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> My Plastic Surgeon USA Home > Search for Plastic Surgeon > J. Gerald Minniti, M.D., F.A.C.S.
Plastic Surgery FAQ Provided by Dr. Gerald Minniti

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Breast Augmentation

Breast augmentation is one of the most common procedures performed by plastic surgeons, and breast implant surgery is the most popular, effective, and safe way to improve breast size and shape.

Persons who are good candidates for breast augmentation have one or more of the following conditions:

  • You feel that your breasts are too small.
  • clothes are too large around the bust but fit well around the hips.
  • you feel self-conscious wearing a swimsuit or form-fitting top.
  • your breast have become smaller and lost their firmness after children.
  • weight loss has changed the size and shape of your breasts.
  • one of your breasts is smaller than the other.

During your consultation, you will be asked about your desired breast size and anything else related to the appearance of your breasts that you feel is important. A full medical history will be asked of you including medical conditions, medications you are currently taking, drug allergies, and any previous surgeries. You will also be asked about any possible family history of breast cancer, your results of mammograms if you have had one, and your smoking history. Your plastic surgeon will examine your breast and will consider such factors as size and shape of your breasts, the quality of your skin, and the position of your nipples and areolas.

For women contemplating breast augmentation, there are more choices today than ever before regarding implant shape, profile, and type, as well as, techniques to place these implants into proper position.

IMPLANTS

Since November of 2006, silicone gel implants have been approved by the FDA and released for use in primary cosmetic breast augmentation. This now gives American women the choice not available to them since 1992.

The primary advantages to silicone gel implants are their more natural feel, with less risk of rippling or wrinkling that is common in saline filled implants, especially in thinner women with minimal breast tissue. Silicone gel implants are also more durable than saline implants, decreasing the likelihood of a secondary surgery for implant leakage (rupture), especially in the first ten to fifteen years.

There are a number of disadvantages to silicone gel implants, however. When a silicone gel implant ruptures, it is 'silent', and there is no change to the appearance of the breast (unlike the deflation seen with a saline implant). Therefore, silicone gel implants require periodic monitoring using either ultrasound or magnetic resonance imaging (MRI), beginning 5 to 6 years after surgery. Because silicone gel implants are filled and sealed at the factory, they require incisions on or just below the breast for placement, in contrast to incisions that can be placed in the belly button or armpit for saline implants. Finally, silicone gel implants are three times more expensive than saline filled implants.

Implants come in a variety of 'shapes', from traditional round to the teardrop, contoured, or anatomic types. In general, the non-round implants are oval, being taller than they are wide, with their most projecting point located toward the lower portion of the implant. Because these implants can rotate, affecting its positioning, and because they offer no advantage to a 'natural' look, most surgeons use round implants almost exclusively.

Implants come in a variety of projections, thereby affecting their overall width and height for any given volume. This allows the surgeon the ability to match a particular implant to the size of the patient's chestwall and breast dimensions. The surface of an implant can be smooth or textured, the latter most common in non-round or teardrop implants. In general, most surgeons utilize smooth implants because their walls are thinner, making it less likely to feel rippling or wrinkling once surgically placed.

INCISIONS

There are four potential incisions that are available for placement of breast implants. The periareolar or nipple incision is most commonly thought to decrease nipple sensibility, which is not true. (In fact, nipple sensibility is most affected by the size of the implant). It tends to heal well with an inconspicuous scar. The quality of scarring cannot be determined beforehand, however, and therefore there is uncertainty of its ultimate appearance.

The inframammary incision is also very commonly performed, yielding a scar in the crease below the breast (if there is a crease). This and the periareolar incisions are utilized most for silicone gel filled implants because of their proximity to the breast for ease of placement.

The armpit or transaxillary incision is a remotely placed incision primarily used for saline filled implants. Some surgeons use this site for placement of silicone gel filled implants, but requires an incision that is much larger than the usual inch and one half. Surgery can be performed with or without an endoscope or television camera.

The bellybutton or transumbilical or TUBA incision is only for saline filled implants. It is the only technique yielding a singular incision, utilizing the one incision for both breasts. Few doctors are adequately trained or have enough experience for this surgery. There are many misconceptions regarding this surgery, propagated by both laypersons and doctors too. In the right individual, this is an excellent way of placing implants.

IMPLANT POSITION

Although there are many different names for the locations implants are placed, there are really only three potential places that exist: below the breast (subglandular), below the pectoralis muscle (subpectoral), and below all the chest wall muscles (submuscular), the last being the least common.

There was a tendency for surgeons to place silicone gel implants in the subglandular position prior to and during the early days of saline filled implants. The imposed restrictions on silicone gel implants in 1992 gave surgeons more experience with saline implants and their more pronounced tendency to wrinkle or ripple. This prompted surgeons to place implants into a submuscular or subpectoral position, giving the saline implant more tissue coverage with a better look and feel.

Today, there is a general consensus that implants placed under the pectoralis muscle look and feel better, and have a lower risk of abnormal scarring called capsular contracture compared to implants placed in the subglandular position. Regardless of this, there are some doctors who prefer the subglandular position for implant placement.

IMPLANT SIZE

The issue potential breast augmentation patients worry over the most is 'how big are my breast going to be?' Most patients are worried that their breast augmentation will be too big, and they will look out of proportion. The reality is that after surgery most women wish they had bigger implants!

Unfortunately, there is a significant increase in risk of complications, both short and long term, with placement of implants that are too large for the patient's breast and chestwall dimensions. Worse, some of these complications can be difficult or impossible to correct. The most important parameter for the surgeon and patient to consider is the matching of the base width of the breast with the width of the implant to be used. By keeping the diameter of the implant equal to or less than that of the breast, the risk of many complications can be minimized.

PREPARATION FOR SURGERY

The risks, alternatives and benefits of breast augmentation surgery will be discussed by your surgeon and again separately by his consultant. Ample time will be given for your questions, so that you will feel perfectly comfortable about your decision to proceed. Remember, this is the beginning of building a long and trusting relationship with your surgeon.

In certain instances you will be asked to get a baseline mammogram before surgery and some months after surgery to detect any future changes in your breast tissue. If you are a smoker, you will be asked to stop well in advance to decrease the risk of poor healing and infection, increased bleeding and bruising, and abnormal scar formation (capsular contracture). A list of medications to be avoided will be provided, including aspirin (Excedrin, Buffrin), ibuprofen (Motrin, Advil), and naprosyn (Aleve). Other instructions will be provided as well.

The surgery is performed in a fully accredited outpatient surgery center located in the same building as your plastic surgeons office. A board certified anesthesiologist will provide general anesthesia, because it is the safest type of anesthesia. After your surgery, you will be taken to the recovery area and closely monitored. You will be permitted to go home after about an hour.

RECOVERY

There is usually minor pressure and stiffness experienced by most patients immediately after surgery that is managed well with a muscle relaxer and pain medication. The following day, the tight wrap is taken off and a bra is placed. Most patients are driving in 4 to 6 days, and feeling back to normal in two weeks. Most people begin light exercise then, and resume their regular athletic routine by 3 to 4 weeks.

Your breasts will be somewhat swollen and may have some minimal bruising, but this disappears quickly. They will appear too high and full on top, and have an odd shape. Over the course of weeks to months your breasts will drop, soften, and take a more pleasing shape.

It is important to make all follow up visits with your plastic surgeon so that your recovery can be monitored. It is also important to note that your questions and concerns are addressed in a timely fashion, making follow up essential.

RESULTS

Breast augmentation will make your breasts fuller and enhance their shape. You will find it easier to wear certain styles of clothing, and like many women, have a boost in self-confidence.

The results of your breast augmentation surgery will be long lasting. However, implant deflation, the effects of gravity, and aging will eventually alter the size and shape of your breasts. If after a period of years you become dissatisfied with the appearance of your breasts, you may undergo a breast lifting procedure to restore their more youthful contour.

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Breast Reduction

Patients who undergo breast reduction surgery are either seeking relief from physical symptoms caused by excessive weight of large breasts or desire to have smaller, more well proportioned and lifted breasts. Breast reduction surgery usually can solve these problems, making your breasts lighter, more comfortable, and more proportionate; allowing clothes to fit better.

EVALUATION

You may be a good candidate for breast reduction surgery if you have one or more of the following conditions:

  • breasts that are too large in proportion to your body.
  • heavy, pendulous breasts with nipples and areolas that point downward.
  • one breast is much larger than the other.
  • back, neck or shoulder pain caused by the weight of your breasts.
  • skin irritation beneath your breasts.
  • indentations in your shoulders from tight bra straps.
  • restriction of physical activity due to the size and weight of your breast.
  • self-consciousness about the large size of your breasts.

Breast reduction can be performed at any age, but plastic surgeons usually recommend waiting until breast development has stopped. Childbirth and breast-feeding may have significant and unpredictable effects on the size and shape of your breasts. Many women, however, decide to undergo breast reduction before having children and feel they can address any possible subsequent changes later.

During your consultation, you will be asked about your desired breast size as well as anything else about your breasts that you would like to see improved. This will help your plastic surgeon to understand your expectations and determine whether they realistically can be achieved.

You should come prepared to discuss your medical history. This will include information about any medical conditions, drug allergies, medical treatments you have received, previous surgeries, and medications that you currently take. You should tell your plastic surgeon if you plan to lose a significant amount of weight, particularly if you have noticed that your breasts become smaller with weight loss.

Your plastic surgeon will examine your breasts, taking measurements and taking photographs. The size and shape of your breasts, the quality of your skin, and the placement of the nipples and areolas will be carefully evaluated.

INSURANCE COVERAGE

Insurance coverage is sometimes available for breast reduction surgery. Many factors determine your eligibility, including the specific terms of your insurance policy and the amount of breast tissue to be removed. A letter of predetermination may be required by your insurance company prior to surgery.

SURGICAL TECHNIQUE

The most common method of reducing the breasts involves three incisions: one around the areola, one that runs vertically from the areola to the bottom of the breast at its crease, and one that runs along the crease.

After the surgeon removes excess breast tissue, fat, and skin, the nipple and areola are shifted to a higher position, and the areola is usually reduced in size. The nipple and areola usually remain attached to the underlying tissue, preserving the sensation. The ability to breast-feed may also be preserved, but this cannot be guaranteed. Liposuction may also be used to improve the contour of the breast near the armpit and side of the chest.

There are many variations to the design of the incisions for breast reduction. The size and shape of your breasts, as well as the desired amount of reduction, are factors that will help your plastic surgeon determine the best technique for you.

RISKS AND COMPLICATIONS

Fortunately, significant complications from breast reduction are infrequent. Every year, many thousands of women undergo successful breast reduction surgery, experience no major problems and are pleased with the results.

Some of the potential complications that may be discussed with you include bleeding, infection and reactions to anesthesia. Following reduction, sometimes the breasts may not be perfectly symmetrical or the nipple height may vary slightly. Minor adjustments can be made at a later time, if desired. Permanent loss of sensation in the nipples or breasts may occur rarely. Incisions that have healed poorly may be revised as well. In the unlikely event of injury to or loss of the nipple and areola, they usually can be satisfactorily reconstructed using skin grafts.

PREPARATION FOR SURGERY

Depending on your age, or if you have a history of breast cancer in your family, your plastic surgeon may recommend a baseline mammogram before surgery and another mammographic examination some months after surgery. This will help to detect any future changes in your breast tissue. Following breast reduction surgery, you will be able to perform breast self-examination. Breast reductions surgery will not increase your risk of developing breast cancer.

If you are a smoker, you will be asked to stop smoking well in advance of surgery. Aspirin and other anti-inflammatory drugs can cause increased bleeding, so you should avoid taking these medications for a period of time before surgery. Your surgeon will provide you with additional preoperative instructions.

Breast reduction surgery will be performed on an outpatient basis. You will need someone to drive you home and stay with you overnight and the next day to drive you to your surgeon's office. Alternatively, there are aftercare facilities available that specialize in the care of plastic surgery patients for one or more days after their surgery. These facilities are operated inside hotels located nearby the surgery center, and staffed by registered nurses.

SURGERY

The goal of your plastic surgeon and the entire staff is to make your surgical experience as easy and comfortable for you as possible.

Your surgery will be performed in a fully accredited outpatient surgery center in the same building as your surgeon's office. A general anesthetic is administered, so that you will be asleep throughout the procedure. Afterward, you will be taken into a recovery area where you will continue to be closely monitored for about one hour. You will be in a snug compressive elastic wrap. After you are awake and comfortable, you will be discharged by the nurse and allowed to go home or to an aftercare facility.

RECOVERY

On the day of your surgery you should feel fairly comfortable. You should expect only minor discomfort, usually described as pressure. You will be encouraged to get out of bed for short periods of time. The following day you will be seen by your surgeon and placed in a bra. There will be tape over your incisions that will remain until the following week. You will be instructed to avoid straining, bending, and lifting for a few weeks, and to sleep on your back to avoid pressure on your breasts.

There will be no stitches to be removed, but the tape over the incisions will be changed on a regular basis for about four weeks. You may notice that you feel less sensation in the nipple and areola areas. This is usually temporary, but it may take weeks, months, or even a year before normal sensation returns. Your breasts will possibly have some discoloration that may last for a few weeks. It might take some time for the breasts to take a more natural shape. The incisions will initially be pink or red in color, but there appearance will become less conspicuous with time.

After breast reduction surgery, it is possible to return to work within a few days to a week, depending on your job. You may resume normal activities including exercise in a few weeks. You may experience mild discomfort occasionally during this recovery period. Care must be taken to be gentle with your breasts for four to six weeks.

RESULTS

Breast reduction surgery will make your breasts firmer and smaller. The incisions from your surgery will heal and fade over time. It is important to realize, however, that the incision lines will be permanently visible, more so in some individuals than others. Fortunately, the incisions for breast reduction are in locations easily concealed by clothing, even lo-cut necklines.

Breast reduction often makes a dramatic change in your appearance. For this reason, it may take some time to adjust to your new body image. Most women, however, eventually become comfortable with their smaller breasts and feel very pleased with the results of surgery. In fact, the level of patient satisfaction resulting from breast reduction is among the highest of any plastic surgery procedure.

Unless you gain or lose a significant amount of weight or become pregnant, your breast size should remain fairly constant. However, gravity and the effects of aging will eventually alter the size and shape of virtually every woman's breasts. If, after a period of years, you become dissatisfied with the appearance of your breasts, you may choose to undergo a breast "lifting" procedure to restore their more youthful contour.

You will return to your plastic surgeon's office for follow-up care at prescribed intervals, at which time your progress will be evaluated. Once the immediate postoperative follow-up is complete, you will be encouraged to return periodically to observe and discuss long-term results of your surgery.

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Breast Lift

Loss of skin elasticity, gravity and other factors such as weight loss, pregnancy and breast-feeding ultimately affect the shape and firmness of your breasts. Patients who are generally satisfied with the size of their breasts can have a breast lift to raise and firm them, resulting in a more youthful breast contour. Some patients may be unhappy that they have lost a significant amount of breast volume over time. In such cases, implants inserted in conjunction with a breast lift can increase breast size at the same time as the shape and position of the breasts are enhanced.

EVALUATION

You may be a good candidate for breast lift surgery if you have one or more of the following conditions:

  • breasts that are pendulous, of satisfactory size
  • breasts that lack substance or firmness
  • nipples and areolas that point downward, especially if they are positioned below the breast crease

Sometimes these conditions may be inherited traits. In certain cases, the breast may have developed differently so that one breast is firm and well positioned while the other is not. There may be differences in the size of your breasts as well as their shape. Breasts that are large and heavy can be lifted, but the results may not be as long lasting as when the procedure is done on smaller breasts. In this situation, breast reduction is recommended.

Breast lift surgery can be performed at any age, but plastic surgeons usually recommend waiting until breast development has stopped. Childbirth and breast-feeding may have significant and unpredictable effects on the size and shape of your breasts. Many women, however, decide to undergo breast lift surgery before having children and feel they can address any possible subsequent changes later. Since the milk ducts and nipples ate left intact, breast lift surgery usually will not affect your ability to breast-feed; however, you should discuss this with your plastic surgeon.

During your consultation, you will be asked about your desired breast shape and size as well as anything else about your breasts that you would like to see improved. This will help your plastic surgeon to understand your expectations and determine whether they realistically can be achieved.

You should come prepared to discuss your medical history. This will include information about any medical conditions, drug allergies, medical treatments you have received, previous surgeries, and medications that you currently take. You should tell your plastic surgeon if you plan to lose a significant amount of weight, particularly if you have noticed that your breasts become smaller with weight loss.

Your plastic surgeon will examine your breasts, taking measurements and taking photographs. The size and shape of your breasts, the quality of your skin, and the placement of the nipples and areolas will be carefully evaluated.

SURGICAL TECHNIQUE

The most common method of lifting the breasts involves three incisions: one around the areola, one that runs vertically from the areola to the bottom of the breast at its crease, and one that runs along the crease.

After the surgeon removes excess skin, the nipple and areola are shifted to a higher position, and the areola is usually reduced in size. The nipple and areola remain attached to the underlying tissue, preserving the sensation. The ability to breast-feed may also be preserved, but this cannot be guaranteed.

There are many variations to the design of the incisions for breast lifting. In some instances, it may be possible to avoid the horizontal incision beneath the breast. Sometimes a technique may be used that avoids the horizontal incision as well as the vertical incision. The size and shape of your breasts, as well as the use of breast implants to enlarge and fill the breasts, are factors that will help your plastic surgeon determine the best technique for you.

RISKS AND COMPLICATIONS

Fortunately, significant complications from breast lifting surgery are infrequent. Every year, many thousands of women undergo successful breast lifting surgery, experience no major problems and are pleased with the results.

Some of the potential complications that may be discussed with you include bleeding, infection and reactions to anesthesia. Following this surgery, sometimes the breasts may not be perfectly symmetrical or the nipple height may vary slightly. Minor adjustments can be made at a later time, if desired. Permanent loss of sensation in the nipples or breasts may occur rarely. Incisions that have healed poorly may be revised as well. In the unlikely event of injury to or loss of the nipple and areola, they usually can be satisfactorily reconstructed using skin grafts.

PREPARATION FOR SURGERY

Depending on your age, or if you have a history of breast cancer in your family, your plastic surgeon may recommend a baseline mammogram before surgery and another mammographic examination some months after surgery. This will help to detect any future changes in your breast tissue. Following breast lifting surgery, you will be able to perform breast self-examination. Breast lifting surgery will not increase your risk of developing breast cancer.

If you are a smoker, you will be asked to stop smoking well in advance of surgery. Aspirin and other anti-inflammatory drugs can cause increased bleeding, so you should avoid taking these medications for a period of time before surgery. Your surgeon will provide you with additional preoperative instructions.

Breast lifting surgery will be performed on an outpatient basis. You will need someone to drive you home and stay with you overnight and the next day to drive you to your surgeon's office. Alternatively, there are aftercare facilities available that specialize in the care of plastic surgery patients for one or more days after their surgery. These facilities are operated inside hotels located nearby the surgery center, and staffed by registered nurses.

SURGERY

The goal of your plastic surgeon and the entire staff is to make your surgical experience as easy and comfortable for you as possible.

Your surgery will be performed in a fully accredited outpatient surgery center in the same building as your surgeon's office. A general anesthetic is administered, so that you will be asleep throughout the procedure. Afterward, you will be taken into a recovery area where you will continue to be closely monitored for about one hour. You will be in a snug compressive elastic wrap. After you are awake and comfortable, you will be discharged by the nurse and allowed to go home or to an aftercare facility.

RECOVERY

On the day of your surgery you should feel fairly comfortable. You should expect only minor discomfort, usually described as pressure. You will be encouraged to get out of bed for short periods of time. The following day you will be seen by your surgeon and placed in a bra. There will be tape over your incisions that will remain until the following week. You will be instructed to avoid straining, bending, and lifting for a few weeks, and to sleep on your back to avoid pressure on your breasts.

There will be no stitches to be removed, but the tape over the incisions will be changed on a regular basis for about four weeks. You may notice that you feel less sensation in the nipple and areola areas. This is usually temporary, but it may take weeks, months, or even a year before normal sensation returns. Your breasts will possibly have some discoloration that may last for a few weeks. It might take some time for the breasts to take a more natural shape. The incisions will initially be pink or red in color, but there appearance will become less conspicuous with time.

After breast lifting surgery, it is possible to return to work within a few days to a week, depending on your job. You may resume normal activities including exercise in a few weeks. You may experience mild discomfort occasionally during this recovery period. Care must be taken to be gentle with your breasts for four to six weeks.

RESULTS

Breast lifting surgery will make your breasts firmer and more uplifted. The incisions from your surgery will heal and fade over time. It is important to realize, however, that the incision lines will be permanently visible, more so in some individuals than others. Fortunately, the incisions for breast lifting are in locations easily concealed by clothing, even lo-cut necklines.

Unless you gain or lose a significant amount of weight or become pregnant, your breast size should remain fairly constant. However, gravity and the effects of aging will eventually alter the size and shape of virtually every woman's breasts. If, after a period of years, you become dissatisfied with the appearance of your breasts, you may choose to undergo a breast "lifting" procedure to restore their more youthful contour.

You will return to your plastic surgeon's office for follow-up care at prescribed intervals, at which time your progress will be evaluated. Once the immediate postoperative follow-up is complete, you will be encouraged to return periodically to observe and discuss long-term results of your surgery.

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Liposuction

Liposuction (lipoplasty) is particularly well suited for women and men who are of relatively normal weight but have isolated pockets of fat that cause certain areas of their body to appear disproportionate. These localized fat deposits may sometimes be an inherited trait and typically do not respond to dieting or exercise. Liposuction is often the only way to eliminate them.

While it is possible to undergo liposuction at almost any age, you will obtain the best results if your skin still has enough elasticity to achieve a smooth contour following fat removal. When skin is inelastic, as in some older patient, it may not redrape well and a skin tightening procedure may be necessary.

Liposuction may sometimes be used to treat a condition called gynecomastia, or male breast enlargement, which frequently occurs among both teenage and adult males.

Liposuction should not be considered a substitute for overall weight loss, nor is it an effective treatment for cellulite, a condition that gives the skin an uneven, dimpled appearance. Alternatively, treatments may be considered, in some instances, to improve this problem.

Liposuction can be performed on several areas of the body at the same time, and it can also be done in conjunction with other aesthetic plastic surgery.

EVALUATION

You may be a good candidate for liposuction if you have localized excess fat or if you desire contouring in any of the following areas:

  • cheeks, jowls, and neck
  • upper arms
  • breast or chest areas
  • back
  • abdomen and waist
  • hips and buttocks
  • inner and outer thighs
  • inner knees
  • calves and ankles

Because of individual physical factors, not everyone will achieve the same results from liposuction. Your plastic surgeon will take into consideration your unique characteristics in determining the most effective treatment. During the consultation, you will be asked to point out the exact areas which you would like to see improved. This will help your surgeon to understand your expectations and determine whether they can realistically be achieved.

Your plastic surgeon will examine you while you are standing. Your skin tone and the amount of excess fat, and the location of the fat will be assessed.

You should come prepared to discuss your medical history. This will include information about any medical conditions, drug allergies, medical treatments you have received, previous surgeries, and medications that you currently take. It is important for you to provide complete information.

How much you currently weigh and whether you plan to lose or gain weight in the future will be factors in evaluating you for liposuction. Your plastic surgeon may ask you about the effects of prior weight loss on the appearance of those areas which you have indicated for contouring. He or she will assess the elasticity of your skin and estimate the amount of fat to be removed for optimal results.

SURGICAL TECHNIQUE

Fat is removed by first inserting a small, hollow tube, called a cannula, through one or more tiny incisions near the area to be suctioned. Incisions are usually less than one-quarter inch in length and are placed as inconspicuously as possible, often within skin folds or contour lines. The cannula is connected by tubing to a vacuum pressure unit. Guided by the surgeon, the suction device literally vacuums away the unwanted fat.

Prior to performing liposuction, fluid is instilled into the areas to be suctioned. Plastic surgeons may use a 'dry' technique, a 'tumescent' technique that introduces large amounts of fluid, or other variations, most of which introduce smaller amounts of fluid than the 'tumescent' technique. Your surgeon will discuss with you the particular method that he or she recommends for treating specific areas of your body.

Other options may involve the type of instrumentation used or whether suctioning is performed on the deep or more superficial layers of fat. Ultrasonic and Vaser technology involves high frequency sound waves to deliver energy to emulsify fat prior to suctioning. Power assisted liposuction utilizes mechanical vibration to allow the cannula to travel more easily through the fatty tissue. Currently, there has been development and media coverage of the use of a laser device inserted through a small skin incision; but unlike the other variations, there is no actual suction involved. This technology has not been able to demonstrate any significant effects at this time.

RISKS AND COMPLICATIONS

Fortunately, significant complications from liposuction surgery are infrequent. Every year, many thousands of women undergo successful liposuction surgery, experience no major problems and are pleased with the results.

Some of the potential complications that may be discussed with you include bleeding, infection and reactions to anesthesia. Blood accumulations under the skin are possible, but these normally resolve themselves and rarely require removal. While numbness of the skin following liposuction is almost always temporary, it is possible for some lack of sensation to persist or for skin discoloration to appear in treated areas. Contour irregularities including depressions or wrinkling of the skin can result in some patients, but treatments are usually available to help minimize these problems if they occur.

PREPARATION FOR SURGERY

If you are a smoker, you will be asked to stop smoking well in advance of surgery. Aspirin and certain anti-inflammatory drugs can cause increased bleeding, so you should avoid taking these medications for a period of time before surgery. Your surgeon will provide you with additional preoperative instructions.

Liposuction surgery will be performed on an outpatient basis. You will need someone to drive you home and stay with you overnight and the next day to drive you to your surgeon's office. Alternatively, there are aftercare facilities available that specialize in the care of plastic surgery patients for one or more days after their surgery. These facilities are operated inside hotels located nearby the surgery center, and staffed by registered nurses.

SURGERY

The goal of your plastic surgeon and the entire staff is to make your surgical experience as easy and comfortable for you as possible.

Your surgery will be performed in a fully accredited outpatient surgery center in the same building as your surgeon's office. A general anesthetic is administered, so that you will be asleep throughout the procedure. Afterward, you will be taken into a recovery area where you will continue to be closely monitored. There may be some discomfort, but this can be controlled by medication which you may continue taking at home. Compressive dressings such as an elastic garment or abdominal binder have been placed over the areas that were suctioned. Your surgeon will tell you how long you should wear the garment and will instruct you on how to remove it so that you may shower or bathe.

You probably will be permitted to go home after a few hours, although some patients may stay overnight in a surgical aftercare facility.

RECOVERY

The day after surgery, you will need to move around occasionally to promote blood circulation. Your plastic surgeon will advise you to limit yourself to these brief periods of gentle activities for the first few days. Remember, you must not take aspirin or certain anti-inflammatory medications, and you should not smoke for two weeks following surgery.

Your dressings will be temporarily removed within several days so that your plastic surgeon can examine the treated areas. You will notice swelling and bruising, which is to be expected. Swelling usually begins to subside a week or so following surgery, while bruising can last three weeks or longer. There may also be numbness in some areas, and it may take several weeks before feeling returns. There are usually no stitches to be removed from the incisions because they are buried beneath the skin.

You may be able to return to work in a few days. In many instances, you can resume most of your normal activities within one or two weeks and begin some form of exercise soon after. The timing of your recovery depends largely on the extent of your surgery.

RESULTS

Liposuction surgery will reduce those areas of fatty deposits that previously created unflattering bulges and perhaps made it difficult to feel comfortable in you clothing or caused self-consciousness. Factors such as fluid retention following surgery and prolonged swelling may delay the appearance of your new, slimmer contour. The healing process is gradual, so you should expect to wait a while before fully enjoying the results of your liposuction.

The results of liposuction will be permanent, as long as you maintain your postoperative weight. Even if you gain a few extra pounds, you may find that the weight is distributed more evenly instead of accumulating in the areas that were problematic for you in the past.

Occasionally, a touchup may be desired to further improve an area that has been suctioned. The additional treatment can sometimes be performed under local anesthesia in your plastic surgeon's office. More extensive revisions may require a return to the operating room.

You will return to your plastic surgeon's office for follow-up care at prescribed intervals, at which time your progress will be evaluated.

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Tummy Tuck

Women and men who have loose abdominal skin and fat that is concentrated in the abdomen can benefit from abdominoplasty. Sometimes these conditions are inherited. In other instances, substantial weight loss may cause abdominal skin to become flaccid. Abdominoplasty also can tighten muscles that have been separated and weakened by pregnancy. The procedure may partially improve stretchmarks, especially those located below the navel.

EVALUATION

You may be a good candidate for abdominoplasty if you have one or more of the following conditions:

  • excess or sagging abdominal skin
  • an abdomen that protrudes and is out of proportion to the rest of your body
  • abdominal muscles that have been separated and weakened
  • excess fatty tissue that is concentrated in your abdomen.

Certain individuals who carry excessive fatty deposits inside their abdomen may have a protuberant and firm abdomen. These persons may not be a good candidate for abdominoplasty.

Your plastic surgeon will examine you while you are standing. Your skin tone and the degree of loose skin in the abdominal region will be assessed. The amount of excess fat, the location of the fat (just below the skin or deep beneath the muscles), and the condition of your abdominal muscles will be assessed.

You should come prepared to discuss your medical history. This will include information about any medical conditions, drug allergies, medical treatments you have received, previous surgeries, and medications that you currently take. It is important for you to provide complete information.

SURGICAL TECHNIQUE

Individual factors and personal preferences will determine the specific technique selected to smooth and flatten your abdomen. Generally, a horizontal incision is placed just within or above the pubic area. The length of the incision will vary somewhat according to the structure of your abdomen and the style of bathing suit or undergarments that you prefer. Your plastic surgeon will try to keep the incision within your bathing suit lines, but this may not always be possible.

Some patients have loose skin above the navel. In such cases, the surgeon may make a second incision around the navel so that the redundant skin above it can be pulled down. The excess abdominal skin is then removed. The position of the navel remains unchanged,

Skin of the lower abdomen that contains stretch marks may be removed as well. Any remaining stretch marks may be repositioned into the lower abdomen, possibly improving their appearance.

The underlying muscle is frequently tightened, especially in women who have had children. Usually strong permanent sutures are used to bring the muscle back into the midline. This tightening of the muscles can help to improve the overall flatness of the abdomen.

There are many variations both to the design of the incisions and the technique itself. In some instances, it may be possible to avoid an incision around the navel when there is minimal laxity of skin above the navel. In this situation, liposuction is frequently employed to reduce the fatty deposits above and around the navel. This is known as a mini or modified abdominoplasty.

RISKS AND COMPLICATIONS

Fortunately, significant complications from breast lifting surgery are infrequent. Every year, many thousands of women undergo successful breast lifting surgery, experience no major problems and are pleased with the results.

Some of the potential complications that may be discussed with you include bleeding, infection and reactions to anesthesia. Tissue loss along portions of the horizontal incision is a possibility when the abdominoplasty is very extensive. This complication, which delays healing and prolongs recovery, is more common in patients who smoke or have medical conditions such as diabetes. Revisionary surgery is sometimes helpful in certain instances where incisions may have healed poorly.

Following surgery, occasionally, fluid may accumulate under the skin. Removal of this serum is a painless process but may require several visits to the plastic surgeon's office.

You can help lessen certain risks by following the advice and instructions of your plastic surgeon, both before and after surgery.

PREPARATION FOR SURGERY

If you are a smoker, you will be asked to stop smoking well in advance of surgery. Aspirin and certain anti-inflammatory drugs can cause increased bleeding, so you should avoid taking these medications for a period of time before surgery. Your surgeon will provide you with additional preoperative instructions.

Abdominoplasty surgery will be performed on an outpatient basis. You will need someone to drive you home and stay with you overnight and the next day to drive you to your surgeon's office. Alternatively, there are aftercare facilities available that specialize in the care of plastic surgery patients for one or more days after their surgery. These facilities are operated inside hotels located nearby the surgery center, and staffed by registered nurses.

SURGERY

The goal of your plastic surgeon and the entire staff is to make your surgical experience as easy and comfortable for you as possible.

Your surgery will be performed in a fully accredited outpatient surgery center in the same building as your surgeon's office. A general anesthetic is administered, so that you will be asleep throughout the procedure. Afterward, you will be taken into a recovery area where you will continue to be closely monitored for about one to two hours.

Small drain tubes will have been placed below the abdominal skin to help avoid accumulation of fluids. Gauze dressings will be applied to your abdomen and covered with tape and an elastic binder. You will have a second set of smaller tubes that have also been placed under the skin. Attached to these tubes is a pump that will continuously administer an anesthetic medication for three days, significantly decreasing discomfort. Once cleared by the recovery room nurse, you will be allowed to go home or to an aftercare facility overnight.

RECOVERY

The day after surgery, you will be encouraged to get out of bed for short walks to promote blood circulation. Although you may not be able to stand up completely straight, it is best if you do not sit for long periods of time during the first several days. Straining, bending, and lifting must be avoided, since these activities might cause increased swelling or even bleeding. You may be instructed to sleep on your back with a pillow under your knees.

On your first day after surgery, you will return to your plastic surgeon's office to remove your dressings and general evaluation. Thin tape will cover your incisions only. On your third day after surgery, you will return to your plastic surgeon's office for removal of the anesthetic pump catheter, which is a painless procedure. The remaining drain tubes usually are removed 7 to 9 days after surgery. You will keep your compression binder on for one to two weeks after that. Paper tape will cover your incisions for 3 to 4 weeks. All sutures are buried, and need not be removed.

You will notice swelling, which is to be expected. Much of the swelling will disappear over a period of weeks, however, it may be months before all swelling subsides and you see the final result of your abdominoplasty. You may also notice some numbness over portions of the abdominal area, and this may persist for several months. Incisions will initially be red of pink in color. They will remain this way for many months following surgery and may even appear to worsen before they finally begin to fade.

The amount of time it takes for recovery varies greatly among individuals. Depending on the extent of your abdominoplasty and your general physical condition, you may be able to return to non-strenuous work anywhere from one to three weeks after surgery. In many instances, you can resume most of your normal activities, including some form of mild exercise, after a few weeks. You may continue to experience some mild, periodic discomfort and swelling during this time, but such feelings are normal. Severe pain should be reported to your doctor.

RESULTS

Abdominoplasty will enhance your body contour by making your abdomen firmer and flatter. You may find that you feel more comfortable in your clothing and are more confident about your appearance.

The incisions from the procedure will heal and fade over time. It is important to realize, however, that the incision lines will be permanently visible. In some instances, they will eventually be only faint lines. Certain individuals may have incision lines that are more noticeable. Fortunately, the incisionsyou're your abdominoplasty are usually in locations concealed by most bathing suits and undergarments.

Unless you gain or lose a significant amount of weight or become pregnant, your abdomen should remain firmer and flatter for many years. However, gravity and the effects of aging will eventually take their toll. If, after a period of years, you become dissatisfied with the appearance of your abdomen, you may choose to undergo a second procedure to restore a more youthful body contour.

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Rhinoplasty

Plastic surgeons usually recommend that patients wait until they are at least 14 or 15, and possibly older for boys, before undergoing rhinoplasty. This is because the nose may not be fully developed at a younger age. If you are a teen, your plastic surgeon will want to be certain that you have thought carefully about surgery and that the desire to change your appearance is based on you own feelings rather than those of your parents or friends.

Assuming you are in good health, there is no upper age limit for giving your nose reshaped. Rhinoplasty is sometimes performed in conjunction with a facelift or other rejuvenating surgery to correct aging changes of the nose such as a drooping tip.

Sometimes certain breathing problems related to the internal nasal structures can be corrected at the same time as nose reshaping is performed. Your plastic surgeon will be able to help you determine whether these structures should be modified along with reshaping your nose.

EVALUATION

During the initial consultation, you may be asked to look in a mirror and point out exactly what you would like to see improved. This will help your plastic surgeon to understand your expectations and determine whether they can realistically be achieved.

Some of the indications that you may be a good candidate for rhinoplasty are:

  • your nose appears too large for you face
  • there is a bump on the nasal bridge when viewed in profile
  • your nose seems too wide when viewed from the front
  • the nasal tip froops or plunges
  • the tip is thickened or enlarged
  • your nostrils are excessively flared
  • your nose is off-center or crooked
  • previous injury has made your nose asymmetrical

It is important that you have a clear idea of how you would like your nose to look and, at the same time, realize that there are limitations to the procedure. Patients with sufficient physical and emotional maturity who undergo rhinoplasty because they want to enhance their self-image are usually very satisfied with their decision.

You should come to the consultation prepared to discuss your medical history. This will include information about any medical conditions you may have, medical treatments you have received, previous surgeries including repair of nasal injuries, and medications that you currently take. Your plastic surgeon may also ask whether you have difficulty breathing through your nose, suffer from allergies that may cause nasal stuffiness, or are a chronic user of nasal spray, It is important for you to provide complete information.

In evaluating you for rhinoplasty, your plastic surgeon will conduct a routine and painless examination of your internal nasal structures. Your skin quality as well as the size and shape of your nose and its relationship to your other facial features will be carefully studied, In some instances, your plastic surgeon may recommend surgery of your chin, making it either more or less prominent, improve facial balance. This procedure can be done at the same as your rhinoplasty.

SURGICAL TECHNIQUE

Because of individual factors, not everyone will achieve the same results from rhinoplasty. Your surgeon's goal is to obtain the best possible results for you.

Alterations may be made to increase or decrease the nasal bridge, reduce the size or width of the nose, narrow the nostrils, change the angle between the nose and upper lip, or reshape the tip.

The surgical techniques employed will depend primarily on the goals established by you and your plastic surgeon. In some instances, all of the incisions will be placed inside your nose, where they will not be visible.

External incisions are employed when the base of the nose is narrowed or the nostrils are reduced. Small wedges of skin at the base of the nostrils are removed, hiding the incisions in the crease where the nostril joins the cheek.

More complex procedures require greater exposure of the tip and bridge, which is accomplished by connecting the internal incisions across the vertical strip of skin that separates the nostril, called the collumela. This technique is called an 'open rhinoplasty.' Whatever incisions are used to reshape your nose, they will ultimately be very inconspicuous.

Through the small incisions described, work is done on the cartilage and bone that form the framework of you nose. Sometimes, the position of certain bones may need to be altered slightly in order to make your nose look narrower and straighter. If your nose needs to be built up in some areas, this can be done using nasal cartilage, or perhaps bone or cartilage from another site. The skin and soft tissues then redrape themselves over this new 'scaffolding."

RISKS AND COMPLICATIONS

Fortunately, significant complications from rhinoplasty surgery are infrequent. Every year, many thousands of women undergo successful liposuction surgery, experience no major problems and are pleased with the results.

Complications include surface irregularities or asymmetries, deviation of the bridge or tip to one side, difficulty breathing through one or both nostrils, or general dissatisfaction with the appearance of the nose. Many apparent problems with appearance improve with time and healing, resulting in a satisfactory result. If you and your surgeon decide that improvement can be made to your nose with a second surgery, it is usually not planned for at least six months to one year after the first surgery, allowing adequate time for the nose to heal completely.

PREPARATION FOR SURGERY

If you are a smoker, you will be asked to stop smoking well in advance of surgery. Aspirin and certain anti-inflammatory drugs can cause increased bleeding, so you should avoid taking these medications for a period of time before surgery. Your surgeon will provide you with additional preoperative instructions.

Rhinoplasty will be performed on an outpatient basis. You will need someone to drive you home and stay with you overnight and the next day to drive you to your surgeon's office. Alternatively, there are aftercare facilities available that specialize in the care of plastic surgery patients for one or more days after their surgery. These facilities are operated inside hotels located nearby the surgery center, and staffed by registered nurses.

SURGERY

The goal of your plastic surgeon and the entire staff is to make your surgical experience as easy and comfortable for you as possible.

Your surgery will be performed in a fully accredited outpatient surgery center in the same building as your surgeon's office. A general anesthetic is administered, so that you will be asleep throughout the procedure. Afterward, you will be taken into a recovery area where you will continue to be closely monitored. There may be some discomfort, but this can be controlled by medication which you may continue taking at home. A splint will be placed over the bridge of your nose, and tampon-like packing will be placed inside each nostril. These dressings will help protect your nose from being accidentally bumped.

You probably will be permitted to go home after a few hours, although some patients may stay overnight in a surgical aftercare facility.

RECOVERY

It is important to realize that the amount of time it takes for recovery varies greatly among individuals.

The first couple of days after surgery, you should restrict your activities and sleep with your head elevated. This will help to minimize swelling and reduce the possibility of minor bleeding, which is not uncommon. Remember, you must not take aspirin or certain anti-inflammatory medications.

Generally, bruising around the eyes and cheeks is most apparent during the first three days following surgery. Most discoloration will disappear within a week. A few days after surgery, you can begin to use makeup as a concealer, if desired. Noticeable swelling may last for several weeks. Minor residual swelling, most frequently affecting the nasal tip, may continue for many months, but generally this should not be apparent to others.

Packing is removed the following day after surgery and your surgeon will evaluate you and clean around the sutures and inside of the nostrils. You will again return to five to seven days after surgery for removal of your splint and possibly sutures, if there are any. At this time, your swelling will have improved, however there will probably be a fair amount of swelling in the tip of your nose and between your eyes. It is not uncommon for the cheeks of your face to be slightly swollen too.

Straining, bending or lifting should be avoided during the early postoperative period. In many instances, you may be able to return to work within a week or ten days after surgery. Most normal activities including exercise can usually be resumed within three to four weeks.

It will be a few months before you can expose your reshaped nose to direct sunlight. Your nose will be sensitive during this time, and you must be conscientious about using a sunblock to protect your skin. If the bones of your nose were altered, it may be a number of weeks before you can wear glasses without special support such as tape.

RESULTS

The goal of rhinoplasty is a nose that looks natural and blends harmoniously with your other facial features.

Since the healing process is gradual, you should expect to wait up to one year to see the final results of your rhinoplasty. You are likely, however, to begin enjoying your new look within weeks of your surgery.

Occasionally, a touch up may be desired to further improve the results. If this is the case, the additional procedure is usually less extensive than the original operation.

In most instances, the results of rhinoplasty are permanent, except for possible changes associated with the normal aging process.

You will return to your plastic surgeon's office for follow-up care at prescribed intervals, at which time your progress will be evaluated.

Please remember that the relationship with your plastic surgeon does not end when you leave the operating room. If you have questions or concerns during your recovery, or need additional information at a later time, you should contact your surgeon.

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Facelift

A facelift restores smoother, more pleasing contours to your face and neck. It can help you look as good as you feel, and perhaps feel younger than you are.

EVALUATION

Any one or combination of the following conditions may indicate that you are a good candidate for a facelift:

  • a deep line, or fold, running from the corner of your nose to the corner of your mouth.
  • jowls, or loss of a well-defined jaw line associated with youthfulness.
  • deep wrinkles in the cheeks and sagging of the 'highlight' areas of the cheekbones.
  • loose skin, wrinkles, vertical 'cords' or excess fatty tissue in the neck.

A facelift can improve all of these problems, It cannot, however, correct conditions such as sagging eyebrows, excess skin and fatty deposits in the upper and lower eyelids, or wrinkles around the mouth. Your plastic surgeon can provide further information if you have an interest in other procedures to treat these areas.

During the initial consultation, your plastic surgeon may ask you to look in a mirror and point out exactly what you would like to see improved. You should be very frank in discussing anything about your appearance that bothers you, as well as what you hope to achieve with surgery. This will help your surgeon to understand your expectations and determine whether they can realistically be achieved.

In evaluating you for facelift surgery, your plastic surgeon will assess the thickness, texture and elasticity of your skin, and the severity of wrinkles and folds. Your hairline will be examined to determine where incisions can be discreetly placed. All of these factors, as well as your bone structure and underlying tissues, will be considered in developing as individual surgical plan.

Your plastic surgeon may discuss with you additional procedures that can be performed along with a facelift in order to address all the concerns you have identified. For example, a facelift is frequently combined with a forehead lift, eyelid surgery, nose reshaping or skin treatments such as a chemical peel, dermabrasion or laser resurfacing.

SURGICAL TECHNIQUE

Because of individual factors, not everyone will achieve the same results from a facelift. Your plastic surgeon will select the surgical technique that he or she feels will obtain the best outcome for you.

Although there are many variations to the facelift procedure, generally an incision is hidden in the natural contour of your ear, and then extends around the earlobe and back into the hairline. Following surgery, incisions can be easily concealed by your hair or with makeup. There may also be a small incision hidden underneath you chin.

Through the discreet facelift incisions, your plastic surgeon is able to free the skin from the underlying tissues to the extent necessary for the particular surgical technique selected. After the skin has been pulled up and back, the excess is removed. In some instances, the deeper tissues may also need to be repositioned in order to restore a more youthful contour to your face. If necessary, a small incision beneath the chin permits the removal of fatty tissue in that area and smoothing of the cord-like structures of the underlying muscle in the neck.

RISKS AND COMPLICATIONS

Fortunately, significant complications from facelift surgery are infrequent. Every year, many thousands of women undergo successful facelift surgery, experience no major problems and are pleased with the results.

Some of the potential complications that may be discussed with you include hematoma (an accumulation of blood under the skin that may require removal), infection and reactions to anesthesia. While plastic surgeons are trained in techniques for safely manipulating facial skin and tissue, injury to underlying structures is possible, though it is usually only temporary. Facelift incisions are most often inconspicuous, but this is not entirely predictable due to individual variations in healing.

You can help minimize certain risks by following the advice and instructions of your plastic surgeon, both before and after surgery.

PREPARATION FOR SURGERY

If you are a smoker, you will be asked to stop smoking well in advance of surgery. Aspirin and certain anti-inflammatory drugs can cause increased bleeding, so you should avoid taking these medications for a period of time before surgery. Your surgeon will provide you with additional preoperative instructions. If your hair is very short, you may want to let it grow enough to cover your incisions while they heal. If you are overweight and you have a realistic desire to lose more than 15 pounds, you should discuss this with your surgeon.

SURGERY

The goal of your plastic surgeon and the entire staff is to make your surgical experience as easy and comfortable for you as possible.

Your surgery will be performed in a fully accredited outpatient surgery center in the same building as your surgeon's office. A general anesthetic is administered, so that you will be asleep throughout the procedure. For your safety during the operation, various monitors are used to check your heart, blood pressure, pulse and the amount of oxygen circulation in your blood. Afterward, you will be taken into a recovery area where you will continue to be closely monitored. A bandage will be wrapped around your face to be closely monitored. Small tubes will have been inserted beneath the skin to drain away fluids that might otherwise accumulate, but you will not feel these at all. In fact, there is surprisingly little discomfort from the surgery.

You probably will be permitted to go home after a few hours, although some patients may stay overnight in a surgical aftercare facility.

RECOVERY

It is important to realize that the amount of time it takes for recovery varies greatly among individuals.

After surgery, you will be asked to restrict your activities and simply relax for a few days. Elevating your head when you sleep will help to minimize swelling and bruising. Remember, you must not take aspirin or certain anti-inflammatory medications, and you should not smoke or be exposed to heavy secondary smoke for a while.

Bandages and tubes will be removed in one to three days. At that time, you will notice puffiness and discoloration that may be more pronounced in some portions of your face than others. Do hot be alarmed by any unevenness or temporary asymmetry caused by this variance in swelling and bruising, which is perfectly normal. Generally, the greatest amount of swelling occurs 24 to 72 hours after surgery, but it may take several weeks before all puffiness is resolved. Most bruising will disappear within two weeks. After a few days, you will be permitted to wear makeup which will help conceal any discoloration. You will also experience some numbness in the facial area, which may be present for several weeks or longer. Your stitches will be removed from four to seven days after surgery.

Straining, bending and lifting should be avoided during the early postoperative period. In many instances, you will be able to resume most of your normal activities within two weeks and begin to exercise three to four weeks after surgery. You will be instructed to temporarily avoid exposure to direct sunlight and, for the long-term, to be conscientious about the use of a sunblock to protect your skin.

RESULTS

The results of your facelift may be dramatic or subtle, depending on how you look before surgery as well as the specific goals that you and your plastic surgeon have established. Since the healing process is gradual, you should expect to wait at least several weeks for an accurate picture of your 'new look.' Additional minor changes, or settling, may occur over several months.

You will return to your plastic surgeon's office for follow-up care at prescribed intervals, at which time your progress will be evaluated.

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J. Gerald Minniti, M.D., F.A.C.S.
Plastic and Reconstructive Surgery
Office Address:
120 S Spalding Drive
Suite 236
Beverly Hills, CA 90212
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