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General:
Who is a good candidate
for cosmetic surgery?
Is it expensive?
Where
is the surgery performed?
Who gives
anesthesia?
Will it hurt?
Are there scars?
How
do I know my doctor is qualified?
What
is involved at the first Consultation?
Facial Rejuvenation:
Forehead/Eyebrows
Eyelids
Midface
Face and Neck
Where performed?
Post
op discomfort
Cost
Breast Augmentation:
General Information
What happens at the consultation?
Where
is the implant placed?
Where
is the incision?
Can
we use gel implants?
Is
the implant shaped?
Where
is the surgery performed?
Post
op discomfort
What
are the possible complications?
How much
does it cost?
Skin
Care:
The Skin
How our skin ages
Why
peel your skin?
Chemical
Peeling
Microdermabrasion
Safety & Outpatient Surgery
General:
Who is a good candidate for cosmetic
surgery?
People who have features that make them look older than they
feel or who have features that they don’t feel are attractive
are candidates for elective cosmetic surgery. If you can specifically
identify traits that you would like to improve and have an
idea of how you want to look it is helpful. An example is
someone who wants a different shaped nose, smaller or larger
breasts, a face and neck with less “sagging” or
who has fat deposits that are diet and exercise resistant.
A good candidate for surgery also understands the risks and
limitations of surgery as explained by their surgeon and works
in partnership with their doctor to attain their goals. Likewise,
a poor candidate has unrealistic expectations, ignores the
advice of their surgeon, does not follow pre and post operative
directions and expects the surgery to change their luck, performance
or love life.
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Is it expensive?
Quality cosmetic surgery, like any skilled endeavor, requires
years of training and experience on the part of the surgeon
and anesthesiologist. You should not be gouged, but do expect
to pay a fair price for your procedure. You should also expect
attention to detail, an attentive staff and excellence in
the performance of your surgery. The pleasure of a bargain
is forgotten sooner than the memory of a job poorly done.
As in anything else, you pay for what you get. Be sure to
check your surgeons credentials and ask questions before you
have surgery.
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Where is the surgery performed?
We believe your safety is the most important aspect of what
we do. All of our surgery is performed in an accredited outpatient
surgery facility or in a hospital OR.
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Who gives anesthesia?
Anesthesia is provided by anesthesiologists,
the same ones who work in local hospitals. It is not in your
best interest to have your surgeon trying to give anesthesia,
monitor your vital signs and do surgery at the same time.
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Will it hurt?
Pain is a subjective feeling. It is perceived differently
by different people. Procedures where muscle manipulation
is involved (abdominoplasty, breast augmentation) will be
more painful than procedures where only the skin and subcutaneous
tissue is operated on (S-facelift, liposuction, breast reduction,
eyelid surgery). In all cases care is taken to limit the amount
of trauma to your tissue and anesthetics are used liberally
during the operation to limit pain afterward. In addition,
post operative pain medication is prescribed.
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Are there scars?
Skin cannot be cut without scarring. The trick is to limit
the length of any necessary incisions and close them in such
a way that the body has the best chance of healing with a
thin line in the skin. In addition, the incision is placed
in a previous wrinkle if possible. After the operation, topical
medication is used to decrease the appearance of the scar.
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How do I know my doctor is
qualified?
At the minimum, your surgeon should be board certified by
a board recognized by the American Board of Medical Specialties
(http://www.abms.org/). For cosmetic surgery procedures we
believe that is The American Board of Plastic Surgery (http://www.abplsurg.org/).
In addition, look to make sure they were trained in a reputable
institution (link to our bios), and are members of societies
such as The American Society of Plastic Surgery (http://www.plasticsurgery.org/)
and/or The American Society for Aesthetic Plastic Surgery
(http://www.surgery.org/index.php). Check the National Practitioner
Data Bank (http://www.npdb-hipdb.com/) and the local medical
societies (http://www.mcmedsoc.org/home6.html) for complaints.
Ask friends for references and then make certain you are comfortable
talking to and being around your surgeon. You should be able
to find a well qualified doctor without having to put up with
poor bed side manner.
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What is involved at the
first Consultation?
At the initial consultation a history will be taken and a
brief examination performed. We will try to understand what
is most important to you. After a brief examination we will
discuss the various options for you to achieve your goals.
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Facial Rejuvenation
General Information:
The desire for a more youthful appearance is common among
men and women. The decision to seek a change in your appearance
is highly personal and should be made only after you have
considered all of the options along with the risks and benefits.
As we age our skin and connective tissue loses elasticity
and the shape of our facial features changes. We begin to
notice a “droop” to our tissues often associated
with a loss or displacement of fat that leads to a sagging
appearance. A common complaint is “I am starting to
look like my mother/father”. A marked improvement can
be made by realigning and tightening both the underlying soft
tissue and the skin. In some cases the addition of soft tissue
fillers or an implant can have dramatic effects.
This section will answer many of your questions regarding
facial rejuvenation. Actual recommendations will depend upon
your individual situation and cannot be made until an examination
has been performed.
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Forehead/Eyebrows:
Many people notice excess skin in the upper and lower eyelids
and attribute this to loss of elasticity. What in fact has
often occurred is the eyebrow has become too low and needs
to be lifted. This can have a dramatic effect on appearance.
In addition, at the time it is done, the corrugator (wrinkler)
muscles that cause lines between the eyes can be weakened
to give a better appearance. Browlift. (link to photo section)
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Eyelids: Sagging and
bagging of the lids can be corrected by a judicious removal
of fat and skin. This removes the appearance of being tired
and opens the eye to allow the natural shape to be seen. The
lower lid often requires tightening (canthopexy) to restore
a youthful appearance. All of this can be done with minimal
incisions. Blepharoplasty. (link to photos)
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Midface: The area
of tissue beneath the eye down to the naso-labial fold can
be elevated to restore a youthful roundness to the face and
decrease the fold formed when we smile. This can be performed
through the mouth or with tiny incisions in the fold itself.
Midface lift. (link to photos)
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Face and Neck: Two of
the most obvious areas of facial ageing are the cheeks and
the neck. A clear jaw line with a smooth neck devoid of sagging
skin looks younger. This can often be achieved by sculpting
the neck with liposuction, tightening the neck muscles and
removing excess skin with an “S” shaped incision
around the ear. This “mini” or ‘S”
lift is very safe, heals quickly and does not look overdone.
Facelift. (link to website).
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Where performed?:
Surgery is performed in a certified surgery center.
Plan on spending 4 to 6 hours from beginning to end. You will
need a ride home afterward.
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Post op discomfort:
Your surgery is performed in a precise manner using the latest
techniques which include: local anesthesia infiltration of
the surgical site to decrease bleeding and pain, minimal incisions
around the ear to decrease the appearance of scars and self
absorbing sutures for the most part. Local anesthesia provides
several hours of pain free recovery while you are awakening
from anesthesia.
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Cost: Typical surgical
costs are approx. six to twelve thousand dollars including
surgery, anesthesia, and all post op visits. You can find
this procedure for less, but you get what you pay for. We
have been doing this surgery for 15 years and have hundreds
of happy patients.
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Breast Augmentation
General Information:
The desire for larger breasts is common among many women.
The decision to enlarge your breasts is highly personal and
should be made only after you have considered all of the options
along with the risks and benefits.
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What happens at the consultation?:
At the initial consultation a history will be taken and we
will listen to understand what your desires are. Some women
are nervous. We will try to put you at ease. Your brief exam
will be conducted in a non-threatening atmosphere where your
wants and needs are catered to. We will discuss the various
options for you to achieve your goals, including the type
of implants, its size, the placement of the incision and what
you can expect after the surgery. We will also review pre
and post operative photos of actual patients to give you an
idea of what you will look like.
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Where is the implant placed?:
For the majority of women, placing the implant beneath the
chest muscle (pectoralis major) makes the most sense, because
it minimizes the “step off” effect of an implant
seen at the upper chest and decreases the chance of a capsule
(scar) forming around the implant.
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Where is the incision?:
The most common incision sites chosen by women are in the
crease under the breast or at the junction of the light and
dark skin of the areola. Another option is to place the incision
in the armpit. All incisions leave a small (1 1/2 inch) scar
that fades with time.
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Can we use gel implants?:
Yes, they are now FDA approved.
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Is the implant shaped?:
Round, smooth implants give the most natural appearance and
the least amount of post operative problems. Studies have
shown they cannot be differentiated from “anatomical”
or “shaped” implants and have far fewer potential
problems.
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Where is the surgery
performed: Surgery is performed in a certified surgery
center. We feel your safety is enhanced in this environment.
Plan on spending 4 to 6 hours from beginning to end. You will
need a ride home afterward.
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Post op discomfort:
Your surgery is performed in a precise manner using the latest
techniques which include: tumescent anesthesia infiltration
of the surgical site to decrease bleeding and pain, NO blunt
dissection, liberal use of long acting anesthetic placed directly
into the surgical site. This last step provides several hours
of pain free recovery while you are awakening from anesthesia.
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What are the
possible complications?: The following complications,
though rare can occur.
-Hematoma (bleeding within the developed pocket requiring
a return to the OR to remove) occurs in less than one percent
of cases and is NOT life threatening. Treatment consists of
removing the implant, evacuating the blood, finding the bleeding
point and replacing the implant.The blood is removed to decrease
the chance of a denser scar forming around the implant.
-Change of breast sensation, either increased or decreased
in all or part of the breast can occur.
-Capsular contracture is a condition in which scar forms around
the implant and changes the feel and shape of the breast.
This develops over time and often requires removal of the
capsule to correct.
-Asymmetry and noticeable scar are both rare but do occasionally
occur and can be corrected.
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How much does it cost?:
Typical surgical costs are approx. $6000 including implants,
surgery, anesthesia, and all post op visits. You can find
this procedure for less, but you get what you pay for. We
have been doing this surgery for 15 years and have hundreds
of happy patients.
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Skin Care
The Skin
The skin, our body’s largest organ is both
a complex and multipurpose organ. It protects the body against
injury, chemicals, bacteria and even UV light. It regulates
body temperature, and is a vital part of our immune system.
In addition it has the wonderful power to constantly repair
itself.
The skin is made of three layers. The epidermis (the outermost
layer-which has five sublayers) the dermis (the middle or
supporting layer) and the subcutis (bottom or fatty layer).
The epidermis, the layer we see and touch is very tough but
microscopically thin. It is the layer with the highest content
of water. However, as we mature, the skin’s ability
to retain water decreases which causes the skin to become
dehydrated. This is why many of us feel the need to use a
moisturizer when we reach our mid 20’s. The melanocytes
(the cells responsible for skin’s pigment) are present
in the lower layers of the epidermis. These protective cells
produce pigment (melanin) in response to ultraviolet rays,
skin trauma, and/or hormones. Melanocytes migrate into individual
cells to form a physical umbrella over the cell’s nucleus.
This “brown umbrella” (a suntan) is created to
protect the cell’s nucleus from even further sun damage
and sunburn. Because a tan is created only
when the skin is confronted with injury, there is NO
such thing as a healthy tan (unless it comes from a self tanner).
When severe damage has occurred and as we mature, these cells
often coagulate into clumps causing hyperpigmentation (age
spots).
The dermis (middle layer) is often referred to as the living
skin. This layer is made of collagen (95%) and elastin ( 3
%) protein fibers that are woven together in a microscopic
network. Collagen enables the skin to stretch and elastin
brings it back to form. Elasticity depends on a well balanced
water content in the dermis and other skin layers. The dermal
layer is also responsible for supporting the epidermis the
skin’s repair, immune system and sensory system.
The subcutis (the bottom layer) consists mainly of fat and
cells interspersed with blood vessels, nerve fibers and muscle
fibers. This layer acts as a protective cushion for what lies
above it and below it.
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How our skin ages
The skin, which has the ability to renew itself, goes through
a natural shedding process called desquamation. This cellular
renewal takes about 30 days in normal skin. However as we
age, this natural shedding process slows down. In addition,
collagen production declines as well as the skin’s natural
moisture level. Furthermore, the subcutis fat begins to thin
and facial muscles begin to sag.
This natural aging process is inevitable. However, many of
our lifestyle choices make our skin age before it’s
time. Activities such as smoking, sunbathing, excessive alcohol
consumption, a poor diet, and lack of sleep all take a toll
on our skin. Terms such as “weathered skin” ,
“photoaging” and “premature aging”
are often used to describe such skin.
The good news is that we can do something about it.
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Why peel your skin?
Artificially removing the outer layer of skin by
a process called peeling or exfoliating helps speed up the
body’s natural process of skin renewal. The skin grows
back without replicating many of the problems that have developed
during its life—such as fine lines, sun damage, dark
spots etc. Consistently removing the outer layers of skin
(epidermis) results in a skin that is well hydrated, less
pigmented and more youthful looking.
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Chemical Peeling
Chemical peeling involves applying an acidic solution to the
skin. The most popular chemical peels are glycolic acid (made
from sugar cane) and lactic acid (made from milk). These chemicals
are also called alpha hydroxy acids. The chemical solution
promotes the shedding of the skin by breaking down the substance
that holds the skin cells together. The extent of the exfoliation
depends on the type of acid, its pH and the condition of your
skin.
Chemical peels have a cumulative effect and are best done
is a series of 4-6 treatments.
Benefits include:
- Smoother skin surface and texture
- Minimized appearance of lines and wrinkles
- Increased production of collagen and elastin
- Reduction of Hyperpigmentation
Salicylic acid (betahydroxy acid) another popular chemical
peel contains the same active ingredient found in aspirin.
Although this acid is similar to alphahydroxy acids, it has
the added ability to penetrate the skin’s pores because
it is lipid (oil) soluble. This type of acid peel is excellent
for refining clogged pores and reducing skin’s breakouts.
Because this acid is related to aspirin, it is an anti-inflammatory
and is a great treatment for acne and rosacea.
Helps Improve:
- Comedones
- Epidermal pigmentation problems
- Fine lines and wrinkles
-Large Pores
- Shallow Scarring
- Skin Laxity
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Microdermabrasion
This manual peel uses a harmless sand like crystal to exfoliate
the skin’s surface. No harsh acids are used and the
skin is left noticeably smoother after just one peel. This
peel is an excellent treatment for men and anyone who wants
a quick healthy glow. Microdermabrasion is great for light
scarring and hyperpigmentation . Because this peel has a cumulative
effect, a series of 5 to 10 treatments is recommended for
optimal results.
Benefits include:
- Reduction in fine lines
- Superficial Scarring
- Uneven skin tone
- Acne and acne scarring
- Sun damage
In addition to peeling the skin, a skin care regimen (including
cleanser, moisturizer, antioxidants and sunscreen) is highly
recommended to obtain the best results.
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