Facts About Cosmetic Surgery

G. D. Castillo, M.D., F.A.C.S.Cosmetic Plastic Surgery

Table of Contents

General Information ............................................................................ PageIntroduction.....................................................................1GeneralFacts.................................................................1PhysicalConsiderations.................................................2ConsultationandExamination........................................2ComputerImaging..........................................................3OperatingRoom/OurSurgicalFacility............................3YourSurgeon.................................................................4InsuranceInformation.....................................................4FinancingOptions...........................................................5AnswerstoCommonQuestions.....................................5Anesthetics.....................................................................6BeforeSurgery...............................................................6AvoidTheseMedications...............................................7AfterSurgery..................................................................9

Procedures

ArmLift:Brachioplasty.................................................10

Botox®:TreatmentoftheAgingFace..........................11BreastEnlargement:BreastAugmentation.................12BreastLift:Mastopexy.................................................16BreastReduction:ReductionMammoplasty...............19BrowLiftandForeheadLift..........................................21CheekBoneSurgery:MalarAugmentation.................23ChinSurgery:Mentoplasty..........................................24EyelidSurgery:Blepharoplasty...................................26Facelift:Rhytidectomy.................................................28FatSuction:Liposculpture...........................................32Fillers:Injectables........................................................36NoseSurgery:Rhinoplasty..........................................36ProtrudingEarSurgery:Otoplasty...............................39TummyTuck:Abdominoplasty....................................40

Skin Rejuvenation, Ablative and Non-Ablative

AblativeLaserSkinSurgery.......................................................43SkinSanding–Dermabrasion......................................47

Non-AblativeIPL-PhotoRejuvenation..............................................48IPL-HairReduction.....................................................48IPL-VeinTreatment...................................................49

SkinCareMicrodermabrasion.......................................................51ChemicalPeels.............................................................51

G.D.Castillo,M.D.,F.A.C.S.ProfessionalCredentials......................InsideBackCover

G.D. Castillo, M.D., F.A.C.S.Educational and Professional Background

Introduction ConsideringthatthisyearseveralmillionAmericanswillundergocosmeticsurgerytoimprovetheirappearances,itisessentialthattheprospectivepatientknowfactsaboutplasticsurgery. Theterm“plastic”originatesfromtheGreekterm“Plastikos,”meaningformormolding.Appliedtoplasticsurgery,thetermsignifiesthereshapingoftissueandstructuresinamorevisuallyappealingform,andoften,morefunctional. Theterm“cosmeticsurgery”isusedmanytimesinterchangeablyandessentiallysignifiessurgerythatresultsinabeautificationofthebody. Youareurgedtoreadandre-readthisbookletbeforeandafteryourconsultationwiththedoctor,especiallythosesectionsconcerningyouandyoursituation.Althoughthevarioussurgicalproceduresexplainedinthisbookletarediscussedinthetermsoftheaveragepatient,variationsdoindeedexistandeveryperson’scaseisdifferent.Thedoctorwillspecificallyattendyourindividualproblematthetimeofyourconsultation.Thedecisiontohavecosmeticsurgeryshouldnotbemadesolelyonthebasisofreadingthisbooklet.Rememberthatanymattersofconcerntoyoushouldbeansweredtoyourcompletesatisfaction.Weconsiderservingourpatientstobeaprivilege,andwebelievethatyouareentitledtoandwillreceivetheveryfinesttreatmentthatwecanprovide.Ourentirestaffiscommittedtothehighestqualityofmedicalcare.

General FactsIs it vain to improve our appearance?

Tosomeextentitis,butlet’sfaceit,weareallvain,andthisisindeedagoodtrait.Wetrytodressneatly,keepourselvesclean,styleourhair,shaveandusecosmetics.Obviously,thepotentialbenefitsofcosmeticplasticsurgeryarenotonlytoimproveappearancebutalsotobetterourself-image;thisreflectsitselfinthewaywefeelaboutourselvesandhowothersperceiveus. Realisticgoalsareimportant.Thegoalofanoperationshouldbeimprovement,notperfection.Toexpectabsoluteperfectionignorestherealitiesthatsurgeryoffers. Thegoalofcosmeticsurgeryistoobtainandimprovethenaturallook.Closefriendsmaynotevennoticethechange.Manytimesfriendsdonotsharethepatient’senthusiasm,butremember,theyhavenotseenthebefore-and-afterphotographs. Thebestpatientistheonewhosharesthedecisiontohavecosmeticsurgerywithfamilyandfriends.Awillingnessandfranknesstobeopenabouttheproposedsurgeryisoneofthebestindicationsthepatientispsychologicallyhealthyandreadyforsurgery.

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Physical Considerations Asurgeonisaphysician,notamagician.Thedegreeoftheoperation’ssuccessdependsnotonlyonthesurgeon’sskillandexpertise,butalsoonthepatient’sage,health,skintexture,bonestructureandspecificproblems.Itisunethicalforanyphysiciantoguaranteetheresultsofanytreatmentoroperation.Nosurgeoncanguaranteetheresultofanycosmeticprocedure.Theonlyguaranteeistodothebesttohelpthepatient. Allsurgicalincisionshealbyscarformationandthescarispermanent.Therefore,thesurgeontriestokeepthescarareasassmallandthinaspossible,andtohavethemcamouflagedinthenaturalfoldsoftissueifpossible.Scars,though,healdifferentlyindifferentpeople,andindifferentlocations,sothattheeventualresultcannotalwaysbepredictedwithanycertainty.Hereagain,scartissueformationandotherunfavorableresultsarebeyondthecontrolofthesurgeon,buttheymayinfluencetheendresultofthesurgery.Therefore,inacertainpercentageofpatients,additionalsurgicalproceduresmaybenecessarytoobtainmaximumimprovement. Rememberthatalthoughcosmeticsurgeryisconsideredtobesafesurgery,anyoperation,nomatterwhereonthebodyitisperformedorforwhatreasonsitisperformed,maybeassociatedwithcertainrisksandcomplications.

• Bleeding:Thereisalwaysasmallchancethat bleedingmayoccursometimeinthepost-operative period.

• Infection:Althoughsignificantinfectionofan operatedareaisrare,itstillmayoccur.

• Asymmetry:Nopersonisperfectlysymmetrical. Nomatterhowcarefulandskillfulthesurgeon is,therewillbesmallirregularitiesandasymmetries betweentherightandleftsides,whichthepatientwill notice.Oftenthesearenotnoticeablebyothers.

• AllergicReactions:Occasionallyapatientwillhave anallergicreactiontothemedicationusedduringthe anestheticorinthepost-operativeperiod. Unfortunately,thesereactionsareindividualand virtuallyimpossibletopredictbeforehand.

Consultation and Examination Atthetimeofyourconsultation,yourspecificneedswillbediscussedandIwillexaminethecondition(s)youwantchanged.Iwillsharemyopinionastowhatcanberealisticallyaccomplishedbysurgeryforyourparticularsituation. Thefeeforsurgeryispayableinadvancepriortotheprocedure(thisisstandardprocedurewithallreputablecosmeticplasticsurgeons).Becausethisoperationis

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elective,patientsgenerallyhavesufficienttimetomakethenecessaryfinancialarrangements.However,ifpaymentisnotreceivedpriortosurgery,wereservetherighttocanceltheprocedure. Paymentinadvanceassuresthesurgeonthatthepatientisnotundertakingelectivesurgeryheorshecannotaffordatthetime.Italsoassuresthepatientthatthesurgicalfeefortheoperationandpost-operativecareispaidinfullandtherewillbenounexpectedadditionalchargebythesurgeon.

Computer Imaging Insomeinstances,avideoorpictureofapatientcanbemodifiedwithacomputerviaspecialsoftware,andareasofthefacethatonewishestochange(forexample,alargenose)canbemodifiedtoproduceapictureofthefacewithbetterproportionorrefinedstructure.Thisoptionisavailableinsomecases;however,becauseofmultiplereasons,wedonotcarrycomputer-generatedimagesoneverypatient,andfurthermore,donotrecommendthisoptionforeveryone.

Operating Room - Our Surgical Facility AlthoughIhavebeendoingcosmeticsurgeryforthelast33years,Ihavebeendoingnearlyexclusivelyoutpatientcosmeticsurgeryforthelast22years.Wehavefoundthatwecansatisfyalloftheelementsthatthepatientseeksinambulatorysurgery;thatissafety,convenienceandconfidentiality.Insofarassafetyisconcerned,thefacilitiesatCosmeticPlasticSurgeryhavebeenaccreditedbytheAccreditationAssociationforAmbulatoryHealthCareforthelast18years.Thisaccreditationsignifiesthatthisfacilityhasequalstandardstothesafety,qualityassurance,andemergencyresponsecapabilities(intheextremelyunusualeventofanemergency)asahospitalwould.Insofarasconfidentiality,theconvenienceofhavingyoursurgerycarriedoutatafacilitywhereyou’reonlygoingtobeencounteringasmallnumberofdedicatedsurgicalstafftotakecareofyou,andthefactthatourpatientdatabaseisnotcomputerized,assuresyouoftotalconfidentialityinyourcosmeticsurgery.Theconvenienceofhavingstaffthatarededicatedtothesolepurposeofperformingyoursurgicalprocedure,alsoassuresyouthatyourvisittoCosmeticPlasticSurgerywillbefruitfulanduneventful. Ourfacilityisequippedwiththelateststate-of-the-arttechnology.Wehaveourownemergencypowercapability,thecapabilitytoprovidelasersurgerywith

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threelasersbasedattheoffice,endoscopicproceduresforminimalincisionsurgery,facilitiesforlocal,twilightorgeneralanesthesia,andthesafetyofmindthatduringanygivensurgicalproceduretherewillbeatleastthreestaffmembers(amongourotherstaff)qualifiedandcertifiedinadvancedcardiaclifesupport.In1984whenCosmeticPlasticSurgeryfirstbeganoperationsonanoutpatientbasis,weweretheleadersofoutpatientsurgeryinthearea.Todaywecontinuethisleadershipwiththeabilitytoprovideafullspectrumofcosmeticsurgeryservicesonanoutpatientbasiswiththelatesttechnologicalandpatientsafetyfeatures.

Your Surgeon Mypracticeisstrictlylimitedtocosmeticplasticsurgeryofthefaceandbody.Ibelievethatitisonlythroughsuchnarrowsub-specializationthatyou,thepatient,canbeassuredofthebestpossibleresults.Toassistmeinyourcare,weemployspeciallytrainedpersonneltohelpduringyourconsultation-examinationandoperation.Theymayremovebandagesandstitchesafteryoursurgery.Ourassistantsperformnofunctionsthataffectthefinalresultofyoursurgicalprocedure.

Insurance Information Insomecases,ourofficestaffwillcompleteyourclaimformaftersurgery,andprovidecopiesofoperativerecordsifyourinsurancecompanyrequeststhem.Itmustbeclearlyunderstoodthatwearenotparticipantsinthecontractthatexistsbetweenyouandyourinsurancecompany.Thus,theinsurancecompanyisresponsibletoyou,nottome,thesurgeon;likewiseyouandnotyourinsurancecarrierareresponsibleforanysurgicalchargesthatareincurred.Ourofficestaffwillbegladtoinformyouwhichclaims(surgeries)arelikelytobehonoredbyinsurancecompanies,andwhicharenot. Thefeethatwillbequotedwillbeall-inclusive.Thatis,itwillcoveroursurgicalcharge,thechargeforoutpatienthospitalcharges,laboratorywork,supplies,implants(whenneeded),etc.Wheninquiringelsewhereaboutsurgicalcosts,patientswouldbewelladvisedtomakesurethatallcostsincurredinrelationtothesurgeryareincludedandthatthecostquotedisnotonlyconcernedwiththephysician’ssurgicalcharge.

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Financing Options Mostmajorcreditcards(Visa,Mastercard,AmericanExpressandDiscover)areacceptedbythisoffice. However,gonearethedayswhenpatientswerelimitedtoeitherreadycashorcreditcardstofinancetheirprocedureofchoice.Withthefinancialalternativesavailabletoday,patientsarefreetoselectthemostfavorabletimefortheirsurgerywithoutmonetaryconcernsdelayingtheirpersonaland/orprofessionalschedule(s). Whiletherearevarioushealth-relatedfinancecompaniesofferingservicestocosmeticsurgeryoffices,CosmeticPlasticSurgeryis not aligned withanyfinancialorganization,allowingCosmeticPlasticSurgerytosearchextensivelyforthebesttermsforourpatientsonanindividualbasis.Credittermsmaybeginaslowas7.99%andrangeupwarddependingontheapplicant’spersonalcredithistory. Ifyou’vefeltthatyourprocedureofchoiceisbeyondyourreachduetofinancialconsiderations,whynotgiveourbusinessofficeacallat(217)359-7508.We’realwayshappytoassistyouinanywaypossible.

Answers to Common QuestionsQ - Where do I go for surgery?A-Allofoursurgeriesareperformedonanoutpatient

basis(inandoutonthesameday)atouraccreditedoffice-basedoperatingsuite.(SeeOperatingRoom-OurSurgicalFacility.)

Q - How long will the surgery take? When can I go home?

A-Theactualtimeforsurgeriesvarywiththetypeofprocedure.However,mostcosmeticsurgeriesareperformedonanoutpatientbasis.Youwillarriveatthefacility1/2hourbeforeyourscheduledtimetoallowenoughtimetoreceiveadequatesedationandallothernecessarypreparations.Aftersurgery,youwillbekeptintherecoveryroomfor1to3hours.Whenyourconditionhasstabilized,youwillbepermittedtogohome.Youmustbeaccompaniedbyaresponsibleadult,usuallyafriendorrelative.

Q - Why don’t I need to stay in the hospital overnight?

A-Youmaybesurprisedthatcosmeticsurgerycanbeperformedonanoutpatientbasis.Thistypeofoperationisperformedonhealthy,notsickpeople.Asitinvolvesmainlysuperficialtissues,thereis

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minimaldiscomfortandfewrisks.Duringthefirstfewpost-operativehours,whicharemostcritical,youwillbeundercloserobservationbythesurgeonandprofessionallytrainedregisterednursesthaninmostin-patienthospitalsettings.Oncethiscriticalperiodhaselapsed,thereislittledangeroflatercomplications.Severalyearsexperienceinthousandsofoperationshasconvincedmethatoutpatientsurgerypatientsrecoverfaster,havelessdiscomfortafterwards,andfewercomplicationsthaninpatients.

Thepopularityofoutpatientsurgeryisduetoitsprovenrecordofsafetywithfewerriskstothepatientinadditiontotheincentiveofdecreasedcostsandincreasedconvenience.

Anesthetics Oursurgicalproceduresarecarriedoutundereithergeneralanesthesia,providedbycertifiedanesthesiologist-anesthetists,orbylocalanesthesiaunderdeepsedation(twilightanesthesia).

Before Surgery Itisnotunusualforapatienttobesomewhatnervousafewdaysbeforesurgeryanddevelop“lastminutejitters.”Suddenly,heorshemaydevelopdoubtsaboutdoingthiselectiveprocedure. Questionslike“whatamIgettingmyselfinto,”or“whatamIgoingtolooklike,”arequitecommon.Thesearenormal,lastminutefears.If,however,thesefearsandanxietiesbecomeoverwhelming,weencourageyoutodiscussthemwithyoursurgeon,whowillreassureyouhonestlyandsincerely. Foraperiodoftwoweeksbeforesurgery,youmust discontinuetheuseofaspirinormedicationscontainingaspirincompounds,VitaminEandfishoilandmostdietarysupplements.Ourpersonalexperienceandrecentstudiesindicatethatthesesubstancesincreasebleedingduringsurgeryanddaysfollowingbecauseoftheirpowerfulanticoagulantproperties.Bleedingandbloodaccumulationmayslowhealingandcausecomplications,whichinturnmayleadtopoorresults.Youmay,however,substituteforaspirinwithproductscontainingacetaminophensuchasTylenolorDatril. Becausemanyofthecommoncoldmedicationsandover-the-counterpainrelieverscontainaspirin,wehaveincludedalist(onpages7&8)ofmostofthesethatareavailablewithoutprescription.Ifyouareunsurewhetherthemedicationsthatyouusecontainaspirinornon-steroidalanti-inflammatories,pleasecallusorcallyourpharmacist.Please follow our advice so that you

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can help us give you the safest operation with the best results. Thenightbeforeyoursurgery,trytohaveaquiet,relaxedeveningandabstainfromalcoholicbeverages.Forapeacefulsleep,youmayuseamildsedative.Remembertoshampooyourhairandwashyourfaceifyouarecontemplatingfacialsurgery-oryourbodyifyouarecontemplatingbodysurgery-withBetadineskincleansersoap.Youshouldrepeatthisprocessthemorningofthesurgery.Donotapplycosmetics,moisturizers,creamsoranyothertreatmentsafteryourcleanseyourfaceorbody. Ifyouarecontemplatingsurgerythatmayrequiretheprioruseofanironsupplement,orifyouareapersonwhosuffersfromconstipation,youmaywanttobegintakingastoolsoftener(suchasMetamucil)threetofourdayspriortosurgeryandthroughoutyoursurgicalrecovery.Thiswillpreventconstipationthatislikelytohappenwhenyouaretakingcodeine(narcoticmedicationforpain)oriron,arelessactivethanusual,ormaybesomewhatdehydrated.

AspirinAlka-SeltzerEffervescent PainReliever&Antacid (MilesLaboratories)Alka-SeltzerPlusCold Medicine(Miles Laboratories)AnacinAnalgesicCapsules (Whitehall)AnacinAnalgesicTablets (Whitehall)AnacinMaximumStrength AnalgesicCapsules (Whitehall)AnacinMaximumStrengthAnalgesicTablets(Whitehall)ArthritisPainFormulabythe MakersofAnacinAnalgesic Tablets(Whitehall)ArthritisStrengthBufferin (Bristol-Meyers)Ascriptin(Rorer)AscriptinA/D(Rorer)Aspergum(Plough)AspirinSuppositories(G&W Laboratories)BayerAspirin&Bayer Children’sChewableAspirin (Glenbrook)BayerChildren’s ColdTablets(Glenbrook)

Avoid These Medications

BayerTime-ReleaseAspirin (Glenbrook)Bufferin(Bristol-Meyers)CamaInlay-Tabs(Dorsey)Congespirin(Bristol-Meyers)Coricidin“D”Decongestant Tablets(Schering)CoricidinDemiletsTabletsfor Children(Schering)CoricidinMediletsTabletsfor Children(Schering)CoricidinTablets(Schering)DristanDecongestant/ Antihistamine/Analgesic Capsules(Whitehall)DristanDecongestant/ Antihistamine/Analgesic Tablets(Whitehall)EcotrinTablets(Menley& James)Empirin(Burroughs Wellcome)EnTab-650Tablets (Mayrand)Excedrin(Bristol-Meyers)Extra-StrengthBufferin Capsules&Tablets(Bristol- Meyers)4-WayColdTablets(Bristol- Meyers)

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Gemnisyn(Rorer)Goody’sHeadachePowders (Goody’s)Midol(Glenbrook)NorwichAspirin(Norwich- Eaton)Panalgesic(Poythress)QuietWorldAnalgesic/Sleeping Aid(Whitehall)St.JosephAspirinforChildren (Plough)St.JosephColdTabletsfor Children(Plough)Sine-OffSinusMedicine Tablets-AspirinFormula (Menley&James)TriminicinTablets(Dorsey)Vanquish(Glenbrook)Viro-MedTablets(Whitehall)

Aspirin BufferedArthritisPainFormulabythe MakersofAnacinAnalgesic Tablets(Whitehall)ArthritisStrengthBufferin (Bristol-Meyers)Extra-StrengthBufferinCapsules&Tablets(Bristol- Meyers)

Aspirin MicronizedArthritisPainFormulabythe MakersofAnacinAnalgesic Tablets(Whitehall)

MomentumMuscularBackache Formula(Whitehall)

Topical Medications Containing Salicylate or Salicylate DerivativesAbsorbentRub(DeWitt)AbsorbineArthritic(W.F. Young)AbsorbineJr.(W.F.Young)Act-OnRub(Keystone)Analbalm(Central)AnalgesicBalm(Lilly)Antiphlogistine(Roberts)Arthralgen(Robins)Aspercreme(Thompson)Banalg(O’Neal,Jones& Feldman)Baumodyne(NorthAmerican)BenGay(Leeming)BenGayGel(Leeming)BenGayGreaseless/Stainless Ointment(Leeming)BenGayOriginal(Leeming)Braska(Keystone)CounterpainRub(Squibb)Dencorub(Roberts)Doan’sRub(Purex)Emul-O-Balm(Pennwalt)End-Ake(ColumbiaMedical)End-AkeCream(Columbia Medical)ExocainePlus(Kirk)ExocaineTube(Kirk)

Heet(Whitehall)IcyHot(Searle)Infra-Rub(Whitehall)Lini-Balm(Armar-Stone)Mentholatum(Mentholatum)MentholatumDeepHeating (Mentholatum)Minit-Rub(Bristol-Meyers)MusteroleDeepStrength (Plough)Musterole(Plough)Neurabalm(S.S.S.)Oil-O-Sol(Mosso)OmegaOil(Block)Panalgesic(Poythress)Rid-A-Pain(Pfeiffer)Rumarub(Pfeiffer)Sloan’s(Warner-Lambert)SolticeHi-Therm(Chattem)SolticeQuickRub(Chattem)SPD(Amer.Pharm.)Stimurub(OtisClapp)Surin(McKesson)Yager’sLiniment(Yager)ZemoLiquid(Plough)

OtherVitaminEFishOilIbuprofen(Motrin,Advil, Nuprin)NaprosynFeldeneIndomethacin(Indocin)

Aleve(Proctor&Gamble)VinegarSolutions

NASID’sDiclofenacDiflunisalEtodolacFenoprofenIndomethacinKetoprofenNabumetoneNaproxenOxaprozinPhenylbutazonePiroxicamSulindacTolmetinKetorolacToradolCataflamVoltarenDolobidLodineNalfonOrudisRelafenDayproClinorilTolectinVioxxRofecox13CelebrexCelicoxiB

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After Surgery Whenyouleaveourfacilityafteryouroperation,youwillbequitesleepy.Muchofthesamedayandnightwillbespentsleepingonandoff.Ifyouarehungryorthirsty,youmayeatordrinknormally,butrefrainfromalcohol.Ifyourstomachisunsettled,startwithicechips(crushedice)–feedslowlywithaspoonandwaittwotothreehoursbeforedrinkingoreating.Yourmouthwillprobablybesomewhatdry.Youmayparticipateinmostnormaldailyactivities,butdonotmakeimportantdecisions,driveoroperatemachinery.Duringthisfirstnightaftersurgery,itissuggestedthatacompanionstaywithyou. Thefirstdayaftersurgery,youmayfindyouarestillabitsleepy.Youshouldbeabletoparticipateinthemajorityofyournormaldailyactivities.Thereshouldnotbeasignificantamountofpain,andwesuggestyoutotryandkeepyourpainmedicationtoaminimum.(Ifyoudoneedsomethingforpain,tryTylenolcapletsbeforetakingsomethingstronger.)Thelesspainmedicationyoutake,thequickeryourrecoverywithfewersideeffects. Someswellingandbruisingaftersurgeryisnormal.Theseeffectsareusuallyatamaximumondaytwoaftersurgery,exceptforliposuction,whenmaximumswellingisexperiencedbetweendayssixandten.Thebodyhandlestheswellingandbruisingbygraduallyabsorbingthefluid;asthisoccurs,thebruisinglessensandchangescolor.Simultaneously,theswellingdissipates.

Thisprocessusuallytakesupto1-1/2to2weeks.Itisnotuncommon;however,formuchoftheswellingandbruisingtohavedisappearedwithinoneweek. Ifyouarenottooconcernedaboutotherpeoplenoticingyourbruisesorstitches,youmayverywellbeableto“getout”withinafewdaysaftersurgery.Mostrhinoplasty(nose)patientslookquite“normal”withinoneweek.Mostliposuctionandbreastaugmentationpatientslooknormalwithinonetotwodays(exceptforoperatedareas)andareabletogobacktoworkbythefourthdayfollowingsurgery.Mostface-liftpatientslook“normal”within10daysfollowingsurgery.Theseareaveragefigures.Sometimesthereisvirtuallynobruisingorswelling,andthetimeperiodmaybeless;otherscouldbelonger. Weareallawarethatexcessiveexposuretothesunisbadfortheskin.Duringtheperiodwhenbruisingisstillevident,itisnotwisetogetsunexposure.Bloodpigmentsmaybecomeimbeddedintheskin,andleavesomediscoloration.Thisisespeciallytrueforpeoplewhoalreadyhavepigmentation(darkcirclesundertheireyes).Itisalwaysadvisabletouseastrong(45orbetter)sunblockifyouaregoingtobeinsunlightforaperiodoftime. Beforeyouleavethesurgicalfacility,wewilltellyouwhenwewouldlikeyoutoreturntotheofficeforanormalpost-operativefollow-upvisit.

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Arm Lift, Arm Reduction: Brachioplasty Anumberofindividualsarecandidatesforarmreduction,whetheritberelatedtoanaccumulationoffattytissueinoraroundthearm,orwhetheritberelatedtoweightreductionwithsignificantleft-overfattytissueandlooseskin.Patientscaneasilybetreatedwitheitherliposculpture(armreduction)orwithabrachioplasty(armreductionplusarmlift). Iftheprocedurecanbedonebyliposculptureonly,itiscarriedoutthroughverysmallincisionsabouttheelbowandmid-armareas.If,ontheotherhand,alargeamountofskinneedstoberemoved,anincisioniscarriedoutintheinnerportionofthearmfromthearmpittotheelbowarea.Theincisionisgenerallywellcamouflagedbythepositionofthearm. Theprocedureiscarriedoutunderanesthesiainourownoutpatientfacility.Abandageiswornforapproximatelyoneweekfollowingsurgery,atwhichtimethesuturesareremoved.Wegenerallytapetheincisionforanotheronetotwoweeks.Thereisminimaldisability,withonlyrestrictedactivitiesfortwotothreedaysfollowingsurgeryandthenalllightactivitiescanberesumed.Thereareseveralvariationsofthisprocedurethatwillbeexplainedduringtheconsultation.Typically,markingsofthesurgicalincisionsarealsocarriedoutduringtheconsultation.

Mostpatientsresumeworkwithinfourtosevendaysandgenerally,painisminimal.

BEFORE AFTER

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Botox® in the Treatment of the Aging Face: Whilemanhasnotyetdiscoveredthefountainofyouth,Botox®facialrejuvenationtherapyisequaltotakingasmalldipinthatfountain.Clostridium Botulinumwasfirstidentifiedasatoxinin1895.Botulinumtoxinwasthenpurifiedinthe1940’sandproducedinafairlystableform.Inthe1970’s,itwasdiscoveredthatBotulinumcausestheremovalofthefaciallinesofanimation(thedynamiclinesorwrinklesthatappeararoundtheeyelids,frownareaandforeheadwhensmilingorgesturing).ThatdiscoveryhasleadtotheuseofBotulinumoverthelast17+yearsinthemanagementoflinesoffacialexpression,andisnowAmerica’smostpopularcosmetictreatment. TheinjectionofBotulinumiscarriedoutintothemusclesoffacialexpression.Thiscausesatemporaryreductioninthemotoractivityofthemuscleandweaknessofthemusclethatresultsinlossofwrinklinginthecrow’sfeetarea,frownlines,foreheadandotherfacialareas. Otherareastreatedincludetheverticalnecklinesthatarecausedbythehyperactivityoftheplatysmamuscleintheneck. TheresultsofusingBotox®forfacialexpressionhavebeenfairlyspectacular,andtheonlydrawbackfromtheseinjectionsisthattheeffectoftheBotox®is

temporary,lastingthreetofourmonths.Wehavefoundatremendousincreaseinthedemandforthistreatmentinourpractice,bothasasingletreatmentandincombinationwithotherprocedureslikefacialresurfacing,facelift,dermalfillers,IPL,etc.

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Breast Enlargement: Breast Augmentation Breastaugmentationiscarriedoutwitheithersalineorsiliconeprostheses.AtCosmeticPlasticSurgery,ourpatientshavetheoptionofchoosingeithersaline-filledprostheses,orsiliconeimplants.Inotherareasoftheworld,othertypesoftissuesuchasyourownfattytissueissometimesusedasthematerialforbreastaugmentation.Today,significantresearchisbeingcarriedoutastotheadvisabilityandpossibilityofundesirableresultswhenoneusesthepatient’sownfattytissue(wecanelaborateaboutitduringconsultation). Whiletherearemanyincisionsthatcanbeutilizedtoinsertanimplant,siliconeimplantsareinsertedthroughanincisionaroundthenipple,whichbecomesnearlyundetectablewithinafewweeks,andmostsaline-filledprosthesescanbeinsertedwithavarietyofincisions.AtCosmeticPlasticSurgery,wehavedevelopedaprocedurewhereanincisionoflessthan1-inchintotallengthiscreatedinthelateralportionofthebreastfold.Throughthisverysmallincision,accessisgainedtothespacebehindthepectoralmuscle(retro-pectoralspace)andanaugmentationcanbedoneifneededthroughanendoscope.Thisallowsforaverysmallincisionthathealsquitewell,aroutethatcreatesminimalinflammationofthetissue,andbecauseall

ofthesurgicalprocedureisdonebehindthepectoralmuscle,thebreasttissueislefttotallyundisturbed.Thisisabigadvantagesincemammographycanbecarriedoutwithoutinterferencefromartifactsinthefuture,andwhennecessary,breastfeedingismorelikelywhenthebreasttissueisleftundisturbed. Inthelast10years,theround-shapedsalineprosthesishasgainedtremendousacceptanceandpopularityduetotheverylowfailurerateofthisparticularprosthesisandtheexcellentcosmeticresultthatitgiveswhenitisusedbehindthepectoralmuscle.Therearetwotypesofroundbreastprostheses.Theyhavetodowiththetypeofexteriorfinishthattheprosthesishas.Thereis(1)thetexturedprosthesisand(2)thesmoothprosthesis.Thedifferencesbetweenthetwoprosthesesareasfollows:lows:

Weusethesmoothprosthesisinover95%ofcases. Themaindifferencesbetweensalineandsiliconeimplantshavetodowiththeshapeandfeelofthe

Textured Smooth • No need to massage or exercise

the breast • Very acceptable softness of the

breast • The movement of the breast may

not be as natural as a normal breast.

• Greater failure rate (chance of deflation).

• Need to daily massage the breast (move up, sideways and squeeze)

• A softer breast feel • A breast that tends to move

more naturally, provided it is properly massaged.

• Less chance of deflation.

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BREAST AuGMENTATION

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BREAST AuGMENTATION

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BREAST AuGMENTATION

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BREAST AuGMENTATION

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breast.Siliconegivesamorenaturalfeeltothebreastandamorenaturallooktothebreast. Siliconeprosthesesaregenerallyplacedabovemuscle,andthatisbecausetheirfeelandconsistencyissosimilartotissuethattheyblendbetteranatomicallywithaplacementrightbehindbreasttissueandontopofmuscle.Salineprosthesesarenearlyalwaysplacedbeneathmusclebecausetheydoneedthecamouflageofthemusclestructure.Siliconeprosthesesaremoreexpensivethansalineprostheses.Becausesiliconeprosthesescomeprefilledfromthemanufacturer,theincisiontoinserttheprosthesisisslightlylargerthanforasalineprosthesis,andthepreferredroutetoplacethesiliconeprosthesisisthroughtheareolaitself(thedarkareathatsurroundsthenipple).Salineprosthesescanbeinsertedthroughaverysmallincision(lessthan1inch),whichisgenerallylocatedwithinthebreastfold. Breastaugmentationsurgeryiscarriedoutundergeneralanesthesiaonanoutpatientbasis.Postoperativepainisgenerallywellcontrolledwithnarcotics,andwecanutilizecontinuousinfusionofalocalanestheticsolutionthroughapumppostoperatively(localanestheticisslowlyandcontinuouslypumpedinthebreastpocketthroughaverythintube),forpaincontrolifneeded. Althoughheavyexercising(likejogging)isnotallowedforthreeweeks,routineactivitiescanberesumedonetotwodaysfollowingsurgery.Aspeciallydesignedbra-garmentprovidedbyourofficeistobewornfortwoweeksfollowingsurgery.Weutilizeprophylactic

antibioticspriortoandimmediatelyafterthesurgery. Makingadecisionaboutbreastsizeisapersonaldecision,andonethatmostpatientscanmakewithouttoomuchproblem.Mostbreastaugmentationsarecarriedoutwithanywherebetween9to14ouncesforeachbreast(270to420ccs.).Rememberthatone-ounceequals30ccs.Todeterminethesizethatyouwouldbehappywith,youcanexperimentathomeusingasandwichtypebaggie(foodstoragebag).Donotuseziplockbagssincetheyaretoofirmtoproperlydeterminesize.Youshouldfillthesebagswithuncookedrice,birdseedoroatmeal.Youshouldprobablystartwith1-1/4cups(10ounces)or1-1/2cups(12ounces)foreachbaggie.Puttheminsideofanunpaddedbra(youmayneedtobuyaC-cupbrasothatyoucanproperlysizeyourbreast).Feelfreetoaddorsubtractmaterialasneeded,alwayskeepingtrackofhowmanyouncesorccs.youhaveinsidethebaggie.Whenyoufindthesizethatyouarecomfortablewith,youmaywanttowearthebaggiesforafewhourswithdifferenttypesofgarmentsorgoouttodochores,tomakesurethatyouarecomfortablewiththissize.Wewillneedtoknowwhatthisfinalmeasurementissothatwecanutilizethecorrectsizeprosthesis. Wedohavesizersattheofficeandwecanhelpfinalizethedecisionwithoursizersprovidedyoubringyourownbrasothattheycanbeinsertedintoyourbra. Therearesomecomplicationstobreastaugmentationsurgerythatyoushouldbeawareof.Inapproximately1%ofcases,decreasedsensationinthenippleareacan

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beencountered.Occasionally,acapsularcontracturecanoccur.Capsularcontracturemeansthatyourbodyhasformedafirmcoverovertheimplantthatmakesitlookroundandfeelhardandfirm.Whenthishappens,furthersurgery(acapsulectomy)mayberequired.Deflationoftheimplantinthecaseofasalineimplant,orruptureoftheshellinthecaseofasiliconeprosthesiscanalsooccur.Themanufacturerguaranteestheprostheses,sothemanufacturerwillreplacetheprosthesesfreeofcharge.Theywillalsopayoperatingroomandsupplychargestoreplacetheimplantifithappenswithin10yearsfollowingaugmentationwiththeextendedwarranty. Whilethedetectionofcancerissomewhatmoredifficultinapersonwithimplants,withthepropertechnique(Eklundtechnique)mostmammogramscanrevealbreasttissuewithfewlimitations. Breastprosthesesarenotconsideredlifetimedevices,soitislikelythattheymayneedtobereplacedinthefuture.Whilenooneknowsthelifeexpectancyoftheprostheses,itislikelythatthesemaybequitedurabledevices(maylast20-30+years).

Breast Lift: Mastopexy Breastsaggingorptosisisoftenadisturbingconditionforwomenbecauseitreflectstheeffectsofagingandgravityonthebreastposition.Thebreastsappeardroopyandlowerthannormal.Theupperportionsofthebreastsappearflattened,andthelowerportiondescendsbelowthefoldofthebreasts.Breastskinoftenmayhavereducedelasticityandbecomestretchedorweakened. Symmetrical,naturallyproportionedandpositionedbreastsarethegoalsofmastopexy.Apatient’sunderstandingandinputisessentialindeterminingthebreast’ssize,shapeandposition. Manypatientsseekmastopexyfollowingweightloss,pregnancy,lactationormenopause.Thepresenceofptosisindicatestheinelasticnatureoftheskinandacorrespondingdecreaseinbreastvolume. Becausetherearevariousdegreesofsagging(ptosis),thesurgicaltreatmentinvolvesarangeofpossiblecorrectionsbasedprimarilyonthenippleareolapositionandsize,theamountofexcessskinandthebreastvolume.Correctionmaybeassimpleasbreastaugmentation.Thisaddsfullnessandwillgivecleavageandthismaybecombinedwithskinexcision.Additionalimprovementmaybeobtainedbyremovingexcessskinfromaroundtheareola. Forthemoreadvancedptosis(sagging),anadditionalverticalincisionmayberequired.Theincisiongoesfrom

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Breast Lift: Mastopexy (Front)

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Breast Lift: Mastopexy (Left Side)

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Breast Lift: Mastopexy (Right Side)

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theareolatobeneaththebreast.Forthemostsevereptosis,anadditionalthirdincisionunderneaththebreastisrequired.Itisimperativethatthepatientunderstandstheplacementoftheincisionsandthiswillbeexplainedindetailduringtheinitialconsultation. Therearepossiblecomplicationsthatmustbeclearlyunderstoodandweighedpriortosurgery.Widescarsarethemostcommonproblemseenpost-operatively.Otherunusualcomplicationsareasymmetryofthebreasts,hematoma,infectionandlossofnipplesensation.Thesewillbediscussedindetailduringtheinitialconsultation. Theproceduretakesgenerallytwohoursandisdoneunder“twilightanesthesia”orgeneralanesthesia.Therecoveryperiodisquitebriefandthepatientmayreturntoworktwoorthreedaysaftersurgery.Theoperationiscarriedoutonanoutpatientbasisinourofficesurgicalsuite. Theresultsofmastopexyareverygratifyingfortheproperpatient.

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Breast Reduction: Reduction Mammoplasty Asgratifyingasbreastaugmentationistosome,justasgratifyingattheoppositeendofthespectrumisbreastreduction. Largebreastscancauseproblemsinmanyareasofawoman’slife.Whentheyarelargerthantheusualstandardsofattractivenessinoursociety,thebreastsareconsideredaestheticallyunpleasing.Afull-breastedwomanmayappearheavierthanshereallyisandshemayhavedifficultyobtainingstylishclothing.Somewomenwithlargebreastsfeelveryself-consciousandteenagersmaynotdevelopproperpoiseandpostureastheytrytohidethefullnessoftheirbreasts. Theactualweightandbulkofthebreastsmaycausephysicalproblemsandsymptomsthatcompoundthefeelingofunattractiveness.Therecanbeafeelingofuncomfortablefullness,neckandbackpainandshouldergroovingfromclothingstraps.Theymaycontributetolimitedperformanceincertainoccupationsandinsports.Largebreastscanalsobedifficulttoassessforlumpsormasses. Thegoalofreductionmammoplastyistoreduce,re-contourandreshapethebreasts.Thebreastsaremadesmaller,thenippleareolaisrepositionedupwardandtheexcessskinisremoved.Thesurgeonwillattempttomakethebreastsasidenticalaspossiblebutoftensomeasymmetryremains.Thereareusuallythreeincisions;

oneincisionaroundthenipple,averticalincisionfromthenippletobeneaththebreastthatremainsvisibleforsometimeandanincisioninthebreastfold.IPLtreatmentsareavailabletoimprovetheappearanceofpost-surgicalincisions. Theproceduregenerallytakesthreehoursandisdoneonanoutpatientbasis.Theinitialrecoveryperiodisquitebrief;although,ittakessometimeforfinalhealingandshapingofthebreasts.Thereissomesorenessaftertheoperationbutthereisminimalpain.Generally,thepatientmayreturntowork4to7daysaftersurgery. Therearepossiblecomplicationsthatmustbeclearlyunderstoodandweighedpriortosurgery.Widescarsarethemostcommonproblemseenpost-operatively.Otherunusualcomplicationsareasymmetryofthebreasts,hematoma,infection,lossofnipplesensationandlossofnipple.Thesewillbediscussedindetailduringyourconsultation.Occasionallyaminorrevisionmaybenecessaryaftersurgery. Breastreductionisanoperationthatisenjoyingincreasingpopularity.Fortheproperpatient,theresultsareverygratifying.

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Breast Reduction: Reduction Mammoplasty (Front)

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Breast Reduction: Reduction Mammoplasty (Side)

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Brow and Forehead Lift Insomepatients,asaggingbrowmaygivethefacetheappearanceoftiredness,angrinessoraseverelook.Oftentimes,thecurtainofskinhangingfromtheuppereyelidmaybepartiallyduetosaggingoftheeyebrows,whichinturn,isduetoaloosenessoftheforeheadskin.Then,itmaybenecessarytoadvisethatthesestructuresberaised.Thisoperationmaybedoneatthesametimeasanuppereyelidprocedureorafacelift,orasaseparateoperation.Itisintendedtoimprovetheappearanceoftheeyebrowand/orforehead. Theforeheadliftnotonlyraisestheeyebrowsbutalsohelpsdecreasehorizontalforeheadwrinklesaswellastheverticalfrownlinesbetweentheeyebrows.Allthetissuesoftheforeheadareloosenedandthenpulledupwardandbackwardsothatitraisestheeyebrowsandsmoothesouttheforehead. Althoughthissoundslikearathermajorprocedure,itreallyisnotandhealingisusuallyuneventfulandrapid.Therefrequentlyissomebruisingandswellingaroundtheeyelidsforafewdaysandtherewillalsobesometemporarynumbnessofthescalpand/orforehead. Today,wecancarryoutforeheadliftsviaverysmallincisionsinthescalpandelevatethetissuewiththehelpofa“lightedoperatingscope.”Thistechniqueiscalledendoscopicforeheadlift.Theadvantagesofthisoperationareverysmallincisionsandaquickerrecovery;althoughmoreexpensive,thisprocedureoffersverysignificantimprovements.

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Breast Reduction: Reduction Mammoplasty (Front)

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Theseproceduresaredoneasanoutpatientunder“twilightanesthesia”inouraccreditedoperatingsuite.Routineactivitiescanberesumedwithin1or2daysandworkcanberesumedwithin7days;althoughcosmeticsordarkglassesmaybenecessarytoconcealtracesofbruisingorswellingwhichmayremain. Foreheadliftingisthesinglebestoperationtorejuvenatetheupperfaceproducingnotonlyayoungerupperface,butalsoalarger,fashionableandmoreawakeeyeshape.

Brow and Forehead Lift

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Cheek Bone Surgery: Malar Augmentation Highcheekbonesaregenerallyconsideredasignofbeauty,givingtheappearanceofyouthandvitality.Althoughwehavebeenutilizingcheekboneaugmentationformanyyearsinreconstructivesurgery,ithasbeenwithinthepast12to17yearsthatcosmeticsurgeonshaverecognizedhowthisprocedurecanbeusedtotransformarelativelyflatmidfaceintoamoreattractiveappearance.Althoughcheekbonesurgeryisoftenindicatedasasolitaryprocedure,itisfrequentlycombinedwithothercosmeticoperationstoenhancetheoveralleffectofsurgery. Cheekboneimplantsaremadeofahardsilasticmaterialthatisalsousedforpacemakersandotherimplants. Theoperationconsistsofinsertionofaproperlysizedimplantthroughasmallincisionmadewithinthemouth.Theincisionismadeabovethegumlineoneitherside.Asmalltunneliscreatedandthegraftisinserted.Itistemporarilyheldinplacebyasuture,whichispassedupintothehairlineandremovedtwotofourdaysaftertheoperation.Theoperationisperformedunder“twilightanesthesia,”andiscarriedoutinouraccreditedoperatingsuite. Thereismoderateswellinganddiscomfortassociatedwiththeprocedurelastingonlyafewdays.Themain

riskoftheoperationisthattheimplantmaynotbetolerated.Fortunately,thisisveryrareandevenwhenitoccurs,theimplantcanoftenberemovedandreplacedagainwithgoodresults.Infectioncanoccurbutitalsoisrareandusuallyrespondstoantibiotics.Routineactivitiesandworkcanberesumedwithin3days. Cheekboneaugmentationisarelativelynewandexcitingprocedurethatisrapidlygaininginpopularity.Theoperationisrelativelysimpleandsafeandjustlydeservesitsgrowingdemand.

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Chin Surgery: Mentoplasty Inevaluatingthefacialprofile,theshapeofthechinplaysaveryimportantrole.Inmanycases,arecedingchinaccompaniesanoverlylargenose.Inothercases,lackofadequatechinprojectioncanmaranotherwiseacceptableprofile.Fewpeoplerealizethatarecedingchinisquiteeasilycorrectedbysurgery. Insomecases,arecedingchinisrelatedtoafunctionalproblemintherelationshipofthelowerandupperjaws.Thistypeofrecedingchinmaybebestcorrectedbyshiftingtheentirelowerjaw.Usually,theproblemismerelyoneofappearance,andthisisbestcorrectedbyamuchsimpleroperationcalledaugmentationmentoplastyorchinimplant. Thisoperationmaybecombinedwithrhinoplastyorwithafaceliftprocedure;although,inmanycasesitiscarriedoutalone.Frequently,itiscombinedwithliposuctionsurgeryoftheneck(seediscussionofliposuction).Theimplantcanbeinsertedeitherthroughasmallincisioninsidethemouthoranincisionmadeunderthechin.Thechoiceofapproachwilldependonthedesiresofthesurgeonandthepatientaswellaswhetherornototherproceduresarebeingcombined.Forexample,withafacelift,asmallincisionisfrequentlymadeunderthechinforfatremovalorskinundermining.Inthiscase,thatsameincisioncanbeusedtointroducethechinimplant. Theoperationisquitesafe.Theimplant,madeof

Silastic,iswelltolerated.Afterwards,theremaybesometemporarynumbnessofthelowerlipandsomeswelling.Forthefirstfewweekswhenthepatientsmiles,thelowerlipwillfeelquitetightandthelowerteethmaynotbeproperlyvisible.Withinafewweeks,thefeelingandactionreturntonormal. Thisisoneofthemostrewardingproceduresinfacialprofilecorrectionsincesomanypatientsarenotinitiallyawareofthepossibilityofcorrectingarecedingchin.Itgivesbigdividendsinimprovedappearanceandpatientgratificationwithminimaldiscomfort.Theprocedureisdoneunder“twilightanesthesia”inouroperatingsuite.

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Mentoplasty (Chin Implant) Chin Surgery: Mentoplasty

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Eyelid Surgery: Blepharoplasty The Myths:Thereareseveralmisconceptionsabouteyelidsurgery.Twoofthemostprevalentinclude: 1. Theneedforitissolelyduetoagingand;therefore,reservedforolderindividuals.Thisis,ofcourse,untrue.Basedonheredityfactors,manyyoungerpersons,includingmanyteenagers,mayhave“bags”undertheeyesand/orpoorlydefineduppereyelids.Aheavyfoldofskinandtissueobscuresthenormaleyelidcreaseandcomesdowntothelashlinesoitobscurestheuppereyelid.Thisconditionmakesitvirtuallyimpossibletoproperlyapplycosmetics.Correctionofthisproblemsignificantlyimprovestheeyeandfacialappearancesothattheeyeslookmore“alive”andbecomeavibrantpartofthefacialexpression. 2. Theeyelidsurgerymustberepeatedeveryfewyears.Wrongagain!Whenproperlydone(notmerelyremovingalittlestripofskinbutactuallyresculpturingtheeyelid),theeffectsarepermanentandwillrarelyhavetoberepeated. The Facts:Usually,theupperandlowereyelidsurgeriesaredonesimultaneouslybuttheseprocedurescanbedoneseparately,dependingontheneedsofthepatient.Theunattractiveeyelidpresentstwoproblemsthatinvolvefatpouchesand/orexcessiveskinandtissues.

Lower eyelid:Extrudedfatfromtheeyeballcavityisusuallymorepronouncedundertheeyesandcauses“bags,”ortheappearanceofdarkcircles.Thisoftengivesaverytiredlooktotheface.Whenthisconditionoccursatayoungage,itisprobablyinherited;inolderpersons,thesebagsformaspartoftheagingprocess.Removalofthesefattydepositsissuccessfulandmakesthepersonlooklesstired,morealertandyouthful. Excessiveskininthelowereyelidshowsaswrinklesorcrepenessintheskin.Althoughthiscanbesomewhatalleviatedbysurgery,itwillnotdisappearcompletely.Thewrinklelinesbesidetheeye(“crow’sfeet”or“smilelines”)willnotberemovedbythissurgery.Somepersonshave“doublebags;”thesecondbagisanareaoffullnesslowerdownoverthecheekboneswhichisduetofluidretentionbythebodyandcannotbecorrectedbyanyacceptableconventionalsurgicaltechniques. Upper eyelid:Excessiveskinisusuallymostsevereintheupperlids,formingaheavyfoldthatdropsoverthenormallidcrease,overtheuppereyeliditselfandobscuresit.Sometimes,thisskineveninterfereswithvision,causingfrowningorheadaches.Surgerytocorrectthisconditionisverysuccessfulandcanhelpbothvisionandappearance.Cosmeticscanbeusedeffectivelytodrawattentiontotheeyeareaandgiveitamoreopened,youthfulappearance. Insomepatients,thecurtainofskinfromtheuppereyelidmaybepartiallyduetothesaggingofthe

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eyebrow.Then,itmaybenecessarytoadviseelevationofthosestructuresatthesametimethattheuppereyelidfacialprocedureisperformed.(Foradditionalinformation,seethesectiononBrowandForeheadLiftonpage21.) Anotherminorprocedurealsousedtoeffectivelyenhancethebrowresultislaserskinresurfacingwhichcanbedoneatthesametimeaseyelidsurgery(seeLaserSkinSurgeryonpage43).

After Surgery

Blepharoplastycauseslittleornopostoperativediscomfort.Itisextremelyrareforanyonetohavetotakepainmedication.Youwillbeaskedtoapplyointmentovertheincisionlinesforthefirstfewdays.Somebruisingorswellingisinevitable,butmostofthiswilldisappearwithinoneortwoweeks.Patientsareencouragedtoresumenormalactivitiesassoonaspossible. Forthefirstfewweeks,somepatientsexperienceintermittentflowoftears,slightblurringofvisionorasandyfeelingintheeyes. Theincisionlinesareplacedinsuchawaythattheyfallintoanaturalskinfoldandarehardlyvisible.Eyelidskinisverythinandhealsrapidly,usuallyresultinginverythin,threadlikescars.Forthefirstfewweeks,thesescarlines(likeanyotherscar)willbealittlered,slightlyirregularandbumpy,buttheseallresolveoveraperiodoftime.Withinaweekafterthesurgery,cosmeticsmay

beusedtohelphidethem.

Thisprocedureisdoneasanoutpatientunder“twilightanesthesia”inouraccreditedoperatingsuite.Routineactivitiescanberesumedwithoneortwodaysandworkcanberesumedwithinsevendays,althoughcosmeticsordarkglassesmaybenecessarytoconcealtracesofbruisingorswellingwhichmayremain.

Eyelid Surgery-upper Blepharoplasty

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Facelift: Rhytidectomy Rhytidectomy,betterknownasthefacelift,isbecomingincreasinglypopular.Astoday’smedicaladvancesincreaseourlifeexpectancy,manymaturewomenandmenbelievetheylookmucholderthantheyfeelphysicallyandmentally.Surgerycanhelpcounteractthisdiscrepancy.Rhytidectomyallowsapersontoprojectanewimageconsistentwithhisorherattitude. Asweage,wetendtodevelopwrinklingcausedbylooseskin.Thesesaggingtissuesappearasjowlsaroundthejawline,orasdoublechinsand/orloosenessoftheneckskin.Thefaceliftoperationisdesignedtoremovethislooseness. Therhytidectomyprocedurealonehelpsalleviateloosenessoftheneckmusclesandtheappearanceofthejowls.Verylittlechangecanbeexpectedintheupperportionofthefaceandnochangeatallintheforeheadregion.Forthisreason,thefaceliftisfrequentlycombinedwithotherancillarysurgicalprocedures.(Pleasereadtheappropriatesections,especiallytheBrowandForeheadLift,page21,andEyelidSurgery,page26.) Howlongtheimprovementwilllastcannotbeaccuratelypredictedbecauseitdependsontheagingprocessintheskin;thisvariesfromonepersontoanother.Ontheaverage,though,theimprovementlastsaboutseventotenyears;then,youmayhaveasmuchsaggingasyoudidpriortothesurgery.Butremember,

youshouldstillnotappearasoldasyoumightappearifyoudidnothavetheoperation.Inotherwords,thefaceliftcannotpermanentlypreventthenaturaleffectsofaging.Thesurgeoncanmerelyturnbacktheclock,butcannotstopitcompletely. Sincetheresultsoffaceliftsurgeryarenotpermanent,thepatientmaydesiretohaveanotheroperationatalaterdate,withfurthersignificantimprovement.Frequently,thesecondprocedureneednotbeasextensiveasthefirstoperation,butisusefulinmaintainingtheimprovedappearance. Thefaceliftwillalsonotcorrectthefineetchedwrinklingoftheskin,especiallyaroundthemouthandeyes.Separateproceduresarerequiredtoeliminatethiswrinkling.(SeesectiononLaserResurfacing,page45.) Inthepastfewyears,therehasbeensignificantchangeinthetechniqueoffaceliftsurgery. Withthenewertechniques,a“double”faceliftisperformed.Aftertheskinhasbeenelevated,a“deepfacelift”isdone;thatis,tighteningthedeepermuscletissues,fattytissues,etc.,toformafoundationforthenewdrapingoftheskin.Theexcessfattytissueisremoved(fatsculpturing)toreshapethecontourofthedoublechinandotherlooseskintissues.(SeesectiononLiposculpture,page32.) Incertaincases,weperforma“deep-planefacelift”or“subperiostealfacelift,”whichareusedforthecorrectionofspecificproblems. Aftermakingthisnewfoundationtheconventional

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aroundtheearandtheaffectedareasmaybeswollenandtendertopressure.Theseafter-effectsresolvethemselvesduringthenextseveralweeks. Discolorationoftheskinoverthefaceandneckisalmostalwayspresent.Eventhoughitmaynotappearasprominentlyasitdidthefirstcoupleofdays,thediscolorationgraduallyturnsyellowishandthendisappearsinaboutsevendays. Mostpeopleresumetheirroutineactivitieswithin7to10days.Judicioususeofcosmeticsisallowed. Theskinmustaccommodateitselftothemovementoftheunderlyingmusclesandtissues;sosomelooseningupdoestakeplaceduringthefirstfewmonths.Afewofthefinewrinklelinesmaypartiallyreappear.Thisisnotanindicationthatthefaceliftis“fallingapart,”becausefromthispointon,thechangesinthenextfewyearsshouldbeveryminimalandslow.Infact,mostpeopleactuallylookbetterafewmonthsafterthesurgerythantheydoafewweekspost-operatively.

For Better Healing

Duringthepastfewyears,wehavefoundthatsmokingplaysasignificantroleinthewaythatafacelifthealsandwilldefinitelyinfluencetheresultantscarlines.Foroptimalhealing,thepatientneedsagoodbloodsupplytotheskinedges.Sincemostoftheskinoverthefaceandneckhasbeenloosenedup,itsbloodsupplydependsontheperipheralareas.Ifthereisaninterferencewiththisbloodsupply(asoccursin

faceliftisperformedtoremoveexcessskin,butwithaminimalamountofskintension.Withthisdoublefacelift,theresultsaresignificantlybetterandshouldbemuchlongerlasting. Forfaceliftsurgery,thehairontheheadisnotcut,shavedoraltereddrastically.Thesurgicalincisionlineextendsfromthefrontoftheear,undertheear,alongthecreasebehindtheear,andthenalongthehairlinetowardthebackoftheneck.Mostoftheseincisionalscarscanbecoveredeasilybyhairstyling. Manypatientshavefattydepositsinthejowlsand/orunderthechincausingadoublechin,ortheymayhaveheavybandsrunningverticallyinfrontoftheneck.Therefore,aspartofthefacelift,anothersmallincisionisoftenmadejustbelowthechin.Throughthis,correctionscanbemadeinthecentralpartoftheneckandchin.(SeesectiononLiposculpture,page32.) Thefaceliftprocedureisdoneonanoutpatientbasisinourofficeoperatingsuiteoranaffiliatedhospital.

After Surgery

Youwearabandageforonedayandthismayberemovedathomeortheoffice.Youmayshampooyourhairandwashasyounormallydotwodaysaftersurgery. Thereisusuallyaminimalamountofpainaftersurgeryandsosomepainmedicationisrequired.Youwillexperienceanareaofnumbnessaroundtheearandsurroundingarea.Therewillbeafeelingoftightness

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smokers),thescarlineswillnothealaswell,portionsoftheskin“flaps”maybeundernourished,nothealwell,andresultinmorevisiblescarringespeciallyintheareabehindtheear. Ifyouareasmoker,itisimperativethatyoustopsmokingforatleastaweekpriortosurgeryandrefrainforatleasttwoweeksaftersurgery;thisshouldalleviatesomeoftheproblemsofscarformationandpoorhealing. Oncethisoperationwasconsideredthepromiseofactresses,matronsandthewealthy.Today,manyworkingmenandwomenfindthattheirappearanceisanimportantaspectintheircareersandemploymentopportunities,especiallyintoday’syouth-orientedsociety. Butmoreimportantly,afaceliftenhancesself-imageinadvancingyears,whenonecontinuestoenjoylifeandfeelwell.

Facelift - Eyelid Surgery and Laser Resurfacing

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Facelift and Mentoplasty (Chin Implant) Facelift - Forehead Lift, upper Lids with Laser of the Lower Lids.

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Facelift - Neck Liposculpture and Corner-of-Mouth Lift.

Fat Suction: Liposculpture, Tumescent Liposculpture, Ultrasound Liposculpture and Subsonic Liposculpture SincetheintroductionofliposuctionattheCosmeticPlasticSurgeryClinicin1983,theconceptandexecutionofliposuctionhasadvanceddramatically.Today,wemayutilizelaserincisionsthataresmallenoughthattheyhealwithoutscarformation,probesthatutilizeultrasound(sonicenergy)todissolvefat,andmicrocannulatoimprovethetextureoftheskinandcellulite. Liposuctiontodayutilizestheprincipleoftumescentinfiltration,thatis,theinjectionofrelativelylargeamountsoffluidintheareatobeliposuctioned.Thisfluidcontainsalocalanestheticandepinephrine(arelativeofadrenaline).Theresultofthisfluidinfiltrationisatemporaryhardeningofthetissuewhichallowsthesurgeontobettersculpttheareathatisbeingliposuctioned,andthepreventionofanybleeding.Infact,forthelast21years,wehavenotutilizedbloodofanykindonanypatientundergoingliposuctionincludingthelargestremovals(twogallonsoffat). Theidealpatientforliposuctionsurgeryisonethathasbulgesthatcannotbecorrectedthroughweightcontrolandexercise,orpatientswhoarepoorly

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Liposculpture - Hips, Thighs, Buttocks and Knees

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Liposculpture - Stomach, Waist, Hips and Back

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Liposculpture - Hips, Waist, Stomach & Thighs Liposculpture - Male Gynecomastia

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BEFORE AFTER

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proportionedintheirbodyparts.Thisindeedhappensbecauseofgeneticaccumulationoffatcellsincertainareas.Liposculptureisatechniquethatutilizeshighvacuumattachedtospecialprobesthatarepassedthroughtinyincisions,mostininconspicuousplacesaboutthebody.Fatcellsareliterallysuckedoutormeltedawaybyanultrasonicprobe,allowingthesurgeontoshapeandcontourvariouspartsofthebody.Liposuctionsurgerycanbeusednearlyanyplaceinthebody.Ithasprovenparticularlyeffectiveinthehipsandthighs,intheso-called“saddle-bag”area.Itisalsowidelyutilizedinthehiparea,intheso-called“love-handle”region,theabdomenandwaistareas,knees,armandbuttocks.Thesearetheareasthataremostfrequentlycontouredbyliposuctionsurgeryinfemales;however,inmalesliposuctioncanbeusedtocorrectgynecomastia(enlargedbreasts)andmostfrequentlyusedtoreduce“love-handles”andfatfromtheabdomen. Liposuctionsurgeryissuitableforbothmenandwomenandageitselfisnotadeterminingfactor.Whiletheprocedureremovesfatonlyanddoesnotremovetheoverlyingskin,excessskinorskinredundancyisusuallynotaproblemsinceitusually“shrinks”bytheuseofultrasoundprobesthatallowthefattobemeltedawayandtheskintobecontractedoverit.Celluliteinmanycasescanbeimprovedbytheuseofspecialmicroprobesthatseparatetheskinfromtheunderlyingscartissuethatcreatesthedimplesintheskin.Celluliteisalsoimprovedinsomeinstancesbytheuseofultrasoundlipoprobesthatproducesignificantskin

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contractionafterthefattytissueismelteddownbysonicenergy.

After Surgery

Surprisingly,therecoveryperiodisveryshort.Inmostinstances,ourpatientsareabletoreturntoworkwithinfourdays.Aspecialgarment(girdle)mustbeusedintheareatreatedforthreeweeksfollowingsurgerytoassistinthefinalshapingofthetissuefollowingliposuction.Itisnotinfrequenttohavelargeareaslookbruised;however,thisbruisingwillalwaysdisappearwithinafewweeks.Duringtherecoveryperiod,youareencouragedtobeasactiveaspossibleregardingroutineactivitiesandwalking.Afterthefirstweek,mostexerciseispermitted,exceptforjoggingandhigh-impactaerobics.Swimmingalsocanbestarted

BEFORE AFTER

Volume-Reduction Liposculpture

oneweekfollowingliposuction. Liposuctionsurgeryisdonesuccessfullyasanoutpatientsurgicalprocedurealmostuniversallyinourownaccreditedsurgicalsuite.Mostliposuctionsurgeriesarecarriedoutundergeneralanesthesia,andpatientsarerequestedtorestquietlyforadayorsoafterthesurgery. Painisusuallyquitemoderateandcanbecontrolledwithoralmedication.Patientsareabletogohomewithoutunduedifficultiesafewhoursaftertheprocedure.

About the Risks

Althoughanysurgicalprocedurecarriescertainrisks,liposuctionsurgeryhasbeencarriedoutfor21yearswithoutanyseriouscomplications.Commontemporaryproblemsaftersurgeryarenumbnessthatmayremainsometimeaftersurgery,acollectionoffluidthatmayrequiredrainageandslightirregularitiesthatsubsidewithfrequentmassage.

About Obesity

Liposuctionsurgeryisdefinitelynotawaytotreatobesity.Itisabodyshapingandsculpturingprocedureusedtoshapeandmoldoffendingbulges.Itisnotcarriedoutintheobesepatient.

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Fillers – Injectables Dermalfillersareusedformylolabialfolds,marionettelines,and,ingeneral,helptoplumplinesorwrinklesintheskinandfillindepressedareas. Weofferallavailablefillerinjections,suchasHylaform®,Radiesse®,Restylane®,Collagen,Alloderm®,etc.

Nose Surgery: Rhinoplasty Rhinoplasty,orcosmeticnasalsurgery,isoneofthemostcommoncosmeticproceduresperformedtoday.Theoperationisusuallyperformedbecauseapatientdesirestoimprovehisorherappearance.Itisalsofrequentlyemployedforrepairofinjuriesorforcorrectionoftheincreasingdisfigurementofthenosethatoccursasthepatientgrowsolder.Otherpatientsmayseeksurgerybecauseofobstructionsinsideofthenosethatimpairbreathing,causeheadachesorleadtosinusinfection. Becauseofthefrequencywithwhichtheoperationiscarriedout,technicalrefinementshaveallowedconsistentlygoodresultswhicharebetterthanwerepossible25yearsago.Nevertheless,patientsmustrecognizethatthegoalofthisoperationisimprovementandnotperfection.Duringyourconsultation,wewillreviewseveraltypicalbeforeandafterpictures.The

purposeofseeingotherpatientsisnottoallowyoutopickoutthenosethatyouwant,butrathertogiveyousomeideaofthetypesofresultsthataregenerallyachievedinthistypeofsurgery. Thetimingofthenasalreconstructionwilldependonmanyfactors.Ingeneral,cosmeticrhinoplastyshouldbedelayeduntilapatient’sfacialdevelopmentisapproachingmaturity.Thisisusuallyaroundtheageof14forgirlsand15forboys. Whensurgeryiscarriedouttocorrectbreathingproblemsortocorrectdeformityproducedbyinjury,itisoftenadvisabletoproceedwiththeoperationatanearlierage.Thereisnoupperagelimitfornasalreconstruction.Patientsintheirsixtiesandseventieschoosetohavethisoperationwithgoodresults.Wearenowbeginningtoseemorepatientscombinenasalreconstructionwithothertypesofsurgeryforagingsuchasfaceliftorcorrectiveeyelidsurgery. Theoperationiscarriedoutinouraccreditedoperatingsuiteonanoutpatientbasis,undergeneralanesthesia.Withfewexceptions,theincisionsareallmadeinsidethenoseandsoscarringisavoided.Eachoperationisdifferent,butbasicallytheprocedureinvolvesshiftingorremovalofboneandcartilageandisthereforeprimarilyamodificationoftheframeworkofthenose.Skinredrapesitselfoverthenewnasalframework.Manypatientswillcombinechinorcheekbonesurgery(seepages24and23)withrhinoplasty.

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After Surgery

Noseblowingshouldbeavoidedforthefirstweek.Sneezingshouldnotbeaproblem,aslongasthepatientsneezeswithhis/hermouthopen. YouwillbeinstructedtobeginapplyingBacitracinointmentthedayfollowingsurgery.Afterdippingacottonswabintheointment,thepatientshouldinsertitinsidethenoseandwipeitabout.Thiswillloosenandremovecrustinganddriedblood.Drainageandslightoozingofbloodarenormalforafewdays.Breathingwillberestrictedthefirstweekandthengraduallybegintoimprove.Significantbleedingproblemsfollowingsurgeryareveryrare. Aftertheoperation,acastisplacedoverthenosethatremainsinplaceforaweek.Inmostcasesthenoseisnotpacked.Afterremovalofthecast,theremaybesomeswellingandbruising,butbytheendofoneweekmostpatientsfindthattheswellinghasresolved. Patientsmustunderstandthatalthoughthemajorportionoftheswellingresolvesquickly,somewilllastforafewmonthsaftertheoperation.Ingeneral,theappearanceofthenosecontinuestoimproveforaslongasayearaftertheoperation. Aftertheremovalofthedressings,thepatientmustbeverycarefulthatthenoseisnotinjureduntilcompletehealinghastakenplace.Theframesofglassesshouldnotbeallowedtorestonthebridgeofthenoseforthreeweeks.Contactlensesmaybeusedtwotothreedaysfollowingsurgery.

BEFORE AFTER

Septal Nasal Reconstruction

BEFORE AFTER

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Innearlyallcases,thereissignificantimprovementintheappearanceandfunctionofthenoseafterrhinoplasty. Mostpatientsarehighlysatisfiedwiththeresultsofrhinoplasty.Duringtheconsultation,thesurgeonandpatientwillhavetheopportunitytodiscusstheindividualgoals,risksandlimitationsindetail.

Protruding Ear Surgery: Otoplasty Otoplastyisthesurgicalprocedureusedto“pinback”orrepositionflyawayloopearsclosertothehead. Thisdeformitycausesdeepemotionalscarring,andisnotoftenrealizedbyeventheparentsofchildrenwhohaveit. Becausethevisualandpsychologicalimprovementaftertheoperationisusuallydramatic,itishighlyrewardingtothepatient,thefamilyandthesurgeon. Thesurgeryisperformedpreferablyonthepreschoolchild,beforetheageofsixyears,toavoidclassroomteasing.Theoperationcanbedoneatanytimelater;infact,mostpatientsareteenagersoradults. Anincisionismadebehindtheearwhereitjoinsthescalpandsomeoftheskinisremoved.Thecartilageisreshapedbyincisionandsuturestoobtainabettershapeandtohavetheearlieclosertothehead.

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Thescarsresultingfromtheincisionsarelocatedbehindeachearandarehiddenbythecreaseoftheears.Thedepthofthefoldbetweentheearandthescalpwillbedecreased;therefore,ifthepatientisaccustomedtowearingeyeglasses,areadjustmentoftheframeswillbeadvised. Thesurgeryisperformedonanoutpatientbasisunderlocal“twilightanesthesia”(orgeneralanesthesiainchildren).

After Surgery

Afterleavingtheoffice,thepatientwearsatightbandageforthefirst24hours.Ifadrainwasused,itisremovedattheoffice24hourslater.Therewillbepainanddiscomfortintheearsandpainmedicationwillberequiredfortwotothreedays.Afterthefirst24hours,thebandagesmayberemovedandreplacedwithaskibandthatisworntokeeptheearssnugagainstthesideofthehead.Thisbandshouldbewornconstantly,24hoursaday,forthenextsevendays.Then,thepatientneedonlywearitwhilesleepingforthenextoneortwoweeks.

Otoplasty (Ear Pinning)

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Tummy Tuck: Abdominoplasty Abdominoplastydescribesagroupofdeformitiesthatarecorrectedbymanydifferentbody-contouringmethods.Ingeneral,tummytucksaredesignedtocorrecttheabnormallylooseskin,multiplewrinklingorfoldswhichdevelopinthestomach,whetheritbearesultofaging,childbearingorrapidweightloss. Inthelastfewyears,Ihavefoundthatalargenumberofpatientswhowouldneedtobetreatedbyatummytuckprocedurecannowbetakencareofbyliposuctionsurgery(seesectiononliposuctiononpage32).Insomeinstances,butparticularlywhenthepersondesirestogetridofmostoftheloosewrinkledskin,anabdominoplastyisnecessary. Abdominoplastyisdoneonanoutpatientbasisatouraccreditedoperatingsuite.Itmaybecombinedwithcorrectionofumbilicalherniasorpoormusculatureintheabdomen.Insomeinstancestheseancillaryproceduresarecoveredbyinsurance;however,most“straight”tummytucksarenot.Iprefertousegeneralanesthesia. Anincisioniscarriedoutimmediatelyabovethepubicarea(thehairbearingareaofthegenitalarea)andextendinglaterallytowardthehipitself.Throughthislowerabdominalincision,theskinandfattytissuemaybeelevateduptotheribcage.Aftertherightamountofskinandfathasbeenremoved,anewnaveliscreated.

BEFORE

AFTER

Tummy Tuck: Abdominoplasty

BEFORE AFTER

BEFORE AFTER

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Tummy Tuck: Abdominoplasty

BEFORE AFTER

BEFORE AFTER

Tummy Tuck: Mini Abdominoplasty

BEFORE AFTER

BEFORE AFTER

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Theskinisstretchedinferiorlyandtheexcessskinandfattytissueiscompletelyremoved.Thestomachmusclesaregenerallystrengthened.Thewoundisclosedwithseveralrowsofsutures. Usuallytwodrainsareplacedinthelowerportionoftheincisionandthesedrainsareremovedwithin24hoursofthesurgery.Apressurebandageorgirdleiswornforthreeweeks.Followingsurgery,thereismoderatepainthatisusuallyeasilycontrolledwithoralmedication.Prescriptionsupportstockingsshouldbewornatalltimes;lightactivitiescanberesumedimmediatelyaftersurgery,androutineactivitiesfromtheseconddayonwithcaretoavoidheavyexertion.Werecommendwalkingasthebestall-aroundexercise.Abdominalcrunchesandexercisesshouldbeavoidedforfourweeks. Aswithmanysurgeries,therearerisksandcomplicationswithanabdominoplasty,whichhappeninapproximatelyfourtofivepercentofthecases.Therisksincludebleeding,whichinmostinstancesisminor,andrequiresonlytappingofsmallbloodcollectionswithaneedle.Occasionallytheaccumulationoffluidinthelowerportionoftheabdomen(seroma)willrequiresimilartreatment,removalbysyringe.Althoughmoreseriouscomplicationslikepulmonaryembolismhavebeenreported,theyappeartobeveryrareandpreventable. Anabdominoplastyshouldbeconsideredasatrade-offbymostpatients.Thatis,theywouldbetradinglooseskinforascarlocatedintheareajustdescribed.

Althoughthisscariscompletelyhiddenbybikinisorpanties,itisnecessarythatthepatientunderstandthatanincisioninthelowerpartoftheabdomenisanabsolutenecessityfortheperformanceofthissurgery. Othercomplicationsincludeskin-healingdifficulties,usuallyrelatedtotensioninthewound.Mostoftheseresolvewithoutadversecomplications.Inthepastfewyears,thecombinationofliposuctionsurgeryandabdominoplastyhavegivenusexcellentresultsandwhetherthisisapplicableforyourcarewillbediscussedatlengthinyourprivateconsultation. Inselectedcases,abdominoplastycanbecarriedoutwithoutincisionsutilizingendoscopictechniques.

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Skin Rejuvenation:Ablative and Non-Ablative–Laser Skin Surgery Today,withrejuvenationoftheskinandreversaloftheagingprocessofparamountimportanceinthemindsofmany,theoptionsandtreatmentshavevastlyimprovedandwecandividethemintoablativeprocedures(thatbreaktheskindown)andlessaggressivenon-ablativeprocedures(thatleavetheskinintact).Theprincipalchangesofagingskinareasfollows:

• Wrinkles• Blotchiness• AgeSpots• BrokenBloodVessels

Allofthesechangescanbereversedwithtoday’streatment.Byproperlymatchingthedegreeofinjurytotheskinorskindamagetotherighttreatment,thepatientisassuredofthebestresultswhileminimizingrisk,inconvenienceandcost.Manyoftoday’smethodsallowthepatienttoreturnbacktoworkonthesamedayoftreatment.Thefollowingisasimplifiedtableforproperlymatchingthedegreeofskininjurytotherighttreatment.

Skintypeclassificationbyreactivitytothesunisanindicationofhowwellasubject’sskindefectswillrespondtotreatment.The best candidates for treatment are types 1 through 3;however,withmodernmedications,suchasretinoicacidandbleachingcreams,onemaytreatnearlyalltypesofskinsuccessfully.Table No. 2

Table No. 1

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Laser Resurfacing by CO2 Laser and Phenol Peel

Inthisgroup,patientswithadvancedphotoaging,frequentskinlesions,acnescarring,heavywrinklingwithmuchlaxityoftheskinatrestandwithfacialanimation,patientsneedingheavymake-upwithlimitedsuccessandacakeylook,arepatientswhoarebesttreatedbyCO2laserandphenolpeel.Laserresurfacingrequires7-9daysofrecuperation,butgivesanexcellentresultwithverysignificantskinrejuvenationandformationofnewcollagen.

Table No. 3

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Laser Skin Surgery

Skin Rejuvenation by Laser - Laser Resurfacing Surgery Cosmeticlasersurgeryhascometotheforefrontoffacialrejuvenationsurgicalprocedures.ThishasactuallyevolvedovermanyyearsanditismostrecentlyduetosignificantchangesintechnologywiththeapplicationoftheCO2laser.WhiletheCO2laserhasbeenusedinmedicineforalmosttwodecades,recentadvancesincludingthesuperpulseCO2lasermodeandthethirdgenerationofCO2lasers,havemadecosmeticfacialrejuvenationmoreviableandtheresultsmorepredictableanddesirable. Itisforthisreasonthatlaserresurfacinghasbecomeamostpopularandeffectivemethodoftreatmentofsundamagedskinorphotoaging,laxoragingskin,wrinklesandfacialscarringsuchasthatduetoacne.Itisalsousefulforotherconditions. Lasersurgeryiscarriedoutonanoutpatientbasisunderanesthesia.Followinglaserresurfacing,theskinappearspink,moistandusuallyquitesmooth.Theouterlayershavebeenremovedduringthesurgicalprocedureandaftertheanestheticwearsoff,theskinwillbesomewhattenderandsomeswellingisexpectedforthefirsttwotothreedays.Aburningsensationwillbepresentbutwillbehelpedbythemedicationprovided.Itisimportanttokeeptheheadelevatedas

Table No. 3 Continued

muchaspossiblefortwodaysfollowingthesurgicalprocedure.Areclinerismosthelpfulsinceitallowsonetobeabletosleeponhis/herback.Whiletheabilitytoworkisnotimpaired,mostpatientsmayreturntoworkandsocialactivitieswithin7to10days,dependingontheextentoftreatment.Theskinatthatpointwilllookredandsunburnedinappearance;however,makeupisusedaftertheseventhday.OurSkincareDepartmentcanteachyouhowtocamouflagethepinkorredskinappearancequitewell.Exercisesmayberesumedwithinoneweek.Extremesofheat,coldandwindshouldbeavoidedforseveralmonths. Oncetheskinhashealed,itisimperativetoavoidsunexposureforatleastsixweeks;otherwise,sunburn,hyperpigmentationandothercomplicationsmayoccur.Laseredareasshouldbeprotectedbyusingwide-brimmedhatsandpotent,broad-spectrumsunblockproducts(thatprotectagainstbothUVAandUVBexposure)foratleastsixmonths. Priortolaserresurfacing(andincludedinthecostoftheprocedure),anappointmentwillbemadeforyouattheofficeformicrodermabrasion.Thissimplenon-ablativeprocedurewillremovetheupperlayersoftheepidermisthatcontainsdeadskincells(keratin).Thisallowsforproper,evenpenetrationofthelaseratthetimeoftheprocedure.Followingthesurgery,specialproductsthatenhancethegrowthofnewskinwillbeappliedtothefaceforthefirstweek,whichwillfacilitateandspeedupthere-growthofnewskinandtheformationofnewcollagen.Aftertheskinhashealed,a

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bleachingcreamandsunblockwillbeprescribed. Laserresurfacingincombinationwithfaceliftandotherfacialrejuvenationprocedures(eyelidsurgery,foreheadlift,etc.)hasproducedextremelygoodresultsfortotalfacialrejuvenation.

Skin Sanding – Dermabrasion Dermabrasionisprimarilyusedforthesmoothingofsurfaceirregularitiesproducedbythescarsofacne.Itcanalsobeusedinthetreatmentoftheagingfacetosmoothwrinkledskin.Dermabrasionismostoftencombinedwithfullfaciallaserresurfacingforthetreatmentofacnescars.Itisatechniqueinwhichtheskinismechanicallyabradedwithaspecialsurgicalinstrument.Theprocedureisdoneinouraccreditedoperatingsuiteonanoutpatientbasis. Oncedermabrasioniscompleted,theareasarecleansedandadressingisapplied.Thedressingwillberemoved24hourslateratourfacility.Thedermabradedareagenerallyoozesforapproximately48hoursanditmustbecontinuouslycoveredwithaspecialcreamprovidedbyouroffice,whichpreventsdrynessandpromoteshealing.Followingsurgery,thefaceandeyelidsaregenerallyswollenfor48hours.Itishelpfultosleepwiththeheadelevated.Facialswellingdiminishesrapidlyafterthethirddayandtheskincangenerallybecoveredwithcosmeticsinsevendays.Itisimportantthatthepatientavoidsunexposurecompletelyforthefirstsixweeksfollowingtheprocedure,andcontinuestobecarefulaboutsunexposureforthefirstsixmonths.Asunblockofatleast45SPFisusedforthefirstsixmonths,andoccasionallyableachingagentisalsoused. Theskinwillappearpinkforanywherefromthree

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tofourweeks;however,itcaneasilybecamouflaged.Mostpatientsexperienceonlyamildamountofdiscomfortandburningfollowingthedermabrasion.Thisiseasilycontrolledwithmedications.Mostpatientsresumeworkwithin10daysofafull-facedermabrasion. Patientswhohavehadrepeatedcoldsores(herpesIinfection)ofthelipsandfacecoulddevelopcoldsoresaftersurgicaldermabrasion.Pleasebesuretoletthisofficeknowifyouhaveahistoryofthiscondition.Allofourpatientsareplacedonprophylacticantibioticandanti-viralmedications.Thisisparticularlytrueinpatientswhohavehadcoldsoresinthepast.

IPL (Intense Pulsed Light) and Laser Treatments Bothlifestyleandtheinevitablepassingoftimetendtomagnifytheagedappearanceofourskin.Tomanyofus,itisimportantthatourouterappearancereflecttheyouthfulnessofourinnerspirit.AtCosmeticPlasticSurgery,webelievethatwecanhelptoattainthosegoalsthroughproperskincareandIPL/Lasertechnology. IPLandLasertechnologyisanon-ablative,safeandeffectivetreatmentthatnotonlyofferssolutionstonumerousskinimperfections,butalsoallowsustotreatallthoseimperfectionsatthesametime.ThisFDA-approvedtechnologyworksbydirectingdifferentwavelengthsoflightenergybelowtheskin’ssurfacetobreakdownandeliminateunwantedpigmentationandotherskinimperfections,allwithoutdisturbingsurroundinghealthytissue.TheIPLsystemhasitsowncoolingsystemtoprotecttheskinandminimizediscomfort. IPLandLasertechnologycantreatskinconcernssuchasfacialrednessorRosacea,brown-tonedspotsfromsundamageandaging,brokencapillaries,unevenskintoneandtexture,largepores,portwinestains,aswellasfinelinesandwrinklesthroughaprocesscalledphotorejuvenation.Manypatientspairphotorejuvenationwithmicrodermabrasion(seepage51)forthebestnon-ablativeresultsavailable.

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Treatmentisgenerallyadministeredin3-6treatmentsessionstoprovideimpressive,long-lastingresults.Thisprovidesgradualimprovementthatallowsyoutoreturntoyourbusyscheduleimmediatelyfollowingtreatment.Forpatientswhoarelookingforamoreaggressiveapproach,withfewersessions,weofferIPLwithaminolevulinicacid.Anestheticcrèmecanbeappliedtominimizediscomfort,butisrarelyneeded.Tanskincannotbetreated.Patientsmustmakeacommitmenttorefrainfromsuntanning,andself-tanninglotionsfor28daysbeforetreatmentand28daysfollowingtreatment. Aftertreatment,patientscanexpectsomerednessandpossibleswelling,whichwillresolvein24-72hours.Mineralcosmeticscanbeappliedimmediatelyfollowingtreatmenttocoverupanyrednessuntilitdissipates.

Hair Reduction Althoughwedonotyethavetheabilitytototallydestroyhair,wehavethetechnologyavailabletoreducehairinaverysignificantwayandtolightenandsoftenthehairthatsometimesremains. TheIPL(IntensePulsedLight)orLaserworkstoreducehairbytargetingthedarkpigment(melanin)inthehairshaft.Themelaninabsorbsthelightenergy,heatsupthehairbulbthatgrowsthehairatthebaseofthefollicle,causingpermanentinjurytothehairfollicle,withoutcausingdamagetosurroundingtissue.Becauseofthisprinciple,whitehaircannotbetreatedsuccessfully.Whitehairisnotabletotransferenergy

sincethereisnopigmenttotarget.Thebestcandidatesforhairreductionarethoseindividualswhohavedarkhairandlightskin. Thenormalgrowthcycleofhairconsistsofthreestages–Anagen(activegrowthstage),Catagen(stageinbetweenAnagenandTelogen),andTelogen(dormantorsleepingstage).Itisimportanttounderstandthatnotallhairfolliclesareproducinghairatthesametime.AverysignificantnumberofhairfolliclesareintheTelogenstagewherenohairispresent.Whenoneutilizesthesetechniquestoinjurehair,thedormanthairwillnotbeaffectedbecausethereisnothairavailabletotransfertheenergyanddamagethefollicle.Sinceonlythegrowinghaircanbesuccessfullytreated,severaltreatmentsarenecessarytocatcheachhairfollicleinitsgrowthstage. Thetreatmentisperformedintheprivacyofouroffice.Thereisatolerableamountofdiscomfort.Anestheticcrèmecanbeappliedtoreducediscomfortbutisrarelyneeded.Tanskincannotbetreated.Patientsmustrefrainfromsunexposure,tanningbedsandself-tanninglotions28daysbeforeand28daysaftertreatment. Themostfrequentlytreatedareasonmalesaretheback,armsandchest.Femalesmostoftenrequesttreatmentofthebikiniline,underarmsandface.

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Vein Treatment:IPL and/or Laser Treatment for Veins AtCosmeticPlasticSurgery,wecanofferfourmajoradvantagestothosewhochoosetohavetheirvenousimperfectionstreatedwithourIPL(IntensePulsedLight)orLasertechnology–noneedles,nocutting,noscarringandnostockingsorbandages. IPLand/orlaserenergyveryeffectivelyselectsanddestroysbloodvesselsofvarioussizesanddepthswithoutdamagingthesurroundingtissue.TheIPL/Laserhasitsowncoolingsystemtoprotecttheskinandminimizediscomfort.Thelightpenetrates,thencoagulatesthevessel,whichiseventuallyreabsorbedbythebody. Candidatesforthistreatmentwouldbethosewithtelangectasia,spiderveinsoftheface,bodyorlegs,andreticularveinsthatarelessthan4mmindiameter.Largerveinsarebesttreatedbyageneralorvascularsurgeon.Acommitmenttoavoidthesun,tanningbedsandself-tanninglotionsisrequiredfor28daysbothbeforeandaftertreatment. Thistreatmentsuccessfullydestroysapproximately90%ofalltreatedveinsandblemishes.Itgenerallytakes4-8weekstoseetheeffectsofthetreatment.

Post-Treatment

Thetreatedareasdonotrequirebandagesorstockings.Theremayberednessandinflammationoftheskin(muchlikethatofacatscratch)thatwillresolvein48-72hours.Sometimes,bluishorbrownspotsmayappearinthetreatmentarea.Thisisnormalandwillresolveaswell.Patientscanreturntomostnormalactivitythedayoftreatment.Webelievethisisthebestwayoftreatingvenousimperfectionsaswellastheleastinvasivetreatmentfortheseconditions.

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Skin Care: Complete Skin Rejuvenation AtCosmeticPlasticSurgery,weofferacompleteskincareprogram.OurSkinCareDepartmenthasbeendevelopedtoprovideourpatientswiththebestavailabletreatmentutilizingpharmaceuticalgradeskincareproductscontainingexfoliants,aswellasRetinol,bleachingagents,anti-agingactiveingredients,moisturizersandbroad-spectrumsunblocks.TheproductsthataremadespecificallyforCosmeticPlasticSurgeryhavehistoricallygiventhebestresultsinrejuvenationofagingskinandtreatmentofsensitiveskintypesaswell. Ourtreatmentconsistsofanevaluationbybothaphysicianandatrainedmedicalskincarespecialist.Aprogramisthendesignedandtailoredtohelpyouachievelastingimprovementinthewayyourskinlooks,actsandfeels.Aftertheappropriateproductsareselected,thepatientiseducatedonhowtousethemandinsomeinstancesthisiscombinedwithamedicalmicrodermabrasion,chemicalpeel,skinrejuvenatingmaskorIPL(intensepulsedlight)orlasertreatment. Inaddition,weofferafulllineofpharmaceuticalgrademineralmake-up.Itnotonlyprovidesskinnurturinganti-oxidantsandUVprotection,butalsoprovidesyourskinwithradiant,flawlesscoverageintheseason’slatesthues.Ourskincarespecialistisavailabletohelpyouselectthebestcolorsforyourskintoneandguide

youinapplicationtechniquesandcamouflage.Thesecosmeticsarenon-comedogenic,containnoperfumesorchemicaldyes,andareevensuitableforsensitiveskintypesandconditions. Withtheabundanceofskincareproductsonthemarkettoday,weunderstandhowconfusingitcanbeforyoutoselectproductsthatworkforyourskincareneeds.Therefore,Dr.Castilloofferscomplimentaryskincareandcosmeticconsultationswithourmedicalskincarespecialiststoallestablishedpatients.

Microdermabrasion, Chemical Peels and Medical Microdermabrasion Microdermabrasionisanon-invasiveformofskinresurfacing(exfoliation)thatremovesthetopmostlayerofskincells,leavingyourskinsupple,vibrantandrefreshed. Chemicalpeelsareanotherformofexfoliationusedtoimproveanumberofskinimperfections.Chemicalsolutionsareusedtoloosendeadskincellscreatingasmoother,softerandmoreevenskintone.Chemicalpeelsareavailableinmanydifferentstrengthsandformulations,allowingustodesignatreatmentprogramespeciallyforyourskincareneeds. Forenhancedresults,microdermabrasioncanbeimmediatelyfollowedbyachemicalpeelandvitaminnutrientoxygenfacial.Thiscombinationtreatmentisreferredtoas“medicalmicrodermabrasion.” Thesetreatmentsareveryeffectiveforthose

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withmildtomoderatesundamage,largepores,unevenskintexture,slightyellowskindiscoloration,hyperpigmentationandfinelines.Itistypicallybesttobeginwithaseriesof6treatments(dependingontheseverity);however,thesemayalsobedoneasastand-alonetreatment.Eachtreatmentisscheduledapproximately1-2weeksaparttoobtainmaximumresults.Manypatientsthenchoosetocontinuetoscheduleasinglemedicalmicrodermabrasiontreatmenteveryfewmonthsasa“maintenance”programtoassurearadiant,healthylookingskin.Allofthesetreatmentsallowthepatienttoreturntoworkornormaldailyactivityimmediatelyfollowingtreatment.Patientscanexpectsomepinknessorrednessoftheskin,whichtypicallygoesawaywithinthehour.Cosmeticsmaybeappliedimmediatelyfollowingthesetreatmentstocoveranyresidualredness.Aprofessionalmineralbasecosmeticisrecommended.

G.D. Castillo, M.D., F.A.C.S., LTD.Cosmetic Plastic Surgerywww.cosmeticplasticsurgery.com

2409 East Washington Bloomington, Illinois 61704

Headquarters: Champaign-Urbana1804 Woodfield Drive • Savoy, Illinois 61874

tElEpHonE: Champaign (217) 359-7508 Bloomington (309) 662-0436 toll-Free (800) 252-7123

Education:

Bachelor of Sciences from University Center Degree of Doctor of Medicine from national University, Mexico Internship - Colorado University Hospitals, Denver, Colorado (presbyterian Hospital) Surgical Internship - Community Hospital, Roanoke, Virginia Surgical Residency - Henry Ford Hospital, Detroit, Michigan Residency in Facial plastic and Reconstructive Surgery, Wayne State University, Detroit, Michigan

Board Certification:

American Board of Facial plastic and Reconstructive Surgery - Diplomat, verification available at www.abfprs.org American Board of Cosmetic Surgery – Diplomat, verification available at 708-474-7200

Teaching Appointments:

Clinical Associate in Cosmetic Surgery - University of Illinois College of Medicine, Urbana Campus. Faculty, Board of Cosmetic Surgery Review Course. Faculty, guest lecturer and multiple scientific national and international meetings in facial, plastic and general cosmetic surgery.

Professional Organizations:

American Academy of Cosmetic Surgery - Fellow American Academy of Facial plastic & Reconstructive Surgery - Fellow American Academy of Head and neck Surgery - Fellow American College of Surgeons - Fellow American Society of liposuction Surgery - Fellow International Academy of Cosmetic Surgery International Academy of Aesthetic Surgery and Aesthetic Medicine

Honors:

past-president of the American Academy of Cosmetic Surgery (1997/1998), (the American Academy of Cosmetic Surgery is the largest scientific organization in the world dedicated exclusively to cosmetic surgery). president of the American Society of liposuction Surgery (1997/1998) Senator, University of Illinois (1997/1998) past-trustee, American Academy of Cosmetic Surgery Editorial Board Member, Journal of Aesthetic Dermatology and Cosmetic Dermatologic Surgery. Editorial Board Member, American Journal of Cosmetic Surgery

Publications and Scientific Journals and Books:

Multiple scientific papers published in the American Journal of Cosmetic Surgery, Otolaryngology Head and Neck Surgery, and Michigan Medical Journal. Understanding plastic Surgery, How to Get the Best Results. Update on Breast Surgery. published scientific thesis in blood gases in the ethiopathology of shock. Multimedia Source: Quoted in electronic media, major publications and fashion magazines; i.e., New York Times, Wall Street Journal, UPI, CNN, ABC, CBS, Longevity, Harper’s Bazaar, GQ, etc.