is made just inside the mouth in the gum line where the upper lip and gum meet. A pocket is created and the implant inserted. The incision is then closed with absorbable sutures.

Generally this procedure is done under local anesthesia. The cheek implant procedure may take between thirty and forty-five minutes.

If you are having a cheek implant combined with another procedure (such as a face lift, forehead lift or eyelid surgery), the implants may be inserted through the incisions made for those procedures.

Nose Reshaping

Not everyone will achieve the same results with rhinoplasty. However, your surgeon’s goal is to obtain the best possible results for you. The surgery takes between one to three hours, but many factors may prolong it. There are two methods. You and your surgeon will decide whether open or closed rhinoplasty will be best suited for you.

Open Rhinoplasty
The first incision is made at the base of the nose, between the two nostrils, while the other incisions will be made inside the nose. The skin is then lifted to allow the structure of the nose to be examined. Then bone and cartilage are reduced and /or contoured to provide a new shape for your nose. The skin is finally re-draped over the newly shaped are and a splint is placed. Soft, absorbent material may be used inside the nose to maintain stability along the dividing wall of the air passages. If your nostrils were worked on, you may have nasal packs or soft plastic splints placed inside to stabilize the septum. Swelling can last longer with this method than the alternative closed procedure.

Closed Rhinoplasty
In this procedure, all incisions are made inside the nose, thus reducing swelling and recovery time. Due to limited visibility, your surgeon may not be able to achieve some changes. After incisions are made, certain amounts of underlying bone and cartilage are reduced, added to, or contoured to provide a newly shaped structure. The skin is finally re-draped over the newly shaped area. Once the procedure is complete, a splint will be placed to help your nose keep its new shape. Soft, absorbent material may be used inside the nose to maintain stability along the dividing wall of the air passages.

Lip Augmentation

There are two common methods: injections and implants.

Injection Method
Injections are placed in predetermined locations to plump and make your lips fuller. This method takes approximately thirty minutes.

Some injectable lip augmentation products are:
Collagen, Isolagen, Hylaform, Hydroxyappetite, and Fat. Results using these products are temporary and may last from three months to three years. Examples of permanent and irreversible injectable lip augmentation products are Artecoll™ and DermaCellagen™. The latter products are currently in the FDA approval process.

It is generally safer to under-inject than to over-inject no matter which product is used, therefore there is a possibility that you will be coming in again to “finish up” your desired look.

Implant Method
Incisions can be made inside the mouth or on the outside edges of the lip. You can expect this method to take approximately one hour or so.

The implant will be fed through the lip. Once inserted, it will be trimmed and the incisions will be closed.

Your surgeon may recommend the addition of Alloderm to bulk up and increase the fullness of your lips. This material is long-term and will gradually be replaced by your body’s own collagen. Gore-Tex™ and Advanta are the only approved synthetic, permanent implants.

Otoplasty

Otoplasty may last between two and three hours. To begin, your surgeon will fold your ear forward and make a small incision in the back of the ear to expose the ear cartilage. Depending on your particular needs, a piece of cartilage may or may not then be removed. The cartilage is folded back on itself, pinned, and sutured to maintain the newly created shape of your ear.

For younger children, general anesthesia is commonly used so they will sleep throughout the procedure. For teenagers and adults, surgeons prefer to use a local anesthesia and may combine it with a sedative. This way you will be awake, but very relaxed.

Liposuction/Liposculpture

The liposuction procedure can typically take between thirty minutes to four hours depending on the technique performed and the amount of excess fat removed. Various types of anesthesia can be employed for liposuction including local turnescent anesthesia, conscious sedation anesthesia, and general anesthesia. Your surgeon will discuss which type of anesthesia will best be suited for your specific situation. The two surgical liposuction techniques most commonly used are:

Tumescent Liposuction
This is an advanced form of traditional liposuction that has been performed in the United States since the 1970s. First, your surgeon fills the predefined areas with tumescent fluid which also provides anesthesia (saline mixed with adrenaline and lidocaine). Next, the fat is suctioned out using long thin rods. This entire procedure is done through tiny incisions that are well hidden by the creases of your skin.

Ultrasonic Liposuction
This technique is similar to the tumescent liposuction technique in the fact that predefined areas are filled with tumescent fluid, but then ultrasonic energy is used to liquefy the fat before being removed. This energy is delivered via a rod that emits ultrasonic waves. Your surgeon next inserts the small rod through a tiny incision and massages the fatty tissue before suctioning it out.

There are differences in time, costs, scars and other risks.

Thigh/Buttock Lift

The thigh/buttock life procedure may last between two and four hours depending on the amount of surgery to be completed. There can be two parts of this procedure: inner thigh plasty or outer thigh plasty. These procedures are often performed in conjunction with a tummy tuck.

To begin, general anesthesia will be administered and tumescent liposuction performed to remove excess fat. Incisions are customizable, but generally begin in the inner thigh and extend around to the buttock crease for the inner thigh plasty.

The incision for the outer thigh and buttock lift is longer and begins in the buttock crease, runs around the groin to the other side of the abdomen before ending back in the crease of the buttock. Once incisions are made, excess fat inside the thigh and buttocks are removed and the skin is lifted. Incisions will be sutured and sterile dressings applied.

Breast Augmentation

The breast augmentation procedure can take one to three hours depending on the technique performed:

Incisions may be placed inframammary (at the base of the breast), peri areolar (around the nipple), transaxillary (under the arm pit), or TUBA (above the belly button). Placement will depend on your desired look, whether or not you have had previous breast surgeries and the amount of breast tissue you have.

There are many technical factors to consider when planning your breast augmentation including: size, shape, incision placement, implant type and location. Your surgeon will review what is best for you. Other issues to discuss many include pregnancy, breast feeding, mammograms, and breast cancer.

Pocket Location
Implants can be placed subglandular (in front of the pectoral muscle) or submuscular (in back of the pectoral muscle).

Implants have two parts: a shell and fill material. There are many varieties.

Breast Lift

The breast lift procedure can take from two to four hours. The most common method requires an anchor-shaped incision circling the areola, extending downward following the natural crease below the breast. The incision will outline the area from which the skin will be removed as well as define the new location for the nipple. Once the excess skin has been removed, the nipple and areola are moved to their higher position. Skin surrounding the areola is brought down and helps reshape the breasts. Stitches will then be placed around the areola, the line running downward from the nipple area, as well as the lower crease of the breast. Fortunately, incisions can be placed so that scars cannot be seen when wearing low-cut tops.

For patients with relatively small breasts, modified methods such as vertical and concentric mastopexy could be performed. Vertical mastopexy requires that incisions be made around the areola, and a vertical incision extends down the breast. The concentric technique leaves a circular scar around the areola. Breast augmentation can also be performed at the time of a mastopexy or later depending on your goals.

Breast Reduction

This procedure can take between two to four hours depending on the complexity of your particular needs. Although techniques vary, the most common method is an anchor shaped incision circling the areola, extending downward following the natural crease below the breast. Excess glandular tissue, fat and skin will be removed. The nipple and the areola are then moved to their new higher location. Your surgeon will bring the skin from both sides of the breast down and around the areola to contour the new shape of your breasts. You may want to consider liposuction to remove excess fat from the underarm area as well.

Talk to your surgeon about whether your nipples will remain attached. If your breasts are very large, the nipples and areolas may need to be completely removed and re-attached to a higher location. Stitches will be applied around the areola, down a vertical line, and finally along the lower crease of the breast.

Breast Reconstruction

The two options commonly used for breast reconstruction are: breast implants and muscle flap reconstruction- which is sometimes performed in combination with implants.

Saline Breast Implants
This option is usually completed in two phases. The first surgery may last up to an hour and consists of placing a tissue expander in the breast area underneath the skin and chest muscle. Your surgeon will fill the tissue expander (similar to a balloon) with salt-water solution approximately once a week. Once your skin has stretched (usually three to four months), the next surgery will be to replace the tissue expander with a permanent saline implant. If you do not need the tissue expander, your surgery will only consist of inserting the saline implant. About half of saline patients need replacement or modifications of their implants after five to ten years.

Muscle Flap Reconstruction
This procedure involves the use of your tissue to rebuild the breast. Various tissue may be used such as tissue from the back, stomach, or buttock area. Scarring occurs where the tissue was taken as well as the reconstructed breast.

Two additional muscle flap methods include Tansverse Rectus Abdominis Muscle (or TRAM) flap and the Latissimus Dorsi flap.

In the Tansverse Rectus Abdominis Muscle procedure, the surgeon uses skin, fat, and small amounts of muscle from your abdominal area to contour the reconstructed breast. If you do not have enough tissue to be used in reconstructing a breast, a small saline implant may be inserted.

In a Latissimus Dorsi flap procedure, the surgeon uses muscle and skin from your back and transfers it to the breast area. This helps create a ‘pocket’ so an implant may be inserted and placed. The Muscle flap procedures may take several hours as well as a hospital stay of up to four days. Recovery is a slower process than the breast implant method, however the breast usually looks and feels more natural. Smokers and diabetic patients may not be able to undergo this type of breast reconstruction.

Expander/implant reconstruction usually requires an overnight stay in the hospital after the expander is placed, but the removal of the expander and the reconstruction.

Expander/implant reconstruction usually requires an overnight stay in the hospital after the expander is placed, but the removal of the expander and the insertion of the permanent implant is an outpatient procedure. Generally, several weeks are required for recovery prior to returning to all normal activities. Recovery is quickest with the expander implants and longest with the TRAM procedure. Nipple recreation can take place two to six months after your initial breast reconstruction surgery. A new nipple is created using skin from the reconstructed breast, while color is provided by medical tattooing.

Laser Skin Treatment

The laser skin procedure is usually performed in a similar way for most skin problems.

To begin, a cooling gel or numbing cream will be applied to the area to receive treatment. If the mark is on your face, your eyes will be covered with protective gear. Your technician will then run a scanner against the area to activate the laser. Once started, the laser sends pulses of light to seal or disrupt the unwanted vessels. Colored pigments are broken up to be small enough so they may be absorbed by your body, thereby disappearing. After the procedure, an antibiotic ointment or sunscreen will be applied to the treated areas. Several sessions may be required to reach your desired results.

Port Wine Birthmarks
Removal can take from a few minutes to more than an hour depending on how large the area is to be treated.

Rosacea
Removal generally takes about one hour.

Freckles and Age Spots
Removal of freckles and/or age spots can take anywhere between ten to thirty minutes depending on the amount of area to be treated.

Laser Sclerotherapy (Spider Veins)
Removal of the spider veins takes approximately twenty minutes. In addition to the laser session, your surgeon may want to use sclerotherapy for larger veins, on your legs especially. The process of sclerotherapy is simple. A solution is injected into the veins that causes them to shrink and gradually fade away. Ask your surgeon if this is recommended for you.

Skin Resurfacing

Chemical Peels
A chemical peel involves the application of chemical solutions to remove damaged upper layers of skin. The solution is applied to the skin for a brief period of time, after which a neutralizing solution is generally applied. Varying strengths of TCA (Trichloroacetic acid) and Phenol are the most common peeling agents. For less-damaged skin and maintenance, numerous agents, such as glycolic acid, can be used to provide a lighter treatment. These are sometimes called “quick fixes” or a “lunchtime” peel.

Dermabrasion/Dermaplaning
Today, dermabrasion generally refers to the use of brushes or diamond-embedded tips, to remove the damaged layers of skin. Recently, a less-invasive technique called microdermabrasion has become popular. These procedures involve passing a handheld instrument back and forth until the safest level of skin is removed. Much like the lighter chemical peels, these procedures can generally be done as a “lunchtime” procedure.

Lasers
Laser technology is used in medicine to treat a variety of skin problems. Changing the material used in the laser will alter the tissues affected by the laser energy. The carbon dioxide (CO2) and Erbium lasers can be used to treat damaged skin. The energy emitted from the laser is absorbed by the skin cells. By adjusting the energy level and the treatment time, the depth of skin treated can be altered (in much the same way that the strength of chemical peeling agents can be varied). The laser is carefully passed back and forth over the skin until a level is reached that will reduce or eliminate wrinkles and/or scars. Protective creams or ointments will be applied to treat the newly resurfaced skin. In some cases bandages may also be applied.

Laser Hair Reduction

This procedure can last from a few minutes to more than one hour depending on how large the area to be lasered is. To begin, a gel will be applied and the hair will be treated with a beam of concentrated laser light. This light selectively absorbs the melanin in the hair shaft as well as the surrounding hair follicles. Laser procedures can treat hundreds of follicles at a time, unlike electrolysis which kills one hair follicle at a time.

You can anticipate approximately four treatments in a six week interval. Lasers tend to treat hair follicles that are in an active growth phase, therefore more than one treatment is generally required to disable hair follicles that are still growing. A schedule will be discussed and planned before treatment so that you can achieve your desired results.

Cosmetic and Reconstructive Surgery Procedures