Please select a surgery prodecure that you would like to learn more about.
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- BREAST AUGMENTATION (IMPLANTS)
Procedure
Breast Augmentation increases the size of the breast. It is helpful for women who naturally have relatively small breasts or those that have lost volume from childbirth/breast feeding or weight loss.
Breast Augmentation can also be useful to improve symmetry. Currently, I use saline and silicone gel implants and await FDA approval of the form - stable 'Gummy Bear' Silicone implant. When possible, I generally prefer placing saline implants partially under the pectoral muscle, as there are several advantages to this. Silicone implants can be placed partially submuscular, subfascial or subglandular depending on ones tissue characteristics. Several possible incisions are available.
Currently, I prefer an incision in the natural crease below the breast (inframammary incision). However, the incision can also be placed in the areola (the pigmented skin around the nipple), or in the armpit (Axillary incision). The belly button incision has never been FDA approved and is a choice I do not offer.
Anesthesia
Local with IV sedation or General Anesthesia.
Operative Time
Generally one and a half hours to two hours.
Risks
Although rare, infection, bleeding and asymmetry can occur. Hardening of the breast, visible implants, and malpositioning has also been reported.
Recovery
Generally 2 weeks to resume aerobic type activities.
- BREAST AUGMENTATION (FAT TRANSFER)
Procedure
If you desire breast enlargement, however prefer to avoid synthetic implants, two other options are available.
At the Center for Plastic Surgery we have performed fat transfer to various areas of the face and body since 1997. As technology has greatly improved over the last decade, we have recently introduced fat transfer for breast enhancement. Fat is harvested from unwanted areas such as the abdomen, hips, or thighs using technology similar to liposuction, purified, and subsequently via small needle holes transfered into the breast. Advantages include a faster recovery and abscence of a synthetic implant. Disadvantages include limitations in volume gained (usually 1/2 to 1 1/2 cup) and the possible need for more than one procedure to achieve the desired final breast size.
Anesthesia
Local with IV sedation or general anesthesia.
Operative Time
Generally one and a half to two and a half hours.
Risks
Although rare, infection, bleeding, fat cysts and asymmetry can occur. Fat may be totally or partially reabsorbed. More than one procedure may be required to achieve the desired size.
Recovery
Generally 2 weeks to resume aerobic type activities.
- BREAST AUGMENTATION (BRAVA)
Procedure
Another option is the BRAVA System of breast enlargement which the Center for Plastic Surgery first utilized in the late 1990s. This sytem requires no surgery and utilizes an external tissue expander which must be worn several hours daily for several months. In our experience, permanent increase in breast size ranges from 1/4 to one cup. An advantage is that the system requires no surgery; it is completely non invasive. Disadvantages include the system is somewhat tedious, requires several months and the volume gained may be limited.
Anesthesia
None
Operative Time
None
Risks
Although uncommon, skin blistering or scabbing can occur.
Procedure
Breast lifting (Mastopexy) is indicated for women with sagging breast. Lifting repositions the breast to a more youthful position.
Although several methods of lifting are available, I prefer the short scar or vertical technique. This technique limits scarring and provides for a long lasting youthful breast contour. Breast tissue is lifted and skin is tightened resulting in scars only around the areola (the pigmented skin around the nipple) and a vertical scar in the lower breast. On rare occasions an inverted “T” scar is necessary.
Anesthesia
Local with IV sedation or General Anesthesia.
Operative Time
Generally one and a half to two and a half hours.
Risks
Although rare, infection, bleeding, asymmetry and delayed healing may occur.
Recovery
Generally 2 weeks to resume aerobic type activities.
Procedure
Breast Reduction is indicated for women with excessively large breasts or those who simply desire reduction in cup size.
Although several Breast Reduction methods are available, I prefer the short scar or vertical technique. Similar to the technique used for breast lifting, this technique limits scarring and provides for a smaller, long lasting youthful contour. Scars are limited only to the areola (pigmented skin around the nipple) and a vertical scar in the lower breast. Occasionally an inverted “T” incision is necessary if skin is marginally loose. Breast tissue is primarily removed centrally thereby reducing volume as well as narrowing the breast. Liposuction is often performed at the outer breast adjacent to the chest wall to further improve contour.
Anesthesia
Usually General Anesthesia, Local with IV sedation optional.
Operative Time
Generally 2 to 3 hours.
Risks
Although rare, infections, bleeding, loss of sensation, asymmetry and delayed healing have been reported.
Recovery
Generally 2-3 weeks to resume normal aerobic type exercises.
Procedure
Nipple Reduction is indicated for women who perceive their nipples as large. Excess tissue is excised to reduce the nipple to a smaller size, usually without visible scars
Anesthesia
Local or Local with IV sedation.
Operative time
30 minutes to 1 hour.
Risks
Rare infections and bleeding.
Recovery
One to 2 weeks.
Procedure
Areola Reduction is indicated for women who wish a reduction in the size of the pigmented skin around the nipples. Excess pigmented skin is excised.
Anesthesia
Local or Local with IV Sedation.
Operative time
One to one and a half hour.
Risks
Rare infections, bleeding, visible scarring.
Recovery
One to 2 weeks.
Inverted Nipples occur when the nipples do not have normal projection. In some cases the nipples are inverted only intermittently, however, in others the nipples are always inverted. The condition can be present on one or both sides.
Procedure
A small incision is placed at the base of the nipple and fibrous bands responsible for the inversion are divided. A temporary absorbable suture is then placed maintaining the nipple in the projected position.
Anesthesia
Local or local with IV sedation.
Operative Time
Approximately 30 minutes per side.
Risks
Although rare, recurrence and loss of sensation have been reported.
Recovery
Normal activities immediately. Near complete healing 2-3 weeks.
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Upper Facial Rejuvenation
The upper 1/3 of the face consists primarily of the forehead, the upper eyelids, and the lower eyelids. Signs of aging can occur individually in any one of these components or in any combination. Goals of surgical rejuvenation are to restore a youthful appearance and balance without surgical stigmata (ie, a natural appearance).
At the Center for Plastic Surgery several different operative procedures are available for Facial and Neck rejuvenation depending on patient desires and existing anatomy. Our goal is to produce a totally natural unoperated appearance.
Lower Face and Neck Lifts address primarily the jowl and neck region.
Procedure
Via incisions placed under the chin and around the ears, soft tissue and skin are reposition to give a youthful contour to the jowls and neck.
Operative Time
3-5 Hours.
Anesthesia
Local with IV sedation or General.
Risks
Although rare, bleeding, infection, contour irregularities, nerve injury, and visible scarring have been reported.
Recovery
Generally 10 days to 2 weeks for acceptable appearance at social distances.
Full Face and Neck Lifts give all of the benefit of lower facelifts (see above) and additionally elevate the cheek to a more youthful position as well as lessen the Nasolabial folds (NLF- the sometimes deep groove between the lower nose and corner of the mouth).
Procedure
Similar to incision of Lower Facelift, however the incision also extends around the sideburn and rarely into the scalp behind the ear.
Operative Time
5-6 Hours.
Anesthesia
Usually local with sedation. General anesthesia optional.
Risks
Although rare, bleeding, infection, contour irregularities, nerve injury, visible scarring, and loss of hair around incisions have been reported.
Recovery
Generally 2 weeks for acceptable appearance at social distances.
Procedure
Via a small incision in the upper Buccal recess (within the mouth between the upper lip and teeth) and a small incision in the front scalp the entire cheek tissue is repositioned to its natural youthful higher position.
Operative Time
1 to 1 1/2 Hours.
Anesthesia
Usually local with sedation. General anesthesia optional.
Risks
Although rare, asymmetry, temporary or permanent loss of sensation, weakness, as well as infections or bleeding have been reported.
Recovery
Generally 1 week for acceptable appearance at social distances.
Extended Facelift is the combination of a Full Facelift (see above) and a Mid Facelift (see above). For persons with marked facial aging, extended facelifts produce the most dramatic natural result.
Procedure
See Full Facelift and Mid Facelift above.
Operative Time
6-7 hours.
Anesthesia
Local with IV sedation or general.
Risks
Although rare, bleeding, infection, contour irregularities, asymmetry, nerve injury, visible scarring, and loss of hair around incisions have been reported..
Recovery
Generally 2 weeks for acceptable appearance at social distances.
- LIMITED INCISION NECKLIFT
Limited Incision Necklift is an excellent procedure for those whose aging is primarily isolated to the neck and have relatively good skin tone.
Procedure
Via a small incision under the chin excess fat is removed, muscles tightened, and soft tissue sculpted to improve neck contour.
Operative Time
1 1/2 to 2 hours.
Anesthesia
Local with IV sedation, General optional.
Risks
Infection, bleeding, and contour irregularities have been reported.
Recovery
Generally 10 days to 2 weeks for acceptable appearance at social distances.
Neck Z-plasty is indicated for older male patients who wish improvement in neck appearance and wish to avoid a Face/Neck lift.
Procedure
Excess skin and fat are excised directly from the front of the neck and then muscles tightened. The skin is then closed in a "Z" pattern which makes the scar less conspicuous.
Operative Time
1 1/2 to 2 Hours
Anesthesia
Local with sedation or General.
Risks
Infection, bleeding, and visible scarring have been reported.
Recovery
Generally 2 weeks for acceptable appearance at social distances.
Buccal Fat excision proves beneficial for those with full or "Chubby" cheeks.
Procedure
Through small incisions on the inside of the mouth, Fat is removed from the cheek creating a more sculpted appearance to the face.
Operative Time
1 to 1 1/2 Hour
Anesthesia
Local with Sedation, General Anesthesia optional.
Risks
Although rare nerve injuries resulting in temporary or permanent facial weakness have been reported.
Recovery
Generally 3 to 5 days for acceptable appearance at social distances.
The most common sign of aging in the forehead is that of eyebrow descent. The outer 1/3 to ½ of the eyebrow is most commonly affected.
Procedure
Although several techniques, including the coronal (long incision) approach and the endoscopic approach have been described, I currently favor the limited incision approach. This approach allows stable elevation of the outer 1/3 to ½ of the eyebrow with no visible scarring providing a natural and youthful appearing brow. Forehead wrinkles also usually improve after the lift.
Operative Time
1 to 1 1/2 hour
Anesthesia
Usually local with IV sedation, General optional.
Risks
Although extremely rare, there have been reports of nerve injury resulting in decreased sensation or movement of the brow and slight hair loss.
Recovery
Generally 3 to 7 days for acceptable appearance at social distances.
The most common signs of aging in the upper eyelids are loose skin and excess "Fat Pockets", resulting in a sad or tired appearance.
Procedure
Upper Blepharoplsty is the medical term used to describe upper eyelid surgery. Excess skin and fat are removed via an incision in the natural crease. Muscles resulting in frown lines between the brows can also be modified to diminish the lines.
Operative Time
45 min. to 1 hour
Anesthesia
Usually local with IV sedation. General optional.
Risks
Although rare, dry eye syndrome or the inability to completely close the lids has been reported.
Recovery
Generally 7-10 days acceptable appearance at social distance.
The most common signs of aging in the lower eyelids are loose skin, excess "bulging" fat, and droopiness.
Procedure
Lower Blepharoplasty is the medical term used to describe lower eyelid rejuvenation. Apparent excess fat is repositioned and or removed and redundant skin excised. The lower eyelid is usually also tightened (canthopexy) to correct or prevent future droopiness. Incisions are made on the inside of the lid, the outside or combination depending on the degree of aging.
Operative Time
1 1/2 to 2 hours
Anesthesia
Local with IV sedation. General optional.
Risks
Although rare, dry eye syndrome, visual disturbances, round eye appearance, droopy eyelid (ectropion) have been reported.
Recovery
Generally 10-14 days acceptable appearance at social distances.
Rhinoplasty or Nasal (nose) contouring is an operative procedure intended to permanently alter the shape of the nose. The changes can be subtle or dramatic. The closed or open approach can be utilized. In the closed method all incisions are placed inside of the nose, there are no visible external scars. In the open technique incisions are placed both inside the nose and also on the outside surface in well-hid locations. The closed and open approaches both have advantages and disadvantages. I currently use each approach approximately 50% of the time.
Rhinoplasty ranges from relatively minor changes such as skin modifications to change the shape of the nostrils to more dramatic changes that modify the cartilaginous and bony framework of the nose. The specific procedure for a given person depends on that person's specific nasal characteristics and goals.
Operative Time
1 hour to 4 hours (Depending upon the extent of the proposed procedure)
Anesthesia
Local with IV sedation or General Anesthesia.
Risks
Prolonged swelling, visible scarring, and asymmetry have been reported. Although rare, prolonged difficulty with breathing and loss of smell can occur.
Recovery
2 weeks acceptable appearance at social distance. May take 9-12 months to realize the final result.
- SKIN PEELS
Chemical Peels
Chemical peels are a technique that utilizes various solutions to remove the damaged outer layers of the skin revealing the youthful underlying skin. Although superficial to deep peeling can be performed, at the Center for Plastic Surgery we perform only superficial and medium depth peels as the complication rates with the deeper peels markedly increases.
We offer various strength Glycolic Peels, Lactic Peels, Salicylic Peels, Jessners Peels and Trichloracetic Acid (TCA) peels. In general, the Glycolic Peels provide for a relatively superficial effect with little to no downtime. The TCA peels provide for a superficial to medium depth effect and require several days downtime. For our TCA peels we utilize the Obagi Blue procedure, one of the safest and most effective TCA methods. Lactic peels are indicated for sensitive, dry or sun damage skin. Whereas salicylic peels prove beneficial for oily, acne prove, or aging skin. Also offered are Glyco-Blend (Baker's) and Lactic-Blend (Morgan's) peels.
Operative Time
20 min to 1 hour.
Anesthesia
Lighter peels- none. Medium depth- IV Sedation.
Risks
Although extremely rare hypopigmentation, hyperpigmentation, and scarring have been reported.
Recovery
Light peels-none. Medium depth 3-10 days.
Fat transfer is a technique where fat is removed from areas of the body with relative excess (donor area) and transferred to an area of relative lack of volume (recipient area). Fat can be transferred FROM almost any area TO almost any area of the face and body. Once transferred, the result is usually permanent, although more than one session may be required to achieve the desired volume. Interestingly, the transferred fat takes on the characteristics of the area it is transferred to. i.e. if transferred to the lips, the lips look and feel entirely natural.
The most common donor sites are the abdomen, hips, and inner or outer thighs. The most common recipient areas are the lips, the upper cheek, chin, the brow roll, and the buttocks as well as contour depressions after liposuction.
Operative Time
1/2 to 2 hours, depending on areas treated.
Anesthesia
Usually local with sedation.
Risks
Although rare, irregularities and contour abnormalities have been reported.
Recovery
5-10 days to appear acceptable from social distances.
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Liposuction is a surgical technique that utilizes small cannulas and a suction source to remove excess fat via small access incisions. Liposuction obtains the best results for persons who are at or near their baseline or goal weight and have localized fullness.
Several methods of liposuction are available including the Brazilian (syringe) technique, power assisted liposuction (PAL), and ultrasonic assisted liposuction (UAL). The most recent addition to UAL is the VASER system. At the Center for Plastic Surgery all of these methods are available. Each has certain advantages and disadvantages. The choice of methods depends upon patient desires and body characteristics.
In conjunction with the various methods the tumescent technique is utilized. In this technique the areas to be treated are first injected with a dilute solution of local anesthetic and vasoconstrictor (reduces bleeding). Potential advantages include less bleeding, less post-operative pain, less bruising, and smoother results.
Operative Time
30 min to 3 hours (depending upon areas to be treated)
Anesthesia
Usually local with IV sedation or General Anesthesia optional
Risks
Infection, bleeding, irregularities, and need for touch-up procedures have been reported.
Recovery
Immediate return to non- aerobic activities, one-two weeks for aerobic type activities.
- ABDOMINOPLASTY/TUMMY TUCK
Abdominoplasty or Tummy Tuck is indicated for patients with loose skin, excess fat, and lax muscles. These conditions most commonly present after childbirth.
Abdominoplasties remove excess skin and fat as well as tighten lax muscles creating a more youthful and firm abdomen. Although a relatively long scar results, the scar can be placed low allowing for styles such as hip-hugger pants/skirts and bikinis. If only slight to moderate laxity is present, a mini Abdominoplasty, which limits the length of the scar, may be indicated.
Operative Time
1 1/2 to 3 hours
Anesthesia
Local with sedation or General Anesthesia
Risks
Infection, unsightly scarring, fluid collections, navel irregularities, and the need for revision can occur.
Recovery
2-3 weeks to resume moderate physical activity.
Brachioplasty is indicated when there is both excess fat and skin in the upper arms. If the skin is toned and taught with only excess fat, liposuction alone is indicated.
Procedure
Although fat and skin can be directly excised from the upper arms, my preferred technique is to remove the excess fat by liposuction, then excise the excess skin. This method provides excellent contour and decreases complications such as sensory loss. Although relatively long, the scar lies in a relatively inconspicuous location on the inside of the arm.
Operative Time
1 ½ to 2 hours
Anesthesia
Local with IV Sedation or general
Risks
Wide scars, decreased sensation, and contour irregularities have been reported
Recovery
Limited activity of the arms 7-10 days, then gradual return to full activity.
Fat transfer is a technique in which fat is transferred from an area of relative excess to an area of relative deficit. (See face, fat transfer). The most common areas of the body to transfer fat to are the buttocks and irregularities after liposuction. Occasionally, more than one treatment may be necessary.
Operative Time
1 to 2 hours
Anesthesia
Local with IV Sedation, General optional
Risks
Contour irregularities and need for repeat procedures can occur.
Recovery
7 to 10 days.
For women with problematic relatively large labial, labial reduction is beneficial. The procedure reduces the labia to a smaller more aesthetic appearance.
Operative Time
30 to 45 minutes
Anesthesia
Local or local with sedation
Risks
Although rare, bleeding and infection has been reported.
Recovery
Limited walking for several days. Avoidance of aerobic activity for 2 weeks. No sexual activity (Intercourse) for 6 weeks.
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