Cosmetic Surgery

A chemical solution is used to improve and smooth the texture of the facial skin by removing its damaged outer layers. It is used to correct facial blemishes, uneven skin pigmentation and wrinkles. A combination of phenol, trichloroacetic acid (TCA) and alphahydroxy acids (AHAs) are used in a chemical peel. The precise mixture may be adjusted to meet the needs of the individual patient.

A chemical peel is not a substitute for a facelift and will not prevent or slow the aging process. A chemical peel may be performed in conjunction with a facelift.

Although most chemical peels are performed for cosmetic reasons, the procedure can also be used to remove pre-cancerous skin growths, soften acne facial scars and control acne. Health insurance may cover the procedure in certain cases. Be sure to check with your insurance provider for more information.

The mildest of the peel formulas are called alphahydroxy acids (AHAs). They can provide smoother, brighter-looking skin and can be used to treat areas of dryness, fine wrinkling, uneven pigmentation and acne. To obtain the best results, AHA may be applied weekly or at longer intervals. An AHA can also be mixed with a facial wash or cream in lesser concentrations as part of a daily skin-care regimen to improve the skin’s texture. Your physician will decide what course is best for you at your initial consultation.

Trichloroacetic acid (TCA) is commonly used for medium-depth peeling to treat superficial blemishes, surface wrinkles and pigment problems. In many cases, more than one TCA peel may be needed to achieve the desired result.

Phenol is the strongest of the chemical solutions and is used to treat patients with coarse facial wrinkles, areas of blotchy or damaged skin caused by sun exposure or pre-cancerous growths. Phenol produces a deep peel and is primarily used on the face. Scarring may result if it is applied to other areas of the body.

In a chemical peel, some unpredictability and risks such as infection and scarring are possible but infrequent. Stinging, irritation, redness and crusting may be caused by AHA peels. However, these problems should subside as the skin adjusts to the treatment regimen.

If you have a TCA peel, you will probably be advised to stay out of the sun for several months after your treatment to protect the newly formed layers of skin. TCA may also produce some unintended color changes in the skin.

The new skin frequently loses its ability to tan after a phenol peel. This means you will always have to protect the skin from the sun. Phenol may also pose a risk to patients with a history of heart disease. So be sure your doctor is aware of your medical history. On rare occasions, phenol may cause uneven pigment changes.

Alphahydroxy acids (AHAs) are used to assist in the control of acne, to smooth rough, dry skin and to improve the texture of sun-damaged skin. It can also be mixed with a bleaching agent to correct pigment problems or used as a pre-treatment for TCA.

As with most peel treatments, sunblock must be used after an AHA treatment. A series of peels may be necessary to achieve the desired results.

Trichloroacetic acid (TCA) is used to correct pigment problems, smooth out fine surface wrinkles and remove superficial blemishes. A TCA treatment takes about 10-15 minutes and can be used on the neck and other body areas. It may require a pre-treatment with AHA or Retin-A creams.

TCA is preferred for darker-skinned patients and healing is usually fairly quick. The peel depth of a TCA treatment can be adjusted. Repeat treatments of TCA may be needed to maintain results. Sunblock must be used for several months after the procedure.

Phenol is used to remove pre-cancerous growths, to smooth out coarse wrinkles and to correct blotches caused by birth control pills, aging and sun exposure. Phenol can be used only on the face and is not recommended for patients with dark skin. The procedure may also pose a risk for patients with heart problems.

It may take an hour or more for a full-face treatment using phenol. Complete healing may take several months after the procedure. The results of phenol are dramatic and long lasting. It can cause permanent skin lightening as well as the loss of freckles.

Be sure to find a qualified surgeon who has experience in skin resurfacing before deciding on your chemical peel. Many states permit non-physicians to administer certain peel solutions.

Be sure to discuss your expectations with your plastic surgeon during your initial consultation. Also, ask your surgeon any questions you may have about the procedure. Your surgeon will explain the procedure in detail as well as its risks and benefits. Be sure to find out about your expected recovery time and the costs involved. Chemical peel treatments are only covered by insurance if they are performed for medically related problems.

Your plastic surgeon will tell you how to prepare for the procedure. Retin-A may be used to pre-treat the skin. The medication thins out the skin’s surface layer so the TCA solution can penetrate the skin more deeply and evenly. An AHA cream may also be used for this purpose.

A bleaching agent called hydroquinone may be used with Retin-A or AHA cream if you have blotchy skin or pigmentation problems. Some patients spend more than a month in the pre-treatment phase before the actual peel.

Your plastic surgeon will perform the chemical peel in an office-based surgical facility, outpatient surgical center or plastic surgeon’s office. If other cosmetic procedures are being performed at the same time, your surgeon may want you to stay overnight.

AHA peels may cause a slight stinging sensation so anesthesia is not needed. Anesthesia is not used for phenol or TCA peels as the chemical solution acts as an anesthetic. Sedation may be used to relax you and keep you comfortable during the procedure.

The AHA peel will take about 10 minutes. During the procedure, your surgeon will apply the solution to your cleansed skin. After-peel ointments or coverings are not required. However, periodic treatments may be needed to reach the desired effect. Applying an AHA-based face wash or cream once or twice a day may accomplish that goal. Your surgeon may recommend that you use Retin-A or a bleaching agent at home as well. Your doctor will examine your skin again to determine if your regimen needs to be adjusted.

If you are having a phenol or TCA peel, tour skin will be thoroughly cleansed first. The plastic surgeon will then carefully apply the solution. You may feel a stinging sensation as the peel is applied. However, the feeling will quickly pass.

It should take about 15 minutes for a full-face TCA peel. More than one TCA peel may be necessary to achieve the desired results. The procedures will be spaced out over several months.

After a phenol peel, your surgeon may coat the treated area with petroleum jelly or a waterproof adhesive tape. It will take from one to two hours for a full-face phenol peel. A phenol peel of a smaller area may take only 10 or 15 minutes. Phenol peels don’t usually need to be repeated.

It is common to experience some flaking or scaling, redness and dryness of the skin after an AHA peel. As the skin adjusts to the peel, these conditions will disappear.

Your doctor may prescribe a mild pain medication to relieve tingling or throbbing you may feel after a phenol or TCA peel. If the surgeon used a tape to cover your face, it will be removed a day or two after your treatment. Expect a crust or scab to form over the treated area. Depending on the strength of the solution, you may experience some swelling after a TCA peel.

Your face may also swell after a phenol peel. You may also notice your eyes are swollen shut for a brief period. During the first few days of your recovery, your doctor may advise you to stick to a liquid diet and to avoid talking.

With continued AHA treatments, you will have fresher and improved skin texture. The temporary redness, flaking and dryness you may experience will not prevent you from working. Be sure to protect your skin from the sun after your treatment. Your surgeon can recommend an adequate sunblock.

The discomfort and mild swelling you may experience after a TCA peel will subside within the first week. You new skin will be apparent in about 7 to 10 days and you should be able to return to your normal activities. Exposure to the sun should be avoided unless you are adequately protected.

New skin will begin to form about 7 to 10 days after a phenol peel. Expect your face to be red after the procedure. It will gradually fade to a pinkish color over the following weeks and months. It is especially important to use sunblock during this time or irregular, blotchy skin may result. You may return to your normal activities about two weeks after your phenol treatment.

It may take several AHA peels before you will notice an improvement in the texture of your skin. However, you may detect a healthier glow after just one treatment.

Your skin will be noticeably smoother after a TCA peel. However, TCA peels are not as long lasting as phenol peels.

You can expect a dramatic improvement in the surface of your skin following a phenol peel. You will probably notice fewer wrinkles, fewer blemishes and more even-toned skin. Although the results of your phenol peel will be long lasting, they are not immune to the effects of aging and sun exposure.

Top of Page

Controlled surgical scraping helps to refinish the skin’s top layers. Dermabrasion and dermaplaning soften the sharp edges of surface irregularities, giving the skin a smoother appearance. Dermabrasion is most often used to smooth out fine facial wrinkles, such as those around the mouth, or to improve the look of facial skin left scarred by accidents or injury. Pre-cancerous growths called keratoses can also be removed using dermabrasion. Dermaplaning is most commonly used to treat deep acne scars.

Dermabrasion and dermaplaning can be performed on the entire face or on small areas of skin. They are sometimes used alone, but often used in conjunction with other procedures such as scar removal or revision, facelift or chemical peel.

Dermabrasion and dermaplaning use surgical instruments to remove the affected layers of skin. Conversely, chemical peels, an alternative method of removing the top layer of skin, uses a caustic solution.

One or a combination of procedures will be used to correct your problem. Most plastic surgeons perform all three while others prefer one technique for all surface repairs. In general, chemical peels are used to treat fine wrinkles while dermabarasion and dermaplaning are used for deeper imperfections such as acne scars. More information on chemical peels is also available on this Web site.

Neither dermabrasion nor dermaplaning will remove all scars and flaws or prevent aging. Before undergoing the procedure, be sure to discuss your expectations with your plastic surgeon.

Dermabrasion and dermaplaning can help men and women of all ages enhance their appearance and self-confidence. Skin type, coloring and medical history are important factors to take into consideration. For example, dark complexions may become permanently discolored or blotchy after a skin-refinishing treatment. A flare-up of fever blisters or cold sores may occur after a treatment. Also, freckles may disappear in the treated area after dermabrasion or dermaplaning.

Most surgeons won’t perform dermabrasion or dermaplaning during active stages of acne because of a greater risk of infection. The procedure may not be a viable one for you if you’ve had radiation treatments, a previous chemical peel or a bad skin burn.

The most common risk in dermabrasion and dermaplaning is a change in skin pigmentation. Some patients may experience a permanent darkening of the skin, which is usually caused by exposure to the sun in the days or months following surgery. However, some patients find the treated skin remains a little lighter and blotchy in appearance.

After your surgery, you may develop tiny whiteheads that usually disappear on their own or with the use of an abrasive pad. On rare occasions, they have to be removed by a surgeon. Enlarged skin pore may also develop. But these usually shrink to near normal size once the swelling has subsided.

Occasionally, infection and scarring occur after skin-refinishing treatments. Excessive scar tissue is treated with the application or injection of steroid medications to soften the scar.

It is important to find a plastic surgeon or dermatologist who is trained and experienced in this procedure. Your expectations for the surgery will be discussed during your initial visit. Your surgeon will explain factors that may influence the procedure and its results such as age, previous plastic surgeries and skin condition. Your medical history will also be discussed and the surgeon will conduct a routine examination. Pictures will be taken of your face.

At your initial consultation, the surgeon will explain the procedure in detail as well as the risks and benefits. The recovery time and the costs associated with the procedure will also be discussed. The procedure may be covered under insurance if it is performed to remove precancerous skin growths or extensive scars. Check with your insurance provider to be sure.

Specific instructions on how to prepare for your surgery will be provided by your surgeon. He will provide guidelines on eating and drinking and on avoiding aspirin and other medications that affect blood clotting. Special instructions on caring for your skin prior to the surgery may also be provided. You will probably be told to stop smoking for a week or two before and after the surgery if you are a smoker. Smoking decreases the blood circulation in the skin and impedes healing.

Dermabrasion and dermaplaning are usually performed on an outpatient basis in a surgeon’s office-based facility, an outpatient surgery center or a hospital. You may be admitted to the hospital if you are undergoing extensive work.

Local anesthesia, which numbs the area, is most commonly used combined with a sedative that makes you drowsy. You will feel minimal discomfort during the procedure. A numbing spray such as freon is sometimes used along with or instead of local anesthesia. On rare occasions, a general anesthesia is used to help you sleep through the procedure.

Dermabrasion and dermaplaning usually take from a few minutes to more than an hour, depending on how large an area of skin is involved. The procedure is sometimes performed more than once or in stages, especially when scarring is deep or a large area of skin is involved.

In dermabrasion, the surgeon uses a rogue wire brush or a burr containing diamond particles, attached to a motorized handle to scrape away the outermost layer of skin. The surgeon scrapes away the skin until he reaches the safest level that will make the scar or wrinkle less visible.

In dermaplaning, a hand-held instrument called a dermatone is used to evenly skim off the layers of skin that surround the craters or other facial defects. The dermatone has an oscillating blade that moves back and forth, resembling an electric razor. The surgeon continues the dermaplaning until the lowest point of the acne scar becomes more even with the surrounding skin.

After the procedure, the skin may be treated with an ointment, a wet or waxy dressing, dry treatment or a combination of these.

Your skin will be quite red and swollen after the procedure. You may have difficulty talking and eating. Any tingling, burning or aching you feel can be controlled with medications prescribed by your surgeon. The swelling will go down in a few days to a week.

A scab or crust will form over the treated area as it begins to heal. A new layer of tight, pink skin will form underneath and this scab will fall off. Your face may itch as the new skin grows and your surgeon can prescribe an ointment to make the process more comfortable. Little or no scab will form if ointment is applied immediately after the surgery.

Your plastic surgeon will provide detailed instructions for care of your skin after the surgery.

You can resume your normal activities in the next few weeks. You can return to work about two weeks after your surgery. You will generally be advised to avoid any activity that could cause a bump to your face for two weeks. Avoid playing more active sports for four to six weeks. Stick to indoor pools if you are swimming to avoid the sun and wind and keep your face out of chlorinated water for at least four weeks. You shouldn’t drink alcohol for three to four weeks after your surgery as you will experience a flush of redness. Also, remember to protect you skin from the sun for as long as six to 12 months, until the pigment has completely returned to your skin.

It may take time before you can see the final results of dermaplaning and dermabrasion. The pinkness in your skin will fade in about three months. The color of your new skin should closely match the surrounding skin, making the procedure virtually undetectable.

Top of Page

Eyelid surgery

A blepharoplasty (eyelid surgery) is a procedure that can correct drooping upper eyelids and puffy bags below the eyes by removing fat along with excess skin and muscle from the upper and lower lids. Blepharoplasty cannot remove crow’s feet or other wrinkles, lift sagging eyebrows or eliminate dark circles under the eyes. Blepharoplasty can be done in conjunction with other facial surgery procedures like facelift or browlift or it can be done alone.

A blepharoplasty may enhance your appearance or your self-confidence but it may not change your looks to match your ideal. Be sure you have realistic expectations about the outcome of the surgery and discuss those expectations with your surgeon.

Most candidates for blepharoplasty are over 35. But if droopy, baggy eyelids run in your family, you may opt to get the surgery at an earlier age. Men and women who are physically healthy, psychologically stable and realistic in their expectations make the best candidates.

Some medical conditions make blepharoplasty more risky. These include: thyroid problems, high blood pressure, cardiovascular disease, dry eye or lack of sufficient tears and diabetes. Glaucoma or a detached retina are also cause for caution.

All surgery carries some uncertainty and risk

Complications from blepharoplasty are infrequent and usually minor. However, there is always a possibility for complications including a reaction to the anesthesia or infection. Other minor complications that could result include temporary swelling at the corner of the eyelids, double or blurred vision for a few days, and a slight asymmetry in healing or scarring. You may also notice some tiny whiteheads that may appear after your stitches are taken out. Your plastic surgeon can remove these with a very fine needle.

After the procedure, some patients have difficulty closing their eyes to go to sleep. In rare cases, this condition can be permanent. Another rare complication is called ectropion, which is a pulling down of the lower eyelids. Further surgery may be required to correct ectropion.

At your initial consultation, your doctor will need your complete medical history. Your surgeon will also need to know if you have any allergies, if you’re taking any vitamins, medications or other drugs and if you smoke.

Your surgeon will test your vision and assess your tear production at your initial visit. Be sure to bring along any relevant information from your ophthalmologist as well as your most recent eye exam. Be sure to bring along any glasses or contacts that you wear.

Make sure you discuss your expectations for the surgery with your doctor at your initial consultation. You and your surgeon should discuss whether to do all four eyelids or just the upper or lower ones, whether skin as well as fat will be removed and whether any additional procedures are appropriate.

At your initial consultation, your surgeon will discuss any anesthesia that will be used, the type of facility where the surgery will be performed, the techniques and the risks and costs involved. Most insurance policies do not cover eyelid surgery. Be sure to check with your insurance provider.

Your plastic surgeon will provide specific instructions on how to prepare for your surgery. He will give you guidelines on eating and drinking, smoking and taking or avoiding certain drugs, vitamins and medications.

Eyelid surgery is usually performed at our Arrowhead Surgery center located in Arrowhead Park in Maumee.

Oral and intravenous sedatives are usually used for eyelid surgery along with a local anesthesia, which numbs the area around the eye. You will be relaxed and insensitive to pain during the surgery even though you will be awake. If your plastic surgeon opts for a general anesthesia, you will be asleep through the entire operation.

Depending on the extent of the surgery, blepharoplasty usually takes between one and three hours. If you’re having all four eyelids done, your plastic surgeon will first work on the upper lids followed by the lower lids.

Generally, the surgeon makes incisions just below the lashes in the lower lids and in the crease of the upper eyelids. The incisions may extend into the outer corners of your eyes. The surgeon then separates the skin from the underlying fatty tissue and muscle, removes excess fat and trims sagging skin and muscle. At the conclusion of the procedure, the surgeon closes the incisions with very fine sutures.

Your plastic surgeon may perform transconjunctival blepharoplasty if you have a pocket of fat beneath your lower eyelids but don’t need any skin removed. The incision is made inside your lower eyelid and fat is removed with tiny forceps. No skin is removed and the incision is closed with dissolving sutures. This procedure is usually performed on patients who are younger with thicker, more elastic skin.

Your plastic surgeon will probably lubricate your eyes with ointment and may apply a bandage after your surgery. As the anesthesia wears off, your eyelids may feel tight and sore. Your surgeon can prescribe some medication to control your discomfort.

Bruising reaches a peek in the first week after surgery and can last anywhere from two weeks to a month. You will be instructed to keep your head elevated for several days and to use cold compresses to reduce bruising and swelling. Your surgeon will show you how to clean your eyes, which will be gummy for about a week. You may want to use eye drops if your eyelids feel dry or if your eyes burn or itch. In the first few weeks after your surgery, you may experience sensitivity to light, excessive tearing and temporary changes in your eyesight such as double vision or blurring.

The stitches will be removed two days to a week after your blepharoplasty surgery. The swelling and discoloration around the eyes will gradually subside once they are out. This will probably help you look and feel much better.

After two or three days, you should be able to read and watch television. You won’t be able to wear contact lenses for about two weeks. And even then, they may feel uncomfortable for a little while.

Most people feel ready to resume normal activities in about 10 days. At this time, you’ll probably be able to wear makeup too hide any bruising that remains. You should wear sunglasses and sunblock for the first several weeks when you go out because you may be sensitive to wind, sunlight and other irritants.

You will probably be advised to keep your activities to a minimum for three to five days after your surgery. Be sure to avoid strenuous activities for about three weeks. You may also be told to avoid drinking alcohol, bending, lifting and playing rigorous sports.

Your scars may remain slightly pink for up to six months after the surgery. They will eventually fade to a thin, nearly invisible, white line. After the surgery, you will probably notice your upper eyelids no longer droop and the skin under the eyes is smooth and firm. For many people, these results are permanent.

Top of Page

The effects of gravity, the stresses of daily life and exposure to the sun can be seen in our faces as we age. Folds and fat deposits appear around the neck, deep creases form between the nose and mouth and the jawline grows slack and jowly.

Rhytidectomy, also known as a facelift, can’t stop the aging process but it can improve the most visible signs of aging by removing excess fat, tightening underlying muscles and redraping the skin of your face and neck. A facelift can be done in conjunction with other cosmetic procedures such as nose reshaping, eyelid surgery or a forehead lift or it can be done alone.

The best candidates for facelift

A man or woman whose face and neck have begun to sag but whose skin still has some elasticity and whose bone structure is strong and well-defined may make a good candidate for rhytidectomy. Facelifts can be done on people in their 40s to 70s and 80s.

Be sure to have realistic expectations going into your surgery and discuss those expectations with your plastic surgeon. Keep in mind: a facelift can make you look younger and fresher but it can’t give you a totally different look.

Complications from rhytidectomy are infrequent and usually minor. However, the outcome is never predictable because people are so different in their anatomy, their physical reactions and their healing abilities.

Some complications you may experience include injury to the nerves that control facial muscles, infections, hematoma which is a collection of blood under the skin that must be removed by a surgeon, or reactions to the anesthesia. If you smoke, you may experience poor healing of the skin.

Your plastic surgeon will evaluate your face including the skin and underlying bone and discuss your goals for the surgery at your initial consultation. Be sure to inform your plastic surgeon about conditions such as blood clotting problems, uncontrolled high blood pressure or the tendency to form excessive scars. These conditions could cause problems during or after the surgery. If you smoke or if you are taking any medications, especially aspirin or other drugs that affect clotting, inform your doctor.

You may want to let your hair grow out before surgery if your hair is very short. You’ll probably want it to be long enough to hide the scars while they heal.

A hospital, an outpatient surgery center or a surgeon’s office-based facility may be the site of your facelift. The surgery is usually done on an outpatient basis. If you surgeon uses general anesthesia, you may be in the hospital for a day. A short inpatient stay may be required if you have high blood pressure or diabetes.

Local anesthesia combined with a sedative is usually used for a facelift. Your face will be insensitive to pain and you will be awake but relaxed. You may feel some tugging or occasional discomfort. General anesthesia may also be used to make you sleep through the operation.

Expect your facelift surgery to take several hours. Your surgeon will probably begin by making an incision above the hairline. It will extend in a natural line in front of your ear and continue behind the earlobe to the lower scalp. A small incision may also be made under the chin if the neck needs work.

During the surgery, the plastic surgeon separates the skin from the fat and muscle that lies underneath. The fat may be suctioned or trimmed from around the neck and chin to improve the contour. The underlying muscle and membrane is then tightened, the skin pulled back and the excess removed. Stitches are used to secure the layers of tissue and close the incisions. Metal clips may be used on the scalp.

A small, thin tube may be temporarily placed under the skin behind your ear to drain any blood that may collect there following your surgery. Your head may be wrapped loosely in bandages to minimize bruising and swelling.

Most patients don’t experience significant discomfort after rhytidectomy. However, any discomfort you may be feeling can be lessened by pain medication prescribed by your doctor. The sudden swelling of your face or severe or persistent pain should be reported to your surgeon immediately. It is normal to experience some numbness of the skin and the feeling should disappear in a few weeks or months.

To keep the swelling down, your doctor may tell you to keep your head elevated and as still as possible for a couple days after the surgery. If you’ve had a drainage tube inserted, expect it to be removed one or two days after your surgery. If bandages were used, they will probably be removed after one to five days. Once the bandages are removed, expect your face to be pale, bruised and puffy. In a few weeks, you will be back to normal. After about five days, you can expect most of your stitches to be removed. The stitches or metal clips in your hairline may be left in for a few more days.

Even though you will be up and around in a day or day, plan on taking it easy for the first week after surgery. Your skin will be both tender and numb and may not respond normally at first so you want to be especially gentle with your face and hair.

Your plastic surgeon will give you specific guidelines for resuming your normal activities. You will probably be told to avoid strenuous activities including sex and heavy housework for at least two weeks. Avoid alcohol, saunas and steam baths for several weeks and limit your exposure to the sun for several months. Be sure to get plenty of rest following your surgery.

Your face may look and feel rather strange right after your surgery. You’ll probably feel self-conscious about your scars and your facial movements may be fairly stiff. You may experience some bruising for two or three weeks and your features may seem distorted from the swelling. You may find you tire easily and are disappointed and depressed at first.

You’ll feel and look much better by the third week. You will probably be ready to return to work about 10 days to two weeks after your surgery. Special camouflage makeup can mask any bruising that remains.

Your new look

The hair around your temples may be thin and your skin may feel dry and rough for several months after your surgery. Some men find they have to shave in new places where areas of beard-growing skin have been repositioned such as behind the neck and ears.

The scars from your facelift will probably be hidden by your hair or in the natural creases of your face and ears. Your scars will fade with time and should be scarcely visible.

Expect your facelift to give you a fresher, more youthful face but it won’t stop the clock. Your face will continue to age with time and you may want to repeat the procedure in about five years.

Top of Page

If you’re considering liposuction

Unwanted fat is removed from specific areas of the body during liposuction. The procedure can help sculpt the thighs, knees, cheeks, neck, abdomen, hip, buttocks, knees, upper arms and chin. Liposuction is also known as lipoplasty and suction lipectomy. Plastic surgeons use a number of new techniques including the tumescent technique, ultrasound-assisted lipoplasty (UAL) and the super-wet technique to provide patients with quicker recovery times and more precise results. If you have stubborn areas of fat that don’t respond to traditional weight-loss methods, liposuction may be right for you.

Be sure to talk about your goals and expectations for the surgery with your plastic surgeon. The procedure may enhance your appearance and self-confidence, but it won’t necessarily change your looks to meet your ideals. If you are of normal weight with firm, elastic skin with pockets of excess fat in certain areas, you may make a good candidate for liposuction. Older patients may not achieve the same results as younger patients because they may have diminished skin elasticity.

If you have medical problems such as diabetes, significant heart or lung disease, or poor blood circulation, liposuction may pose a greater risk to you. Be sure to let your doctor know if you have recently had surgery near the area to be contoured.

Your surgeon will evaluate your health, determine where your fat deposits lie and assess the condition of your skin at your initial consultation. The body-contouring methods that would be the best for you will be explained by your surgeon. Be open and honest when you are discussing your expectations with your surgeon. He will be equally honest with you in describing the procedure in detail and explaining its risks and limitations.

Getting the answers you need

There is no need for you to feel overwhelmed by the number of options and techniques available to you. In deciding which treatment is right for you, your plastic surgeon will consider safety, effectiveness, cost and appropriateness for your needs. Your plastic surgeon should be able to answer any questions you have about the procedure, its benefits and complications.

Your surgeon will give you guidelines on eating and drinking before your surgery. He will also advise you to stop smoking for a period before and after the surgery and to avoid certain medications and vitamins. Your surgery will have to be postponed if you develop a cold or infection of any kind, especially a skin infection. You doctor may recommend that you have blood drawn ahead of time in the rare case that it is needed during surgery.

Where your surgery will be performed

A hospital, an outpatient surgery center or a surgeon’s office-based facility may be the site of your liposuction. For reasons of cost and convenience, smaller-volume liposuction is usually done on an outpatient basis. However, if the liposuction is being performed in conjunction with other procedures or if a large volume of fat will be removed, a hospital stay may be required.

You and your plastic surgeon will select the type of anesthesia that provides the safest and most effective level of comfort for your surgery. Liposuction can be performed under local anesthesia if only a small amount of fat and a limited number of body sites are involved. The local anesthesia, which numbs only the affected areas, can be used in conjunction with an intravenous sedation, which will keep you more relaxed during the procedure.

For more extensive procedures, a regional anesthesia may be used. An epidural block is one example of a regional anesthesia. If a large volume of fat is being removed, you may want to consider general anesthesia, which will ensure that you are completely asleep during the procedure.

Localized deposits of fat are removed to recontour one or more areas of the body during liposuction. A narrow tube or cannula is inserted through a tiny incision and is used to vacuum the fat layer that lies deep beneath the skin. The narrow tube is pushed then pulled through the fat layer, breaking up the fat cells and suctioning them out. Depending on the surgeon’s preference, the suction action is provided by either a vacuum pump or a large syringe. Your surgeon will then move on to the next area, if additional sites are being treated. He will try to keep the incisions as inconspicuous as possible.

Fluid injection is a variation of the technique described above. In this procedure, a medicated solution is injected into fatty areas before the fat is removed. The fluid is a mixture of intravenous salt solution, a local anesthetic called lidocaine and a drug that contracts the blood vessels called epinephrine. This mixture helps the fat to be removed more easily, reduces blood loss and provides anesthesia during and after surgery. The amount of bruising is also reduced using this variation.

The tumescent technique is another variation of liposuction. Large amounts of fluid are injected in this technique, which is typically performed on patients who need only local anesthetic. The procedure takes significantly longer than traditional liposuction (sometimes as long as four to five hours). Additional anesthesia may not be necessary because the injected fluid contains an adequate amount of anesthetic.

The super-wet technique uses a lesser amount of the fluid. The amount of fluid injected is usually equal to the amount of fat to be removed. This technique takes one to two hours and typically requires IV sedation or general anesthesia.

Another variation on the traditional liposuction is ultrasound-assisted lipoplasty. To learn more about this procedure, see the section titled “Ultrasound-assisted lipoplasty” on this Web site.

All surgery carries some uncertainty and risk

If your plastic surgeon is adequately trained and your procedure is done at an operating facility that is properly equipped, your liposuction will probably be safe. Be sure your doctor has advanced surgical skills to perform procedures that involve the removal of a large amount of fat. Attentive after-care is required for more extensive liposuction procedures. Be sure to find out how your doctor plans to monitor your condition closely after the procedure.

Complications from liposuction are rare, but they can and do occur. If operative sites are larger in size or if a greater number of areas are treated at the same time, the risks increase. Some complications could include infection, delays in healing, the formation of fat clots or blood clots, unfavorable drug reactions, excessive fluid loss, friction burns or other damage to the skin or nerves or perforation injury to the vital organs. Expect scars from your liposuction to be small and they will be strategically placed to be hidden from view.

You may experience some fluid drainage from the incisions after the surgery. To prevent fluid build-up, a small drainage tube may be inserted beneath the skin for a couple of days. You may be fitted with a snug elastic garment to wear over the treated area for a few weeks to control swelling and help your skin better fits its new contours. Antibiotics may be prescribed to prevent infection.

After you surgery you may experience some pain, swelling, burning, bleeding and temporary numbness. Your plastic surgeon can prescribe medications to make you feel more comfortable. However, you may still feel stiff and sore for a few days. During the days and weeks following surgery, it is normal to feel a bit anxious or depressed. These feelings will subside as you begin to look and feel better.

Getting back to normal

To help prevent blood clots from forming in your legs and to reduce swelling, your doctor will probably tell you to start walking around as soon as possible. About a week or two after your surgery, you will begin to feel better. You should be back to work within a few days after your surgery. Within the first week to 10 days, the stitches will be removed or they will dissolve on their own.

You should avoid strenuous activity for about a month as your body continues to heal. Most of the bruising and swelling should disappear within three weeks. However, some swelling may remain for six months or more. Be sure to meet with your surgeon for follow-up visits so he can monitor your progress. Call your doctor if you experience any unusual symptoms such as heavy bleeding or a sudden increase in pain.

Even though you will see a noticeable difference in the shape of your body quite soon after surgery, the improvement will be even more apparent in about four to six weeks when the swelling has subsided. Any persistent mild swelling usually disappears after about three months and the final contour will be visible. You may be more at ease with your body and more comfortable in a variety of clothes after your surgery. You can help to maintain your new shape by eating a healthy diet and getting regular exercise.

Top of Page

Ultrasound-assisted lipoplasty (UAL)

If you’re considering UAL.

Ultrasound-assisted lipoplasty is a relatively new technique that uses sound waves to liquefy unwanted fat. UAL can be an effective tool for removing fat from fibrous body areas such as the back and male breasts, or for removing larger volumes of fat in a single procedure.

Traditional liposuction is often performed with UAL to help shape UAL-treated areas or to treat areas of the body not suited for UAL such as the neck and inner thighs.

Be sure to talk to your plastic surgeon about your expectations before you decide to have UAL or liposuction of any kind. People who are of normal weight and have firm, elastic skin with pockets of excess fat in particular areas, are the best candidates for UAL. You should also be psychologically stable, physically healthy and realistic in your expectations. Liposuction can be performed on people of any age. However, older patients may not achieve the same results as younger patients because of their diminished skin elasticity.

Plastic surgeons have been performing UAL since 1991 and the long-term effects of the procedure are not yet known. Extensive research and clinical trials are needed to establish the safety of UAL. In initial trials, investigators have reported good results from the technique.

When deciding to have UAL, be sure to choose an operating facility that is properly equipped and a plastic surgeon who has completed an appropriate, hands-on UAL training course.

Serious medical complications from UAL or any type of liposuction are infrequent. Possible complications include excessive fluid loss that can lead to shock, infection, clots that block blood flow, excessive fluid accumulation that must be drained, skin injury, perforation injury to the skin or other organs and adverse reactions to anesthesia.

Thermal skin injury or burn caused by the heat from the ultrasound device can also result from UAL. Also with UAL, you may experience temporary collections of fluid beneath the surface of the skin.

You should also note that the cannulas used in UAL are slightly larger than the cannulas used for traditional liposuction. Because longer incisions are needed for UAL, it is required that they are placed carefully in hidden areas. Some surgeons prefer to use the traditional liposuction technique in areas where an obvious scar may result for that reason.

Cosmetic complications can also result from UAL. These complications could include areas of uneven pigmentation, irregularities of the skin’s surface and asymmetry. Some cosmetic problems can be treated by your plastic surgeeon with additional surgery.

Be sure to discuss your expectations with your plastic surgeon. Also, be sure to inform him of any significant weight losses or gains that you have experienced. Tell your plastic surgeon if you smoke or if you’re taking any drugs, vitamins or medications.

Your plastic surgeon will give you guidelines on eating and drinking, smoking and taking or avoiding vitamins, iron tablets and certain medications before your surgery. Your procedure may have to be postponed if you develop a cold or an infection of any kind, especially a skin infection.

A hospital, an outpatient surgery center or a surgeon’s office-based facility could be the setting for your surgery. UAL is usually done on an outpatient basis. However, if a large volume of fat will be removed, a hospital stay may be required.

UAL may be performed under local anesthesia combined with a sedative if you are having only a small amount of fat removed. The sedative will make you drowsy but you will be awake and relaxed, feeling only minimal discomfort. Some plastic surgeons may prefer to use an epidural block. Others like to use a general anesthesia, which will make you sleep through the procedure.

The time required to perform UAL varies depending on the amount of work you are having done. The procedure generally takes longer than the traditional liposuction because of the fat-liquefying step that is involved.

At the beginning of the procedure, salt water containing local anesthesia and adrenaline will be injected into the area to be treated. Through a small incision, the cannula is inserted beneath the skin. The walls of the fat cells will break down as a result of the ultrasonic energy. This will allow the fat to flow out of each cell. The fat will be removed from the body along with the injected fluid by vacuum pressure.

You may feel some warmth and vibration during the procedure if you are awake. To keep your fluid level balanced, you may be given some fluid through an IV. Expect only a small amount of blood to be lost during the procedure. You can donate your own blood before the surgery if your doctor believes a blood transfusion may be necessary.

You will probably experience some fluid drainage from your incisions after your surgery. To prevent fluid build-up, a drainage tube may be inserted beneath the skin. You may be fitted with a snug elastic bandage or compression garment to help control swelling. The bandage or garment should be worn over the treated area for up to four weeks to help your skin shrink to its new contour.

Some of the side effects you can expect after UAL are swelling, burning, pain, bleeding and temporary numbness. Your plastic surgeon can prescribe medications to help control the pain. You may also feel stiff and sore for a few days.

Many people feel a bit depressed in the days and weeks following surgery. This feeling is normal and will subside when you begin to look and feel better.

Your plastic surgeon will probably recommend you start walking around as soon as possible. However, healing is a gradual process and you should begin to feel better after about a week. You should be able to return to work within two weeks. If you have had stitches, they will probably be removed within the first week.

You should avoid strenuous activities for about three weeks as your body continues to heal. Most of the bruising and swelling will disappear within six weeks. However, some swelling may remain for six months or more. Be sure to meet with your surgeon to discuss your progress at follow-up visits.

You will notice a difference in the shape of your body quite soon after the surgery. Most of the swelling will subside in about six weeks and the improvements will become even more apparent.

Top of Page

Surgery to reshape the nose is one of the most common of all plastic surgery procedures. Also called rhinoplasty, the surgery can change the shape of the tip or the bridge, narrow the span of the nostrils, reduce or increase the size of your nose or change the angle between your nose and your upper lip. Some breathing problems may be relieved through rhinoplasty. It may also correct a birth defect or injury.

The best candidates for rhinoplasty

Be sure to talk about your goals and expectations for the surgery with your plastic surgeon. The procedure may enhance your appearance and self-confidence, but it won’t necessarily change your looks to meet your ideals. You may be a good candidate for rhinoplasty if you are physically healthy, psychologically stable and realistic in your expectations.

Age may be a factor in your decision to have rhinoplasty. Some plastic surgeons will not operate on teen-agers until they have had their growth spurt. It is also important to listen to what your child wants if it is a young adult who will be operated on.

All surgery carries some uncertainty and risk

Complications from surgery of the nose are infrequent and usually minor. However, you need to be aware of both the risks and the benefits before having the procedure. Some complications include nosebleed, infection or reaction to the anesthesia. Small burst blood vessels may appear as tiny red dots on the skin’s surface after your surgery. These are usually minor but many are permanent. When rhinoplasty is done from inside the nose, there is usually no scarring. When the procedure calls for a narrowing of flared nostrils or when an open technique is used, the small scars on the base of the nose are not usually visible.

In some rare cases, a second surgery is required. This second surgery may be necessary to correct a minor deformity. This second surgery is usually minimal, if it is needed at all.

Planning your surgery

At your initial consultation, you and your surgeon will discuss what you want your nose to look like. He will evaluate the structure of your nose and face and discuss the possibilities with you. Many factors can influence the result of your surgery including the structure of your nasal bones and cartilage, the thickness of your skin, the shape of your face, your age and your expectations.

Be sure your plastic surgeon explains the techniques and anesthesia he will use as well as the type of facility where your surgery will be performed at your initial consultation. Also, be sure you understand any risks and all of the costs involved. Most insurance companies don’t cover cosmetic surgeries. However, your procedure may be covered if it is for reconstructive purposes, to correct a breathing problem or a marked deformity following injury. Be sure to check with your insurance carrier before scheduling your surgery.

Your plastic surgeon will need to know if you have had any previous nose surgery or an injury to your nose, even if it was many years ago. If you have any allergies or breathing difficulties or if you are taking any vitamins, medications or recreational drugs, your surgeon will need to know. Also, tell your surgeon if you are a smoker.

Preparing for your surgery

Your surgeon will give specific guidelines on eating and drinking before your surgery. He will also tell you to stop smoking for a period of time before and after your surgery. Your plastic surgeon will give you guidelines on taking or avoiding certain medications and vitamins and washing your face.

Where your surgery will be performed

A hospital, an outpatient surgery center or a surgeon’s office-based facility may be the site of your rhinoplasty. For cost containment and convenience, it’s usually done on an outpatient basis. A short hospital stay may be required for some complex procedures.

Types of anesthesia

Depending on the extent of the procedure, rhinoplasty can be performed under local or general anesthesia. Your surgeon may prefer to use a local anesthesia, which will numb your nose and the surrounding area. You will be lightly sedated so you’ll be awake for the surgery but relaxed and insensitive to pain. If your surgeon decides to use a general anesthesia, you will sleep through the operation.

The surgery