Breast Augmentation
What is it?
Breast Augmentation is an operation to increase the size of the breasts using implants.  The implants have a silicone shell that can contain either sterile saline/water or silicone liquid/gel.

The Operation
Depending on the size of the breast, a pocket is surgically created either underneath the breast tissue or underneath the muscle underneath the breast.  The surgery is performed under general anaesthesia. Depending on the type of implant used, it can be performed either through a scar around the nipple, a scar underneath the breast, a scar in the armpit or very occasionally, through a scar around the belly button.

Any Alternatives
In the past, silicone itself was directly injected into the breast tissue but this is not something that is recommended at present.  There are some external suction devices, which can be applied to the breast, and this has been reported to increase breast size following sustained use.  It is not as yet absolutely clear if this is a permanent increase in size.  Sterile derivatives of Soya Oil have also been used as 'fillers' for implants but these should no longer be used.

Before the Operation
It is important for your surgeon to assess the type of breast augmentation that is requested.  It is also important to understand why it is requested, as to whether it is brought about by a change in life circumstances or a problem that has been ongoing for some time.  It is also important to try and understand the patient's expectations as to the outcome and size of breast implants.  There are a large number of breast implants available and the exact type of implant, whether round, shaped, containing saline sterile solution or silicone jelly, would all need to be discussed in detail with your surgeon prior to the operation.  Pre-operative review would also assess how fit you were for surgery.  The type of scar and the exact site and placement of the implant would be discussed in combination with a physical examination of your breasts.  This will indicate the extent of breast tissue that is available and where the implants should be placed.  The size of implants should also be discussed taking into consideration the amount of skin laxity and breast tissue that is present.  If the breasts are very droopy, breast augmentation alone may not be sufficient and corrective surgery may be required in order to place the nipples in a different position.  The site of the scarring would also be agreed.  It is likely that the surgeon may also want to take some photographs prior to surgery.  These are kept in your patient records.  Your surgeon is likely to have the type of implant available for you to feel and understand how it works.  It may also be helpful to get an idea of the type of volume that you require by filling bags of water with various volumes of fluid to gauge the breast size that you might wish for.

After in Hospital
The operation is likely to take around one hour.  On return to the ward you will have dressings around your new breasts and these may be in the form of a comfortably fitting bra, or some wrap-around padded dressings.  It is also likely that there will be drains in each breast.  You may be nursed in a semi-upright position, as this can tend to minimise swelling and hence make you feel more comfortable.  Your chest may feel quite sore following your return to the ward. The nurses will be able to give you painkillers for this, either by injection or tablet form.  You may also feel your breathing somewhat restricted as the surgery to create the pockets to place the implants can often make the chest feel slightly tight.  The nurse will make regular checks and monitor blood pressure, pulse and temperature.  The drains are usually taken out on the day following surgery. Should there be more fluid in the drains than expected, you may well be able to be discharged from hospital and then return to have the drains removed a few days later. 

After at Home
It is important that you rest on your return home.  Excess use of the arms and upper chest area by regular activities which one would normally undertake can cause further irritation and bleeding.  It is best to continue to wear a firm tight fitting bra both night and day for a further two weeks.  The bra may be removed for washing but one should avoid getting the wounds wet for probably one week following surgery.  You should also avoid sleeping face downwards for one month.  It is probably best to avoid doing any heavy activities, particularly lifting the elbows above the shoulder level, or any heavy lifting for a further three to four weeks.  You may also find that your nipples have altered sensation following the surgery but this is likely to improve as time passes.  The scars themselves may be massaged from two weeks following surgery.  However, it is not often necessary to massage the breasts themselves.  It is probably best for you not to drive for at least a week following surgery.  You should then be quite sure that you are able to perform an emergency stop.

Complications
As with any surgical procedure, bleeding can occur but the drains that are left after the operation are usually sufficient to control this.  Very occasionally if bleeding continues to be a problem, it may be necessary to return to theatre to stop the bleeding.  In making a pocket into which is placed the implant, one of the structures that can occasionally be damaged is the nerve supply to the nipple.  This can result in complete loss of sensation to the nipple but more often results in either decreased or very occasionally increased sensitivity.  This increased sensitivity can be uncomfortable.  Any time an object is placed within the body, the body forms a film around it.  This film can occasionally instead of staying nice and loose, increase in thickness, become scarred and occasionally become uncomfortable.  This is known as 'capsule formation'.  This tends to occur in about 10% of patients who have breast augmentation.  It occasionally will only affect one side as opposed to both sides where bilateral breast augmentation has been performed.  The type of capsule can vary from a firm feeling to one where the breast becomes very firm and hard, like a tennis ball.  In these situations the treatment depends on the ongoing problem.  Occasionally it may be necessary to remove the implant entirely and to replace it.  Infection can also occur. If the implant becomes infected then it is likely that the best option is to remove it.
There has been some controversy as to the use of silicone implants.  Many surgeons continue to use silicone implants both for reconstruction and for aesthetic augmentation.  There have been a number of studies which indicate that there is no definite evidence that silicone causes any problems within the body.  However, there are undoubtedly some people who have had breast implants that do have some unexplained symptoms. Most people benefit from having breast augmentation performed.

General advice
Having a bilateral breast augmentation performed can be somewhat uncomfortable.  It is important to avoid driving for about a week following surgery and to be sure that one is able to perform an emergency stop.  If the sensitivity of the nipple has been altered by the surgery, this may take some months to recover and indeed may never fully return to normal.  It is important that placement of the implants is discussed with the surgeon prior to surgery.  The implants will tend to stay where they are placed and will not move around the chest wall, as a normal jelly-like breast would do.  The patient would need to have an understanding about this prior to surgery.                                                                                                             Go back

 

Breast Lift (Mastopexy)
 A breast lift is a surgical procedure to raise and reshape breasts that have sagged as a result of pregnancy, nursing, and the natural force of gravity. Mastopexy is not permanent – since no surgery can permanently delay the effects of gravity but it can reduce the size of the areola, the darker skin surrounding the nipple.

What happens during the procedure?
The procedure is usually performed in an outpatient surgical center, either operated by your surgeon or a hospital facility, and takes 1½ - 3½ hours, but depending on the extent of the procedure, it can take longer. If you are having more than one procedure, overnight hospitalization may be required.

Breast lift surgery can be performed under local anesthesia, along with intravenous sedation, or general anesthesia depending on your health, the extent of the procedure and whether you are having other procedures at the same time. 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.

Are there risks or potential side effects?
As with all surgeries, there is always a possibility of complications including infection, a reaction to the anesthesia, hematoma, seroma, nerve damage and the occurrence of asymmetries or irregularities. Should infection occur, your surgeon will prescribe a treatment with antibiotics. Bleeding and infection following a breast lift are uncommon, but can cause scars to widen. You can reduce your risks by closely following your physician's advice both before and after surgery. Be sure to ask your surgeon about all of the risks associated with the procedure your considering before you make any decision.

A breast lift does leave noticeable, permanent scars. They often remain lumpy and red for months, then gradually become less obvious, sometimes eventually fading to thin white lines. 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.

A breast lift will not make breasts firm forever--the effects of gravity, pregnancy, aging, and weight fluctuations will eventually take their toll again. Women who have breast implants along with their breast lift may find the results last longer.

What to expect post-procedure?
An elastic bandage or a surgical bra over gauze dressings must be worn after surgery. The breasts will be bruised, swollen, and uncomfortable for a several days, and the level of pain ranges from person to person.

The extent of the post-operative swelling and bruising is dependent on whether you tend to bruise or swell easily. The amount you can expect varies for each individual but past surgeries or injuries should be a good indication. Keep yourself elevated to limit the amount of swelling. Applying cold compresses, or ice packs can reduce swelling and relieve discomfort. Many patients use a water-tight plastic sandwich bag filled with frozen berries or peas. Regular icing is the key to relieving swelling.

Within a few days, a soft support bra will replace the bandages or surgical bra. This bra must be worn constantly for several weeks over a layer of gauze. The stitches will be removed after a week or two.

Breast skin can be very dry following surgery, careful application moisturizer several times a day can alleviate this somewhat. Some loss of feeling in your nipples and breast skin can occur, which is caused by the swelling after surgery. Feeling usually returns as the swelling subsides over the following six weeks. In some patients, however, it may last a year or more, and, occasionally, may be permanent.

As with any surgery, it is also sometimes normal to feel anxious or depressed in the days or weeks following the operation. If there is heavy bleeding or increased pain, be sure to inform your surgeon.

How soon does normal life resume?
Healing is individual. Some patients may be up and about in a day or two, but you shouldn’t plan on returning to work for at least two weeks. All patients should avoid lifting anything over your head for three to four weeks.

It is important to follow your surgeons 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.

Who performs it?
A plastic surgeon normally performs a breast lift.

Are you a good candidate?
While breast lift surgery can improve a woman's body image and self-esteem, it does not remedy pre-existing psychological and personal problems. As with all elective surgery, good health and realistic expectations are prerequisites, however, if you want to change the look of your breasts then this procedure may be appropriate, but:

How to prepare for this procedure?
Your doctor will give you specific instructions to prepare for surgery but here are some general guidelines:


 Breast Reduction

What is it?

Breast reduction is the removal of excess skin and breast tissue with re-positioning of the nipple to a higher situation.  It is most frequently performed for heavy breasts that results in physical problems, rather than for cosmetic appearance.

 

The Operation

The surgery is performed under general anaesthesia.  There are different techniques depending on how big the breasts are and how much tissue needs to be removed.  The surgery is performed with pre-operative marks as guidelines.  In moderate size breasts the nipple is left attached to underlying breast tissue, excess skin and breast tissue is removed and then the nipple is placed in a new higher position.  The remaining skin and breast tissue is sutured together.  The types of scars that commonly arise are, a scar that goes around the nipple at its new position and a scar that extends from the new nipple position downward underneath the breast.  In bigger breasts, there is often a scar that goes underneath the breast from the midline to the side.  Drains are usually required and a supportive dressing is placed after surgery.

  

Any Alternatives

Weight loss can occasionally make breasts smaller but this does not usually lead to re-positioning of the nipple in a higher more youthful appearance.  Weight loss can also cause empty sagging breasts.

 

Before the Operation

Breast reduction surgery takes between two and three hours to do and therefore is a major operative procedure.  It is important that the patient's general health has been assessed and it is advisable to stop smoking.  The surgeon will visit pre-operatively and discuss the size the patient wishes.  Marks will then be placed on the patient's chest according to the type of operative procedure to be performed.  Blood tests may also be taken prior to surgery, as very occasionally a blood transfusion is required.  It may also be necessary to take a course of iron tablets following the surgery.  As the operation takes some time to do, measures to prevent clots in the legs are undertaken usually along the lines of special stockings, improvement of the blood flow in legs during surgery, or the addition of blood thinning agents prior to surgery.

 

After - In Hospital

You may notice a firm bandage around your chest when you wake up.  This may also make your breathing slightly restricted.  It is there to provide comfort and also to decrease swelling around the breasts after surgery.   It is likely that you will be in a semi-upright position following surgery. Again this helps to decrease swelling and pain.  Pain and discomfort following surgery is common and can be treated with pain-killing injections or tablets.  Regular painkillers will be needed on return home along the lines of Paracetamol.  There will be a drain in each breast to remove excess fluid that can accumulate following surgery.  It is also likely that there will be an intravenous drip, which is usually removed when you are able to tolerate diet and fluids comfortably.  The nurse will check your blood pressure, temperature and pulse rate following the surgery and in some operations it will be necessary to check the blood supply to the nipple on a regular basis. After the surgery you will be encouraged to gradually increase your mobility and independence.  Assistance will be given with shallow bathing and general hygiene until you are able to manage this independently.  The dressings usually remain intact for twenty-four to forty-eight hours following surgery at which time the drains are usually removed.  The stitch line will then be cleaned as necessary and a new dressing applied.  It is often useful at this time to have soft support type bra that can accommodate a small dressing.  This gives support to the breast and decreases pain.  Your stay in hospital will be variable and will depend on the type of surgery that has been performed and the amount of drainage from the breasts.  You may expect to go home within two to three days following surgery.

 

After - At Home

You may experience pain and discomfort in your breasts, which is usually adequately treated with simple painkillers.  Should you find increased unexpected pain it will be most important to let the hospital know of your pain and discomfort.  As with any major surgical procedure, you may feel tired following the surgery and may need assistance in doing ordinary daily tasks.  It is important to avoid getting the suture line wet.  It is likely that you will be asked to attend the outpatients if only to review the dressings.  It is probably best to also avoid driving at this time as pain and discomfort may prevent adequate control of the steering wheel.

On most occasions, the sutures that are used to close the breast reduction surgery are of a dissolvable type but occasionally some sutures may need to be removed.  This usually takes place some two weeks following surgery.

 

Possible Complications

Breast reduction surgery takes some time to perform and may be considered a major operative procedure.  As with any major surgery you may bleed during the surgery and very occasionally a blood transfusion may be required.  The drains are placed in the breasts after surgery as there is often some bleeding that can occur.  Very rarely bleeding can continue to such an extent that a return to theatre is required.  This is why it is important to have regular post-operative checks on the ward by the nurses. 
 

Infection can occur in the post-operative phase and this is minimised by good surgical technique. Antibiotics are sometimes given around the time of surgery.  Regular reviews after surgery indicates if there is evidence of infection and occasionally it is necessary to have a course of antibiotics.  Often, due to the extent of the surgery, the skin of the breasts appears red. This is more commonly related to inflammation rather than infection.
 

There is often some irregularities around the scars immediately following surgery but these tend to settle down and get better as the swelling disperses and the skin tightens.  Occasionally there are some areas underneath the breast where the skin does not heal immediately and dressings may be required for up to six to eight weeks afterwards.  This is related to the tension that is needed to reshape the new breast, which the skin does not tolerate.  Very very occasionally, skin grafting may be required if significant skin breakdown occurs.  Personal care and hygiene can be maintained once the wounds have become sealed.  This varies from one to two weeks.  If dressings are required because of minor wound problems, your doctor may still be happy for you to shower, dab the area dry and have it redressed.  Supportive bras, which are not under wired, can keep the breasts comfortable following surgery.  It is sometimes necessary to wear them at nighttime as well for comfort.

 

Return to work can take place from two to three weeks after surgery depending on the physical requirements.

 

When driving it would important to make sure that there is no interference with turning the wheel or areas of pain which may cause some difficulty with the need to perform an emergency stop.

 

Direct trauma onto the breast can cause the wounds to split open.  However, one should wear a safety belt when driving or a passenger in a car.

 

It may take some time for the redness of the skin underneath the breast to settle down.  If the breasts are very big prior to surgery, the ends of the scars may remain prominent.  Should this be the case they may need to be 'tidied up'.  This is a procedure that can usually be performed under local anaesthesia.

 

General Advice

The majority of people who have breast reductions are happy with the size and shape of the breasts following surgery.  It can take six to nine months for the swelling to subside entirely.  The outcome of the surgery that some people are not so happy with is the scarring.  The scars, although they look neat initially, can become red itchy and raised above the level of the surrounding skin.  As well as becoming somewhat unsightly they can also give rise to concern.  Some techniques are available to try and make the scars more comfortable including local silicone sheet dressings, local massage or the occasional use of laser treatment.  The scars may become particularly troublesome close to the midline and most surgeons try and avoid placing scars too close to the midline.  This helps with the problems with the scar formation but also avoids putting scars where the patient may want to show their cleavage.  The breasts tend to remain in a satisfactory position but as time goes by, droopiness of the breasts can occur again.  Excess weight gain or pregnancy can precipitate increased size and therefore droopiness to occur more rapidly.

 

It is not always possible to match the breast sizes following surgery and this may become more apparent when the swelling has decreased.  Depending on the type of breast surgery that has been performed it may be possible to breast-feed if one becomes pregnant.

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Gluteal Augmentation 

Solid-silicone implants are the only realistic choice for amplifying the buttocks, and great things can be done with them

 

In the past few years, gluteal augmentation has been one of the faster-growing aesthetic-surgery procedures. The public wants to learn more about this procedure, but few well-trained surgeons have experience with it and can meet the demands of the patient population. Only recently has peer-reviewed information been available to surgeons interested in the procedure.

 

Early buttock augmentation can be traced to surgeons in Mexico and South America, where buttock appearance is more of a focus of sensuality and beauty than in the United States. Outside the United States, silicone-gel implants are routinely used to augment the buttocks. Gel implants provide a natural, soft feel, along with a pleasing shape.

 

Silicone-gel implants are not available in the United States for gluteal augmentation, and will most likely not be available for many years to come. Currently, no clinical trials are in progress, and no manufacturer appears to be interested in spending the resources necessary to gain US Food and Drug Administration (FDA) approval for buttock gel implants.

  

Implants and Filler Problems        

 

One of the problems with gel implants is their potential to rupture, which can lead to complications such as secondary infection, silicone migration, granulomas, and eventually, additional surgery to remove the gel. Occult rupture is also a problem: Imaging studies using magnetic resonance or sonograms are often needed to determine whether the implant is intact. Another impediment is that seromas and small hematomas cannot be managed with needle aspiration in the presence of a gel implant due to the risk of implant perforation and leakage.

 

Likewise, the use of saline implants for gluteal augmentation is not approved by the FDA. I have seen patients from other countries who had undergone gluteal augmentation with saline implants that needed to be removed because of a poor aesthetic result. In addition, a saline implant is susceptible to rupture from trauma or wear because it is not durable enough to withstand mechanical forces in the gluteal region. For these reasons, solid implants are the only ones available for gluteal augmentation in the United States.

 

Buttock augmentation using transplanted fat has yielded mixed results. In many thin patients, not enough fat is available to significantly increase the projection in the gluteal region. However, in heavier patients, liposuction can provide large amounts of fat that can be injected into the gluteal region.

 

The fate of this transplanted fat varies from complete reabsorption within several months—requiring additional fat grafting—to partial graft survival. However, fat grafting is beneficial for contouring small defects and contour irregularities that do not require an implant.

 

The use of fillers to augment the buttock has produced poor results. Currently, no biocompatible, long-lasting injectable material can be used to augment the gluteal region.

  

Liquid and Solid Silicone

 

Liquid silicone has been used as an “injectable implant” to augment the gluteal region. However, large-volume silicone injections can lead to severe complications, including granuloma formation, skin necrosis, infection, deformity, and silicone migration. These complications are not easily treated and, in some cases, require surgical debridement that produces significant morbidity.

 

The early results from gluteal augmentation using solid implants were mixed. The implants tended to produce a high, unnatural look when they were positioned under the muscle. Subcutaneous implant placement led to capsular contracture and a poor shape. In addition, reports of complications such as infection, scarring, asymmetry, and potential nerve damage left most surgeons in the United States believing that gluteal augmentation was a risky procedure.

 

This perception has changed as mainstream, well-trained plastic surgeons in the United States have reconsidered the procedure and approached it scientifically. As a result, more information on proper technique and postoperative management of gluteal-augmentation patients is now available to surgeons. This focus has led to better surgical outcomes and the standardization of best practices.

  

Candidates for the Procedure

 

The best candidates for gluteal augmentation with solid-silicone implants are normal-weight patients who desire more fullness in the gluteal region and lack central projection. They should have ample soft tissue to provide durable coverage of the implant. The region should be free from chronic skin irritation and infection.

 

However, HIV infection is not a contraindication to this surgery. Many of these patients suffer from HIV-associated lipo­atrophy of the gluteal region and can benefit from gluteal augmentation, provided that their medical condition is satisfactory.

 

The obese patient is not a good candidate for gluteal augmentation with an implant for reasons other than generally poor health. One is that shear force in the buttocks are greater than normal in obese patients, which make seromas more common and wound healing problematic.

 

Patients with uncontrolled diabetes should not undergo gluteal augmentation because of the increased risk of infection. Other contraindications include patients who are noncompliant, have unrealistic expectations, are in poor health, or are not willing to accept the possibility of postoperative complications.

 

In patients with minimal buttock ptosis and good skin elasticity, gluteal implants may improve the appearance of the buttock by creating lift and filling out the involuted region. In patients with greater degrees of ptosis, implants may exacerbate buttock sagging and produce a poor result. These patients are better treated with a buttock lift. In some instances, insertion of a buttock implant with a subsequent infragluteal-fold skin excision can be beneficial.

 

Before the Implantation

 

Preoperatively, the patient is examined and the buttock’s size and shape are evaluated. The need for liposuction of the lower back or hips is considered. Patients with a long buttock may require an oval gluteal implant, whereas patients with a short buttock would normally benefit from a round implant.

 

Almost all male pa­tients are suitable for a round implant. Oval im­plants are more likely to be used in women who have a long buttock that requires inferior-aspect fullness.

 

An array of sizers should be available in the examination room to determine the most appropriate implant (Figure 2). The implant should have the correct base diameter to adequately augment the buttock without providing too much lateral fullness, which, with a solid implant, will be more likely to produce visible edges.

 

The buttock’s height-to-width ratio should be considered when choosing an implant. Placing sizers on the buttock allows the surgeon to determine the implant’s proper shape and the volume needed to augment the gluteal area. In addition, patients are made aware of the available choices.

 

The amount of soft tissue available to cover the implant should be evaluated during the preoperative visit. In men with a paucity of subcutaneous fat and in extremely thin women, consideration should be given to intramuscular implant placement. In patients with ample subcutaneous tissue, subfascial placement of the implant may be appropriate.

 

In patients with a low buttock, it is necessary to place the implant inferiorly; this makes intramuscular-implant placement difficult because of its proximity to the sciatic nerve. In patients with a low buttock, placing the implant subfascially will enable it to be positioned low enough to augment the buttock’s inferior aspect while avoiding injury to the sciatic nerve. Subcutaneous implant placement is not recommended.

 

Patients are given a preoperative antibacterial soap. They are instructed to shower the night before and the morning of surgery, and to apply the soap to the gluteal region. A bowel prep is not required.

  

Outpatient Surgery

 

The surgery is performed on an outpatient basis in a fully accredited surgical facility. Prior to surgery, the size of the chosen implant is outlined on the patient in the standing position. The implant should be centered at the point of maximum projection.

 

General endotracheal or epidural anesthesia is administered. The patient is placed on the operating table in the prone position with adequate padding between the pressure points and the table.

 

Sequential compression devices are applied to the lower extremities and intra­venous antibiotics are administered. Following a routine preoperative surgical scrub, a sterile prep of the buttocks is performed.

 

A 6- to 7-cm vertical midline intergluteal incision is marked superiorly from the tip of the coccyx. The area is then infiltrated with local anesthesia containing epinephrine to aid in hemostasis.

 

An incision is made down to the sacrum, and enough soft tissue is preserved to allow the wound to close. Lateral dissection is then performed away from the midline incision in the subfascial space using a lighted fiber-optic retractor and a long-tip electrocautery.

 

The fibers of the gluteus maximus muscle are divided parallel to their orientation, and an intramuscular pocket is developed with 2 to 3 cm of muscle coverage. A combination of blunt and electrocautery dissection is used. Blunt dissection is recommended inferiorly to avoid injury to the sciatic nerve.

 

If subfascial implant placement is planned, the dissection is continued in the subfascial space until the limits of the skin markings are reached. The newly created periprosthetic space is then packed with laparotomy sponges while the implants are prepared for insertion.

 

The implants are rinsed in saline and povidone-iodine prior to insertion. The laparotomy pads are removed, and hemostasis is obtained. The implants are then inserted into the intramuscular or subfascial space.

 

In the case of intramuscular placement, the gluteus maximus muscle is closed over the implant with a strong, absorbable running suture to provide complete muscle coverage. For both types of implant placement, a closed suction drain is used in most patients to minimize the risk of seroma.

 

The midline wound is closed in several layers to create a tension-free closure. Patients can usually be discharged 1 to 2 hours after surgery.

 

During the postoperative period, patients are encouraged to ambulate to reduce the risk of lower-extremity blood clots and muscle spasm. Oral analgesics are prescribed. Patients are instructed to avoid strenuous activity and pressure on the area for several weeks. The drains are removed when less than 25 mL of fluid is present over a 24-hour period. Com­pression shorts are recommended for the first 2 to 3 weeks after surgery.

  

Medical, Aesthetic Complications

 

In a series of 40 surgeries I performed from 2001 to 2004, the most common complication following buttock augmentation with solid-silicone implants was seroma formation.1 The incidence of this complication was reduced by using closed suction drains liberally in subsequent patients and by extending the time the drains were in place. In several patients who were very active after the drain was removed, it was necessary to reinsert the drain after several weeks.

 

Infection is rare; it occurred in 5% of the patients in the 3-year series.1 A superficial cellulitis can be treated with antibiotics. Periprosthetic implant infection, however, requires periprosthetic-space drainage and implant removal. The implant can be reinserted several months after the infection has resolved.

 

Wound-healing problems, including major wound dehiscence, have been reported anecdotally by several surgeons. This complication can be minimized by tension-free multilayer closure and appropriate implant selection. Capsular contracture is rare and is more likely to occur after the subcutaneous placement of a gluteal implant.

 

Implant migration is a rare complication and can occur as a result of overaggressive dissection of the subfascial or intramuscular space. In patients with very strong gluteal muscles, the implant can be displaced laterally; this condition is difficult to correct.

 

The most common aesthetic complication following gluteal augmentation with a solid-silicone implant is asymmetry due to improper implant placement. The inexperienced surgeon will often place the implant too high. creating too much upper-pole fullness and a hollow inferior pole. The implant may settle over time, but revision surgery may be required to create a better pocket for the implant.

 

Another aesthetic complication is implant ptosis with visible implant edges. This can result from skin laxity from the implant’s weight that develops several months after it has been placed. Moving the implant from the subfascial position to the intramuscular position may improve this condition.

 

Scarring is minimal when the incision is placed in the intergluteal region. However, implant placement through bilateral infragluteal incisions is not recommended. This approach can produce unacceptable scarring and can lead to other complications,  such as inferior displacement of the implants and sciatic-nerve injury.

  

Rewards and Responsibilities

 

Gluteal augmentation with solid-silicone implants can be a rewarding procedure for patients and surgeons when basic principles and best practices are followed. As with all procedures, each surgeon has a learning curve with respect to surgical technique and handling of common postoperative problems.

 

Although many surgeons will not choose to adopt this new procedure, it is important that they are aware of and understand the different options available to meet the needs of patients who seek gluteal augmentation.                                     Go back

 

Buttock, thigh and arm lift
Arm, thigh and buttock lifts are surgical techniques to eliminate loose and sagging skin.

What happens during the procedure?
The procedure is usually performed in an outpatient surgical center, either operated by your surgeon or a hospital facility, and takes 2-3 hours, but depending on the extent of the procedure, it can take longer. If you are having more than one procedure, overnight hospitalization may be required.

Lift surgery can be performed under local anesthesia, along with intravenous sedation, or general anesthesia depending on your health, the extent of the procedure and whether you are having other procedures at the same time.

For an arm lift, incisions are made on the inner and under surface of the arm, often in a zigzag pattern. The surgical opening may run from the armpit to as low as the elbow. As the excess skin and fat is removed, the remaining skin is stretched and sutured into place and the incisions are bandaged. An arm lift usually takes about two hours. After a monitored time in the recovery room, patients can usually go home the same day.

For thigh lifts, excess skin is lifted and removed through incisions made in the inner thigh and/or high upper outer thigh. The incisions are extensive but are usually not visible when clothing is worn. Simultaneous lifting of the thighs and buttocks is done using incisions that follow a French-cut bathing suit line only a bit higher up on the hip. The surgeon lifts and removes the excess skin down to the muscle and removes the thick layer of fat beneath the skin. Drain tubes may be placed at the incision to draw out fluids. The surgery usually takes two to three hours. Your surgeon may recommend an overnight stay in the hospital before being allowed to go home.

A buttock lift is not a common procedure, because it requires leaving scars across the buttock or in the fold. This is usually not desirable and patients opt for liposuction instead.

Are there risks or potential side effects?
As with all surgeries, there is always a possibility of complications, including infection, a reaction to the anesthesia, hematoma, seroma, nerve damage and the occurrence of asymmetries or irregularities. Should infection occur, your surgeon will prescribe a treatment with antibiotics. Occasionally, the superficial lymphatic system in the groin is interrupted during a thigh lift surgery. If this should occur, excessive swelling will probably occur for several weeks as the lymphatic channels form again. This is an uncommon problem, but it requires some patience and understanding if it does occur. Be sure to ask your surgeon about all of the risks associated with the procedure your considering before you make any decision.

What to expect post-procedure?
The areas operated on will initially feel tight and swollen. The swelling is mild to moderate, and peaks at two to three days. Usually, the sutures are covered with adhesive strips (steri-strips), skin tape and surgical gauze. Small amounts of oozing and bleeding are very common but should be no more than a slow staining of the gauze dressing. Because of the location of the incisions for a thigh lift, it is impossible to avoid lying on them. Change position at least every 30 minutes and move as carefully as possible while putting as little stress on the incision lines as possible.

You will probably have several layers of stitches with both arm lift and thigh/buttock/hip lifts. Some will be re-absorbed by the body and some may need to be removed by your surgeon. You will be able to shower on the third day after surgery. Moderate pain can be anticipated after this procedure. Your surgeon may prescribe pain medication for the first few days, after which acetaminophen and/or ibuprofen may be all that you require.

Numbness in small areas on the thighs is possible but usually disappears gradually over several months. Although most bruising and swelling will disappear within 3 weeks, some swelling may remain for 6 months and up to a year. The extent of the post-operative swelling and bruising is dependent on whether you tend to bruise or swell easily. The amount you can expect varies for each individual but past surgeries or injuries should be a good indication. Keep your head elevated, above the level of your heart, when lying down. Applying cold compresses, or ice packs will reduce swelling and relieve discomfort. Many patients use a water-tight plastic sandwich bag filled with frozen berries or peas. Regular icing is the key to relieving the swelling.

As with any surgery, it is also sometimes normal to feel anxious or depressed in the days or weeks following the operation. If there is heavy bleeding or increased pain, be sure to inform your surgeon.

How soon does normal life resume?
For the first week following surgery, you will be allowed light activity but you must avoid bending or lifting. Although you may not feel like it, you should try to walk as soon as possible after a thigh lift to reduce swelling and prevent blood clots from forming in your legs. While each case is individual, recovery from arm lift generally takes one to two weeks; you'll be able to return to work in a week, moderate exercise in 10 days to two weeks, more physical contact sports after a month. Thigh and buttocks lift recovery generally takes one to two weeks; you can usually return to work in a couple of weeks, and resume vigorous exercise or contact sports in approximately four to six weeks. Recovering individual and varies from person to person. After an arm or thigh lift, however, you will begin to see a noticeable difference in the shape of your body almost immediately with additional differences occurring the next 4 to 6 weeks as the swelling subsides.

Are you a good candidate?
Women who have had a mastectomy should not have an arm lift. Since the surgery affects the lymphatic drainage, the combined procedures may cause the arm to swell permanently. If you have had phlebitis (inflamed blood vessels) in either of your legs, you may not be a candidate for lift surgery. Most lifts require fairly lengthy incisions and scarring is visible, and each patient should be prepared for this. As with all elective surgery, good health and realistic expectations are prerequisites, but if you want to change the shape of your arms or thighs, then a lift surgery may be appropriate, but: 


How to prepare for this procedure?
Your doctor will give you specific instructions to prepare for surgery but here are some general guidelines: 


Are there alternatives to this procedure?
Arm or thigh liposuction can reduce a reduction in size but liposuction cannot alter skin quality and there may be extra skin once the fat has been removed. Although wearing the compression bands will help to firm the area, this extra skin may sag, especially if your skin was not particularly elastic. Such excess skin would necessitate an arm or thigh lift to reduce the amount of loose skin. Exercise, especially weight lifting, however, can significantly improve the shape and tone of the arms and, to a lesser extent, the thighs including that of the loose skin.                                                                         Go back

 

Chemical Peel
 (AHA, TCA, Phenol, etc.)
A chemical peel can revitalize and resurface skin. It can treat wrinkles and fine lines around the eyes and mouth, sun spots, age spots, freckles, blotchy skin, mild scarring, certain types of acne, pre-cancerous keratoses and scaling patches. Chemical peels cannot, however, remove loose or sagging skin, halt the aging process, change pore size, remove deep scars or broken blood vessels. The different types of peels penetrate to different levels and, consequently, produce different results, but all are similar in that they involve applying a chemical solution to remove the damaged outer layers of skin and allow newer layers to replace the old ones. The deeper a peel penetrates, the more profound the results but the more lengthy the recovery period. Chemical peels can also prove to be an excellent additional treatment following more extensive procedures like a facelift, brow lift or eyelid lift.

Most peels can be performed on the face, neck, chest, hands, arms and legs. Peels vary in intensity and depth depending upon the type and strength of chemical used. Your physician may choose to use a combination of chemicals for your procedure, in effect, tailoring the treatment specifically to your skin type and its needs. Your individual skin type, the condition it is in and the severity of the unevenness or wrinkling will allow your physician to determine which of the following types of chemical peel is appropriate.

Superficial Peels use mild chemical solutions like alpha hydroxy acids (AHAs), glycolic acid , lactic acid, salicylic acid, trichloroacetic acids to lightly peel skin. These peels are so called “lunch hour peels” because there is almost no recovery involved but they must be done repeatedly to maintain results over time.

Medium peels or Trichloroacetic Acid (TCA) Peels can correct pigment problems, superficial blemishes, moderate sun damage, fine lines and weathered skin. TCA peels sometimes require two or more treatments, spaced out over weeks or months, to achieve the best results. The Obagi or “Blue Peel” is a commonly used brand of TCA peel.

Phenol (carbolic acid) Peels are the deepest peels and use the strongest chemical solutions. These are usually one-time procedure and produce the most dramatic, long-term results. They are used to treat wrinkling, brown age spots, mild scarring and pre-cancerous growths. Because phenol peels result in permanently lighter skin, they are not recommended for most patients with very dark skin tones and require that sunscreen be used at all times afterwards.       See also Dermobrasion
 

What happens during the procedure?
The treatment begins with cleansing the skin and removing all traces of grease with rubbing alcohol or acetone. The face is then rinsed with water and blown-dry with a small fan. The physician applies the chemical peeling agent so that all areas of the skin to be treated are covered evenly. A grey-white film, referred to as “frost”, develops on the skin by the end of the application. The peeling solution is left in place for a few minutes and then thoroughly removed with water.

AHA peels are performed in the physician’s office and require no sedation or anesthesia. The process usually takes 10 to 15 minutes and although your face may seem a bit red, you can resume normal activities right away. You can expect the redness to be followed by temporary flaking, dryness and scaling until your skin adjusts to the treatments.

TCA peels are performed in the physician’s office or in an out-patient surgery center. No anesthesia is necessary because the chemical solution actually numbs the skin but you may be given a sedative prior to the treatment. You may feel a warm or burning sensation which is followed by some stinging. Your physician will control the depth to which the chemical penetrates but a full-face treatment should only take about 15 minutes.

Phenol peels are usually performed in an outpatient surgical center, either operated by your physician or a hospital facility. If you are having another procedure, such as a facelift or eyelid lift at the same time, then overnight hospitalization may be required. No anesthesia is necessary because the chemical solution actually numbs the skin. A full-face, deep chemical peel requires a sedative prior to the treatment and an analgesic given intravenously during the procedure. You will be monitored with an EKG during a deep chemical peel. You may feel a warm or burning sensation which is followed by some stinging. A full-face phenol peel generally takes one or two hours, while a phenol peel to a smaller area on the face, such as the upper lip, may take only 10 or 15 minutes.

Are there risks or potential side effects?
As with all elective procedures, there is always a possibility of complications including infection, scarring, temporary or permanent color change in the skin and uneven pigment changes. Phenol may pose a special risk for patients with a history of heart disease and any peel carries the risk of cold sores in persons who have a history of recurring fever blisters or herpes.

Before you undergo a chemical peel, tell your physician if you have a history of cold sores, a tendency to scar unusually, a family history of heart problems, or have undergone radiation or numerous x-rays to the face. Be sure to ask your physician about all of the risks associated with the procedure you are considering before you make any decision.

It is important to note that Asians tend to have a darker skin tone than Caucasians, and as a result, have a different set of complications caused by skin peels. Asians are at a higher risk for hyperpigmentation of the skin (darkening of the skin). Although there is a risk for scarring in Asians who elect to have medium to deep chemical peels, they are at no greater risk than Caucasians when opting for superficial peeling. It is recommended that Asians make sure that they see an experienced physician who has performed chemical peels on Asians, and who is aware of how to treat such skin types.

What to expect post-procedure?
Your physician may recommend a soft diet and suggest that you take it easy and try not to talk too much for a few days. A mild pain medication may also be prescribed. Swelling and crusting of the skin are to be expected. You may be given an ointment to apply to your skin for seven to 10 days following the peel to keep it supple and to help in healing.

At the end of a phenol peel, the treated skin may be coated with petroleum jelly or a dressing, which will be left on a day or two. The treated area will be very swollen. If you have had your face peeled, your eyes may swell shut and you will need to have someone to care for you for 48 hours after the procedure.

How soon does normal life resume?
A TCA peel usually results in swelling and blisters that scab over. Most patients can resume their normal activities in a week to ten days when the rawness has subsided and new skin has emerged. The TCA peel does not lighten the skin, so your skin will still be able to produce pigment again, i.e. tan. It is important, however, that you avoid sun exposure for several months after the peel to protect the newly formed layers of skin. Chlorinated pools should be avoided for a month or so. Daily use of a sunscreen with both UVA and UVB protection is essential. We all know that the sun damage and ages skin prematurely, even more so when a new layer of skin is exposed to it.

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. After about two weeks, your skin will be healed enough that you can resume normal activities and begin to wear makeup. By the end of four weeks, the redness should fade to pink. To protect this delicate new skin, sunscreen must be used at all times so you do not end up with blotchy, unevenly colored skin. Again, avoid chlorine for a month. A deep peel can be a painful, emotionally difficult process to endure, but the end result is smoother skin that lasts for 15 years or more.

Who performs it?
Chemical peels are usually administered by a plastic surgeon, a dermatologist or an otolaryngologist (ENT).

Are you a good candidate?
As with all elective surgery, good health and realistic expectations are prerequisites, but if you want to reduce refine the texture and pigmentation of your skin without surgery, then a chemical peel may be appropriate, however: 


How to prepare for this procedure?
Your doctor will give you specific instructions to prepare for the procedure. You may prescribed medications to take prior to the treatment to prevent a bacterial infection or fever blisters (herpes simplex) and topical medications to prepare your skin and decrease the risk of post-operative pigmentation changes. You will be asked to limit your sun exposure at least a month before the peel. Here are some general guidelines to follow: 


Are there alternatives to this procedure?
Alternatives to chemical peels include dermabrasion, laser skin resurfacing , and injectable fillers like collagen, etc.. Although chemical peels can have a rejuvenating effect on the skin only a surgical procedure like facelift, eyelid lift or a brow lift can actually tighten sagging skin. Finally, vitamin A, glycolic acid and other topical treatments, known as “skin polishers”, stimulate generation of new skin from underneath and promote filling in of wrinkles and depressed acne scars. These preparations are often used to pre-treat the skin before administering a peel or other resurfacing treatment.

Anything else you need to know?
A “Parisian Peel” is not a chemical peel at all. In fact, it is a brand of microdemabrassion which uses fine crystals, sprayed on in a very fine stream to exfoliate the outer layers of skin, which are vacuumed away. Although it has some effects on skin texture they are very subtle compared to a peel. This is not considered as having any lasting or permanent results and must be repeated frequently.

Another peel which is known by a brand name is the Obagi Blue Peel. This is a TCA-type peel formulated by dermatologist Zein E. Obagi, M.D. A blue coloring is added to the chemical solution to allow for even distribution, slower release of the solution to help reduce irritation, and slower penetration of the chemicals resulting in less of a burning sensation. For deeper exfoliation, an additional number of coats of the chemical can be applied during the procedure. The Blue Peel procedure can be repeated every four to six weeks.

The BioMedic MicroPeel is a type of light AHA peel in a three-step process that takes around 20 minutes. The treatment involves exfoliation of the skin then the alpha hydroxy acid is applied and last carbon dioxide is applied to cool the skin.

                                                                                                                                               See also Dermobrasion

Chin Implants
 (Mentoplasty and Genioplasty)
Chin surgery involves the augmentation, reduction, or general reshaping of the chin. The two most common methods are: chin augmentation, which reshapes the chin by inserting a silicone implant under the skin, and chin reductions, which involve bone reduction with power bone instruments.

A more serious type of procedure, craniofacial surgery, corrects misshapen jaws caused by misalignment of the teeth and jaws (malocclusion), or mild inadequate tissue development (hypoplasia) which can appear as a recessed upper jaw. Patients with a major chin deficiency require bone surgery (osteotomy) where the bone of the chin is moved forward following various oblique bone incisions, thereby reshaping the chin.

In chin augmentation surgery, implants are used to change the underlying structure, which affects the overall balance of facial features. Often chin implants are used together with other facial implants, particularly cheek implants, however, they can be used alone. This operation is often performed in conjunction with nose surgery as well as a facelift and/or liposuction of the face and neck.

Chin implants are made in various shapes and sizes. They are made out of both solid and semi-solid materials.

What happens during the procedure?
Chin augmentation is usually performed in an outpatient surgical center, either operated by your surgeon or a hospital facility. It takes between 30 and 60 minutes but depending on the extent of the procedure, it can take longer. If you are having more than one procedure, overnight hospitalization may be required.

Chin surgery can be performed under local anesthesia, along with intravenous sedation, or general anesthesia depending on your health, the extent of the procedure and whether you are having other procedures at the same time. Before your surgery, routine laboratory tests may be requested including blood counts and blood chemistries.

A small incision is made, usually inside the lower lip, to create the pocket and then the implant is inserted inside the mouth, along the lower lip, directly over the jawbone or in the skin just under the chin area. The implants are made in a variety shapes and sizes. Incisions inside the mouth (intra-oral incision) are closed with sutures (stitches) that dissolve. Removable sutures are used for incisions under the chin and are taken out after five to seven days. To minimize swelling and discomfort, the chin is usually taped for about a week.

Are there risks or potential side effects?
If the surgery involves an incision inside your mouth, it is important that you inform your physician if you smoke or if you have any dental or gum problems.

As with all surgeries, there is always a possibility of complications following chin surgery, including infection, bleeding, a reaction to the anesthesia, hematoma, seroma, extrusion (the implant works its way back up to the skin’s surface), capsular contracture (excess tightening of the scar tissue) which may distort the implant, asymmetry, nerve damage and bone erosion.

Sometimes, a facial implant can shift slightly out of alignment and a second operation may be necessary to replace it in its proper position.

Should infection occur, your surgeon will prescribe a treatment with antibiotics, however, the implant might have to be temporarily removed if the infection does not clear up and replaced at a later date. Other, less-common risks may be associated with certain implants. Be sure to ask your surgeon about all of the risks associated with the procedure you are considering before you make any decision.

What to expect post-procedure?
The extent of the post-operative swelling and bruising is dependent on whether you tend to bruise or swell easily. The amount you can expect varies for each individual but past surgeries or injuries should be a good indication. Keep your head elevated, above the level of your heart, when lying down. Applying cold compresses, or small ice packs will reduce swelling and relieve discomfort. Many patients use a water-tight plastic sandwich bag filled with an ounce of frozen berries or peas. Regular icing is the key to relieving the swelling. There is pain and discomfort for several days after surgery and your doctor will prescribe medication to alleviate it.

Some difficulty talking and smiling for several days following the surgery is normal. Patients with intra-oral sutures are sometimes placed on a liquid diet for several days until there is enough healing for food particles to come in contact with the stitches. Your surgeon will instruct you about dental hygiene, eating and any restrictions to your activities after surgery and it is important that you follow all of his or her instructions to minimize risks and help speed-up your recovery.

How soon does normal life resume?
Within the first week, you can be back at work. Although you should avoid strenuous activities, exercise can be resumed in about two weeks. Be careful to avoid contact sports or any activity that may result in the face being jarred or bumped for several weeks. Check with your surgeon about resuming such activities. Although most of the significant swelling will subside over a period of several days, prolonged mild swelling may prevent your final facial contour from becoming apparent for several months.

Who performs it?
Chin augmentation and reduction surgery is usually performed by a plastic surgeon or an otolaryngologist (ENT), while craniofacial surgery is best performed by maxillofacial surgeons and otolaryngologists.

Are you a good candidate?
As with all elective surgery, good health and realistic expectations are prerequisites, but if you want to change your profile or are having nose surgery, a facelift or facial liposuction, then chin surgery may be appropriate, but: 


How to prepare for surgery?
Your doctor will give you specific instructions to prepare for surgery but here are some general guidelines: 


Are there alternatives to this procedure?
An alternative to chin augmentation is submental liposuction, in which excess fatty tissue is removed to redefine the chin or neckline. Orthodontistry can treat a malocclusion and misaligned teeth, which are often at the root of a protruding or recessed jaw.                                                                                                                                        See also Cheek Implants

 

Dermobrasion
 Dermabrasion is like laser skin resurfacing in that it can treat deeper wrinkles and improve the appearance of acne scars or skin discolorations and remove pre-cancerous keratoses. In addition, this treatment is useful in treating unwanted tattoos and scarring caused by chicken pox or injuries. Dermaplaning is a similar treatment but involves deeper planing of skin, which is used for crater-like scars.

Dermabrasion penetrates much deeper than chemical peels and the skimming of the outer layers of skin to the dermis layer causes the skin to produce collagen. Dermabrasion is also performed in conjunction with more extensive procedures like a facelift, brow lift or eyelid lift.

What happens during the procedure?
Dermabrasion is usually performed in a physician’s office or in an outpatient surgical center, either operated by your physician or a hospital facility. If you are having another procedure, such as a facelift or eyelid lift at the same time, then overnight hospitalization may be required. Dermabrasion and dermaplaning are fairly quick procedures, but depending on the extent of the treatment it can take a few minutes to an hour or more. It is not unusual for your physician to recommend that the procedure be repeated or done in stages, especially when treating deep scars or a large area of skin.

The procedure is usually performed under local anesthesia with a sedative to relax you and make you drowsy. First, the skin is thoroughly cleansed with an antiseptic and may be sprayed with a topical anesthetic to numb it. The physician then uses a high speed rotating abrasive brush or diamond-impregnated burr (like a mini-sander) to remove the outermost layers of damaged skin.

The physician controls the depth to which the treatment will penetrate the skin layers depending on the degree of wrinkling or scarring. This abrading action reveals a new layer of smoother skin. At the completion of the procedure, your skin may be dressed with a soothing ointment, a wet or waxy dressing or some combination of these.

In Dermaplaning, an instrument with an oscillating blade called a dermatome is used to evenly skim off layers of skin to make the scarred area more even with the surrounding skin. Dermaplaning is often combined with dermabrasion, chemical peel or a surgical procedures such as facelift.

Are there risks or potential side effects?
As with all elective procedures, there is always a possibility of complications including infection, scarring, temporary or permanent color change in the skin and uneven pigment changes. Any skin resurfacing treatment carries the risk of cold sores in persons who have a history of recurring fever blisters or herpes simplex. Before you undergo dermabrasion, tell your physician if you have a history of cold sores, a tendency to scar unusually.

It is important to note that Asians and people of colour tend to have a darker skin tone than Caucasians, and as a result, have a different set of complications caused by any skin resurfacing treatment like permanent discoloration or blotchiness. Those of Asian, African and Latin origins are at a higher risk for hyperpigmentation of the skin (darkening of the skin). It is recommended that these individuals make sure that they see an experienced physician who has performed dermabrasion on darker skins, and who is aware of how to treat such skin types.

Although age is not a limiting factor in most cases, it is important to recognize that older people heal more slowly. Acne sufferers may not be able to undergo the procedure if their acne is in an active stage due to a greater risk of infection. Be sure to ask your physician about all of the risks associated with the procedure you are considering before you make any decision.

What to expect post-procedure?
For a few days following dermabrasion or dermaplaning, your skin will look and feel like you’ve experienced a bad sunburn. It may be uncomfortable to move the muscles of your face (talking, eating). Your physician may recommend a soft diet and suggest that you take it easy and try not to talk too much for a few days.

A mild pain medication may also be prescribed. Swelling and crusting of the skin are to be expected. You may be given an ointment to apply to your skin for seven to 10 days following the peel to keep it supple and to help in healing.

In one to two weeks after surgery, the newly formed skin, which is pink at first, gradually develops a normal appearance. In most cases, the pinkness will largely fade by eight to 12 weeks.

How soon does normal life resume?
You can expect to be back at work in about two weeks or less in some cases. You can use makeup as soon as the skin has healed. Strenuous activity that might result in a bump to your face should be avoided for at least six weeks. You should not swim in chlorinated water for a month or more.

Your skin will appear lighter for weeks or even months after the procedure, but as the pigment is restored, your skin color will look more normal. To protect this delicate new skin, sunscreen must be used at all times so you do not end up with blotchy, unevenly colored skin. Daily use of a sunscreen with both UVA and UVB protection is essential. We all know that the sun damage and ages skin prematurely, even more so when a new layer of skin is exposed to it.

Who performs it?
Dermabrasion and dermaplaning are usually administered by a plastic surgeon, a dermatologist or an otolaryngologist (ENT).

Are you a good candidate?
As with all elective surgery, good health and realistic expectations are prerequisites, but if you want to reduce refine the texture and pigmentation of your skin without surgery, then a chemical peel may be appropriate, however: 


How to prepare for this procedure?
Your doctor will give you specific instructions to prepare for the procedure. You may prescribed medications to take prior to the treatment to prevent a bacterial infection or fever blisters (herpes simplex) and topical medications to prepare your skin and decrease the risk of post-operative pigmentation changes. You will be asked to limit your sun exposure at least a month before the procedure. Here are some general guidelines to follow: 


Are there alternatives to this procedure?
Alternatives to dermabrasion include chemical peels, laser skin resurfacing, and injectable fillers like collagen, etc. Although dermabrasion can have a rejuvenating effect on the skin only a surgical procedure like a facelift, eyelid lift or brow lift can actually tighten sagging skin. Finally, vitamin A, glycolic acid and other topical treatments, known as “skin polishers”, stimulate generation of new skin from underneath and promote filling in of wrinkles and depressed acne scars. These preparations are often used to pre-treat the skin before administering a skin resurfacing treatment.

Anything else you should know?
Microdermabrasion is not the same as dermabrasion. It is a more superficial treatment which does not produce the same results as dermabrasion. The treatment affects only the outer-most layer of skin, the epidermis, and causes the basal cell layer to increase production of skin cells. Microdermabrasion is not a solution for major acne scarring or tattoos or deep wrinkles. It will not treat the type of complaints that a chemical peel or laser resurfacing will. Results are subtle. Skin is usually described as being more radiant, and make-up goes on better because of the feeling of improved smoothness of the skin.

What happens during the procedure?
The skin is treated with a fine, pressurized stream of crystals, which loosen skin debris and are immediately suctioned away. The pressure at which the crystals are sprayed against the skin can be adjusted. There is minimal discomfort, and skin looks slightly pink. There is no healing time, and no need for dressings or obscuring make-up.

Goggles should be worn to protect the eyes from irritation from the crystals. If contact lenses should be removed. The treatment area is cleaned with water, and an alcohol pad is used to remove any residual dirt and makeup. The physician or assistant passes the wand of the microdermabrasion unit over the skin in smooth, stroking movements, being careful to anchor the skin at the end of the stroke with a finger to prevent the tissue from being drawn into the suction device. The intensity of the treatment can vary, either by varying the amount of crystals used, the pressure used, the length of the session or the equipment.

What to expect post-procedure?
Some redness, which last for an hour or two, will appear right after the treatment. Streaking may occur but usually disappears after one or two days. There can also be swelling in sensitive areas, such as underneath the eyes. Cold compresses will help alleviate it. Finally, the underlying skin color may change compared to untreated areas.

Are there risks or potential side effects?
Patients who are using any kind of exfoliant. particularly alpha-hydroxy products, vitamin A cream, glycolic acid products, salicylic acid or benzoyl peroxide should discontinue use for 2-7 days prior to the procedure, and wait until two days after the procedure to restart use. Sun exposure should be avoided and sunscreens should be used for at least a week after the procedure.

As with chemical peels, laser resurfacing and dermabrasion, microdermabrasion carries certain risks. The reactivation of herpes simplex and an outbreak of cold sores are one such risk. Those with recurrent herpes simplex infections should start anti-viral treatment one day prior to the procedure and maintain anti-viral therapy for 7-10 days afterward. Patients with acne who have been treated with Accutane should have completed such therapy a year prior to having this procedure. Also, this procedure may not be appropriate for anyone who has a history of keloid formation. Some patients may experience pigmentation changes after the treatment, in which case lower pressures should be used in subsequent treatments.  Go back
 

Correction of Prominent Ears (Pinnaplasty)
What is it?
A prominent ear protrudes excessively from the side of the head.  It is frequently a source of teasing, using names like 'Dumbo, FA Cup, Jug Ears, and Wing Nut'.

The Operation
Surgical correction of prominent ears is usually performed under general anaesthesia in children. It can also be done under local anaesthesia. There are many ways of performing this surgery. Most frequently, an incision is made behind the ear, some skin is removed, and the cartilage remaining is marked on the front surface to allow it to bend backwards towards the head.  Dissolving sutures are then used to hold it in the new position.  A dressing is placed to keep the ear comfortable. Many surgeons use cotton wool and a bandage to end up like a turban to avoid disturbing the new position of the ear. The procedure is usually done as a Day Case.

Any Alternatives
The cartilage of the ear is very soft immediately after childbirth and it is possible to have moulds made which can gently re-shape the ear in the first few weeks of life.  Some people get so upset about the prominence of their ears sticking out that they have even used 'super glue' to hold them to the side of their head.

Before the Operation
Sort out any tablets, medicines, inhalers that your child is using. Keep them in their original boxes and packets. Bring them to hospital with you. On the ward, your child may be checked for past illnesses and may have special tests, ready for the operation. Many hospitals now run special preadmission clinics, where you visit for an hour or two, a few weeks or so before the operation for these checks.

After - In Hospital
There may be some discomfort following the surgery.  If the surgery is performed under general anaesthesia, local anaesthesia is also given so that when the patient wakes up they usually do not feel pain, but they may have some discomfort.

It is likely that there may be a bandage, dressing or turban around the head to protect the ears in the new position.  The dressing may cover the external ear canal and make hearing difficult.  One should not interfere with the dressings, however, as this can lead to infection and poor healing of the operation scar.  Children often try and scratch their itchy ears under the dressings.  This should be discouraged.

Some pain and discomfort will follow when the local anaesthetic wears off. This is usually well controlled using simple painkillers like Paracetamol.  If there is unexpected pain or discomfort it may be necessary to have the dressings removed and the ear reviewed by a nurse or the surgeon.

After - At Home
It is useful to sleep upright the night following the surgery.  The bandages should not be interfered with and it is best to make sure that children do not stick their fingers up to try and scratch the back of their ears.  This can lead to infection.  The head bandage is left on for up to ten days following surgery.  On removal of the head bandage the ears are cleaned.  Examination is performed to make sure there is no collection of blood between the skin and the cartilage.  Rough games should be avoided for up to two months following surgery.  A 'sweat band' at night-time is useful for up to three weeks following surgery. 

When the head bandage is removed, there is often bruising and swelling of the ears. This can occasionally continue to make them look as if they are still sticking out. The swelling and bruising does take some weeks to finally resolve.  There may occasionally be some bruising and scabbing over the skin on the front part of the ear. This will heal by itself.

Possible Complications
Complications are unusual.  There can be a collection of blood between the skin and the cartilage-giving rise to a 'cauliflower type' ear. This can be treated surgically.   The skin on the front of the ear is very thin and occasionally after surgery it may be bruised.  On rare occasions the skin can become scabbed and one needs to be particularly careful, with regular reviews of dressings, to make sure that the underlying cartilage does not become exposed and dry out.  If the cartilage dries out, it can lead to a misshapen ear.

The ears may be red and sensitive after the surgery and take some time to settle.  The scar behind the ear can sometimes become red and raised, exceeding the height of the normal surrounding skin.  It is often difficult to make both ears absolutely symmetrical and there are often minor irregularities on the skin surface.  Less than 1 in 10 patients require any surgical re-correction.

General Advice
It is often useful to try and have the surgery performed in children out of school time.  However this may not always be possible and some children have to go to school wearing the turban type bandage in order to protect the ears.          Go back

 Eye Lift (Blepharoplasty)
What is it?
An eyelift operation, or Blepharoplasty, is the removal of excess skin, saggy muscle and sometimes fat from the eyelids.  It may be performed alone or as part of a face lift procedure.

The Operation
The surgery can be performed under local or general anaesthesia. The surgeon marks out the excess skin on the upper eyelid so that the final scar will tend to be hidden when the eye is open.  On the lower eyelid, the scar is very close underneath the eyelashes and extends out onto a crease line.  The type of surgery performed depends on the exact underlying problems.  The surgery is frequently performed as a Day Case.

Any alternatives

There are no surgical alternatives for Blepharoplasty.

Before the Operation
Pre-operative assessment by the surgeon is most important to achieve the best results.  Assessment will indicate where the problem is.  Sometimes the problem may be related to  excess drooping of the eyebrows.  This may need to be surgically corrected.    The older one gets the more tissue tends to sag and some of the tissue on the eyelids may be related to laxity of the underlying ligaments as much as to the overlying skin.  This may need to be corrected at the time of surgery.  It is also very important to make sure that there is adequate tear production in the eye.  Should this not be the case, 'dry eyes' can occur following surgery, which can lead to damage to the outer lining of the eyes.  It is important to avoid smoking before the surgery and to avoid taking Aspirin, or other medication, which makes you more likely to bleed.

After - In Hospital
There will be stitches on the upper eyelid and just beneath the lashes of the lower eyelid.  There may also be some paper tapes in order to support the stitches.  Ice packs may be used over the eyes in order to decrease the amount of swelling and to keep the eyelids comfortable.  It is best to sleep propped up for forty-eight hours following surgery as this is when most swelling tends to occur.  The eye vision and blood pressure will be checked following surgery.  Ointment may also be placed in the eyes to prevent them from drying out and becoming irritated.

After - At Home
As the surgery may be performed as a Day Case, you may be able to go home on the same day as the surgery.  There is likely to be bruising or swelling for two to three weeks. This can be well hidden by sunglasses.  It is also important to avoid heavy lifting or bending for two to three weeks following surgery.  It is advisable to avoid any heavy activity or gym work for about one month after surgery.  Sleeping propped up at nighttime tends to help reduce swelling. The stitches from around the eyes are usually removed between five and seven days following surgery.

Possible Complications
Swelling persists for some weeks after the surgery.  Very occasionally serious complications can occur with eye lifts.  It is very important to let the doctor know if pain is experienced beyond that which one would expect. This can be an indication of bleeding into the back of the eye.  Occasionally wounds can get infected and lead to infection in and around the eye.  Inadequate removal of the tissue can also lead to an unsatisfactory result.  Drooping of the upper eyelid can also occur if the muscle that lifts the upper eyelid is damaged during the surgery.  People who wear contact lenses may find that they are difficult to put in after the surgery.

Excess removal of fatty tissue can result in a hollow 'dead eye' appearance, which does not look nice.   Excision of too much skin can lead to an 'open eye' appearance. This can be difficult to correct.  Very very rarely loss of vision can occur.

General Advice
Following eyelid surgery it is important to avoid any activities that involve bending stooping or straining.  It is also important to avoid situations where foreign material may get into the eyes.                                                                               Go back

 Full face Lift
What is it?
A full face-lift, or Rhytidectomy, is an operation to improve the loose skin of the neck, the jaw line, the deeper wrinkle lines, and the corners of the mouth.  It may be combined with other procedures to improve the fine wrinkles on the face and also with blepharoplasty (baggy eyelids).  These options should be discussed with the surgeon at the initial consultation.

The Operation
There are a number of different techniques used to tighten the skin on the face.  The surgery is usually performed under general anaesthesia and may be aided by using endoscopic surgical techniques.

Any Alternatives
Some improvement in the fine wrinkles of the face can be achieved temporarily by skin hydration.  Deep furrows and wrinkles may be helped by the use of Botox injections, which paralyses the underlying muscles and prevents wrinkling of the skin.  However, the excess saggy skin will still be noticeable.

Before the Operation
It is most important to give up smoking.  This can have a serious effect on the blood supply to the skin and cause areas of skin on the face to become black and scarred following surgery.  It is also useful to be at one's chosen weight or even somewhat underweight, as weight loss subsequent to the surgery can allow further wrinkling to occur.  One should avoid taking Aspirin or Aspirin containing pain medication as this can increase bleeding following surgery and cause blood clot formation underneath the skin, and interfere with wound and skin healing.  The operation itself takes between two and three hours to perform and your surgeon would assess if you are fit to undergo such a procedure.

After in Hospital
The surgery is performed through an incision that starts in the temporal hair area, downwards  in front of the ears, curving underneath the ear lobe, and then extends up behind the ear sometimes into the hairline.  Depending on the extent of surgery performed you can be in hospital from one to three days.  After you wake up it is likely that you will have soft padding around your face and you may have drains. It is also likely that there will be an intravenous drip to provide fluid.  The nurses will check your blood pressure, pulse and temperature on a regular basis and observe the colour of the skin of your face.  It will also be likely that you will be asked to keep upright, avoid coughing, stooping and straining.  If eyelid surgery has been performed at the same time, your eyes may also be initially covered.  Staying semi upright also helps reduce the swelling and enables better observation by the nurses.  Maximum swelling tends to occur within forty-eight hours. To decrease the swelling further, cold bandages or packs may occasionally be applied during the day. Pain killer tablets or injections will be available.  The drains and dressings are removed prior to discharge to hospital and further dressings or scarf may be applied.

After at Home
You may have numbness on your face and neck for several weeks and this can sometimes last longer.  It is important again to avoid any bending or heavy lifting for two weeks following surgery.  You should not smoke, not take alcohol or Aspirin for at least two weeks following surgery.  Continuing to sleep upright at night will help to decrease swelling of the face.  On the third or fourth day following surgery you can start washing your hair and blow-drying it gently.  You should avoid stooping or straining or bending over as this can cause a rushing of blood to the face, discomfort and occasionally some minor bleeding.  The sutures from around the ear are usually removed between five and ten days following surgery depending on the extent of surgery.  Bruising may be obvious for two to three weeks following surgery.

Cosmetic make-up may be used but should avoid the suture line itself until it is well healed some two to three weeks following surgery. Perming and hair colouring can be used from four to six weeks, depending on the extent of the surgery.  As with any major surgery, you may feel tired for a few days after the operation and this can last for two to three weeks.  Serious physical or gym activity, aerobics are probably best avoided for up to one month following surgery although one can do gentle exercises such as swimming once the wounds are soundly healed.  You may also notice, over a period of time, numbness of the face and potentially some numbness of the ear, particularly on the posterior aspect.

Complications
The blood supply to the face is very good.  Because of this, wounds heal very well but during any surgery bleeding can occur.  Your surgeon is very careful to stop bleeding at the time of surgery and drains are usually left in afterwards.  If heavy bleeding occurs following surgery underneath the skin, it is likely that you will need to return to the operating theatre in order to have this controlled.  Small episodes of bleeding are likely to occur and this can result in areas of thickening underneath the skin flaps.  This will settle with time, particularly with gentle massage for a few weeks following surgery.  Infection is unusual but can occur and can cause problems with wound healing.  It is also important that surgery should not be performed if there is evidence of any cold sore or Herpes at the time of surgery.  The nerves of facial expression are underneath the muscle layer of the face and these can very occasionally be bruised or injured when doing face-lift surgery.  This particularly occurs with the nerve that goes to the side of the mouth and so can result in a weakness here. It is unusual for this to occur and usually settles over a period of a few months. Numbness of the ear may also be noted as the nerve that gives sensation to the ear is quite close to the surface of the skin in the neck region.  Although the blood supply to the skin is very good, in order to get a good result a certain amount of tension has to be placed on the skin.  This can sometimes interfere with the circulation of the skin, particularly in smokers, and should the circulation be badly affected some of the skin can become necrotic and die.   This can result in areas of skin loss and very occasionally skin grafting may be required.  When the surgery involves some of the hair-bearing scalp, hair thinning or hair loss may occasionally occur.  The scars in front of the ear are usually not that noticeable, but scar spread can occur as time progresses.  Occasionally if the wound does not heal up satisfactorily underneath the earlobe, the earlobe itself may be pulled down and a scar can become noticeable in this region.  It may take two to three months for the swelling and discomfort on the face to settle down entirely.  You may also find it comfortable to wear a light bandage at night-time to prevent your ears from bending forward initially.

General Advice
A face-lift may be part of a number of procedures to try and rejuvenate the ageing face.  The type of  face-lift procedure will depend on the individual, the excess skin and the overall facial appearance. Significant weight loss can also precipitate a problem with excess skin on the face. 

Face-lift operations last for from five years upwards depending on the age at which it is performed.  It also depends on whether or not excess weight gain or weight loss occurs subsequent to the surgery.  It can be performed again. Best results are in non-smokers.                                                                                                                                                    Go back

 Cheek Implants
(Malarplasty)
Malarplasty is the medical term used to describe the augmentation or general reshaping of the cheeks and jaw. Cranial facial surgery, a more serious type of procedure, is performed to correct misshapen jaws or facial asymmetry due to a congenital abnormality or a serious illness or injury.

In cheek and jaw augmentation surgery, implants are used to change the underlying structure, which affects the overall balance of facial features. Often cheek implants are used together with other facial implants, particularly chin implants, however, they can be used alone. These procedures are often performed in conjunction with other cosmetic procedures such as facelift, nose surgery, eyelid surgery or chin surgery. Cheek and jaw implants are made in various shapes and sizes and are made out of both solid and semi-solid materials.

What happens during the procedure?
The procedure is usually performed in an outpatient surgical center, either operated by your surgeon or a hospital facility, and takes between 30 and 60 minutes, but depending on the extent of the procedure, it can take longer. If you are having more than one procedure, overnight hospitalization may be required.

Cheek and jaw augmentation can be performed under local anesthesia, along with intravenous sedation. General anesthesia may be advised depending on your health, the extent of the procedure and whether you are having other procedures at the same time. Before your surgery, routine laboratory tests may be requested including blood counts and blood chemistries.

Cheek augmentation involves placing the implant over the cheekbone through an incision made inside the mouth or through an opening just beneath the lower eyelash. The incision blends with the lash line and is nearly unnoticeable. The surgeon creates a pocket in the tissue and then inserts the implant. The implant is placed directly on or below the cheekbone. Incisions are closed with sutures (stitches) that dissolve in a week or two. In some cases a small titanium screw may be used to attach the implant to the bone. After surgery, a dressing will be applied to minimize discomfort and swelling.

Insertion of a jaw implant usually takes about one to two hours. Incisions are made inside the mouth on either side of the lower lip. The surgeon creates a pocket into which the lower-jaw implant can be inserted. The incisions are closed with dissolving stitches.

Are there risks or potential side effects?
As with all surgeries, there is always a possibility of complications following facial implant surgery, including infection, a reaction to the anesthesia, hematoma, seroma, bleeding, extrusion (the implant works its way back up to the skin’s surface), capsular contracture (excess tightening of the scar tissue) which may distort the implant, asymmetry, nerve damage and bone erosion.

If the surgery involves an incision inside your mouth, it is important that you inform your physician if you smoke or if you have any dental or gum problems.

Sometimes, a facial implant can shift slightly out of alignment and a second operation may be necessary to replace it in its proper position.

Should infection occur, your surgeon will prescribe a treatment with antibiotics, however, the implant might have to be temporarily removed if the infection does not clear up and replaced at a later date. Other, less-common risks may be associated with certain implants. Be sure to ask your surgeon about all of the risks associated with the procedure you are considering before you make any decision.

What to expect post-procedure?
The extent of the post-operative swelling and bruising is dependent on whether you tend to bruise or swell easily. The amount you can expect varies for each individual but past surgeries or injuries should be a good indication. After jaw implant surgery, swelling is sometimes significant and usually peaks 24 to 48 hours afterward. Although most of the significant swelling will subside over a period of several days, prolonged mild swelling may prevent your final facial contour from becoming apparent for several months.

There can be numbness and/or stiffness as well as pain and discomfort for a few days following facial implant surgery. You doctor will prescribe medication to alleviate it the pain and to fight infection.

Keep your head elevated, above heart level, when lying down. Applying cold compresses, or small ice packs will reduce swelling and relieve discomfort. Many patients use a water-tight plastic sandwich bag filled with an ounce of frozen berries or peas. Regular icing is the key to relieving the swelling

Some difficulty talking and smiling for several days following the surgery is normal. Patients with intra-oral sutures are sometimes placed on a liquid diet for several days until there is enough healing for food particles to come in contact with the stitches. Your surgeon will instruct you about dental hygiene, eating and any restrictions to your activities after surgery and it is important that you follow all of his or her instructions to minimize risks and help speed-up your recovery.

How soon does normal life resume?
Within the first week, you can be back at work. Although you should avoid strenuous activities, exercise can be resumed in about two weeks. Be careful to avoid contact sports or any activity that may result in the face being jarred or bumped for several weeks. Check with your surgeon about resuming such activities. Although most of the significant swelling will subside over a period of several days, prolonged mild swelling may prevent your final facial contour from becoming apparent for several months.

Who performs it?
Cheek and jaw augmentation surgery is usually performed by a plastic surgeon or an otolaryngologist (ENT).

Are you a good candidate?
As with all elective surgery, good health and realistic expectations are prerequisites, but if you want to change the shape of your face or are having a facelift, eyelid or nose surgery, then cheek or jaw augmentation surgery may be appropriate, but:


How to prepare for surgery?
Your doctor will give you specific instructions to prepare for surgery but here are some general guidelines:

Are there alternatives to this procedure?
An alternative to cheek and jaw augmentation surgery is orthodontistry, which can treat a malloclusion and misaligned teeth and can significantly change the overall shape of the face.                                                                                     Go back

Facial line Filling 

WHAT IS BIO-ALCAMID®?

BIO-ALCAMID® is an injectable product that is an absolute innovation in the medical sector. For the first time, medical science can employ a product comprising 96% water and 4% synthetic reticulate polymer ( poly-Alkyl-Imide ). This blend guarantees softness to the touch; the implant has a similar consistency to the surrounding tissues without causing unsightly visible or palpable effects of artificiality. 

 

WHERE IS BIO-ALCAMID® USED?

BIO-ALCAMID® is used to correct all types of secondary imperfections caused by soft tissue deficit, in post-traumatic injuries and post-surgery scars, serious congenital facial and body microgenia and also cosmetic applications.

BIO-ALCAMID® is also the ideal implant for defining the lip outline and correcting volumetric face deficits of the cheekbones, chin, jaw etc... Unlike other fillers, BIO-ALCAMID® can be used to correct severe and large soft tissue deficits without any risk due to its biocompatibility. 

 

HOW LONG DOES BIO-ALCAMID® LAST ONCE INJECTED?

Under general physiological conditions BIO-ALCAMID® is a definitive implant like any other artificial prosthesis. The visible effect created by BIO-ALCAMID® is that of youth, but with the passage of time, the skin ages and the tissues (especially muscle tissue) change position and shape creating new imperfections and anomalies in spite of the “mechanical support” provided by BIO-ALCAMID®.  However, the appearance of aging is easily corrected with the addition of more BIO-ALCAMID® in the areas in which it is needed. 

 

IS THE IMPLANT PAINFUL?

Locally injected anaesthetic substances, such as lidocane or a topical numbing agent, can be used to reduce the discomfort of the injections. Areas with BIO-ALCAMID® implants are generally not painful after procedures have been completed. 

 

 

CAN THE IMPLANT BE DONE AT ANY TIME OF THE YEAR

Yes, although it is advisable to avoid exposure to direct sunlight or tanning bed facility for at least a month following the implant; this is to prevent possible alteration of the secondary pigmentation in the temporarily inflamed area caused by the implant.  

 

CAN ANYONE GET BIO-ALCAMID® IMPLANTS?

Studies conducted to date have proven that BIO-ALCAMID® is a safe product; it does not require a sensitization test as no allergic reaction has ever been reported. However, it is advisable to inform the presiding physician regarding any tendency to allergic reactions (“polyallergic” subjects).

  

WHAT HAPPENS AFTER THE IMPLANT?

Immediately after the introduction of BIO-ALCAMID®, a thin, natural, physiological capsule is formed. This encloses the substance forming an actual prosthesis that can, if necessary, be easily identified and removed. The swelling that develops immediately after the implant is minimal under normal conditions. Immediately following the injection, there is a slight reddening in the area, but this disappears after a few minutes.  There is additional swelling a few hours after the procedure is completed.  The positive (acute) self-controlled inflammatory response begins within a few hours and ends approximately 8 weeks later when the encapsulation process is complete.  The resulting appearance of the implanted areas improves with each passing day.  Upon the encapsulation being complete the overall effect is natural both in appearance and to the touch. 

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Brow lift
 (Forehead Lift)
As the skin ages, it begins to lose its elasticity resulting in frown lines, wrinkling across the forehead, and an increasing heaviness in the eyebrows. Forehead lifts are an option if you have a sagging brow or deep furrows between the eyes. This procedure is usually done between age forty and sixty-five but can be performed at an earlier age. A forehead or brow lift tightens loose skin and removes the excess, forehead wrinkling and drooping brows are modified. When necessary, part of the muscle that causes vertical frown lines between the brows is also removed.

Although a brow lift may make you look younger, it cannot curb the ageing process. This procedure is often performed in conjunction with a facelift, which eliminates sagging in the jowls and neck. Eyelid surgery may also be performed at the same time but, sometimes, patients who believe they need upper-eyelid surgery find that a forehead lift can achieve the desired results.

It is important to note that the texture of the skin is not changed by a forehead lift. Although the skin may be tightened, scars, age spots, fine lines and creases will soon return to their original texture. In such cases, skin treatments like laser skin resurfacing, dermabrasion and chemical peels improve the texture of the skin and are frequently used in combination with a forehead lift. Finally, injectable fillers such as collagen can plump forehead lines and BOTOX® injections can retard the formation of wrinkles.

What happens during the procedure?
Most forehead lifts are performed under local anesthesia, combined with a sedative to make you drowsy. This keeps you in a twilight state, you'll be awake but relaxed, and although you may feel some tugging and mild discomfort, your forehead will be insensitive to pain. Some surgeons, however, prefer to use general anesthesia.

There are two techniques used for forehead lifts, the coronal brow lift and the endoscopic forehead lift, both of which take about an hour or two.

To begin with, your hair is tied back with rubber bands on either side of your head where the incision will be made. The head does not need to be shaved, but hair growing directly in front of the incision line may need to be trimmed.

For a coronal brow lift the incision is made slightly behind the natural hairline, running from ear to ear across the top of the head, in the same place that a hair band or headset would sit. The incision is usually made well behind the hairline so that the scar is visible. If your hairline is high or receding, however, the incision may be placed just at the hairline, so as not to add any more height to the forehead. In patients who are bald or losing hair, a mid-scalp incision that follows the natural pattern of the skull bones may be recommended. Wearing your hair down on your forehead camouflages the scars so that they are relatively inconspicuous. Special care is taken for concealing the scar in male patients, as male hairstyles do not necessarily cover the scars.

After the incision is made, the skin of the forehead is lifted away from the underlying tissue so that it can be removed and the muscles of the forehead can be reduced or released. The eyebrows may also be elevated and excess skin at the incision point is trimmed away. The incision is then closed with stitches or clips. Your face and hair is be washed to prevent irritation and the rubber bands holding the hair are removed. Some surgeons do not use any dressings, while others choose to cover the incision with gauze padding and wrap the head in an elastic bandage.

The endoscopic forehead lift typically requires the same preparation steps as the coronal browlift procedure. This technique leaves minimal scars and has a shorter recovery period. Rather than making one long coronal incision, however, your surgeon will make between three to five scalp incisions of less than an inch in length. An endoscope, a small wand with a camera on the end connected to a monitor, is inserted through one of the incisions. The endoscope allows the surgeon to have a clear view of the muscles and tissues beneath the skin. Another instrument is then inserted through a different incision, the forehead skin is lifted and the muscles and underlying tissues are removed or released. The eyebrows may also be lifted and secured into their higher position by sutures beneath the surface of the skin or by temporary fixation screws placed behind the hairline. Finally, the incisions are closed with stitches or clips and the hair and forehead are washed. Again, depending on your surgeon’s individual preference, gauze and an elastic bandage may also be used.

Are there risks or potential side effects?
As with all surgeries, there is always a possibility of complications following a forehead lift, including infection, bleeding, a reaction to the anesthesia, hematoma, seroma, nerve damage and the occurrence of asymmetries or irregularities. Be sure to ask your surgeon about all of the risks associated with the procedure you are considering before you make any decision.

There is a remote possibility that the nerves that control eyebrow movement may be injured on one or both sides, which results in an inability to raise the eyebrows or wrinkle the forehead. Additional surgery may be required to correct the problem.

Another potential complication is the formation of a broad scar, which may be require another surgery to remove the wide scar tissue and create a new, thinner scar.

The loss of sensation along or just beyond the incision line is common, especially with the coronal browlift and is usually temporary, but may be permanent in some patients. Also, some patients may experience hair loss along the edges of the scar.

Should a complication arise during an endoscopic forehead lift, your surgeon may abandon this technique and switch to the coronal procedure, which will result in a more extensive scar and a longer recovery period. Such complications are estimated to occur in less than 1% of all endoscopy procedures.

Certain medical conditions could cause problems during or after the procedure, such as uncontrolled high blood pressure, blood-clotting problems, or the tendency to develop large scars. Make sure to tell your surgeon if you have had previous facial surgery, if you smoke. Smoking can increase the risks of this procedure because nicotine constricts the blood vessels, decreases blood flow to tissues and greatly increases the chance of scarring. Some patients who smoke can actually lose a portion of skin due to decreased oxygen flow into the skin caused by nicotine and decreased skin oxygen levels caused by carbon monoxide can cause the skin to die. These risks are significantly reduced if you stop smoking at least two weeks before surgery and wait until you are completely healed before starting again. Poor healing of the skin may also occur in people who have very thin skin.

What to expect post-procedure?
In general, the post-operative experiences for acoronal brow lift are quite different from a lift performed endoscopically. The amount of pain experienced varies from person to person and depends on the method used and the extent of the procedure.

Regardless of the technique, keep your head elevated, above the level of your heart and apply cold compresses or small ice packs to reduce swelling and relieve discomfort. Many patients use a water-tight plastic sandwich bag filled with an ounce of frozen berries or peas. You will be able to shower and shampoo your hair within a couple of days or when the bandage is removed.

Patients who have had a coronal lift may experience some numbness and temporary discomfort around the incision. Your surgeon will prescribe medication to alleviate any pain. Those patients who are prone to headaches may be treated with an additional longer-acting local anesthesia during surgery as a preventive measure.

The extent of the post-operative swelling and bruising is dependent on whether you tend to bruise or swell easily. The amount you can expect varies for each individual but past surgeries or injuries should be a good indication. Swelling may also affect the cheeks and eyes but should begin to disappear in a week or so.

As the nerves heal, the numbness of the scalp will give way to itching, which may continue for as long as six months. Any bandages are removed a day or two after surgery, while non-dissolving stitches and are removed within two weeks, occasionally in two stages.

Some of the hair around the incision may fall out and/or may be a bit thinner. Normal growth will usually resume within a few weeks or months.

Endoscopic forehead lift patients usually experience little pain at the incision but may experience some numbness, discomfort and mild swelling. They also usually experience less of the itching sensation felt by those who opt for a coronal lift.

Stitches or staples are removed within a week and the temporary fixation screws within two weeks.

How soon does normal life resume?
Although you should be up and about in a day or two, plan on taking it easy for at least the first week after surgery. You will probably be able to return to work within 7 to 10 days, provided it is not strenuous work. Patients who have undergone an endoscopic procedure can expect to be back at work even sooner. Vigorous physical activity including jogging, bending, heavy housework, sex, should limited for several weeks. Prolonged exposure to heat or sun should be limited for several months.

Most of the visible signs of surgery should fade completely within about three weeks. Minor bruising can be concealed with special camouflage makeup. You may feel a bit tired and let down at first. As with any surgery, it is also sometimes normal to feel anxious or depressed in the days or weeks following the operation. If there is heavy bleeding or increased pain, be sure to inform your surgeon.

Who performs it?
A forehead lift is usually performed by a plastic surgeon or an otolaryngologist (ENT).

Are you a good candidate?
Understanding the limitations of this procedure is crucial. Skin type, ethnic background, degree of skin elasticity, individual healing, basic bone structure, as well as a realistic attitude are factors that should be discussed prior to surgery. As with all elective surgery, good health and realistic expectations are prerequisites, but if you want to tighten the skin on your face and neck, then a facelift may be appropriate, especially if:


How to prepare for surgery?
Your doctor will give you specific instructions to prepare for surgery. In addition, you will be given specific instructions about taking or avoiding certain vitamins and medications but here are some general guidelines:


Are there alternatives to this procedure?
Less invasive procedures may be alternatives but they cannot produce the same results as a forehead lift. laser skin resurfacing, dermabrasion and chemical peels can smooth fine lines, and as a forehead lift may improve but not eliminate wrinkles, your surgeon may recommend one of these procedures post-forehead lift. To prevent further deepening of lines and wrinkles, BOTOX® injections can be administered. Collagen injections can also fill-in lines and furrows in the brow An eyelid lift may also achieve similar results to a forehead lift for patients who have a heavy brow but no significant wrinkling.

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 Collagen 
Cosmetic surgeons use a form of collagen derived from cows (injectable bovine collagen) to correct imperfections that time has placed on our face. The bovine collagen is purified to create a product that is similar to human collagen. In this form, collagen falls within the category of an "injectable soft tissue filler." When injected beneath the skin, these fillers plump up creased and sunken areas of the face. Collagen can fill out wrinkles, skin depressions and some scars. It cannot, however, correct severe wrinkles, nor can it treat sagging skin. Other techniques such as a chemical peel, dermabrasion or a facelift may be needed to treat these other varied cosmetic concerns.                                                                              Go back

 

Liposuction
What is it?
Liposuction is the removal of fatty tissue from underneath the skin using small incisions and metal cannulas.  It can also be called 'body contouring, lipoplasty or liposculpture'.  It tends to work best for treating localised areas of fat that have not responded to diet.  In some situations ultrasound treatment may also be used in order to assist dissolving the fat prior to removing it by suction.

The Operation
Small areas of liposuction can be carried out under local anaesthesia.   For bigger areas the procedure is performed under a general anaesthetic.  The area of the body which has the excess fat is usually marked out prior to surgery to identify those areas that are most prominent.  During surgery, small incisions are made. Some fluid is then introduced into and around the fat in order to assist removal of the fat.  The fat is then sucked out. Extreme care is taken not to damage the overlying skin or underlying important structures like nerves and blood vessels. The small incisions are closed with dissolving stitches.  The surgery is usually performed as a Day Case. After the operation, it is likely that the patient will need to wear an elasticated garment in order to help control the swelling and improve the overall shape. Liposuction may also be used in conjunction with other procedures such as a face-lift, in order to provide better definition of certain areas (e.g. under the chin).

Any Alternatives
Ultrasonic assisted liposuction can also be used.  The ultrasound causes the fat to break up into smaller particles.  The operation however, takes longer to do than the ordinary liposuction method.

Liposuction removes fat cells and though these fat cells cannot come back again, continued weight gain will remove the benefits of previous liposuction.  It is important to realise that liposuction is not a treatment for obesity.   A properly controlled diet and exercise regime can produce significant weight loss.

Before the Surgery
It is important in your pre-operative assessment to be aware of the quality of your skin prior to surgery.  To have good results, one needs to have skin that has elasticity.  Removal of the fat without skin elasticity can end up with wrinkly excess skin.  In some situations it may be more appropriate to perform surgical excision of the skin and fat, for example tummy tuck.

After - In Hospital
There is likely to be some pain and discomfort in and around the are where the fat has been removed.  Local anaesthetic is frequently given so this may alleviate the immediate postoperative pain.  It is also important to wear an elasticated garment to provide compression to the area where the fat has been removed.  This is helpful in order to minimise swelling and improve the final result.  Simple painkillers, such as Paracetamol, usually alleviate discomfort after surgery.  There will be swelling, bruising and discoloration of the skin.  In most situations this settles down without specific treatment or can be helped by the use of massaging around the area.

After - At Home
It is important to continue to wear the elasticated garment for six weeks.  Following this time it may also be useful to maintain gentle compression over the area.  If the liposuction has been performed around the hips, use a pair of cycle or Lycra shorts (or equivalent).  For other sites, other alternatives can be discussed with your surgeon.  Swelling can persist for several months after treatment.    There may be persistent numbness over the  treated area.

Possible Complications
The complications specifically with sucking out fat include residual irregularities, areas that are lumpy, areas of tenderness, insufficient removal of fatty tissue and wrinkling of the skin in the post operative phase.  If liposuction is performed too close to the surface of the skin, ridging of the area can be noted and this can persist.  Very occasionally damage can occur to the skin itself which can produce scab formation leading to scar formation.  Bleeding can occur underneath the skin that can lead to clot formation and further potential for irregularities.  Large amounts of fatty tissue can be removed using liposuction but it is important, in those situations, that controlled replacement of fluid is performed.  There have been occasional incidences of heart and lung problems related to excess fat aspiration and intravenous fluid replacement.  There can be abnormalities, unusual sensations where large amounts of fat have been removed but this tends to improve as time passes.

General advice
Return to normal activities depends on how much fatty tissue has been removed and to what extent there is continued soreness and problems.

If liposuction is performed as part of a major surgical procedure like a tummy tuck or a breast reduction, it may take many weeks before the patient can return to work.  However, with small areas of liposuction to improve contour defects, the patient may be able to return to work very rapidly, depending on whether the surgery is performed under general or local anaesthesia.

Those with experience should only perform liposuction as significant distortion following inappropriate use can occur. Go back

 Neck lift
 A neck lift, often referred to as a as a "mini-facelift" or a “minimal or partial facelift”, corrects for a minimal amount of loose skin around the neck. This procedure concentrates solely on the neck area and, although it can yield dramatic effects to the neckline without undergoing a full facelift, it t is not for individuals who have a considerable amount of loose skin under the jaw or in front of the neck, sometimes called a "turkey waddle". It is, however, a good option for younger patients who do not require as much correction. It is not only faster but less invasive which means reduced swelling, scarring, bruising and risk. While a neck lift may make you look younger, it cannot curb the ageing process.

Another surgical technique to improve the neckline by removing fatty deposits is sub-mental liposuction, also called neck liposuction, and is often performed in conjunction with neck lift, face lift or chin implant surgery. Although the size and shape of the neck can be significantly changed with liposuction, extra skin once the fat has been removed. Wearing a compression band will help to firm the area but, if your skin elasticity is poor, this extra skin may sag. To correct for extra skin, it may be necessary to perform a neck lift or a face lift, either concurrently or after this procedure.

What happens during the procedure?
Your surgeon will begin with a complete medical history and examination to check for conditions that could cause problems during or after surgery, such as uncontrolled high blood pressure, blood clotting problems, or the tendency to form excessive scars. Before your surgery, routine laboratory tests may be requested including blood counts and blood chemistries.

Both procedures are usually performed in an outpatient surgical center, either operated by your surgeon or a hospital facility, and take about an hour. Most patients can return home after the surgery or can stay in a nearby hotel or recovery facility for the first night. If you are having more than one procedure, however, you may chose to remain in the hospital or in a recovery facility for a few days so that medical staff can monitor the recovery process.

Neck Lift and Neck Liposuction surgery can be performed under local anesthesia mild sedation, under “twilight anesthesia” (which is local anesthesia with heavy sedation) or under general anesthesia. Usually long or multiple procedures are performed under general anesthetia.

In a Neck Lift, the surgeon can remove some of the saggy and redundant neck skin through incisions behind the ear and under the chin area. Sometimes the incisions extend in front of the ear as well. The muscle under the chin is tightened and elevated by placing a suture across the neck crease. Loose skin is tightened by pulling the skin upward and backward and removing the excess skin from behind the ear. The incisions are closed with sutures that will be removed after one to two weeks, self-dissolving sutures or, in the scalp area, removable surgical staples.

Neck Liposuction is not an alternative to weight loss but can remove stubborn fat deposites which do not respond to diet and exercise. Today, a number of new techniques, including Ultrasound Assisted Lipoplasty (UAL), Power Assisted Liposuction (PAL), the Tumescent Technique, and the Super-wet Technique are used.

During the procedure, fat is removed through a small incision usually placed in a natural skin crease under the chin or behind the ear lobes. A thin tube called a cannula is then inserted into the fatty area. The cannula is used to break up the fat deposits and sculpt the area to the desired proportions. The unwanted fat is removed with a high pressure vacuum, leaving the skin, muscles, nerves, and blood vessels intact.

In the Super-wet Technique, a saline solution containing a local anesthetic and adrenaline is injected into the area to be treated, which makes the fat deposits easier to break up and extract. This extra fluid also minimizes trauma to the surrounding tissue, reducing swelling and post-operative pain. The administration of adrenaline also decreases bleeding during surgery, further reducing risks.

The Tumescent Technique, in which even larger amounts of liquid solution are injected, has similar benefits.

A newer method, Ultrasound Assisted Liposuction (UAL), uses sound waves to liquefy the fat after the injection of fluids. UAL also minimizes trauma, causing less bruising and blood loss.

Another earlier method of liposuction is called Dry Liposuction because no liquefying agent is used but it is not in frequent use today.

The technique chosen for your operation will be determined by a combination of factors, including the precise area to be treated, the amount of fat to be removed, your surgeon’s training and experience, and your preferences. The pain during the procedure is most often minimal, although you may feel pressure, movement, or a vibrating sensation.

Are there risks or potential side effects?
As with all surgeries, there is always a possibility of complications following chin surgery, including infection, bleeding, a reaction to the anesthesia, hematoma, seroma, asymmetry, and nerve damage.

Make sure to tell your surgeon if you are a smoker. Smoking can increase the risks of this procedure because nicotine constricts the blood vessels, decreases blood flow to tissues and greatly increases the chance of scarring. Some patients who smoke can actually lose a portion of skin due to decreased oxygen flow into the skin caused by nicotine and decreased skin oxygen levels caused by carbon monoxide can cause the skin to die. These risks are significantly reduced if you stop smoking at least two weeks before surgery and wait until you are completely healed before starting again. Poor healing of the skin may also occur in people who have very thin skin. It is most likely to occur in the thin skin of the neck behind the ear.

Neck Liposuction carries specific risks, such as imperfections in final appearance. The skin surface may be irregular, wavy, asymmetric, or even "baggy", especially in the older patient. Numbness and changes in pigmentation may occur. Often, revision surgery is performed to improve the appearance. Ultrasound Assisted Liposuction carries the risk for burns to the skin and deeper tissues. In addition, the long-term biological effects, if any, of ultrasound energy are not known.

The risks increase if a greater number and size of areas are treated at one time. Removal of large volumes of fat and fluid may require sizable volumes of pre-injection fluid and longer operating times than in smaller operations. The combination of these factors can create greater hazards for infection, delays in healing, improper fluid balance, injury (especially perforation) to vital organs, shock, and unfavorable drug reactions. As with any surgical procedure, blood clots may form in the veins with risk of migration to the lungs, which can be fatal.

Another risk of liposuction is Pulmonary Thromboemboli, blood clots that can break free and travel to the lungs resulting in pulmonary Thromboemboli. This can put a patient into adult breathing distress and subsequently into cardiac arrest or coma that can result in a vegetative state from loss of oxygen to the brain. Although rare, this can happen within three weeks of the surgery but will most likely show symptoms of shortness of breath and fatigue within the first 72 hours. There is also a risk of Pulmonary Edema (or fluid in the lungs) from over hydration. This can occur when extreme amounts of saline are intravenously supplied with the purpose of replenishing fluids that were taken out. Some surgeons try for "twice the amount in as is removed, just to be safe". This is most seen with tumescent and super-wet techniques. Ask your surgeon how much fluid he returns to the patient's body.

Be sure to ask your surgeon about all of the risks associated with the procedure your considering before you make any decision.

What to expect post-procedure?
After a Neck Lift, mild to moderate swelling and bruising can be expected. The extent of the post-operative swelling and bruising is dependent on whether you tend to bruise or swell easily. The amount you can expect varies for each individual but past surgeries or injuries should be a good indication. Keep your head elevated, above heart level when lying down. Your surgeon will prescribe medication to alleviate the pain but, after a few days, an over-the-counter pain reliever should be sufficient to alleviate any discomfort. Your surgeon may recommend that you wear a chin strap for the first one to two weeks after surgery to minimize the swelling and bruising. Initially, the strap is worn day and night.

Following Neck Liposuction, your neck may be stiff and sore for a few days, and you may experience some pain, burning, swelling, bleeding or temporary numbness. Again, your surgeon will prescribe medication to alleviate the pain and initial discomfort.

An antibiotic ointment may also be prescribed to prevent infection at the incision sites. Non-dissolving sutures will be removed in a week to 10 days and you will be fitted with a compression band to reduce the swelling and hold your neck in its new shape until the tissues have adjusted. This must be worn for several weeks after your surgery to ensure that your neck stays firmly shaped.

How soon does normal life resume?
For the first week following neck lift surgery you can to resume light activity but avoid any bending or heavy lifting. You can usually return to work in seven to ten days provided the work is not physically demanding and makeup can be used to conceal bruising.

After Neck Liposuction, most of the bruising and swelling should subside within three weeks and you can return to work within a week, or even within a few days provided the work is fairly sedentary. Remember that you will be wearing the compression band for several weeks after your surgery to ensure that your neck stays firmly shaped.

Most of the visible signs of surgery should fade completely within about three weeks. Minor bruising can be concealed with special camouflage makeup. You may feel a bit tired and let down at first. As with any surgery, it is also sometimes normal to feel anxious or depressed in the days or weeks following the operation. If there is heavy bleeding or increased pain, be sure to inform your surgeon.

Who performs it?
A face lift is usually performed by a plastic surgeon or an otolaryngologist (ENT).

Are you a good candidate?
As with all elective surgery, good health and realistic expectations are prerequisites, but if you want to tighten the skin around your neck or remove excess fat, then a neck lift or neck liposuction may be appropriate, especially if:


How to prepare for surgery?
Your doctor will give you specific instructions to prepare for surgery. In addition, you will be given specific instructions about taking or avoiding certain vitamins and medications but here are some general guidelines:


Are there alternatives to this procedure?
Less invasive procedures may be alternatives but they cannot produce the same results as a neck surgery. To correct deep lines and wrinkles, BOTOX® or collagen injections can be administered. Laser skin resurfacing, dermabrasion and chemical peels can smooth fine lines, while a full facelift can correct for excess skin around the jaw line.               Go back

 Nose reshaping - Rhinoplasty
What is it?
Rhinoplasty is the surgical treatment for reshaping of the nose.  Depending on the exact problem it can involve the removal of bone cartilage, a reshaping of the bridge of the nose, and reshaping and altering the tip of the nose.

The Operation
The surgery is usually performed under general anaesthetic but can be performed under local anaesthesia and heavy sedation.  The surgical scars may be either inside the roof of the nose or at the central strut of the base of the nose.  The surgical scar, if it is placed externally, is occasionally visible and is particularly useful in noses where there has been trauma or where previous surgery has been performed.

Any Alternatives
In noses where there are minor irregularities these may occasionally be corrected by subcutaneous injections.  However these may not be permanent and surgical correction is often the only way of obtaining a lasting result.

Before the Operation.
The patient should be in good general medical health and avoid smoking, Aspirin or Aspirin containing medication.   Surgery should be postponed  if there is any evidence of infection in the nose, throat or sinuses.  In your pre-operative consultation your doctor will discuss your general medical health, what medications you may be taking and if these have any bearing on the surgery.  It is also likely that one would wish your blood pressure to be normal.

After in Hospital
You are likely to have a plaster over your nose to protect the surgery that has been performed.  Depending on the necessity of surgery inside the nose itself, there may be packs up each nostril.  This initially may cause difficulty with breathing and a sense of being gagged. 

If there are no packs up the nose, there still may be residual swelling and this may also cause some difficulty breathing through the nose.  In normal breathing, most people breath through their nose by preference and this inability to breathe through the nose may be initially upsetting.  If packs are in place, some minor bleeding may occur when they are removed, usually twenty-four hours after surgery.  There is often minor bleeding following the surgery anyway.    While in hospital your blood pressure, pulse and temperature will be checked and pain killing tablets or injections given.  The surgery itself does not tend to produce bad pain.  It is important after the surgery not to blow your nose as this can cause significant bleeding.  Occasionally if one needs to clear the nose, it is necessary to gently sniff.  It is also likely that there will be significant bruising and swelling around the face and the patient may end up with black eyes.  On return to the ward you will also be nursed in an upright position.

After at Home

Bruising following the surgery can last for two to three weeks.  You may also find that your nose is blocked off and on, particularly in the first few weeks following surgery. This can take some time to settle down.  It is important to avoid bending, stooping and straining in order not to start the nose bleeding. Paracetamol is usually adequate for pain relief. You should avoid taking Aspirin or tablets containing Aspirin as these can promote bleeding.  It is probably best to avoid people with coughs and colds for the first few weeks following surgery.  The protective plaster dressing is usually taken off between one and two weeks following surgery.  It is likely that your nose will continue to remain swollen although it should have achieved a satisfactory shape and size.  You will also probably notice that there is some numbness over the skin of the nose and this can persist for some time.  You can return to work after a few days but it may be too obvious with the plaster dressing and many people tend to wait until the plaster has been removed and the bruising has settled before returning to non-strenuous work.   It is advisable to avoid any heavy activity such as gym work, strenuous lifting, or straining for one month following surgery.

Possible Complications
Surgery for Rhinoplasty correction should be avoided in people who have a cough, colds or have evidence of infection in and around the nose at the time of the surgery.  Bleeding does occur during surgery but this is usually stopped on return to the ward.  Occasionally it can occur again while the patient is in hospital and this may necessitate a return to theatre.  Infection at any time following surgery is another cause of bleeding and tends to occur between seven and ten days post-operatively.  It may necessitate packing of the nose and very occasionally a return to theatre.  Due to the narrowness of the nasal passageways swelling after surgery causes them to become even narrower.  This can cause some difficulty with breathing which can take a few months to settle.  Removal of some of the cartilage in the centre of the nose may be performed at the time of Rhinoplasty in order to improve nasal airways.  This however would be discussed with your surgeon prior to the operation.  Examination of the nose prior to surgery would indicate whether this was necessary.  Minor irregularities over the tip of the nose can occur following Rhinoplasty type procedures.  These may be apparent and in a small number of cases and need surgical correction at a later date.  This can be performed when the swelling following surgery has returned to normal.  These minor irregularities may be less noticeable in those who have thick-skinned noses.  Some patients also find that they may have an altered smell after the surgery.

General Advice
It is important for the surgeon to understand what problems the patient is having.  It may not be possible to achieve the exact results that the patient expects.  It may also be very important to point out to the patient the relationship of the nose to the rest of the face and that to surgically alter a nose in some situations can leave the face significantly out of balance.  It is also important that the patient would be aware that scars on the external part of the nose are occasionally necessary, particularly if there are large nostrils or if secondary surgery needs to be performed.                                                                 Go back
 
 Vein treatment
Spider veins and varicose veins can be treated by sclerotherapy or laser surgery. Spider veins on the face can be treated with lasers. Leg spider veins are treated with sclerotherapy Varicose veins are caused by faulty valves in the venous system, creating twisted and swollen veins. Varicose veins are larger, darker and tend to bulge with a rope-like texture on the skin's surface. Varicose veins are also more likely to cause pain and be related to more serious vein disorders. In contrast, spider veins are smaller and closer to the skin's surface in a branch-like or linear formation. Treatment of varicose veins is generally considered outside the realm of cosmetic surgery and patients are often referred to a vascular surgeon.                    Go back

 

Abdominoplasty
What is it?
Abdominoplasty means removal of excess skin and fatty tissue from the anterior abdominal walls.  It is also called an apronectomy.  The end result is to improve the shape of the anterior abdominal wall and to decrease the bulging that can occur between the umbilicus and the pubic bone area. 

The Operation
You will be given a general anaesthetic and be completely asleep during the surgery.  The operation takes from about one hour to an hour and a half to perform.

Any Alternatives
Excess fat on the anterior abdominal wall may be caused by being generally overweight or having been pregnant with the skin stretching over the abdominal wall which has lost its elasticity and does not return to its pre-pregnancy state. Weakness of the anterior abdominal wall muscles can be related to excess weight gain, pregnancy, or general abdominal wall weakness.

If the problem is related to simple accumulation of fat in limited areas, liposuction can be performed.  This can be successful if there are good underlying abdominal wall muscles and if the skin elasticity is normal.

If however the skin has lost its elasticity, removal of the fat can result in the overlying skin becoming wrinkly and indented.  The exact type of operation that would be performed, the amount of skin that would be removed and the potential use of liposuction during the surgery would be discussed with each individual, prior to the operation.

The surgery is likely to be of most benefit and last longer if you have finished having your family.  It is probably unwise to go through this major surgical operation if you have any chance of having children in the future.  Pregnancy is likely to undo all the work that has been done, and would therefore be something that most surgeons would be reluctant to undertake this procedure unless there were very firm assurances that you did not wish to become pregnant in the future.

Before the Operation
It would be important for your surgeon to assess your general medical condition prior to the operation.  It may be necessary to have advice from other doctors depending on your weight, blood pressure and general overall health.  In general it is important to avoid smoking as this can decrease the blood supply to the skin that is going to be stretched tight over your stomach and can cause areas of the skin to become damaged or partially dead, and may even  require skin grafting should healing not occur.  It is important to be at the ideal weight as weight loss subsequent to  the abdominoplasty type procedure  can interfere with the final results.

After the Operation
If it has been necessary to tighten up your stomach, you will find that on return to the ward you will be nursed with your knees and hips bent.  This may be with you lying on the left or right side or if lying on your back, with some pillows underneath your knees.  This is to take the pressure off the muscle to help with post-operative pain and discomfort.  It is also likely that there will be drains and you will be required to wear anti-embolism stockings.  The nurses will make regular post-operative checks of temperature, blood pressure and pulse rate. It is likely that there will be an intravenous drip in place, in order to provide fluids until you feel like eating and drinking again.  It is likely there will be  a firm bandage around your stomach, which may have Velcro fastenings that can be loosened if it becomes too uncomfortable.

This supports the surgery that has been done and decreases swelling.
You may experience some pain and discomfort after surgery for which you may need painkilling injections or tablets.  When lying in bed, it is very important to continue to move your feet and legs (up and down) to promote circulation and prevent clot formation in the veins of the legs.  It is also important to take regular deep breaths to expand your lungs following the surgery.  Occasionally it is uncomfortable to do this, particularly if the stomach has been tightened significantly.  You will be asked to mobilise gently over the next few days with assistance from the nurses and physiotherapists, as required.  If the muscle has been tightened it will be a gradual process of straightening up. This means that for some weeks following surgery you may walk with a stooped-over gait.  Assistance will be given with hygiene until you are able to manage independently.  The drains will be removed when they are no longer draining significant amounts.  You will need to wear a firm dressing or corset around your stomach in order to continue to give it support on going home.

You may stay in hospital for two or three days depending on the extent of the surgery.  It is important to maintain a good healthy diet and to avoid becoming constipated as straining can make the stomach uncomfortable.

After - At Home
An abdominoplasty is a major surgical procedure and you may feel tired on returning home.  It is likely that you will be able to be self-caring but you should avoid doing any heavy lifting, straining, bending or lifting.  You will be given advice as to how to get up from a sitting position and as to how to roll rather than sit straight up out of bed.  The wounds can be cleaned when they are sealed, usually from about a week.  The firm corset should be worn all the time in order to try and reduce the swelling and improve the discomfort.  If the stomach muscle needed to be tightened up, you will still walk with a stoop, which may take a few weeks to straighten up altogether.  It is important not to try and straighten up immediately as this can tear some of the sutures that have been used to hold the muscles together and can lead to subsequent problems with further weakness of the anterior abdominal wall.

You can return to driving when you are comfortable enough to do an emergency stop and do not feel any discomfort when moving your feet around when sitting in a car.  A safety belt should always be worn.

Possible Complications
As with any major surgical procedure, bleeding can occur during and after the surgery.  Drains are placed to prevent significant bleeding accumulating under the skin following surgery and it is most unusual to have to return to theatre for excess bleeding.  However, there are sometimes small amounts of fluids that can collect underneath the skin and these may need to be removed at a later date either by surgery or by needle aspiration. 

There is a large amount of undermining  of the skin on the anterior abdominal wall in order to allow it to move into a new position and reshape the tummy.  This interferes with the skin's blood supply and can cause some areas of the skin to become  ischaemic (significant decrease in blood supply) and subsequently  not heal properly.  Should this be the case occasionally  skin grafting is  required.  The position of the scar is discussed with the surgeon prior to surgery and on most occasions, heals leaves a good scar.  However, reactions can occur to the suture materials used and the scars can become red, raised and lumpy above the surrounding skin.  The design of the scar is such to try and hide it under normal  underwear/swimwear.

The shape of the anterior abdominal wall is changed and this may cause other areas of the body to become more prominent, particularly aspects of the hips and the flanks.  It is not always possible to address this at the time of surgery and irregularities in the skin may become obvious when the swelling has diminished.  At the time of surgery liposuction may be used around the flanks in order to try and improve the overall appearance when looking at the tummy from the front.

The most serious complication that can occur during an abdominoplasty procedure is the formation of clots in the veins in the legs.  These can then travel to the heart and lungs and cause severe difficulty with breathing.  The surgeon will arrange to try and prevent this occurring both by using anti-clot stockings and pumps that are placed on the legs during surgery to improve blood flow. Frequently blood-thinning agents are also given so that clot formation is decreased.

The altered sensation of the skin over the anterior abdominal wall may be uncomfortable as time progresses.  You are also likely to feel uncomfortable and have a feeling of tightness on the skin, particularly for a few weeks following surgery.  If the muscle tightening has been required to improve your shape, it may be necessary to avoid physical activity such as swimming and gym work for up to three months following surgery.  You would need to discuss this with your surgeon.  There may be some irregularities in the skin of the anterior abdominal wall following the surgery and it can take some time for these to settle.  Very occasionally the umbilicus can become red and inflamed.

General Advice
Abdominoplasty type procedures can produce very satisfactory results for trimming the anterior abdominal wall and decreasing the lower abdominal bulge.  Although it may address these problems it can make other areas such as the hips and flanks more obvious.  These other areas may be improved by continued weight loss.  In some circumstances however, it may be necessary to perform further surgery at the flanks to improve the position.  Very occasionally, when there is a lot of excess tissue around the back, a similar type operation as performed on the anterior skin of the stomach can be performed on the back.  This will leave a scar directly across the back from side to side.                                                         Go back
 

Buttock, thigh and arm lift
Arm, thigh and buttock lifts are surgical techniques to eliminate loose and sagging skin.

What happens during the procedure?
The procedure is usually performed in an outpatient surgical center, either operated by your surgeon or a hospital facility, and takes 2-3 hours, but depending on the extent of the procedure, it can take longer. If you are having more than one procedure, overnight hospitalization may be required.

Lift surgery can be performed under local anesthesia, along with intravenous sedation, or general anesthesia depending on your health, the extent of the procedure and whether you are having other procedures at the same time.

For an arm lift, incisions are made on the inner and under surface of the arm, often in a zigzag pattern. The surgical opening may run from the armpit to as low as the elbow. As the excess skin and fat is removed, the remaining skin is stretched and sutured into place and the incisions are bandaged. An arm lift usually takes about two hours. After a monitored time in the recovery room, patients can usually go home the same day.

For thigh lifts, excess skin is lifted and removed through incisions made in the inner thigh and/or high upper outer thigh. The incisions are extensive but are usually not visible when clothing is worn. Simultaneous lifting of the thighs and buttocks is done using incisions that follow a French-cut bathing suit line only a bit higher up on the hip. The surgeon lifts and removes the excess skin down to the muscle and removes the thick layer of fat beneath the skin. Drain tubes may be placed at the incision to draw out fluids. The surgery usually takes two to three hours. Your surgeon may recommend an overnight stay in the hospital before being allowed to go home.

A buttock lift is not a common procedure, because it requires leaving scars across the buttock or in the fold. This is usually not desirable and patients opt for liposuction instead.

Are there risks or potential side effects?
As with all surgeries, there is always a possibility of complications, including infection, a reaction to the anesthesia, hematoma, seroma, nerve damage and the occurrence of asymmetries or irregularities. Should infection occur, your surgeon will prescribe a treatment with antibiotics. Occasionally, the superficial lymphatic system in the groin is interrupted during a thigh lift surgery. If this should occur, excessive swelling will probably occur for several weeks as the lymphatic channels form again. This is an uncommon problem, but it requires some patience and understanding if it does occur. Be sure to ask your surgeon about all of the risks associated with the procedure your considering before you make any decision.

What to expect post-procedure?
The areas operated on will initially feel tight and swollen. The swelling is mild to moderate, and peaks at two to three days. Usually, the sutures are covered with adhesive strips (steri-strips), skin tape and surgical gauze. Small amounts of oozing and bleeding are very common but should be no more than a slow staining of the gauze dressing. Because of the location of the incisions for a thigh lift, it is impossible to avoid lying on them. Change position at least every 30 minutes and move as carefully as possible while putting as little stress on the incision lines as possible.

You will probably have several layers of stitches with both arm lift and thigh/buttock/hip lifts. Some will be re-absorbed by the body and some may need to be removed by your surgeon. You will be able to shower on the third day after surgery. Moderate pain can be anticipated after this procedure. Your surgeon may prescribe pain medication for the first few days, after which acetaminophen and/or ibuprofen may be all that you require.

Numbness in small areas on the thighs is possible but usually disappears gradually over several months. Although most bruising and swelling will disappear within 3 weeks, some swelling may remain for 6 months and up to a year. The extent of the post-operative swelling and bruising is dependent on whether you tend to bruise or swell easily. The amount you can expect varies for each individual but past surgeries or injuries should be a good indication. Keep your head elevated, above the level of your heart, when lying down. Applying cold compresses, or ice packs will reduce swelling and relieve discomfort. Many patients use a water-tight plastic sandwich bag filled with frozen berries or peas. Regular icing is the key to relieving the swelling.

As with any surgery, it is also sometimes normal to feel anxious or depressed in the days or weeks following the operation. If there is heavy bleeding or increased pain, be sure to inform your surgeon.

How soon does normal life resume?
For the first week following surgery, you will be allowed light activity but you must avoid bending or lifting. Although you may not feel like it, you should try to walk as soon as possible after a thigh lift to reduce swelling and prevent blood clots from forming in your legs. While each case is individual, recovery from arm lift generally takes one to two weeks; you'll be able to return to work in a week, moderate exercise in 10 days to two weeks, more physical contact sports after a month. Thigh and buttocks lift recovery generally takes one to two weeks; you can usually return to work in a couple of weeks, and resume vigorous exercise or contact sports in approximately four to six weeks. Recovering individual and varies from person to person. After an arm or thigh lift, however, you will begin to see a noticeable difference in the shape of your body almost immediately with additional differences occurring the next 4 to 6 weeks as the swelling subsides.

Are you a good candidate?
Women who have had a mastectomy should not have an arm lift. Since the surgery affects the lymphatic drainage, the combined procedures may cause the arm to swell permanently. If you have had phlebitis (inflamed blood vessels) in either of your legs, you may not be a candidate for lift surgery. Most lifts require fairly lengthy incisions and scarring is visible, and each patient should be prepared for this. As with all elective surgery, good health and realistic expectations are prerequisites, but if you want to change the shape of your arms or thighs, then a lift surgery may be appropriate, but: 


How to prepare for this procedure?
Your doctor will give you specific instructions to prepare for surgery but here are some general guidelines: 


Are there alternatives to this procedure?
Arm or thigh liposuction can reduce a reduction in size but liposuction cannot alter skin quality and there may be extra skin once the fat has been removed. Although wearing the compression bands will help to firm the area, this extra skin may sag, especially if your skin was not particularly elastic. Such excess skin would necessitate an arm or thigh lift to reduce the amount of loose skin. Exercise, especially weight lifting, however, can significantly improve the shape and tone of the arms and, to a lesser extent, the thighs including that of the loose skin.                                                                         Go back

Botox 

Cosmetic can be used to smooth wrinkles in the neck and face to create a more youthful appearance. It is especially useful in the eye area. Removing wrinkles from between the eyes can dramatically change a person’s look from one of permanent anger or sadness to one of contentment and restedness. It is also frequently used on the thin wrinkles that surround the eyes (often called “crows feet”) and the mouth, but can also be used in other areas, such as along the chin and jaw.
The solution used in these treatments is made of botulinum A toxin, a purified protein made from botulism bacteria. This solution temporarily paralyzes nerves of the facial muscles so that they cannot contract and cause wrinkles in the area being treated.
BOTOX® Cosmetic may also be helpful in treating migraine headaches, and can be used to decrease excess sweating of the palms and underarms.
If you’re considering BOTOX® Cosmetic treatment, the following information will provide you with a good introduction to the procedure. For more detailed information about how this procedure may help you, we recommend that you consult a dermatologist who is board certified or has completed a residency program that includes instruction in this procedure.Go back

Vagina Enhancement
A decision to enhance your intimate organ is purely a precise decision to improve your femininity and a way to eliminate the embarrassment and sexual inadequacy caused by having an abnormal or loose vagina size.

Problem about the size
Some women in their early twenties and in their teens, suffer from an embarrassing problem where their vaginas start becoming large and loose. Primarily caused through a non-active lifestyle, childbirth, and other factors. All of which cause a thinning of the vaginal muscle becoming large and loose with obvious consequences such as suffering from embarrassment and distress because of your size. Poor sexual performance where you can no longer reach orgasm through intercourse, inadequacy in bed since you do not contribute to the sexual relationship between you and your partner.

The procedure
Our specialized non-surgical procedures for tightening, toning and restoration of the vagina to a feminine state, focus on each woman’s individual needs. We focus the techniques in restoring a more normal, more appealing size to the female organ. One that gives your femininity back to you, in a youthful and feminine state, allowing you to feel adequate with your body and with your partner.                                                                                                                                                      Go back


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About the Procedures
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