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General Information
Two weeks before surgery
Avoid Vitamin E (the small amount contained in most multi-vitamin preparations is not harmful), Ibuprofen (Advil) and all aspirin-containing products (these tend to prolong bleeding and increase bruising) for two or more weeks prior to surgery. Tylenol may be taken safely.
Other prescribed drugs may be taken, but please make sure that your surgeon and the anesthesiologist are aware of any medications you take.
Prior to operations such as suction lipectomy (fat suctioning), breast reductions, thigh or buttock lifts, or abdominoplasty (tummy tuck), you will be requested to take iron tablets (ferrous sulfate or ferrous gluconate) twice daily for two weeks before surgery and two weeks after surgery. These are non-prescription medications that may be obtained at any pharmacy.
Make arrangements to have someone bring you to the office on the day of your surgery, to take you home afterward and to spend the first 48 to 72 hours after the operation with you.
To insure that your body's healing mechanisms are working at their best, it is suggested that smoking be stopped at least four weeks before any surgical procedure, and that you refrain from smoking for at least three weeks after surgery as well.
One week before surgery
1. In compliance with suggestions adopted by the American Society of Plastic Surgeons, it is customary for the patient to pay all fees for cosmetic surgery prior to the desired operation. This assures that the patient is sincere in his/her motivation and can afford the surgery, thus creating a better patient /physician relationship.
All fees must be paid prior to surgery, no later than the day of the preoperative visit. Otherwise, it may regrettably be necessary to release your scheduled operative time to another patient who is ready for surgery and to reschedule your procedure.
Additional fees will also be required for laboratory, surgical facility or hospital costs as well as for anesthesiologist's fees or for possible subsequent surgical procedures. It is important that you understand that the patient will be responsible for all costs associated with secondary surgical procedures.
Please note that if a functional component exists (a deformity resulting from an accident or resection of a cancer, etc.), a portion of the fee may be covered by your insurance carrier. Rarely does an insurance carrier cover the entire fee for an operation.
While our staff will assist you by filling out insurance forms, payment of all fees is the patient's responsibility; recovery of any insurance benefits is between you and your insurance company.
2. Be certain to ask your surgeon or the office staff any questions you might still have during your final preoperative visit. Necessary pre-operative laboratory tests may be performed at this visit or, if you prefer, at a local hospital or outside laboratory.
Day before surgery
No restrictions of activity.
Shower and shampoo before going to bed.
Normal diet.
Nothing to eat or drink after midnight or other time as directed by the anesthesiologist; this includes water and other fluids, but you should take all medications prescribed by your physician and approved by your surgeon.
Day of surgery
Shower before leaving home in the morning. Do not apply any makeup (including
moisturizers) prior to facial operations, including eye and nose procedures.
Wear clothing that is easy to put on and take off, such as a sweat suit (preferably with a
zipper up the front of the top) or a robe. Do not wear any pullover type garments. Bring
slippers or flat shoes, and do not wear pantyhose or nylons.
Take all medications prescribed by your surgeon or your personal physician, even if
undergoing a general anesthetic; use a very small amount of water to ingest the pill(s) if necessary. Ordinarily, your anesthesiologist will call you the night before surgery to discuss your anesthesia care.
No food or liquids may be taken after midnight prior to surgery, unless you have
specifically been instructed otherwise by the anesthesiologist.
Bring a credit card or check for the anesthesiologist and surgery center, but do not bring any other money, jewelry, watches or other valuables to the surgical facility. Do bring any post surgical garments, which you have been instructed to purchase.
Arrangements should have been made for someone to bring you to the office for the
surgery. A number must be left where the individual can be called to pick you up after the operation. If such arrangements have not been made, it will be necessary to cancel your procedure.
Depending on the procedure to be performed, your surgeon may recommend using either a local hospital or outpatient surgical facility.
Someone must be with you at home during the first 48 to 72 hours after surgery. If you
cannot arrange for a relative or friend to be with you for this period, please discuss this with the office staff at least one month before surgery and they will attempt to help you arrange for a home health aide. A costlier alternative would be to spend the first night at the Surgery Center.
Additional instructions for specific operations such as for breast augmentations, facelifts, etc., should be followed.
After Surgery
Follow procedure specific instructions as given.
Take pain medication and antibiotics on a full stomach, such as milk and crackers to prevent stomach upset. Avoid alcoholic beverages while taking pain medication or other sedatives.
To avoid unnecessary swelling or bleeding, do not bend over, strain, exercise or do any other activities such as strenuous lifting that could increase pressure in the surgical areas for the first week or longer if bruises and swelling are present. A good rule of thumb is to avoid all activity that causes pain and enjoy those that do not.
Take all other medications prescribed by your personal physician.
Smoking significantly decreases blood flow to the operated area. Stopping smoking a month before surgery and for the first month after your operations will improve your healing ability and minimize the possibility of developing a complication. If you can do that for two months, why not consider stopping completely to better your overall health?
You may resume driving 48 hours after your last pain pill but only if you feel comfortable and physically able to do so.
It is possible that a patient's condition may warrant a transfer from the surgery center to a hospital in order to provide specialized care. In this unlikely event, patients must understand that they will be responsible for any additional costs associated with such a transfer.
Further instructions will be given at the time of the first post-operative office visit.
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Facial Rejuvenation
Facial rejuvenation is at the top of the list of the most common aesthetic surgical procedures performed by your surgeon at Orange County Plastic Surgery. Most people feel physically and mentally vigorous and energetic long after their appearance has begun to deteriorate due to aging. A face or neck lift procedure is designed to provide you with a rejuvenated appearance. The degree of improvement achieved depends on the severity of the initial deformity, the age of the patient, tissue elasticity and the recommended procedure.
A face or neck lift may be beneficial whenever you have excessive sagging of the facial or neck skin or underlying structures. In a younger patient with minimal sagging, the degree of improvement will be subtle, but frequently the result is extremely satisfying to the patient caring about personal appearance. In such a younger patient, one of the newer midface lifts with minimal external incisions may be recommended.
This is considered to be an operative procedure. Contrary to popular belief and despite newspaper and magazine stories, this is not as simple as having your hair set or having a facial. Also, contrary to many of the non-medical reports, it is not possible to remove all folds and eliminate any of the wrinkles of the face, regardless of the treatment applied. As a matter of fact, facelift surgery is designed to tighten lax or sagging tissues - not to remove wrinkles or folds. Patients who wish to have fine lines or wrinkles removed will have to consider a skin resurfacing procedure (e.g. laser or chemical peel) in addition to a facelift.
You must realize that your surgeon will tighten the sagging tissues as much as can be done safely to provide a natural result for your particular facial contour. The facelift procedure is directed toward improvement and does not remove each and every wrinkle or fold of the face. The type of skin, the age, and the aging rate of each patient, are factors that help determine your final result.
A common question regarding a facelift is "How long win it last?" This is impossible to state for a given individual, as there are many factors involved: continued sun exposure, the age of the patient, the patient's type of skin, healing ability, changes in weight, smoking history and general health of the patient. Your surgeon expects you to look better than had you not had a facelift for the rest of your life, but some laxity will return with time. As a matter of fact, the facial tissues continue to sag and loosen, at your natural rate, right after surgery. A small minority of patients, especially those who have a very marked degree of skin laxity in the neck area, will occasionally require a second facelift within a year of the initial procedure if optimal correction is to be achieved, but most patients receive sufficient improvement and only request one facelift during their lifetime. Skin aging continues after any operation – the best measure you can take to slow this process is to use sun block faithfully, and to take care of your skin with proper rejuvenating creams. Our office aesthetician will be glad to help you with a skin care program. This surgical procedure merely turns back the aging process; it cannot stop the “hands of time.” Your surgeon may be able to give you a good idea of what can be expected following surgery by working with our office digital imaging system and by manipulating your skin in front of a mirror.
Regardless of how tightly the facial tissues are pulled, aging and stretching of the facial skin begins to occur immediately after the operation. It is usual to see some recurrence of jowls or looseness of the neck within three months of the operation. You can, however, look forward to a significant degree of improvement permanently. Most patients have sufficient improvement following a face or neck lift, which keeps them looking younger than their friends forever. However, you may choose to have another facelift in future years to maintain a more youthful appearance. Your surgeon always tightens your muscles and skin as much as it is safe to do and cannot control how quickly any individual will sag. Regardless of how quickly you sag, each patient will be responsible for the cost of a subsequent procedure should the patient wish to repeat the operation.
To maximize the degree of rejuvenation, many patients will choose to undergo a brow lift, midface lift, microfat grafting, an eyelid procedure or laser skin resurfacing at the same operative setting.
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Endoscopic Brow Lift
Many people feel physically and mentally vigorous and energetic long after their appearance has begun to deteriorate due to aging. A forehead or brow lift procedure has been designed to provide you with a rejuvenated brows and forehead region. The degree of improvement achieved depends on the severity of the initial deformity and the elasticity of the patient's tissues.
As aging progresses, skin wrinkling and loss of tone can occur in the forehead area causing sagging of the brows and resulting in a tired or sad look. This can aggravate the appearance of excess skin in the upper eyelids. Deep frown lines and wrinkles can also form, further compromising the appearance of the forehead region. The forehead or brow lift procedure is designed to improve these deformities which are caused by age and heredity.
A brow lift may be beneficial whenever you have excessive sagging of the brows, with or without forehead wrinkling. In a younger patient without wrinkling, the degree of improvement will be subtle, but frequently the result is extremely satisfying to the patient.
This is considered to be an operative procedure. Contrary to popular belief and despite newspaper and magazine stories, this is not as simple as having your hair set or having a facial. Also, contrary to many of the non-medical reports, it is not possible to remove all the wrinkles from the forehead, regardless of the treatment applied. You must realize that your surgeon will elevate the brows and sculpt the muscles in a manner to provide a natural result for your particular facial contour. The forehead lift procedure is directed toward improvement and does not remove each and every wrinkle or fold of the forehead. The type of skin, the age and the aging rate of each patient are factors that help determine your final result.
A common question regarding a forehead lift is "How long will it last?" This is impossible to state for a given individual, as there are many factors involved: The age of the patient, the patient's type of skin, healing ability, changes in weight, smoking history and general health of the patient. Skin aging continues after any operation. This surgical procedure merely turns back the aging process; it cannot stop the "hands of time".
Regardless of how tightly the forehead skin is pulled, aging continues and drooping of the brows begins to occur immediately after the operation. Sometimes one brow will droop more than the other, and if this occurs to a degree that is bothersome to the patient, the only solution may be to elevate the brows a second time. It is usual to see some recurrence of brow drooping within three months of the operation. You can, however, look forward to some degree of improvement permanently. Some patients may choose to have another forehead lift in future years to maintain a more youthful appearance. Your surgeon always lifts your forehead as much as it is safe to do and cannot control how quickly any individual will sag. Regardless of how quickly or asymmetrically you sag, each patient will be responsible for the cost of a subsequent procedure should the patient wish to repeat the operation.
To maximize the degree of rejuvenation, many patients will choose to undergo a facelift, eyelid procedure or laser skin resurfacing at the same operative setting.
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The Mid-Face / Cheek / Thread Lift
Mid- face/ cheek/ and thread lift surgeries are being increasingly performed at Orange County Plastic Surgery Center due to the increasing demand for its high quality cosmetic therapies from customers eager to improve their aesthetic look.
As we all know, ageing will show its impact on our face and cheek in a substantial way and this has a direct bearing on our facial appearance and how we look. This process is bound to speed up with each passing year. However, it may not manifest itself in our mental and physical attitude and we may still feel vigorous and energetic despite the ageing process. What our mid- face, cheek and thread lift procedure does is to offer you a rejuvenated facial appearance that matches with your mental and physical attitudes. However, the degree of success of these therapies will also be linked to several other factors including the age of the patient, facial tissue elasticity, the type and degree of the facial deformity etc.
A youthful face is normally curvilinear with graceful curves and with fullness in the upper mid-face region. The lower lids appear tight and are short vertically. As faces age, the soft tissues inevitably drop – the upper cheek tissues descend, creating jowls, a hollowness in the cheek region, and an elongated lower eyelid. The neck skin and muscles loosen as well. As patients age, the central neck becomes fuller and the jaw lines become blunter, loosing the crisp distinction between the neck and jaw seen in youth. Sun damage causes the skin to wrinkle and assume a weathered look.
The traditional face lift is wonderful for dealing with jowls and the neck line. It was designed to pull the skin and superficial muscles backwards to minimize the jowl and to tighten the neck areas, but this procedure does not address the elongated lower eyelid and the hollowness in the mid-face region. As a matter of fact, the tension required to pull the cheek tissues backward actually flattens the mid-face region, further exacerbating the unnatural and definitely anything but youthful look! In some instances of minor neck laxity, the neck may be tightened by inserting a variety of threads beneath the surface and restoring neck laxity in cases of minor laxity. Such minimal incision, thread procedures will not give a patient an optimal result if significant laxity is present, along with a significant skin excess.
The new mid-face or cheek lift procedures specifically address this central facial hollowness and works to restore a curvilinear, youthful facial appearance. This is accomplished two short stab wounds along the fold between the upper lip and cheek, and short incisions behind the side burn, just above the ear. Through these access incisions, the surgeon can elevate the tissues which have drifted downward, back into a more youthful position, with suspension sutures. The aging face can thus be sculpted tension-free to recreate the soft and graceful curves of youth. The midface lift, along with microfat grafting of the tear troughs, are most frequently performed as adjuncts to a traditional lift. Some patients, usually those who are younger with aging limited to the mid-face region, or those who have already had a traditional facelift, will benefit from a mid-face/cheek lift as a sole procedure. Others may best be served with a mid-face lift combined with a traditional lift or other associated procedures in order to achieve the optimal result!
Ancillary procedures are frequently utilized to enhance the final results. Frequently, the eyelids can be addressed at the same sitting. Likewise, most patients old enough to have experienced facial laxity, will also have seen their brows descend; in order to balance the rejuvenated mid-face, an endoscopic brow lift is frequently performed to optimize the results. Autologous fat grafting can be used to fill an excessively hollow face or to augment lips which have thinned as part of the normal aging process. Chin implants are frequently employed to improve jaw contour. A nasal hump may be brought down or a tip refined. Sun damaged skin can be smoothed simultaneously with laser beams or a variety of chemical peels. In order to enhance the results from the chosen procedures, a good skin care program will be recommended for the health of the skin and to enhance the appearance of the skin.
You must realize that your surgeon will tighten the sagging tissues as much as can be done safely to provide a natural result for your particular facial contour. The mid- face/cheek/thread lift procedure is directed toward improvement and does not remove each and every sag or fold of the face. The type of skin, the age, and the aging rate of each patient, are factors that help determine your final result.
A common question regarding any procedure is "How long will the results last?" This is impossible to state for a given individual, as there are many factors involved: continued sun exposure, the age of the patient, the patient's type of skin, healing ability, changes in weight, smoking history and general health of the patient. Your surgeon expects you to look better than had you not had a midface lift for the rest of your life, but some laxity will return with time. As a matter of fact, the facial tissues continue to sag and loosen, at your natural rate, right after surgery. A small minority of patients, especially those who have a very marked degree of skin laxity in the jowl area, will not achieve a youthful look, even with a traditional facelift or a second mid-face lift, but most patients receive sufficient improvement and only require one facelift during their lifetime. Soft tissue aging continues after any operation – the best measure you can take to slow this process is to use sun block faithfully, and to take care of your skin with proper rejuvenating creams. Our office aesthetician will be glad to help you with a skin care program. This surgical procedure merely turns back the aging process; it cannot stop the “hands of time.” Your surgeon may be able to give you a good idea of what can be expected following surgery by manipulating your facial tissues in front of a mirror.
Regardless of how tightly the facial tissues are pulled, aging and stretching of the facial skin begins to occur immediately after the operation. It is usual to see some recurrence of jowls or drooping of the mid-face within three months of the operation. You can, however, look forward to a significant degree of improvement permanently. Most patients have sufficient improvement following a face, midface, brow or neck lift, which keeps them looking younger than their friends, forever. However, you may choose to have another lift, mid or traditional, in future years to maintain a more youthful appearance.
Your surgeon always tightens your tissues as much as it is safe to do and cannot control how quickly any individual will sag.
Regardless of how quickly or slowly you sag, each patient will be responsible for the cost of a subsequent procedure should the patient wish to repeat the operation.
To maximize the degree of rejuvenation, many patients will choose to undergo a forehead lift, eyelid procedure or laser skin resurfacing at the same operative setting. Lifting the mid-facial tissues shortens the height of the lower eyelid tissues and may cause the skin to appear more wrinkles after that procedure than it was initially. In order to optimize the final result, most patients will choose to undergo a lower lid blepharoplasty procedure at the same time as a mid-face lift.
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Blepharoplasty
A blepharoplasty procedure is designed to remove excess skin and bagginess, or to rearrange the fatty deposits, to give the eyes a more youthful appearance. It must be understood that most of the wrinkles around the eyes are etched into the skin and cannot be removed by a blepharoplasty procedure, without the addition of a skin wrinkle treatment.
The operation is designed to improve your appearance as much as possible at the present time. One must accept the judgment of your plastic surgeon and realize that he will remove or reposition as much of the excess or drooping tissue as he feels can be safely done in order to obtain the optimal result for each patient. If a patient presents with droopy brows, it may be impossible to obtain a significant improvement of upper eyelid appearance without first raising the brows. The blepharoplasty procedure by itself (without a forehead lift) does not improve droopy eyebrows. In fact, removing excess upper eyelid skin in someone with low brows may cause the brows to droop further. Your surgeon may discuss a forehead lift with you if he feels that a significant portion of your problem is caused by a low brow position.
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Rhinoplasty
You may have considered corrective nasal surgery if your nose is misshapen, disproportionately large or small for your face, or if you have had an injury, which makes breathing difficult.
INTRODUCTION: A rhinoplasty operation may be designed to:
- Improve the general cosmetic appearance of the patient by reducing, recontouring or reshaping the external nose;
- Straighten a previously injured nose, and/or;
- Improve the patient's ability to breathe.
It is important that you understand that no nose is perfectly symmetrical. Every attempt will be made to decrease your side-to-side dissimilarities, but such differences always persist to some degree, even after the most successful operation. There are many irregularities beneath the skin of a nose before and after surgery, but these may become more noticeable after surgery, especially in individuals with very thin skin and underlying fatty layers. It is unnatural for a nose to be exactly in the center of the face, before or after an operation. The two nostrils are never exactly the same shape or size. These irregularities and asymmetries will persist after a corrective operation. These facts are stressed as many patients are not aware of preoperative nasal irregularities and may be more critical of their appearance following surgery than preoperatively.
Many patients have a fear that the nasal change will be so great as to create a subject of discussion among family members and friends. Actually, rarely do the patient's friends and relatives ever remember the shape of the patient's original nose a few weeks following surgery. The patient is also warned that there may be individuals who will not wish to acknowledge that the patient's appearance has improved and may disappoint the patient by making an unrestrained comment such as, "I liked your nose better the way it was before" or, "I didn't see anything wrong with your nose in the first place."
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Laser Skin Resurfacing
Various methods have been devised over the years to minimize fine facial wrinkles, accident or acne scars. A facelift or blepharoplasty alone cannot remove wrinkles and are especially inadequate for the fine wrinkles around the mouth, eyes and forehead. The chemical peel, dermabrasion and laser skin resurfacing procedures were devised to minimize these surface irregularities. The key words here are minimize or diminish, as none of these procedures can remove all of the lines, marks or surface discolorations.
All three procedures remove the outer scarred or sun damaged skin, attempting to leave the patient with a smoother and more youthful appearance. The chemical peel procedure consists of the application of a medical mixture to the treated skin, which creates a chemical burn. In the dermabrasion procedure, the offensive outer layer is instead mechanically removed with a bur in a "sanding" motion. In the newer methods of laser skin resurfacing, various lasers can be employed to vaporize the outer layer of skin and induce a tightening of the remaining skin. The lasers tend to give the surgeon more precise control of the treatment depth and are the preferred method today in most instances.
The result of the treatment is a general tightening of the skin with obliteration of many of the fine wrinkles and scars while making the deeper wrinkles and scars less noticeable. In patients with excessive wrinkling or scarring, a repeat procedure may be desirable, but complete obliteration of all lines, wrinkles or acne marks will not be possible in any patient.
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Botox
Botulinum toxin injections, often referred to by the commercial name, BOTOX Cosmetic®, are biological toxins that have been transformed into therapeutic agents. Work with botulinum toxin began in the late 1960s to treat neurological disorders. Today, BOTOX® is used for the treatment of frown lines, forehead furrows, "crow’s feet," lines and wrinkles of the lower face, and even nasal muscles (to decrease nostril flaring or nasal “bunny lines”). The lines and wrinkles that respond to BOTOX® injections are those caused by the muscles—specifically those muscles that contract during facial expressions such as frowning or squinting. BOTOX® has been proven to stop excessive under arm sweating and to minimize or prevent migrane headaches. BOTOX® injections have become the most popular, nonsurgical cosmetic procedure.
Restylane® injection: Hyaluronic acid is a natural substance (polysaccharide) that can be used as a soft tissue filler. It is now commercially available as a product called Restylane®. It is being widely used for the management of wrinkles, facial lines, contour deformities, and deficiencies of face, cheeks, and lips associated with aging, developmental anomalies, and certain diseases.
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Chin & Misc. Implants
This section will pertain to solid implants that can be inserted to enhance a chin, jaw angles, cheeks, lips, nose, upper arms, chest wall (“pecs), buttocks or calves. Many patients feel that a certain body part does not match their overall facial features or body physique. In certain situations, balance can be achieved by inserting an implant to receive the desired correction. The solid implants can be made of a soft, smooth silicone rubber or a porous material such as Gortex. Lips may be augmented with a variety of injectibles, a Gortex graft, cadaver skin, or your own tissues, fat or a fat-skin combination. The Gortex grafts are permanent but not very popular because they are palpable and cause the lip to feel unnaturally firm. The cadaver (Alloderm®) as well as the patients own fat or dermal-fat grafts may absorb with time. Lip enhancement is achieved most frequently and safely with an injection of an absorbable, hyaluronic acid substance such as Restylane ®, Pearlane® or Juvederm®.
The most commonly performed procedure in this group is chin augmentation. Most people feel that a stronger chin is more aesthetically pleasing than weak chin. A weak chin will also make a nose look larger or a neck droopier than it actually is.
Less frequently, patients will present with a narrow jaw and request enhancement of the angles of the mandible, or with a weaker upper jaw and request a “pre maxillary implant” that is inserted just under the nose. Implants can also be inserted to give someone more prominent cheek bones.
Most patients who present themselves for nasal surgery are concerned with a nose that is too large for their face. Occasionally, we will see patients who have a deficient nasal bridge. The top of the nose can be enhanced with a variety of cartilage grafts (from the septum, ear or rib), cranial bone or with a man-made, silicone implant that comes from a box.
Some patients present with a concern about a flat pectoral area, small biceps, a weak gluteal area, or thin calves in spite of many hours spent working to enhance these areas in a gym. Such patients cannot build these muscles any further because of genetic limitations, and may be candidates for implants in the areas of concern. Options regarding implant size and type will be discussed with you before the procedure and every effort will be made to create an optimal result for you, but the final determination of an appropriate implant has to rest with the surgeon, and this final decision cannot be made until the pocket has been dissected during your surgical procedure.
The following information has been prepared to familiarize you with facts about a variety of implants that can be inserted for your cosmetic enhancement. The most commonly used implants in aesthetic surgery are used to enhance the breasts. Breast augmentation is performed with silicone rubber bags that are filled with either saline solution or silicone gel – breast implant surgery is covered in a separate section. This section will pertain to solid implants that can be inserted to enhance a chin, jaw angles, cheeks, lips, nose, upper arms, chest wall (“pecs), buttocks or calves.
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Breast Augmentation
Many women feel that their breasts do not match their overall body physique. Breast augmentation is one of the most common aesthetic surgical procedures in the United States of America. Small breast size may be due to a lack of normal breast development or to a decrease of breast volume following pregnancy or menopause. This procedure is designed to give the female patient a fuller breast.
Every effort is made not to alter your breast tissue during a breast enlarging procedure. This operation is performed by creating a pocket behind your existing breast tissue, by placing an implant in the space, and by simply pushing your breast tissue forward, thus enlarging the appearance of the breast. Most patients have been exceedingly pleased with this operative procedure, even though life-long follow up and the need for subsequent surgical procedures are the rule and not the exception.
The increase in breast size will be limited by the tightness of your tissues, but significant improvement can usually be achieved. As unfair as this might seem, the smaller your breasts are to begin with, the smaller a breast implant will have to be selected during surgery, simply because there will not be any room to put in bigger implants! On occasion, especially in patients who begin with a very small breast, a secondary procedure to insert larger implants may become desirable a year or more later, after tissues have had an opportunity to stretch. The fees for all secondary procedures will be the patient’s responsibility. Options regarding implant size and type will be discussed with you before the procedure and every effort will be made to create an optimal breast for you, but the final determination of an appropriate implant has to rest with the surgeon, and this final decision cannot be made until the pocket has been dissected during your surgical procedure.
It is important to understand that no person is perfectly symmetrical from one side to the other, even before a surgical procedure. Every attempt will be made during surgery to minimize your side-to-side dissimilarities, but such differences are natural and always persist to some degree, even after the most successful operation. And it is not unusual to have a greater degree of asymmetry after surgery than existed before implants were placed - this occurs because the formation of the scar layers around the implants and how the implants “settle” is not under the patient's or surgeon's control!
There is no evidence that breast surgery alters the possibility of developing breast cancer. Mammography and MRI techniques have improved in recent years. In spite of these advances, there is a theoretical risk of compromised detection of early breast cancer following an augmentation mammoplasty. If a cancer were to develop, its detection by mammography could be made more difficult, depending on the location of the cancer within the breast, the position and size of the implant and the type of implant employed, and an MRI may be recommended. Regardless of your decision to have an augmentation mammoplasty or not, it will still be necessary for you to examine yourself monthly for breast lumps and to undergo mammography as suggested by your personal physician. All women, whether or not they are contemplating breast surgery, are encouraged to obtain a baseline mammogram at age 35 (or even sooner if recommended by your gynecologist because of a family history of breast cancer) and a yearly mammogram or MRI after the age of 40.
Normal breast function should not be altered by an augmentation procedure. Although not all women are able to breast feed, even without a breast operation, this procedure should not alter the ability to breast feed should this become desirable later. One cannot, however, rule out possible effects on future pregnancy and nursing, particularly when incisions are placed around the areolae (“nipple incision.”)
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Breast Lift
Many women feel that their breasts do not match their overall body physique. Droopy breasts may be the result of pregnancy or the aging process. Such changes most frequently occur for hereditary reasons during menarche, pregnancy or following menopause; or at any time during a woman's life as a result of weight gain.
Although the goals of breast reduction and breast uplift procedures are different, the procedures will be discussed together because the pre-operative preparation, surgical incision, and postoperative course are quite similar. In both procedures, incisions are designed to create a more youthful and natural shaped breast. In both procedures, this involves elevating the nipple/areola complex from a lower, more droopy position, to a more natural position on the center of the breast mound. In addition to reshaping the breast, in a reduction, excess tissue is removed and the patient will end up with a smaller cup size. With a pure uplift, shape is improved but cup size stays unchanged. Occasionally, the patient may desire a small breast implant at the time of an uplift procedure if the patient perceives mat the breasts are not only too droopy, but too small as well.
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Breast Reduction
Many women feel that their breasts do not match their overall body physique. Extremely large or droopy breasts may be the result of excessive development or the aging process. Such changes most frequently occur during for hereditary reasons during menarche, pregnancy or following menopause; or at any time during a woman’s life as a result of weight gain.
Although the goals of breast reduction and breast uplift procedures are different, the procedures will be discussed together because the pre-operative preparation, external surgical incisions, and post-operative course are quite similar. In both procedures, incisions are designed to create a more youthful and natural shaped breast. In both procedures, this involves elevating the nipple/areola complex from a lower, droopier position, to a more natural position on the center of the breast mound.
Occasionally, the patient may desire breast implants at the time of an uplift procedure if the patient perceives that the breasts are not only too droopy, but too small as well. It is important to understand that no person is perfectly symmetrical from one side to the other, even before a surgical procedure. Every attempt will be made during surgery to minimize your side-to-side dissimilarities, but such differences are natural and always persist to some degree, even after the most successful operation.
There is no evidence that breast uplift or reduction surgery alters the possibility of developing breast cancer. It will still be necessary for you to examine yourself monthly for breast lumps and to undergo mammography as suggested by your personal physician. It is suggested that all females 35 years of age or older obtain a mammogram, and annually after the age of 40, whether or not you decide to proceed with elective breast surgery.
With the breast uplift procedure, few incisions are made within the substance of the breast. While reducing a breast, incisions will naturally course across breast ducts, but the ducts immediately beneath the nipple are left intact and usually such a patient would be able to breast feed, if this becomes desirable in the future. Although not all women are able to breast feed even before a breast operation, these procedures by themselves should not rule out the ability to breast feed at a later date.
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Gynecomastia
Gynecomastia is a benign condition, which is characterized by enlargement of the male breast. It usually begins in adolescence as a result of normal hormonal changes. If it does not resolve within several years many men choose surgical correction and obtain excellent results. A small incision is made beneath the breast around the areola (the dark skin surrounding the nipples). Excess fat and glandular tissue are removed, both directly and/or with liposuction and ultrasonic assisted liposuction. The result is a flatter, firmer and normally contoured chest. It can be done alone or in combination with other plastic surgery procedures such as eyelid lift or liposuction of the love handles, tummy or neck.
This procedure takes about two hours and is done under IV sedation or general anesthesia.
Swelling and bruising are to be expected. Medication will control the minimal pain and discomfort that patients usually experience. You may drive one or two days after surgery. A compression wrap around the chest is worn for 8 weeks. Plan on being off work for several days and two weeks before exercising.
The operation is directed toward an improvement and does not in any way guarantee complete obliteration of all breast tissue. You must accept the judgment of your plastic surgeon and realize that he will remove as much as is safe and suitable.
The type of skin, degree of elasticity and age of the patient all influence the overall result that is obtained.
A common question is, "How long will the results of this procedure last?" This is impossible to state. Factors affecting the length of the result include age at the time of operation, physical conditioning afterwards, type of skin, and alterations in weight. In general, it is not necessary to repeat this procedure to maintain the optimal result. It would be rare for gynecomastia to return after surgery, unless massive weight gain is encountered.
Should the patient wish to repeat the operation, regardless of the length of time since the initial operation, the degree of laxity or fatty excess remaining, and each patient will be responsible for the cost of a subsequent procedure.
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Laser Treatment
At Orange County Plastic Surgery, we have a variety of light, laser and chemical options to treat sun damage, vascular blemishes, acne or unwanted hair. After a thorough evaluation of your concerns and your skin, an appropriate treatment option will be offered. Our medial aestheticians, laser nurse and doctors work as a team to provide you with the best possible care of your skin and to address your concerns. Oxygen treatments may be offered to expedite healing. At other times, adjunctive procedure such as BOTOX® or Restylane® injections, micro fat grafting or other surgical options may be recommended.
Laser Hair Removal
Hair can be removed with our 1064 YAG laser. Laser hair removal is safe and effective in removing excess hair. The most common sites for hair removal are the face, arm pits, chest/back, bikini areas and the legs. It usually takes about 6 treatments, each a month apart, to remove hair for cosmetic reasons. While long term hair reduction can be obtained in most patients after a series of laser treatments, partial hair regrowth is typical, suggesting the need for additional treatments to maintain hair removal.
Laser treatment of vascular lesions
Vascular treatments with the YAG laser are most effective in treating telengectasia (“broken capillaries” on the face) and spider veins on legs. The heat from the laser damages the interior of the blood vessels, causing the vein or capillary to clot off, and thus no longer be visible. Results are usually seen within 6 weeks of the treatment. Usually 1 to 3 treatments are necessary to remove the visible veins and capillaries.
Intense Pulse Light (IPL) Skin Rejuvenation
Intense Pulse Light (IPL) therapy is designed to minimize signs of superficial sun damage including brown spots, fine lines and small facial veins. This new, non invasive therapy can be performed over a lunch time visit without any subsequent down time. Usually the patient is pretreated with Retin A and a bleaching cream, two weeks before the first treatment, to optimize the results of the IPL therapy. With this intense pulse light we can treat the face, neck, chest and forearms to reverse some of the damage caused by excessive exposure to the sun. A sun block must be used each day during and after therapy to maintain the results.
Photo Actif
Photo Actif Polychromatic Infrared Therapy was designed by NASA for wound healing and regenerate collagen synthesis for anti aging effects. Such treatments have now been adopted by aesthetic practices to treat sun damage. Infrared light treatments are also effective treatment to minimize pink acne scars or the redness that results from a deeper laser treatment or chemical peel. The emitted light is cold and the process is painless. Treatments are recommended 2 or 3 times per week for more severe conditions or can be done as infrequently as 1 time per week for 6 treatments.
Laser treatment of wrinkles
Wrinkles too severe to be treated with the IPL machine are more effectively treated with the Erbium laser. The procedure is a controlled burn to the skin to effectively treat moderate photo damage. The Microlaser Peel removes the most superficial layers of the skin and causes shrinkage of the underlying dermis, thus minimizing visible wrinkles. The treatments are effective and administered with minimal pain and complications. The healing process varies but will generally take about a week for the coloration to return to normal. Very severe sun damage will require more extensive treatments. Such wrinkling and sun damage will best be treated by one of our doctors under sedation with the higher dose Erbium or CO2 lasers, or with TCA or phenol peels. These deeper treatments may be required to remove the deeper lines, but the more extensive injury to the skin results in a raw surface for up to two weeks after surgery. Such treatments are frequently combined with other facial rejuvenation procedures such as face or brow lifts or eyelid surgery.
Oxymist® Oxygen Therapy
Oxymist® treatments are an adjunct to the laser procedures performed at Orange County Plastic Surgery. Highly concentrated oxygen can be administered to the skin with the Oxymist® system. It serves as an adjunct to wound healing after surgery or laser resurfacing. The oxygen promotes healing and kills surface bacteria. Normally, after the deeper erbium or CO2 laser resurfacing procedures, the skin surface will stay raw for up to two weeks before new skin grows in to cover the entire treated surface. Utilizing Oymist® treatments, the healing process is sped up and the results can be quite astonishing, frequently leaving the patient with a nicely healed, pink surface within a week of surgery. This will hasten the time the patient will be allowed to use make up and expedite returning to work or normal social function.
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Body Contouring
The areas which we can address with plastic surgery are the neck and face, breasts, inner arms, abdomen and back of trunk, hips, thighs and buttocks. As mentioned above, facial skin tightening, breast surgery and a straight forward abdominoplasty are covered elsewhere.
Here, we will focus on procedures designed to improve the inner arms, posterior trunk, hips, thighs and buttocks.
In all of these areas, the problem is an excessive amount of skin. It must be stressed that some skin laxity in these areas is absolutely normal. Every patient over the age of 20 will have some skin laxity in these areas, and the only time they should be addressed surgically is if the amount of skin laxity is much more than average, and if the degree of correction to be achieved can be justified by the resultant scarring. Procedures such as liposuction, rhinoplasty, breast augmentation, eyelid surgery and a face lift most frequently do not leave any visible scars. Body contouring procedures, on the other hand, ALWAYS leave a long and wide scar – each patient will have to decide for themselves if the improvement in the skin laxity will be justified by the resultant scars, cost and risks of surgery.
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Liposuction
Liposuction is currently the most commonly performed aesthetic surgical procedure in the United States. If you have concerns with unwanted fatty deposits, you certainly are not alone! You must understand that this surgery is purely elective. The main attraction of this procedure is that is allows the surgeon to remove bothersome, disproportionate, localized fat deposits through relatively inconspicuous incisions. This procedure has been designed to vacuum away localized, stable fatty deposits, which cannot be conirotled by diet and exercise. It is neither an alternative method of weight control nor a treatment for generalized obesity; nor will suction lipectomy help loose skin (unless combined with a traditional resection), or to contour irregularities caused by irregularities in the fat or structures other than fat (i.e. bone, muscle weakness, protrusion of intra-abdominal contents, etc.). Only the fat within the layer between the skin and the first layer of muscles is accessible to liposuction!
It is important that you understand that no person is perfectly symmetrical from one side to the other. If body-contouring surgery is indicated, every attempt will be made during surgery to minimize your side-to-side dissimilarities, but such differences are not due solely to the fatty layer and always persist to some degree, even after the most successful liposuction procedure.
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Tummy Tuck
An abdominoplasty is an operation in which excess skin and fat from the abdominal wall, particularly below the navel, is removed and the remaining skin tightened. This is accomplished by elevation of the skin and fat, pulling it inferiorly, and excising the excess. It is particularly effective in removing stretch marks from the lower abdomen, but it must be understood that not all stretch marks can be eliminated, and that some laxity, particularly noticeable when flexing the hips, will persist. The navel is reinserted into the skin after the tightening procedure.
Frequently, particularly after childbirth or weight loss, patients present with a weakness of the abdominal wall muscles and fascia; in such cases, the defect between the anterior muscles is repaired (fascial repair) before trimming the excess skin and fat.
This procedure can be combined with other abdominal surgery; for example, the abdominoplasty may be performed at the same time that your gynecologist performs a hysterectomy or other procedure. It may also be combined with non-abdominal operations such as liposuction, facelifts or other procedures.
The operation is directed toward an improvement and does not in any way guarantee complete obliteration of all folds and stretch marks. You must accept the judgment of your plastic surgeon and realize that he will remove as much as is safe and suitable. Particularly in patients with thicker abdominal walls or marked skin excess, it may be desirable to return for a secondary liposuction of the abdominal wall or an additional skin excision to obtain an optimal result.
The type of skin and age of the patient are factors in the overall result to be obtained. The operation should not be undertaken if the patient intends pregnancies in the foreseeable future. While it is not necessary for the patient to reach a certain weight before surgery may be performed, it is desirable that the patient's weight be stable for at least six months prior to surgery and that the patient be at a weight he/she feels can be maintained after the procedure.
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Fat Grafting
Microfat grafting is a new technique that uses your own fat cells to rejuvenate the face and the area around the eye. Strategically placing fat into the face often produces dramatic rejuvenation. As we age our faces lose the fullness of youth and the ideal substance to restore our own fat.
This technique uses a very delicate harvesting and processing procedures in order to insure the viability of the transferred fat and long-term permanence. Fatty tissue is very fragile. Most traditional transfer techniques kill the fat in processing and produce very unsatisfactory results. Microfat grafting, however, allows the majority of the fat to survive the transplantation in most situations.
Once placed, the body accepts the transferred fat as part of your face--not something foreign like silicone or other inert implants. The intact fat parcels then anchor to the surrounding tissues and quickly reestablish a blood supply.
Harvesting of the fat is usually done from the abdomen or thighs using specially designed cannulas.
Regional nerve blocks are the most useful because adequate anesthesia can be provided without obscuring the defect to be treated. General anesthesia is used if the Microfat grafting is done together with other procedures (face lift, breast augmentation, liposuction etc.).
A common question is, "How long will the results of this procedure last?" The traditional fat grafting techniques had a very high resorption rates, this new technique insures more lasting results due to preservation of the viability of the fat cells transferred.
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Ear Surgery
This information has been assembled to familiarize you with the facts regarding ear pin back surgery. You are requested to read the following information thoroughly and to discuss any questions, which might arise with your surgeon before you proceed with the surgical procedure known as otoplasty. You are also requested to keep this information as a reference during your post- operative period.
INTRODUCTION: Ear pin back surgery is a common aesthetic surgical procedure performed by your surgeon at Orange County Plastic Surgery. A normal ear rarely attracts attention – yet one that protrudes does attract attention and can be the source of ridicule or hurtful jokes. Protruding ears can be a source of diminished self esteem in children and adults alike. Often, correction of even a minor deformity can give the affected person and enormous boost in self esteem. Protruding ears may be present on only one side or both. Some asymmetry is always present, before and even after the most successful surgical procedure.
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Body Lift
The following information has been prepared to familiarize you with facts about the surgical procedure known as body lift ("belt lipectomy") or reconstruction following bariatric surgery or diet/exercise induced weight loss. You are requested to read this information thoroughly and to discuss any questions which might arise with your surgeon before you give your consent to proceed with this procedure. You are also requested to keep this form as a reference in the postoperative period.
We are in the midst of an obesity epidemic in America, but this problem is not one limited to the industrialized world. The World Health Organization has stated that world wide, currently, over a billion adults are overweight, and that at least 300 million are grossly obese (more than a hundred pounds overweight). The degree of obesity is commonly assessed by calculating the body mass index, or BMI. A BMI over 25 kg/m2 is defined as overweight and over 30 as obese. In California, 10% of adults were considered obese in 1991, 17% in 1998, and over 23% in 2005. Obesity leads to adverse metabolic effects on blood pressure, cholesterol and insulin resistance (higher incidence of diabetes) as well as non-fatal but debilitating health problems such as musculoskeletal problems, infertility and respiratory difficulties. Over the past decade, increased awareness of this issue has prompted a number of people to loose massive quantities of weight as a result of diet/exercise programs or a variety of advanced surgical procedures (known as bariatric surgery).
The two most popular bariatric procedures entail some type of gastric bypass, in which the GI tract is rearranged so eaten food bypasses a large portion of the absorptive portion of the stomach, or a “band” procedure in which a band is placed around the upper portion of the stomach, physically decreasing the amount of food a person can eat at one sitting, both of which usually result in weight losses from one to two hundred pounds in those who are morbidly obese. Allergan, the maker of the Lap Band® that is used to decrease the upper portion of the stomach, has stated that over 350,000 such procedures have already been performed in the United States. Weight loss is accompanied by numerous health benefits, but leaves patients with undesirable quantities of excess skin. This skin excess varies from person to person, but generally involves an excess of facial/neck skin, upper arm and thigh skin, deflated/droopy breasts and massive degrees of excess involving the anterior and posterior trunk. This hand out will address excess skin in the abdominal and posterior trunk/back areas.
A body lift is an operation in which excess skin and fat from the abdominal wall, particularly below the navel, and posterior trunk/back is removed. This will result in a removal of the hanging abdominal wall skin and a tightening of the skin over the sides, lower back, upper lateral thighs and upper buttocks areas. This is accomplished by first placing the patient in the face down position and resecting the excess posterior trunk/lower back skin. In patients who have been left with a very flat buttocks, some of this tissue from the lower back can be replaced, as a flap, into the buttocks area to enhance that area simultaneously. After returning the patient to a face up position, the abdominal skin is elevated from the anterior muscles, the muscles are tightened as necessary, the excess skin is pulled downward, and the excess skin excised. This procedure is particularly effective in removing vertical skin excess and stretch marks from the lower abdomen, but it must be understood that not all stretch marks can be eliminated, and that significant laxity, particularly noticeable when flexing the hips or when pinching the skin horizontally, will persist. The same navel is reinserted into the skin after the tightening procedure.
Frequently, particularly after childbirth or weight loss, patients present with a weakness of the abdominal wall muscles and fascia; in such cases, the defect between the anterior muscles is repaired (fascial repair) before trimming the excess skin and fat.
This procedure can be combined with other non-abdominal operations such as liposuction, arm lifts, breast uplifts (with or without implants), facelifts or other procedures. It has been shown that the risks of surgery/anesthesia are infinitesimally small for any length of time up to six hours, but that thereafter, risks of infection, blood clots and other risks begin to rise. As all of the procedures here mentioned are elective, your surgeon will discuss your desires and formulate a plan based on how much can safely be done in one sitting that does not exceed six hours –patients desiring full correction of their deformities usually return for two or three procedure until their goals are met.
The operation is directed toward an improvement and does not in any way guarantee complete obliteration of all folds and stretch marks. You must accept the judgment of your plastic surgeon and realize that he/she will remove as much as is safe and suitable. Particularly in patients with thicker abdominal walls or marked skin excess, it may be desirable to return for a secondary liposuction of the abdominal wall or an additional skin excision to obtain an optimal result. Should this prove desirable, the patient will be responsible for all costs associated with all secondary surgical procedures.
The type of skin, degree of elasticity and age of the patient all influence the overall result that is obtained. The operation should not be undertaken if the patient intends pregnancies in the near future. Should a patient become pregnant after a body lift, a normal pregnancy will ensue but the abdominal wall skin will again get stretched. While it is not necessary for the patient to reach a certain weight before surgery may be performed, it is desirable that the patient's weight be stable for at least six months prior to surgery and that the patient be at a weight he/she feels can be maintained after the procedure.
A common question is, "How long will the results of this procedure last?" This is impossible to state. Factors affecting the length of the improvement include physical conditioning afterwards, type of skin, and alterations in weight. In general, it is not necessary to repeat this procedure to maintain the optimal result. It should be noted that this procedure removes the skin and fatty excess that a patient has at the time of the body lift but does not prevent a patient from gaining weight and stretching the abdominal wall again in the future. Should a patient wish to repeat the operation, regardless of the length of time since the initial operation, the degree of laxity or fatty excess remaining, each patient will be responsible for the cost of a subsequent procedure.
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Post Bariatric Surgery
The following information has been prepared to familiarize you with facts regarding a variety of surgical procedures that are utilized to tighten excessively loose skin, frequently after massive weight loss. A smaller group of patients, who are normal weight and have never been overweight, will present with loose enough skin to warrant surgical tightening in the inner arm, posterior trunk, buttocks or thigh regions. If you fall into the post massive weight loss category, you are first to be congratulated for loosing so much weight!
Study after study has demonstrated the benefits of weight loss in patients who are morbidly obese. Your heart and lungs will not have to work as hard. Your legs will have less weight to carry. If you had adult onset diabetes, it will surely have improved or even gone away after the weight loss. Unfortunately, as you have found, skin does not go back to its pre-stretched condition. Most patients who loose a large quantity of weight desire to have the excess remaining skin from their abdomens removed and their breasts uplifted, with or without an implant, or reduced. The tummy tuck and breast recontouring procedures are covered in separate sections entitled abdominoplasty and breast reduction/uplift. Post weight loss patients also frequently are left with loose neck skin or jowls, and these procedures are covered in the face lift section. This section will focus on procedures utilized to address skin laxity along the inner arms, upper and mid back regions, buttocks and thighs.
Twenty five years ago, it was rare to have a patient walk into a plastic surgeon’s office after substantial weight loss. But these days, we routinely see patients who have lost in excess of one hundred pounds. About three quarters of the massive weight loss patients we see did so with the assistance of bariatric surgery – such procedures have been designed to either decrease the size of the stomach pouch or some variety of “bypass” which shunts food down the intestines quicker without absorbing as many calories. With the advent of laproscopic surgery and the more sophisticated bypass and stapling techniques, the efficacy, safety and popularity of such “bariatric” surgery has sky rocketed. This year over 140,000 bariatric procedures will be performed in the United States, and the numbers keep climbing higher each year as more centers with expertise in such procedures open up. But a good quarter of the weight loss patients we see achieved their results the good old fashioned way, by altering their diets and by exercising regularly!
The areas which we can address with plastic surgery are the neck and face, breasts, inner arms, abdomen and back of trunk, hips, thighs and buttocks. As mentioned above, facial skin tightening, breast surgery and a straight forward abdominoplasty are covered elsewhere. Here, we will focus on procedures designed to improve the inner arms, posterior trunk, hips, thighs and buttocks.
In all of these areas, the problem is an excessive amount of skin. It must be stressed that some skin laxity in these areas is absolutely normal. Every patient over the age of 20 will have some skin laxity in these areas, and the only time they should be addressed surgically is if the amount of skin laxity is much more than average, and if the degree of correction to be achieved can be justified by the resultant scarring. Procedures such as liposuction, rhinoplasty, breast augmentation, eyelid surgery and a face lift most frequently do not leave any visible scars. Body contouring procedures, on the other hand, ALWAYS leave a long and wide scar – each patient will have to decide for themselves if the improvement in the skin laxity will be justified by the resultant scars, cost and risks of surgery.
An inner arm brachioplasty is an operation in which excess skin and fat from the inner arm, between the axilla (arm pit) and elbow, is removed and the remaining skin tightened. This is accomplished by excising a large ellipse of this excess skin. The resultant scar will run along the inner arm, hidden with your arm down along your side but definitely visible if a patient is wearing a short sleeve shirt and has their hands up in the air!
The posterior trunk can contain excess rolls of skin either continuing around the back at the level of the breast or lower down as a continuation of the abdominal skin rolls. The upper back excess can be excised by removing wedges and leaving the final scar at the level of a brassiere in a female. The lower trunk is usually addressed in conjunction with an abdominoplasty and is called a “belt lipectomy”. Such belt lipectomies result in a tightening of the abdominal wall and the lower posterior trunk, including the hip/thigh area and upper buttocks. The incision follows the fold along the lower abdomen, above the pubis, and continues on the backside just above the buttocks. Such scars, while noticeable when unclothed, are usually easily hidden within standard shorts. It is important to understand that during such procedures, a transverse wedge of tissue will be removed and the patient will experience a vertical tightening of the skin – if you pinch your abdomen or lower back vertically, a very significant tightening will be appreciated, but if one pinched horizontally, no appreciable tightening will be noted.
The lower buttocks and thighs can be tightened in a similar fashion, with the resultant scar location to be determined by the areas of your most significant skin excess. As with the belt lipectomy or abdominoplasty, the skin tightening will usually occur in one plane, usually vertically, and not result in significant horizontal tightening. If massive skin laxity is present, both a horizontal and a vertical tightening might be desirable. In such situations, a “T” shaped scar may be designed with a transverse incision along the upper inner thigh, perhaps extending obliquely onto the buttocks, as well as a vertical scar down the inner thighs towards or to the inner knees.
Most patients who have lost a lot of weight have multiple areas to address. These body contouring procedures can be combined to address multiple areas, with certain limitations and exceptions. It is not safe to address the inner thighs and abdomen at the same sitting because of blood flow interruption to the pubis and strip of skin between the inner thighplasty scars and abdominoplasty or belt lipectomy scars. But with either procedure, it would be safe to address, for example, the inner arms or breasts. Such procedures may also be combined with non-skin tightening operations such as liposuction, eyelid surgery or other procedures. Your overall health and age will also help determine how much surgery you can tolerate in one day. But even if you are in perfect health, it is unwise to electively schedule procedures that are designed to be longer than six hours in length because after that time, your chance of developing a blood clot in your calved or other complications will become more likely.
The operation is directed toward an improvement and will not in any way give you complete obliteration of all folds, laxity and stretch marks. You must accept the judgment of your plastic surgeon and realize that he will remove as much as is safe and suitable. Particularly in patients with thicker fatty layers or marked skin excess, it may be desirable to return for additional skin excisions to obtain an optimal result. Should this prove desirable, the patient will be responsible for all costs associated with all secondary surgical procedures.
The type of skin, degree of elasticity and age of the patient all influence the overall result that is obtained. The operation should not be undertaken if the patient’s weight is not stable or if a patient has not made a commitment to themselves to keep the weight off in the foreseeable future. While it is not necessary for the patient to reach a certain weight before surgery may be performed, it is desirable that the patient's weight be stable for at least six months prior to surgery and that the patient be at a weight he/she feels can be maintained after the procedure.
A common question is, "How long will the results of this procedure last?" This is impossible to state. Factors affecting the length of the result include age at the time of operation, physical conditioning afterwards, type of skin, and alterations in weight. In general, it is not necessary to repeat these procedures after an optimal result has been achieved. Should the patient wish to repeat the operation, regardless of the length of time since the initial operation, the degree of laxity or fatty excess remaining, each patient will be responsible for the cost of a subsequent procedure.
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