David L. Rayfield, MD - Board Certified Plastic Surgeon
PROCEDURES
Arm Lift (Brachioplasty)
An arm lift, also known as brachioplasty, is a surgical procedure to remove loose skin and excess fat deposits in the upper arm. With age, upper arm skin can become loose and flabby. Plastic surgeons will discuss brachioplasty with patients who want to tighten this skin and look as good as they feel. In some cases your plastic surgeon may suggest that liposuction be used alone or in conjunction with an arm lift to remove excess fat in the upper arms.
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.
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.
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.
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.
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.)
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 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.
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.
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.
Most women can return to work (if it's not too strenuous) and social activities in about two weeks.
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.
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 & 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).
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, crows 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.
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.
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).
Risks: Abnormal color changes (permanent). Tiny whiteheads (temporary); infection; scarring; flare-up of skin allergies, fever blisters, cold sores.
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.
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.
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.
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.
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.
Length: 30 minutes to 2 hours.
Anesthesia: Local with sedation, or general.
In/Outpatient: Usually outpatient. Occasionally overnight hospital stay.
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.
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.
Sculptra® is an enduring treatment approved by the FDA for restoration and/or correction of the signs of facial fat loss, or lipoatrophy, in people with human immunodeficiency virus. It is the first FDA-approved product of its kind for this condition. Facial fat loss, or lipoatrophy, is the loss of fat beneath the skin, which can result in sunken cheeks, indentations, and hollow eyes. Sculptra® is a safe, synthetic, and biocompatible material that is injected below the surface of the skin in the area of fat loss. It provides a gradual and significant increase in skin thickness, improving the appearance of folds and sunken areas.
Juvéderm™ injectable gel is a nonsurgical, physician-administered treatment. Your healthcare professional eases it under the skin using a fine needle to augment, or fill, the soft tissue of the dermis—the dense inner layer of skin beneath the epidermis—to add volume and diminish wrinkles and folds. It is an injectable gel is used most effectively for those wrinkles and folds in the lower third of your face, like your "laugh lines," "smile lines" or "parentheses" (nasolabial folds), or "marionette lines" (oral commissures).
Photo Facial ™ is a 3-5 treatment program that dramatically eliminates signs of sun damage, aging, and Rosacea, on the face and neck.
Restylane is a crystal-clear, non-animal, biodegradable gel based on a natural substance, called hyaluronic acid. The gel is injected into the skin in tiny amounts with a very fine needle. The result is instantaneous and produces a long-lasting, natural enhancement, gentle and safe to your skin.
Radiesse is a biocompatible, non-toxic, non-allergenic filler that reduces the appearance of wrinkles and skin folds around the mouth and nose, and fills certain scars. Popular for its long-lasting results, Radiesse benefits should be evident for two years or more.
Procedure: Smooth the face and smooth fine wrinkles using a carbon dioxide (CO2) 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.
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.
For larger volumes of fat or for fibrous body areas, ultrasound-assisted lipoplasty (UAL) may be used. UAL is a new technique in which a ultrasound probe is inserted beneath the skin to "liquify" the fat before it is suctioned.
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.
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.
Thigh lift is surgery that removes excess skin and fat from your thighs. The goal of the procedure is to improve the appearance of your thighs by removing the “dimpled look” produced by cellulite.
A thigh lift usually lasts several hours and can be an outpatient procedure or require a short hospital stay. You may be given local or general anesthesia depending on the surgical plan you and your doctor have developed. The surgery begins with an incision in the groin area, near the hip. After the incision is made, your surgeon separates the skin on your thigh from the fat and muscle below by pulling the flap of skin upwards. Then, your surgeon removes the excess skin and stretches the remaining skin back in place.
When the procedure is complete, your surgeon closes the incisions with small stitches and covers them with bandages. A small drainage tube may be inserted in your skin for several days to drain excess fluid from the surgery.
