Breast augmentation is one of the most frequently performed cosmetic surgeries in the United States today. This consists of placing implants filled with either saline or Silicone gel under the breast, either on top of the pectoralis muscle or underneath the muscle to increase the size of the breasts. The operation takes about an hour and a half and is a day stay procedure in the hospital. There is definite soreness for the first several days after surgery, particularly when the implants are placed underneath the muscle. Generally, individuals can return to desk type jobs within a week but should not return to jogging or weight lifting for 4 to 6 weeks. There are many potential complications which each patient needs to be aware of before undertaking this procedure. However, breast augmentation patients are amongst the happiest patients in Plastic Surgery.
Breast lift or mastopexy is performed to return the breasts to a more youthful shape and position. Breast sagging can result from weight loss, pregnancy or simply last of elasticity of the skin. Frequently patients will elect to have implants placed at the time of a lifting procedure to increase the fullness of their breasts. There is additional scarring with a breast lift. These scars will fade over time but they will be permanent to a degree. The operation is done as an out patient procedure and generally takes approximately 2 hours. Return to desk type jobs takes approximately a week but strenuous activities should be avoided for 4-6 weeks.
Women with large breasts often experience a great deal of upper back and shoulder pains. Frequently they will undergo physical therapy without any lasting benefit. In addition, large breasts can lead to rashes under the breasts and irritation which are particularly bad in the summer months. A breast reduction can not only reduce the size of the breasts but will lift them as well. This is an operation which not only can make the breasts more proportionate in size but can greatly relieve pain and discomfort that an individual is experiencing. The operation takes about 2 ½ to 3 hours. It is frequently done as a “23 hour admission” in which the patient spends 1 night in the hospital after surgery but can be done as an out patient. Return to work is generally about 2 weeks for office type work. The procedure does involve scarring that goes around the nipple and then down in a “anchor” shape to the crease under the breast.
Male Breast Reduction
Enlarged breast tissue in males (gynecomastia) is a fairly common problem in men. This can be a source of great embarrassment and can keep individuals from going in public with their shirt off. This can be corrected with a combination of liposuction and usually excision of excess breast tissue and fat. In many cases this can be done with a small incision going ½ way around the nipple that is relatively inconspicuous. In men who have a great deal of breast tissue and sagging of skin, scars will need go outside of the nipple area and will therefore show to a larger degree with a shirt off. This operation generally takes 2 hours of general anesthesia and is done as a day stay in the hospital. The patient usually can return to work within a week and heavy exercise in 4 to 6 weeks.
Breast cancer is a devastating diagnosis for any woman. When the best treatment requires a mastectomy, breast reconstruction is frequently performed. This can be done either at the time of the mastectomy or at some “elective time” after the wound is healed. There are many types of reconstructions that can be performed but they generally fall into 2 main categories – those done with implants and those done with one’s own natural tissue – frequently tissue from the lower abdomen brought up to reconstruct the breast. Frequently, surgery is also done on the “opposite breast” to help with the symmetry. The opposite breast can be made either smaller or larger or simply just lifted. Breast reconstruction is a multi-stage procedure which can take several months to ultimately complete. In almost all cases, health insurance will cover not only the reconstruction of the breast that is removed but surgery to the “opposite breast”.
When a woman has finished having children frequently there is a desire to improve areas that are most affected by pregnancy which include the breasts and the abdomen. This will often involve an abdominoplasty (tummy tuck) coupled with some procedure to improve the breasts, frequently with implants or sometimes with a lifting procedure and implants. This is a very common combination and it has been come to be known in the lay press as the “Mommy Makeover.” There is a definite advantage to doing both procedures at once with one recovery time. This generally takes anywhere from 4 to 6 hours of surgery with recovery time of approximately 2 weeks to return to office type work and in 4 to 6 weeks to return to heavy physical activities. Costs are generally less when 2 surgeries are combined.
Post Bariatric Surgery
Bariatric surgery most commonly consists of gastric by-pass or lap band surgery. This surgery can be very successful in helping individuals lose as much as 100 lbs. or more. Frequently, however, after this weight loss the patient is left with a great deal of hanging extra skin which can only be taken care of by body contouring surgery. This can consist of simply a “panniculectomy” in which overhanging skin in the lower abdomen is removed to a more complicated operation such as a lower body lift in which an incision is made all the way around the abdomen to the back. Other operations frequently performed after bariatric surgery include a thigh lift, arm lift, breast lift and face lift. Frequently with the breast lift implants are also required. This can be complicated surgery and usually only one or two areas can be taken care of with the surgery. Unfortunately, many of these procedures are not covered by health insurance today.
Liposuction is one of the most common cosmetic procedures performed in the United States today. Fat can be suctioned from many areas of the body, most commonly the abdomen, hips, thighs, chest and neck area. Best results are obtained in individuals who are near normal body weight but have an excess fatty tissue in certain areas. Liposuction is not a substitute for weight loss and indeed cannot produce a dramatic decrease in size in someone who is greatly overweight. Nevertheless for proper individuals liposuction can give dramatic results with minimal scars. Compression garments are normally worn for 2 weeks after surgery and recovery times require approximately 2 weeks to return to normal regular activities.
Rhinoplasty (nose job) is an operation in which the bones, cartilage, fat, and skin of the nose are trimmed or reshaped to make a better appearance of the nose. Frequently, small incisions are made mostly inside the nose but sometimes in inconspicuous areas on the outside of the nose to produce the results desired. While rhinoplasty can give a dramatic improvement to the appearance of the nose, patients need to have realistic expectations. Careful pre op evaluation needs to be made of your nose to find out exactly what can and can’t be accomplished with a rhinoplasty. The operation generally takes 1 ½ – 2 hours as a day stay in the hospital. A nasal splint is generally worn for 1 week and black and blue can last for 2 weeks.
Forehead lift or brow lift was formerly done with a large incision in the scalp going from ear to ear. This created in many cases a thick scar on the scalp, permanent numbness in the head and frequently an unnatural overly lifted look. Modern brow lifts are done with smaller incisions and endoscopes with scars hidden in the hair to make a more natural appearance in lifting the brows as well as decreasing wrinkles of the forehead. This is frequently done in conjunction with eyelid surgery or face lifts as part of an overall procedure to improve the facial appearance. Black and blue from a brow lift can last for up to 2 weeks or more. Pain, however, is relatively minimal and individuals are usually able to return to work within a week.
Face lift has become an extremely popular operation in recent years. A face lift can make significant improvements in the jowl area, the folds where the cheeks meet the upper lips, as well as sagging of the neck. In the past, face lift was done by simply making a cut in front of the ear then pulling the skin back as tightly as possible and sewing it. The modern face lift is more of a sculpting procedure in which the multiple layers of the face are lifted and tightened including the muscles and then careful trimming the skin to achieve the best results. These newer procedures not only produce better initial results but will last longer as well. The scars involved are hidden about the ears. Black and blue can last for up to 3 weeks although pain is relatively minimal after the first several days. This operation is generally done as an out patient or as a 1 day stay in the hospital. The operation itself can take 3-4 hours and can be combined with eyelid surgery or brow lift.
Eyelid surgery or blepharoplasty is done to remove excess skin and fat about the eyes. Incisions are made in the creases around the eyes and generally fade to acceptable levels but are permanent. Frequently when the upper eyelids are drooping, this is caused in part by lower eyebrows. Therefore many times a brow lift will need to be done in conjunction with upper eyelid surgery. Blepharoplasty can be done under local anesthesia in a minor surgical setting. Stitches are “dissolving” and usually will go away within 3-4 days. Black and blue can last 2 weeks.
Ear surgery or otoplasty is done generally to place ears that stick out closer to the head. This is done with incisions that are generally hidden around the ears to remodel the skin and cartilage to make them more “normal” in position and appearance. I have done this operation on individuals between 5 years of age and 70 years. This operation generally gives very satisfactory results. In an individual who can cooperate (usually 15 years or above), this can be done in minor surgery under local anesthesia. Children would need to be operated on under a general anesthetic. The operation generally lasts an hour and a half. A head bandage is worn for several days afterwards, particularly in children.
Botox Or Dysport
Botox, Dysport or Xeomin are fast becoming the most popular cosmetic “office procedure” done in America today. These substances are purified proteins that are injected in specific areas in the face, generally about the forehead and eyes, to decrease or even eliminate facial wrinkling and lines on a temporary basis. There usually is no “down time” from these procedures although occasionally there can be black and blue which can last for several days. Results usually take effect within 2 to 6 days and last up to 4 to 6 months.
Cosmetic Dermal Fillers
Dermal fillers are injected in various areas on the face, particularly the nasolabial folds between the cheeks and upper lip, the upper lip itself, as well as areas about the eyes and cheek bones to fill out the areas and relieve depressions that occur with aging. Among the fillers that we provide are Restylane, Perlane, Radiesse and Juvederm. These are generally done as an office procedure taking anywhere from 15 to 30 minutes to perform. There can be bruising afterwards but this is rare. Results are immediate. They can last anywhere from 4 to 12 months, depending on the location injected and what type of material is injected.
Abdominoplasty or “tummy tuck” is an operation done to improve the abdomen that has redundant skin and stretching of the muscles frequently due to pregnancy or significant weight loss. Modern abdominoplasty is no longer an operation that simply pulls the skin as tightly as possible and cuts off the excess. Today abdominoplasty involves liposuction to remove fat from the sides and front, tightening of stretched muscles, then careful removal of excess skin. There is usually a fairly long scar that is present in the “bikini line” and usually a small one around the umbilicus (belly button). Recovery time is generally 10 days to 2 weeks to return to office type jobs and 4 to 6 weeks before heavy activity can be performed. There are potential complications each patient should be aware of but in properly selected individuals the improvement is usually very dramatic.