Aesthetics and Plastic Surgery

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Surgical Procedures for Aesthetics

Surgeons can reshape the appearance of body parts through cosmetic surgery. Some of the most common body parts people want to improve through surgery include:

  • Tummy: Flattening the abdomen
  • Eyes: Correcting drooping upper eyelids or remove puffy bags below the eyes
  • Chin: Creating a more prominent jaw line
  • Face: Reconstruction and face lifts
  • Nose: Changing the shape of the nose

Learn More About Each Procedure:

Abdominoplasty
Too much fat can collect in the belly. In abdominoplasty, some of the fat is removed.

The surgeon will make a cut in the fold under the belly. This is the "bikini line." Skin is also cut around the belly button. A large area of fat and skin are then pulled away from the muscle.

The surgeon tightens the abdominal muscles in the belly.

The skin is then stretched downward. Extra skin and fat are trimmed away. A new hole will be cut for the belly button. The opening will then be closed with stitches.

After surgery, there may be some pain and discomfort. This may last for several days. Resting with the legs and hips bent will put less stress on the belly. The remaining scar will fade with time.

Blepharoplasty

What is blepharoplasty?

Sagging eyelids are a normal part of aging. Fat deposits may increase as skin thins and wrinkles. Eyelid surgery (Blepharoplasty) is a surgical procedure that can restore a youthful appearance to the eye area.
The upper and lower eyelids are lifted and loose or excess skin and fat tissue are removed from the eye area. Incisions are made in the natural creases or folds of the eyelids. Underlying fat may be removed, excess skin is trimmed along the natural fold in the eyelid.

Blepharoplasty is used to correct "puffy bags" below the eyes and drooping upper lids that make the patient look older and tired or that interferes with vision. Eyelid surgery will not remove wrinkles around the eyes, lift sagging eyebrows, or eliminate dark circles under the eyes.


What should first be done before considering blepharoplasty?

Before the procedures, an ASDS dermatologist will review the patient’s medical history and outcomes of the procedure. The doctor also will test the patient's vision and his or her ability to produce tears.

Prior to the procedure, patients should:

  • Avoid smoking.
  • Avoid medications, food and beverages indicated by the doctor.
  • Arrange for transportation home following the procedure.

What can I expect after having had blepharoplasty?

  • Post-operative effects are minimal and temporary.
  • Stitches are usually removed after five days.
  • Minor swelling, bruising and discomfort should disappear within two weeks. Cold compresses help alleviate these side effects.
  • After healing, the scars fade and are unnoticeable.

What are the potential complications of blepharoplasty?

A "too tight" or uneven appearance can be caused by the removal of too much skin or uneven amounts of fat. Additional surgeries can usually reverse this problem.

On very rare occasions, bleeding can occur in the socket.

Chin augmentation

The mandible, or lower jaw, determines much of the facial profile and the alignment of the upper and lower teeth. The teeth must be properly aligned for a normal dental bite.

The best candidates for chin augmentation or genioplasty are patients with weak or receding chins (microgenia), but with a normal dental bite. Expectations of looking and feeling better after surgery should be discussed with the plastic surgeon before any surgery, keeping in mind that the desired result is improvement, not perfection. The facial profile can be balanced by extending the chin in relationship to the nose.

Reconstructive genioplasty to correct bite dysfunction can be performed in conjunction with jaw surgery. Thousands of genioplasties are performed successfully each year. Surgery may be performed in the surgeon’s office-based facility, a hospital, or an outpatient facility.

One surgical approach is to make an incision inside the mouth along the inferior sulcus (a landmark inside the jaw) to gain access to the chin bone. There is no incision made on the skin.
A horizontal cut (called an osteotomy) is made through the jaw bone (mandible) with a bone saw or chisel. The lower portion of the separated bone is moved forward to the desired position and wired in place. The neurological nerves are carefully protected. The incision is closed with sutures and an external pressure dressing is applied. There is no visible scarring since the surgery is performed through an incision inside the mouth.

There is some discomfort and soreness, which is easily controlled by medication. A liquid diet may be advised for a day or two. Light activity can resume the same day as surgery. Return to work and usual activity is allowed within 7 to 10 days. Within a week of surgery, the external dressing is usually removed.

Craniofacial Reconstruction

There are four major bones of the face: the maxilla, the zygoma, the mandible, and the frontal bone of the cranium.

Patients requiring craniofacial reconstruction have:

  • birth defects (such as hypertelorism, Crouzon's disease, Apert's syndrome)
  • injuries to the head, face, or jaws (maxillofacial)
  • tumors
  • deformities caused by treatments of tumors

While the patient is deep asleep and pain-free (under general anesthesia) some of the facial bones are cut and repositioned into a more normal facial structure. The procedure may take from four to 14 hours to complete. Pieces of bone (bone grafts) may be taken from the pelvis, ribs, or skull to fill in the spaces where bones of the face and head have been moved.

Small metal screws and plates are sometimes be used to hold the bones in place and the jaw may be wired together to hold the new bone positions in place. If the surgery is expected to cause significant swelling of the face, mouth, or neck, the patient's airway may be an area of major concern. The airway tube (endotracheal tube) normally used for long surgical procedures under general anesthesia may be replaced with an opening and tube directly into the airway (trachea) in the neck (tracheotomy).

Depending on the extent of surgery and how the patient is breathing, the first two days after surgery may be spent in the intensive care unit. Without complications, most patients are able to leave the hospital within one week. Complete healing may take up to six weeks.

Facelift

Indications

Sagging or wrinkled skin occurs naturally with increasing age. Folds and fat deposits appear around the neck, and deep flexion creases form between the nose and mouth. The jawline grows jowly and slack. Heredity, poor diet, smoking, or obesity may contribute to early or severe skin problems. A facelift can help repair some of the visible damage to skin, fat, and muscles and can restore a younger look. A facelift can be done alone or with nose reshaping, a forehead lift, or eyelid surgery.


Incisions

While the patient is sleepy (sedated) and pain-free (local anesthesia) or deep asleep and pain-free (general anesthesia), the plastic surgeon makes incisions above the hairline at the temples, behind the earlobe, to the lower scalp. The surgeon removes some of the fat tissue and loose skin, then stitches (sutures) the incisions closed.

Results

Usually there is not much discomfort after surgery and pain medication can relieve it. Some numbness of the skin is normal and will disappear in a few weeks or months. The head will be elevated on two pillows (or at a 30 degree angle) for a couple of days after surgery to keep the swelling down.

The drainage tube will be removed 1 to 2 days after surgery if one was inserted. Bandages are usually removed after 1 to 5 days. The face will look pale, bruised, and puffy, but in 4 to 6 weeks it will be looking normal. Most of the stitches will be removed in 5 days. The stitches or metal clips in the hairline could be left in a few days longer if the scalp takes longer to heal.

Forehead lift

Forehead lifts are most commonly done for people in their 40s to 60s to slow the visible effects of aging.

In younger people, a forehead lift can raise congenitally low eyebrows that give the face a sad expression. In people whose brows are so low that they interfere with the upper field of vision, the forehead lift can be performed as a reconstructive procedure.

A good forehead lift candidate is someone who has one or more of these facial characteristics:

  • Sagging brows
  • Tissue that hangs down at the outer part of the eyelids
  • Horizontal wrinkling on the forehead
  • A dysfunctional nose
  • Deep furrows between the eyes also can be reduced through a forehead lift.


Many surgeons used local infiltration anesthesia combined with a sedative, so the patient is awake but sleepy and insensitive to pain. Some patients request a general anesthesia, so they will sleep through the operation.

Sections of hair will be held away from the operative area. Hair immediately in front of the incision line may need to be trimmed but the head will not need to be shaved.

The incision is made at the level of the ears and continues across the top of the forehead at the hairline. This avoids making the forehead appear too high. If the patient is bald or balding, the surgeon may utilize a mid-scalp incision, eliminating a visible scar.

The forehead skin is elevated and measured for removal of excess tissue, skin, and muscle. The incision is closed with stitches or staples. This procedure may also be done using an endoscopic with a smaller incision.

The operative area is wrapped with a sterile padding and an elastic bandage to inhibit bleeding and edema. There will likely be numbness and temporary discomfort around the surgical site. These symptoms are easily controlled with medication.

The head should be elevated for two to three days after surgery to inhibit swelling. Bruising and swelling is inevitable around the eyes and cheeks, but this begins to disappear in about a week.

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As the nerves regenerate, numbness of the forehead and scalp will soon be replaced with itching. It may take up to six months for these sensations to fully disappear. The bandages will be removed a day or two after surgery. Within 10 to 14 days, the stitches or clips will be removed.

Nose Surgery (Rhinoplasty)
The nose is made up of bone and cartilage. The size and relationship of the bone and cartilage which make up the nose determine the size and shape of the nose.

Nose surgery (rhinoplasty) offers improvement in the appearance in cases in which the nose is cosmetically unappealing. Age may also be a consideration.

Many surgeons prefer not to perform cosmetic (elective) rhinoplasties until the growth of the nasal bone is completed (around 14 or 15 for girls, a bit later for boys).

With local anesthesia, the nose and the surrounding area is numbed. The patient will usually be lightly sedated but awake during the surgery, and relaxed and insensitive to pain. The surgery is usually done through the incision inside the nostrils. Instruments inserted through the nostril, are used to reshape the bones which make up the nose.

The results of surgery are variable, depending on the initial shape of the nose, but rhinoplasty offers significant improvement in appearance in many cases.

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