Cosmetic Plastic Surgery

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Cosmetic Plastic Surgery Powered By Docstoc
					                                       Cosmetic Plastic Surgery
                              Procedures at a glance




This page offers a general overview of cosmetic surgery procedures. For more in-depth information on these
procedures, please follow the links in the left column.

While this section explores cosmetic surgical offerings, many of these procedures may also fulfill true medical needs.
You should understand that the circumstances and experience of every individual will be unique.


     •    If you're considering cosmetic plastic surgery, please ask your plastic surgeon for further information about
          the particular procedure and what you expect.
     •    In addition, please note that all surgery carries some unce rtainty and risk, including the possibility of
          infection, bleeding, blood clots, and adverse reactions to the anesthesia. You can reduce your risks by
          choosing a qualified plastic surgeon and closely following his or her advice, both before and after surgery.


ABDOMINOPLASTY
(Tummy Tuck)
Procedure: Flatten abdomen by removing excess fat and skin and tightening muscles of abdominal wall.
Length:       2 to 5 hours.
Anesthesia:   General, or local with sedation.
In/Outpatient: Either depending on individual circumstances and extent of surgery.
Side Effects: Temporary pain. Swelling, soreness, numbness of abdominal skin, bruising, tiredness for several
              weeks or months.
Risks:        Blood clots. Infection. Bleeding under the skin flap. Poor healing resulting in conspicuous scarring or
              skin loss. Need for a second operation.
Recovery:     Back to work : 2 to 4 weeks. More strenuous activity: 4 to 6 weeks or more. Fading and flattening of
              scars: 3 months to 2 years.




BREAST ENLARGEMENT
(Augmentation Mammaplasty)
Procedure:   Enhance the size of breasts using inflatable implants filled with saline.
Length:       1 to 2 hours.
Anesthesia:   Local with sedation, or general.
In/Outpatient: Usually outpatient.
Side Effects: Temporary soreness, swelling, change in nipple sensation, bruising. Breast sensitive to stimulation for
              a few weeks.
Risks:        Lack of implant permanence -- surgical removal or replacement of the implants may be required to
              treat problems, including: deflation; the formation of scar tissue around the implant (capsular
              contracture), which may cause the breast to feel tight or hard; bleeding or infection. Increase or
              decrease in sensitivity of nipples or breast skin, occasionally permanent. Mammagraphy requires a
              special technique. (Note: Some women have reported symptoms similar to those of immune disorders.
              Ask your doctor about these and other FDA concerns.)
Recovery:     Back to work: a few days. Physical contact with breasts: 3 to 4 weeks. Fading of scars: several months
              to a year or more.
Duration of   Variable. Implants may require removal or replacement.
Results:



BREAST LIFT
(Mastopexy)
Procedure:  Raise and reshape sagging breasts by removing excess skin and repositioning remaining tissue and
            nipples.
Length:       1 to 3 hours.
Anesthesia:   Local with sedation, or general.
In/Outpatient: Usually outpatient. Sometimes inpatient.
Side Effects: Temporary bruising, swelling, discomfort, numbness, dry breast skin. Permanent scars.
Risks:        Thick, wide scars; skin loss; infection. Unevenly positioned nipples. Permanent loss of feeling in
              nipples or breast.
Recovery:     Back to work: 1 week or more. Strenuous activities: 1 month. Fading of scars: several months to a
              year.
Duration of   Variable; gravity, pregnancy, aging, and weight changes may cause new sagging. Results may last
Results:      longer or be enhanced when breast implants are inserted as part of the procedure.



CHEMICAL PEEL
(Phenol and trichloroacetic acid [TCA])
Procedure:     Restore wrinkled, blemished, unevenly pigmented, or sun-damaged facial skin, using a chemical
               solution to peel away skin's top layers. Works best on fair, thin skin with superficial wrinkles.
Length:       1 to 2 hours for full face.
Anesthesia:   None; sedation & EKG monitoring may be used.
In/Outpatient: Usually outpatient. Full-face phenol peel may require admission for 1 to 2 days.
Side Effects: Both: Temporary throbbing, tingling, swelling, redness; acute sensitivity to sun. Phenol: Permanent
              lightening of treated skin; permanent loss of ability to tan.
Risks:        Both: Tiny whiteheads (temporary); infection; scarring; flare -up of skin allergies, fever blisters, cold
              sores. Phenol: Abnormal color changes (permanent); heart irregularities (rare).
Recovery:     Phenol: Formation of new skin: 7 to 21 days. Normal activities: 2 to 4 weeks. Full healing and fading of
              redness: 3 to 6 months TCA: New skin within 5 to 10 days.
Duration of   Phenol: permanent, although new wrinkles may form as skin ages. TCA: variable (temporary).
Results:




COLLAGEN / FAT INJECTIONS
Procedure: Plump up creased, furrowed, or sunken facial skin; add fullness to lips and backs of hands. Works best
           on thin, dry, light-colored skin.
Length:       15 minutes to 1 hour per session.
Anesthesia:   Collagen: usually none; local may be included with the injection. Fat: local.
In/Outpatient: Outpatient.
Side Effects: Temporary stinging, throbbing, or burning sensation. Faint redness, swelling, excess fullness.
Risks:        Collagen: allergic reaction including rash, hives, swelling, or flu-like symptoms; possible triggering of
              connective-tissue or autoimmune diseases. (A skin test is required before collagen treatment to
              determine whether an allergy exists.) Both: Contour irregularities, infection.
Duration of   Variable; a few months to 1 year.
Results:




DERMABRASION
Procedure:    Mechanical scraping of the top layers of skin using a high-speed rotary wheel. Softe ns sharp edges of
              surface irregularities, including acne and other scars and fine wrinkles, especially around the mouth.
Length:       A few minutes to 1 hour. May require more than 1 session.
Anesthesia:   Local, numbing spray, or general.
In/Outpatient: Usually outpatient.
Side Effects: Temporary tingling, burning, itching, swelling, redness. Lightening of treated skin. Acute sensitivity to
              sun; loss of ability to make pigment (tan).
Risks:        Abnormal color changes (permanent). Tiny whiteheads (temporary); infection; scarring; flare -up of
              skin allergies, fever blisters, cold sores.
Recovery:     Back to work: 2 weeks. More strenuous activities: 4 to 6 weeks. Fading of redness: about 3 months.
              Return of pigmentation/sun exposure: 6 to 12 months.
Duration of   Permanent, although new wrinkles may form as skin ages.
Results:




EAR SURGERY
(Otoplasty)
Procedure:  Set prominent ears back closer to the head, or reduce the size of large ears. Most often done on
            children between the ages of 4 and 14 years. (Occasionally covered by insurance.)
Length:       2 to 3 hours.
Anesthesia:   Young children: usually general. Older children or adults: general or local, with sedation.
In/Outpatient: Usually outpatient.
Side Effects: Temporary throbbing, aching, swelling, redness, numbness.
Risks:        Infection of cartilage. Excessive scarring. Blood clot that may need to be drained. Mismatched or
              artificial- looking ears. Recurrence of the protrusion, requiring repeat surgery.
Recovery:     Back to work or school: 5 to 7 days.
              Strenuous activity, contact sports: 1 to 2 months.
Duration of   Usually permanent.
Results:




EYELID SURGERY
(Blepharoplasty)
Procedure:    Correct drooping upper eyelids and puffy bags below the eyes by removing excess fat, skin, and
              muscle. (Upper-eyelid surgery may be covered by insurance if used to correct visual field defects)
Length:       1 to 3 hours.
Anesthesia:   Usually locally with sedation or general.
In/Outpatient: Usually outpatient.
Side Effects: Temporary discomfort, tightness of lids, swelling, bruising. Temporary dryness, burning, itching of
              eyes. Excessive tearing, sensitivity to light for first few weeks.
Risks:        Temporary blurred or double vision. Infection, bleeding. Swelling at the corners of the eyelids. Dry
              eyes. Formation of whiteheads. Slight asymmetry in healing or scarring. Difficulty in closing eyes
              completely (rarely perman ent). Pulling down of the lower lids (may require further surgery). Blindness
              (extremely rare).
Recovery:     Reading: 2 or 3 days. Back to work: 7 to 10 days. Contact lenses: two weeks or more. Strenuous
              activities, alcohol: about 3 weeks. Bruising and swelling gone: several weeks.
Duration of   Several years. Sometimes permanent.
Results:




FACELIFT
(Rhytidectomy)
Procedure:   Improving sagging facial skin, jowls, and loose neck skin by removing excess fat, tightening muscles,
             redraping skin. Most often done on men and women over 40.
Length:       Several hours.
Anesthesia:   Local with sedation, or general.
In/Outpatient: Usually outpatient. Some patients may require short inpatient stay.
Side Effects: Temporary bruising, swelling, numbness and tenderness of skin; tight feeling, dry skin. For men,
              permanent need to shave behind ears, where beard-growing skin is repositioned.
Risks:        Injury to the nerves that control facial muscles or feeling (usually temporary but may be permanent).
              Infection, bleeding. Poor healing; excessive scarring. Asymmetry or change in hairline.
Recovery:     Back to work: 10 to 14 days. More strenuous activity: 2 weeks or more. Bruising: 2 to 3 weeks. Must
              limit exposure to sun for several months.
Duration of   Usually 5 to 10 years.
Results:




FACIAL IMPLANTS
Procedure: Change the basic shape and balance of the face using carefully shaped implants to build up a receding
           chin, add prominence to cheekbones, or reshape the jawline.
Length:       30 minutes to 2 hours.
Anesthesia:   Local with sedation, or general.
In/Outpatient: Usually outpatient. Occasionally overnight hospital stay.
Side Effects: Temporary discomfort, swelling, bruising, numbness and/or stiffness. In jaw surgery, inability to open
              mouth fully for several weeks.
Risks:        Shifting or imprecise positioning of implant, or infection around it, requiring a second operation or
              removal. Excess tightening and hardening of scar tissue around an artificial implant ("capsular
              contracture"), causing unnatural shape.
Recovery:     Back to work: about 1 week. Normal appearance: 2 to 4 weeks. Activity that could jar or bump face: 6
              weeks or more.
Duration of   Permanent.
Results:




FOREHEAD LIFT
(Browlift)
Procedure: Minimize forehead creases, drooping eyebrows, hooding over eyes, furrowed forehead and frown lines
           by removing excess tissue, altering muscles and tightening the forehead skin. May be done using the
           traditional technique, with an incision across the top of the head just behind the hairline; or with the
           use of an endoscope, which requires 3 to 5 short incisions. Most often done on people over 40.
Length:       1 to 2 hours.
Anesthesia:   Local with sedation, or general.
In/Outpatient: Usually outpatient.
Side Effects: Temporary swelling, numbness, headaches, bruising. Traditional method: Possible itching and hair loss.
Risks:        Injury to facial nerve, causing loss of motion, muscle weakness, or asymmetrical look. Infection. Broad
              or excessive scarring.
Recovery:     Back to work : 7 to 10 days, usually sooner for endoscopic forehead lift. More strenuous activity:
              several weeks. Full recovery from bruising: 2 to 3 weeks. Limit sun exposure for several months.
Duration of   Usually 5 to 10 years.
Results:




HAIR REPLACEMENT SURGERY
Procedure: Fill in balding areas with a patient's own hair using a variety of techniques including scalp reduction,
           tissue expansion, strip grafts, scalp flaps, or clusters of punch grafts (plugs, miniplugs and microplugs).
           Works best on men with male pattern baldness after hair loss has stopped.
Length:       1 to 3 hours. Some techniques may require multiple procedures over 18 months or more.
Anesthesia:   Usually local with sedation. Flaps and tissue expansion may be done with general anesthesia.
In/Outpatient: Usually outpatient.
Side Effects: Temporary achy, tight scalp. Unnatural look in early stages.
Risks:        Unnatural look. Infection. Excessive scarring. Failure to "take." Loss of scalp tissue and/or
              transplanted hair.
Recovery:     Back to work: usually 2 to 5 days. More strenuous activities: 10 days to 3 weeks. Final look: may be
              18 months or more, depending on procedure.
Duration of   Permanent.
Results:
LASER FACIAL RESURFACING
Procedure: Smooth the face and smooth fine wrinkles using a carbon dioxide (CO2) laser device that treats layers
           of damaged skin. Softens lines around the eyes and mouth and minimizes facial scars and unevenly
           pigmented areas.
Length:          A few minutes to 1 hour. May require more than 1 session.
Anesthesia:      Local with sedation, or general.
In/Outpatient: Usually outpatient, unless combined with other surgical procedures that require hospitalization.
Side Effects: Temporary swelling, discomfort. Lightening of treated skin. Acute sun sensitivity. Increased sensitivity
              to makeup. Pinkness or redness in skin that may persist for up to 6 months.
Risks:           Burns or injuries caused by laser heat. Scarring. Abnormal changes in skin color. Flare -up of viral
                 infections ("cold sores") and other infections (rare).
Recovery:        Back to work: 2 weeks. More strenuous activities: 4-6 weeks. Complete fading of redness: 6 months
                 or less. Return of pigmentation/light sun exposure: 6-12 months.
Duration of      Long-lasting, but does not stop aging. New wrinkles, expression lines may form as skin ages.
Results:




LIPOSUCTION
(Suction-Assisted Lipectomy)
Procedure:       Improve body shape by removing exercise-resistant fat deposits with a tube and vacuum device.
                 Can be performed using the tumescent technique, in which targeted fat cells are infused with saline
                 containing solution with a local anesthetic before liposuction to reduce post -operative bruising and
                 swelling. Common locations for liposuction include chin, cheeks, neck, upper arms, above breasts,
                 abdomen, buttocks, hips, thighs, knees, calves, ankles.
                 For larger volumes of fat or for fibrous body areas, ultrasound-assisted lipoplasty (UAL) may be
                 used. UAL is a new technique in which a ultrasound probe is inserted beneath the skin to "liquify"
                 the fat before it is suctioned.
Length:             1 to 2 hours or more. UAL: 20-40 percent longer than traditional liposuction.
Anesthesia:         Local, epidural, or general.
In/Outpatient:      Usually outpatient. Extensive procedures may require short inpatient stay.
Side Effects:       Temporary bruising, swelling, numbness, soreness, burning sensation. Tumescent: Temporary fluid
                    drainage from incision sites. UAL: Larger incisions for cannula.
Risks:              Asymmetry. Rippling or bagginess of skin. Pigmentation changes. Skin injury. Fluid retention.
                    Excessive fluid loss leading to shock. Infection. UAL: thermal burn injury caused by t he heat from
                    the ultrasound device.
Recovery:           Back to work: 1 to 2 weeks. More strenuous activity: 2 to 4 weeks. Full recovery from swelling
                    and bruising: 1 to 6 months or more. Use of tumescent technique or UAL may decrease post -
                    operative bruising and swelling.
Duration of         Permanent, with sensible diet and exercise.
Results:




MALE BREAST REDUCTION
(Gynecomastia)
Procedure:                                              en
             Reduce enlarged, female-like breast in m using liposuction and/or cutting out excess glandular
             tissue. (Sometimes covered by medical insurance.)
Length:          1 hour or more.
Anesthesia:      General or local.
In/Outpatient: Usually outpatient.
Side Effects: Temporary bruising, swelling, numbness, soreness, burning sensation.
Risks:           Infection. Fluid accumulation. Injury to the skin. Rippling or bagginess of skin. Asymmetry.
                 Pigmentation changes (may become permanent if exposed to sun). Excessive scarring if tissue was cut
                 away. Need for second procedure to remove additional tissue.
Recovery:        Back to work: 3 to 7 days. More strenuous activity: 2 to 3 weeks. Swelling and bruising: 3 to 6 months.
Duration of      permanent
Results:




NOSE SURGERY
(Rhinoplasty)
Procedure:    Reshape nose by reducing or increasing size, removing hump, changing shape of tip or bridge,
              narrowing span of nostrils, or changing angle between nose and upper lip. May also relieve some
              breathing problems. (May be covered by insurance.)
Length:       1 to 2 hours or more.
Anesthesia:   Local with sedation, or general.
In/Outpatient: Usually outpatient.
Side Effects: Temporary swelling, bruising around eyes, nose and headaches. Some bleeding and stiffness.
Risks:        Infection. Small burst blood vessels resulting in tiny, permanent red spots. Incomplete improvement,
              requiring additional surgery.
Recovery:     Back to work: 1 to 2 weeks. More strenuous activities: 2 to 3 weeks. Avoid hitting nose or sunburn : 8
              weeks. Final appearance: 1 year or more.
Duration of   Permanent.
Results:




Botox Injections
The cosmetic form of botulinum toxin, often referred to by its product name Botox®, is a popular non-surgical
injection that temporarily reduces or eliminates frown lines, forehead creases, crows feet near the eyes and thick
bands in the neck. The toxin blocks the nerve impulses, temporarily paralyzing the muscles that cause wrinkles while
giving the skin a smoother, more refreshed appearance. Studies have also s       uggested that Botox is effective in
relieving migraine headaches, excessive sweating and muscle spasms in the neck and eyes.


To find a plastic surgeon who performs this procedure, visit the online referral service of the American Society of
Plastic Surgeons (ASPS). ASPS, founded in 1931, is the largest plastic surgery organization in the world and the
foremost authority on cosmetic and reconstructive plastic surgery. All ASPS physician members are certified by the
American Board of Plastic Surgery (ABPS) or the Royal College of Physicians and Surgeons of Canada.




AUGMENTATION MAMMOPLASTY
BREAST AUGMENTATION
If you're considering breast augmentation...

Breast augmentation, technically known as augmentation mammoplasty, is a surgical procedure to enhance the size
and shape of a woman's breast for a number of reasons:


     •    To enhance the body contour of a woman who, for personal reasons, feels her breast size is too small.
     •    To correct a reduction in breast volume after pregnancy.
     •    To balance a difference in breast size.
     •    As a reconstructive technique following breast surgery.


By inserting an implant behind each breast, surgeons are able to increase a woman's bustline by one or more bra cup
sizes. If you're considering breast augmentation, this will give you a basic understanding of the procedure --when it
can help, how it's performed, and what results you can expect. It can't answer all of your questions, since a lot
depends on your individual circumstances. Please ask your surgeon if there is anything you don't understand about
the procedure.
THE BEST CANDIDATES FOR BREAST AUGMENTATION
Breast augmentation can enhance your appearance and your self-confidence, but it won't necessarily change your
looks to match your ideal, or cause other people to treat you differently. Before you decide to have surgery, think
carefully about your expectations and discuss them with your surgeon.

The best candidates for breast augmentation are women who are looking for improvement, not perfection, in the way
they look. If you're physically healthy and realistic in your expectations, you may be a good candidate.
TYPES OF IMPLANTS

A breast implant is a silicone shell filled with either silicone gel or a salt-water solution known as saline.

Because of concerns that there is insufficient information demonstrating the safety of silicone gel-filled breast
implants, the Food & Drug Administration (FDA) has determined that new gel-filled implants, at the present time,
should be available only to women participating in approved studies. Some women requiring replacement of the
implants may also be eligible to participate in the study.

                                                                                     n
Saline-filled implants continue to be available to breast augmentation patients on a unrestricted basis, pending
further FDA review. You should ask your doctor more about the specifics of the FDA decisions.
ALL SURGERY CARRIES SOME UNCERTAINTY AND RISK

Breast augmentation is relatively straightforward. But as with any operation, there are risks associated with surgery
and specific complications associated with this procedure.

The most common problem, capsular contracture, occurs if the scar or capsule around the implant begins to tighten.
This squeezing of the soft implant can cause the breast to feel hard. Capsular contracture can be treated in several
ways, and sometimes requires either removal or "scoring" of the scar tissue, or perhaps removal or replacement of
the implant.

As with any surgical procedure, excessive bleeding following the operation may cause some swelling and pain. If
excessive bleeding continues, another operation may be needed to control the bleeding and remove the accumulated
blood.

A small percentage of women develop an infection around an implant. This may occur at any time, but is most often
seen within a week after surgery. In some cases, the implant may need to be removed for several months until the
infection clears. A new implant can then be inserted.

Some women report that their nipples become oversensitive, un dersensitive, or even numb. You may also notice
small patches of numbness near your incisions. These symptoms usually disappear within time, but may be
permanent in some patients.

There is no evidence that breast implants will affect fertility, pregnancy, or your ability to nurse. If, however, you
have nursed a baby within the year before augmentation, you may produce milk for a few days after surgery. This
may cause some discomfort, but can be treated with medication prescribed by your doctor.

Occasionally, breast implants may break or leak. Rupture can occur as a result of injury or even from the normal
compression and movement of your breast and implant, causing the man -made shell to leak. If a saline-filled implant
breaks, the implant will deflate in a few hours and the salt water will be harmlessly absorbed by the body.

If a break occurs in a gel-filled implant, however, one of two things may occur. If the shell breaks but the scar
capsule around the implant does not, you may not detect any change. If the scar also breaks or tears, especially
following extreme pressure, silicone gel may move into surrounding tissue. The gel may collect in the breast and
cause a new scar to form around it, or it may migrate to another area of the body. There may be a change in the
shape or firmness of the breast. Both types of breaks may require a second operation and replacement of the leaking
implant. In some cases, it may not be possible to remove all of the silicone gel in the breast tissue if a rupture should
occur.

A few women with breast implants have reported symptoms similar to diseases of the immune system, such as
scleroderma and other arthritis-like conditions. These symptoms may include joint pain or swelling, fever, fatigue, or
breast pain. Research has found no clear link between silicone breast implants and the symptoms of what doctors
refer to as "connective-tissue disorders," but the FDA has requested further study.

While there is no evidence that breast implants cause breast cancer, they may change the way mammography is done
to detect cancer. When you request a routine mammogram, be sure to go to a radiology center where technicians are
experienced in the special techniques required to get a reliable x-ray of a breast with an implant. Additional views
will be required. Ultrasound examinations may be of benefit in some women with implants to detect breast lumps or
to evaluate the implant.

While the majority of women do not experience these complications, you should discuss each of them with your
physician to make sure you understand the risks and consequences of breast augmentation.
PLANNING YOUR SURGERY

In your initial consultation, your surgeon will evaluate your health and explain which surgical techniques are most
appropriate for you, based on the condition of your breasts and skin tone. If your breasts are sagging, your doctor
may also recommend a breast lift.

Be sure to discuss your expectations frankly with your surgeon. He or she should be equally frank with you,
describing your alternatives and the risks and limitations of each. You may want to ask your surgeon for a copy of
the manufacturer's insert that comes with the implant he or she will use -- just so you are fully informed about it.
And, be sure to tell your surgeon if you smoke, and if you're taking any medications, vitamins, or other drugs.
Your surgeon should also explain the type of anesthesia to be used, the type of facility where the surgery will be
performed, and the costs involved. Because most insurance companies do not consider breast au gmentation to be
medically necessary, carriers generally do not cover the cost of this procedure.
PREPARING FOR YOUR SURGERY

Your surgeon will give you instructions to prepare for surgery, including guidelines on eating and drinking, smoking,
and taking or avoiding certain vitamins and medications.

While making preparations, be sure to arrange for someone to drive you home after your surgery and to help you out
for a few days, if needed.
WHERE YOUR SURGERY WILL BE PERFORMED

Your surgeon may prefer to perform the operation in an office facility, a freestanding surgery center, or a hospital
outpatient facility. Occasionally, the surgery may be done as an inpatient in a hospital, in which case you can plan on
staying for a day or two.
TYPES OF ANESTHESIA

Breast augmentation can be performed with a general anesthesia, so you'll sleep through the entire operation. Some
surgeons may use a local anesthesia, combined with a sedative to make you drowsy, so you'll be relaxed but awake,
and may feel some discomfort.
THE SURGERY

The method of inserting and positioning your implant will depend on your anatomy and your surgeon's
recommendation. The incision can be made either in the crease where the breast meets the chest, around the areola
(the dark skin surrounding the nipple), or in the armpit. Every effort will be made to assure that the incision is placed
so resulting scars will be as inconspicuous as possible.

Working through the incision, the surgeon will lift your breast tissue and skin to create a pocket, either directly
behind the breast tissue or underneath your chest wall muscle (the pectoral muscle). The implants are then centered
beneath your nipples.

Some surgeons believe that putting the implants behind your chest muscle may reduce the potential for capsular
contracture. Drainage tubes may be used for several days following the surgery. This placement may also interfere
less with breast examination by mammogram than if the implant is placed directly behind the breast tissue. Placement
behind the muscle however, may be more painful for a few days after surgery than placement directly under the
breast tissue.

You'll want to discuss the pros and cons of these alternatives with your doctor before surgery to make sure you fully
understand the implications of the procedure he or she recommends for you.

The surgery usually takes one to two hours to complete. Stitches are used to close the incisions, which may also be
taped for greater support. A gauze bandage may be applied over your breasts to help with healing.
AFTER YOUR SURGERY

You're likely to feel tired and sore for a few days following your surgery, but you'll be up and around in 24 to 48
hours. Most of your discomfort can be controlled by medication prescribed by your doctor.

Within several days, the gauze dressings, if you have them, will be removed, and you may be given a surgical bra.
You should wear it as directed by your surgeon. You may also experience a burning sensation in your nipples for
about two weeks, but this will subside as bruising fades.

Your stitches will come out in a week to 10 days, but the swelling in your breasts may take three to five weeks to
disappear.
GETTING BACK TO NORMAL

You should be able to return to work within a few days, depending on the level of activity required for your job.

Follow your surgeon's advice on when to begin exercises and normal activities. Your breasts will probably be
sensitive to direct stimulation for two to three weeks, so you should avoid much physical contact. After that, breast
contact is fine once your breasts are no longer sore, usually three to four weeks after surgery.

Your scars will be firm and pink for at least six weeks. Then they may remain the same size for several months, or
even appear to widen. After several months, your scars will begin to fade, although they will never disappear
completely.

Routine mammograms should be continued after breast augmentation for women who are in the appropriate age
group, although the mammographic technician should use a special technique to assure that you get a reliable
reading, as discussed earlier. (see All surgery carries some uncertainty and risk.)
YOUR NEW LOOK

For many women, the result of breast augmentation can be satisfying, even exhilarating, as they learn to appreciate
their fuller appearance.

Regular examination by your plastic surgeon and routine mammograms for those in the appropriate age groups at
prescribed intervals will help assure that any complications, if they occur, can be detected early and treated.

Your decision to have breast augmentation is a highly personal one that not everyone will understand. The important
thing is how you feel about it. If you've met your goals, then your surgery is a success.
Breast augmentation is usually done to balance a difference in breast size, to improve body contour, or as a
reconstructive technique following surgery.




Incisions are made to keep scars as inconspicuous as possible, in the breast crease, around the nipple, or in the
armpit. Breast tissue and skin is lifted to create a pocket for each implant.
The breast implant may be inserted directly under the breast tissue or beneath the chest wall muscle.




After surgery, breasts appear fuller and more natural in tone and contour. Scars will fade with time.




MASTOPEXY
BREAST LIFT
If you're considering a breast lift...

Over the years, factors such as pregnancy, nursing, and the force of gravity take their toll on a woman's breasts. As
the skin loses its elasticity, the breasts often lose their shape and firmness and begin to sag. Breastlift, or
mastopexy, is a surgical procedure to raise and reshape sagging breasts--at least, for a time. (No surgery can
permanently delay the effects of gravity.) Mastopexy can also reduce the size of the areola, the darker skin
surrounding the nipple. If your breasts are small or have lost volume --for example, after pregnancy --breast
implants inserted in conjunction with mastopexy can increase both their firmness and their size. If you're considering
a breast lift, this brochure will give you a basic understanding of the procedure --when it can help, how it's
performed, and what results you can expect. It can't answer all of your questions, since a lot depends on your
individual circumstances. Please be sure to ask your doctor if there is anything about the procedure you don't
understand.
THE BEST CANDIDATES FOR BREAST LIFT
A breast lift can enhance your appearance and your self-confidence, but it won't necessarily change your looks to
match your ideal, or cause other people to treat you differently. Before you decide to have surgery, think carefully
about your expectations and discuss them with your surgeon.

The best candidates for mastopexy are healthy, emotionally-stable women who are realistic about what the surgery
can accomplish. The best results are usually achieved in women with small, sagging breasts. Breasts of any size can
be lifted, but the results may not last as long in heavy breasts.

Many women seek mastopexy because pregnancy and nursing have left them with stretched skin and less volume in
their breasts. However, if you're planning to have more children, it may be a good idea to postpone your breast lift.
While there are no special risks that affect future pregnancies (for example, mastopexy usually doesn't interfere with
breast-feeding), pregnancy is likely to stretch your breasts again and offset the results of the procedure.
ALL SURGERY CARRIES SOME UNCERTAINTY AND RISK

A breast lift is not a simple operation, but it's normally safe when performed by a qualified plastic surgeon.
Nevertheless, as with any surgery, there is always a possibility of complications or a reaction to the anesthesia.
Bleeding and infection following a breast lift are uncommon, but they can cause scars to widen. You can reduce your
risks by closely following your physician's advice both before and after surgery.

Mastopexy does leave noticeable, permanent scars, although they'll be covered by your bra or bathing suit. (Poor
healing and wider scars are more common in smokers.) The procedure can also leave you with unevenly positioned
nipples, or a permanent loss of feeling in your nipples or breasts.
PLANNING YOUR SURGERY

In your initial consu ltation, it's important to discuss your expectations frankly with your surgeon, and to listen to his
or her opinion. Every patient--and every physician, as well--has a different view of what is a desirable size and
shape for breasts.

The surgeon will exami ne your breasts and measure them while you're sitting or standing. He or she will discuss the
variables that may affect the procedure --such as your age, the size and shape of your breasts, and the condition of
your skin--and whether an implant is advisable. You should also discuss where the nipple and areola will be
positioned; they'll be moved higher during the procedure, and should be approximately even with the crease beneath
your breast.

                                                                       i
Your surgeon should describe the procedure in detail, explaining t s risks and limitations and making sure you
understand the scarring that will result. He or she should also explain the anesthesia to be used, the type of facility
where the surgery will be performed, and the costs involved.

Don't hesitate to ask your doctor any questions you may have, especially those regarding your expectations and
concerns about the results.
PREPARING FOR YOUR SURGERY

Depending on your age and family history, your surgeon may require you to have a mammogram (breast x-ray)
before surgery . You'll also get specific instructions on how to prepare for surgery, including guidelines on eating and
drinking, smoking, and taking or avoiding certain vitamins and medications.

While you're making preparations, be sure to arrange for someone to drive you home after your surgery and to help
you out for a few days if needed.
WHERE YOUR SURGERY WILL BE PERFORMED

Your breast lift may be performed in a hospital, an outpatient surgery center, or a surgeon's office -based facility. It's
usually done on an outpatient basis, for cost containment and convenience. If you're admitted to the hospital as an
inpatient, you can expect to stay one or two days.
TYPES OF ANESTHESIA

Breast lifts are usually performed under general anesthesia, which means you'll sleep through the operation. In
selected patients--particularly when a smaller incision is being made--the surgeon may use local anesthesia,
combined with a sedative to make you drowsy. You'll be awake but relaxed, and will feel minimal discomfort.
THE SURGERY

Mastopexy usually takes one and a half to three and a half hours. Techniques vary, but the most common procedure
involves an anchor-shaped incision following the natural contour of the breast.

The incision outlines the area from which breast skin will be removed and defines the new location for the nipple.
When the excess skin has been removed, the nipple and areola are moved to the higher position. The skin
surrounding the areola is then brought down and together to reshape the breast. Stitches are usually located around
the areola, in a vertical line extending downwards from the nipple area, and along the lower crease of the breast.

Some patients, especially those with relatively small breasts and minimal sagging, may be candidates for modified
procedures requiring less extensive incisions. One such procedure is the "doughnut (or concentric) mastopexy," in
which circular incisions are made around the areola, and a doughnut-shaped area of skin is removed.

If you're having an implant inserted along with your breast lift, it will be placed in a pocket directly under the breast
tissue, or deeper, under the muscle of the chest wall.
AFTER YOUR SURGERY
After surgery, you'll wear an elastic bandage or a surgical bra over gauze dressings. Your breasts will be bruised,
swollen, and uncomfortable for a day or two, but the pain shouldn't be severe. Any discomfort you do feel can be
relieved with medications prescribed by your surgeon.

Within a few days, the bandages or surgical bra will be replaced by a soft support bra. You'll need to wear this bra
around the clock for three to four weeks, over a layer of gauze. The stitches will be removed after a week or two.

If your breast skin is very dry following surgery, you can apply a moisturizer several times a day. Be careful not to
tug at your skin in the process, and keep the moisturizer away from the suture areas.

You can expect some loss of feeling in your nipples and breast skin, caused by the swelling after surgery. This
numbness usually fades as the swelling subsides over the next six weeks or so. In some patients, however, it may
last a year or more, and occasionally it may be permanent.
GETTING BACK TO NORMAL

Healing is a gradual process. Although you may be up and about in a day or two, don't plan on returning to work for a
week or more, depending on how you feel. And avoid lifting anything over your head for three to four weeks. If you
have any unusual symptoms, don't hesitate to call your surgeon.

Your surgeon will give you detailed instructions for resuming your normal act ivities. You may be instructed to avoid
sex for a week or more, and to avoid strenuous sports for about a month. After that, you can resume these activities
slowly. If you become pregnant, the operation should not affect your ability to breast -feed, since your milk ducts and
nipples will be left intact.
YOUR NEW LOOK

Your surgeon will make every effort to make your scars as inconspicuous as possible. Still, it's important to
remember that mastopexy scars are extensive and permanent. They often remain lumpy and red for months, then
gradually become less obvious, sometimes eventually fading to thin white lines. Fortunately, the scars can usually be
placed so that you can wear even low-cut tops.

You should also keep in mind that a breast lift won't keep you firm forever--the effects of gravity, pregnancy, aging,
and weight fluctuations will eventually take their toll again. Women who have implants along with their breast lift may
find the results last longer.

Your satisfaction with a breast lift is likely to be greater if you understand the procedure thoroughly and if your
expectations are realistic.
Over time, a woman's breasts begin to sag and the areolas become larger. All surgery carries some uncertainty and
risk




Incisions outline the area of skin to be removed and the new position for the nipple.




Skin formerly located above the nipple is brought down and together to reshape the breast. Sutures close the
incisions, giving the breast its new contour.
After surgery, the breasts are higher and firmer, with sutures usually located around the areola, below it, and in the
crease under the breast.




If your expectations are realistic, chances are you'll be satisfied with your breast lift.




BROWLIFT
FOREHEAD LIFT
If you're considering a forehead lift...

A forehead lift or "browlift" is a procedure that restores a more youthful, refreshed look to the area above the eyes.
The procedure corrects drooping brows and improves the horizontal lines and furrows that can make a person appear
angry, sad or tired.

In a forehead lift, t he muscles and tissues that cause the furrowing or drooping are removed or altered to smooth the
forehead, raise the eyebrows and minimize frown lines. Your surgeon may use the conventional surgical method, in
which the incision is hidden just behind the hairline; or it may be performed with the use of an endoscope, a viewing
instrument that allows the procedure to be performed with minimal incisions. Both techniques yield similar results --
smoother forehead skin and a more animated appearance.

If you're considering a forehead lift, this brochure will provide a basic understanding of the procedure -- when it can
help, how it's performed and what results you can expect. It won't answer all of your questions, since a lot depends
on your individual circumstances. Be sure to ask your doctor if there is anything you don't understand about the
procedure.
THE BEST CANDIDATES FOR A FOREHEAD LIFT

A forehead lift is most commonly performed in the 40-60 age range to minimize the visible effects of aging.
However, it can also help people of any age who have developed furrows or frown lines due to stress or muscle
activity. Individuals with inherited conditions, such as a low, heavy brow or furrowed lines above the nose can
achieve a more alert and refreshed look with this procedure.

Forehead lift is often performed in conjunction with a facelift to provide a smoother overall look to the face. Eyelid
surgery (blepharoplasty) may also be performed at the same time as a forehead lift, especially if a patient has
significant skin overhang in the upper eyelids. Sometimes, patients who believe they need upper-eyelid surgery find
that a forehead lift better meets their surgical goals.

Patients who are bald, who have a receding hairline, or who have had previous upper-eyelid surgery may still be
good candidates for forehead lift. The surgeon will simply alter the incision location or perform a more conservative
operation.

Remember, a forehead lift can enhance your appearance and your self-confidence, but it won't necessarily change
your looks to match your ideal or cause other people to treat you differently. Before you decide to have surgery,
think carefully about your expectations and discuss them in detail with your doctor.
ALL SURGERY CARRIES SOME UNCERTAINTY AND RISK

Complications are rare and usually minor when a forehead lift is performed by a qualified plastic surgeon. Yet, the
possibility of complications must be considered.

In rare cases, the nerves that control eyebrow movement may be injured on one or both sides, resultin g in a loss of
ability to raise the eyebrows or wrinkle the forehead. Additional surgery may be required to correct the problem.

Formation of a broad scar is also a rare complication. This may be treated surgically by removing the wide scar
tissue so a new, thinner scar may result. Also, in some patients, hair loss may occur along the scar edges.

Loss of sensation along or just beyond the incision line is common, especially with the classic forehead lift
procedure. It is usually temporary, but may be permanent in some patients.

Infection and bleeding are very rare, but are possibilities.

If a complication should occur during an endoscopic forehead lift, your surgeon may have to abandon the endoscopic
approach and switch to the conventional, open procedure, which will result in a more extensive scar and a longer
recovery period. To date, such complications are rare -- estimated at less than 1 percent of all endoscopy
procedures.

You can reduce your risk of complications by closely following your surgeon's inst ructions both before and after
surgery.
PLANNING YOUR SURGERY

For a better understanding of how a forehead lift might change your appearance, look into a mirror and place the
palms of your hands at the outer edges of your eyes, above your eyebrows. Gently draw the skin up to raise the
brow and the forehead area. That is approximately what a forehead lift would do for you.

If you decide to consult a plastic surgeon, he or she will first evaluate your face, including the skin and underlying
bone.

During your consultation, the surgeon will discuss your goals for the surgery and ask you about certain medical
conditions that could cause problems during or after the procedure, such as uncontrolled high blood pressure, blood-
clotting problems, or the tendency to develop large scars. Be sure to tell the surgeon if you have had previous facial
surgery, if you smoke, or if you take any drugs or medications -- including aspirin or other drugs that affect clotting.

If you decide to proceed with a forehead lift, your surg eon will explain the surgical technique, the recommended type
of anesthesia, the type of facility where the surgery will be performed, the risks and the costs involved. Don't
hesitate to ask your doctor any questions you may have, especially those regarding your expectations and concerns
about the results of surgery.
PREPARING FOR YOUR SURGERY

Your surgeon will give you specific instructions to prepare for the procedure, including guidelines on eating and
drinking, smoking, and taking and avoiding certain vitamins and medications. Carefully following these instructions
will help your surgery and your recovery proceed more smoothly.

If your hair is very short, you may wish to let it grow out before surgery, so that it's long enough to hide the scars
while they heal.

Whether your forehead lift is done in an outpatient facility or in the hospital, you should arrange for someone to drive
you home after your surgery, and to help you out for a day or two.
WHERE YOUR SURGERY WILL BE PERFORMED

A forehead lift is usually done in a surgeon's office -based facility or an outpatient surgery center. However, it is
occasionally done in the hospital.
ANESTHESIA USED FOR THE PROCEDURE

Most forehead lifts are performed under local anesthesia, combined with a sedative to make you drowsy. You'll be
awake but relaxed, and although you may feel some tugging and mild discomfort, your forehead will be insensitive to
pain.

Some surgeons prefer to use general anesthesia, in which case you'll sleep through the entire operation.
THE SURGERY
Your surgeon will help you decide which surgical approach will best achieve your cosmetic goals: the classic or
"open" method, or the endoscopic forehead lift. Make sure you understand the technique that your surgeon
recommends and why he or she feels it is best for you.

The classic forehead lift: Before the operation begins, your hair will be tied with rubber bands on either side of the
incision line. Your head will not be shaved, but hair that is growing directly in front of the incision line may need to
be trimmed.

For most patients, a coronal incision will be used. It follows a headphone-like pattern, starting at about ear level and
running across the top of the forehead and down the other side of the head. The incision is usually made well behind
the hairline so that the scar won't be visible.

If your hairline is high or receding, the incision may be placed just at the hairline, to avoid adding even more height
to the forehead. In patients who are bald or losing hair, a mid-scalp incision that follows the natural pattern of the
skull bones is sometimes recommended. By wearing your hair down on your forehead, most such scars become
relatively inconspicuous. Special planning is sometimes necessary for concealing the scar in male patients, whose
hairstyles often don't lend themselves as well to incision coverage.

If you are bald or have thinning hair, your surgeon may recommend a mid-scalp incision so the resulting scar follows
the natural junction of two bones in your skull and is less conspicuous.

Working through the incision, the skin of the forehead is carefully lifted so that the underlying tissue can be removed
and the muscles of the forehead can be altered or released. The eyebrows may also be elevated and excess skin at
the incision point will be trimmed away to help create a smoother, more youthful appearance.

The incision is then closed with stitches or clips. Your face and hair will be washed to prevent irritation and the
rubber bands will be removed from your hair. Although some plastic surgeons do not use any dressings, your doctor
may choose to cover the incision with gauze padding and wrap the head in an elastic bandage.

The endoscopic forehead lift: Typically, an endoscopic forehead lift requires the same preparation steps as the
traditional procedure: the hair is tied back and trimmed behind the hairline where the incisions will be made.

However, rather than making one long coronal incision, your surgeon will make three, four or five short scalp
incisions, each less than an inch in length. An endoscope, which is a pencil-like camera device connected to a
television monitor, is inserted through one of the incisions, allowing the surgeon to have a clear view of the muscles
and tissues beneath the skin. Using another instrument inserted through a different incision, the forehead skin is
lifted and the muscles and underlying tissues are removed or altered to produce a smoother appearance. The
eyebrows may also be lifted and secured into their higher position by sutures beneath the skin's surface or by
temporary fixation screws placed behind the hairline.

When the lift is complete, the scalp incisions will be closed with stitches or clips and the area will be washed. Gauze
and an elastic bandage may also be used, depending on your surgeon's preference.
AFTER YOUR SURGERY

The immediate post -operative experience for a patient who has had a classic forehead lift may differ significantly
from a patient who had the procedure performed endoscopically.

Classic forehead lift patients may experience some numbness and temporary discomfort around the incision, which
can be controlled with prescription medication. Patients who are prone to headaches may be treated with an
additional longer-acting local anesthesia during surgery as a preventive measure.

You may be told to keep your head elevated for two to three days following surgery to keep the swelling down.
Swelling may also affect the cheeks and eyes-- however, this should begin to disappear in a week or so.

As the nerves heal, numbness on the top of your scalp may be replaced by itching. These sensations may take as
long as six months to fully disappear. If bandages were used, they will be removed a day or two after surgery. Most
stitches or clips will be removed within two weeks, sometimes in two stages.

Some of your hair around the incision may fall out and may temporarily be a bit thinner. Normal growth will usually
resume within a few weeks or months. Permanent hair loss is rare.

Endoscopic forehead lift patients may experience some numbness, incision discomfort and mild swelling.

Incision site pain is usually minimal, but can be controlled with medication, if necessary. Endoscopic forehead lift
patients usually experience less of the itching sensation felt by patients who have had the classic forehead lift.

The stitches or staples used to close the incisions are usually removed within a week and the temporary fixation
screws within two weeks.
GETTING BACK TO NORMAL

Although you should be up and about in a day or two, plan on taking it easy for at least the first week after surgery.
You should be able to shower and shampoo your hair within two days, or as soon as the bandage is removed.

Most patients are back to work or school in a week to 10 days. Endoscopic patients may feel ready to return even
sooner. Vigorous physical activity should limited for several weeks, including jogging, bending, heavy housework,
sex, or any activity that increases your blood pressure. Prolonged exposure to heat or sun should be limited for
several months.
Most of the visible signs of surgery should fade completely within about three weeks. Minor swelling and bruising
can be concealed with special camouflage makeup. You may feel a bit tired and let down at first, but your energy
level will increase as you begin to look and feel better.
YOUR NEW LOOK

Most patients are pleased with the results of a forehead lift, no matter which surgical method was used. Often,
patients don't realize how much their sagging forehead contributed to the signs of aging until they see how much
younger and more rested they appear after the lift.

Although a forehead lift does not stop the clock, it can minimize the appearance of aging for years. As time passes,
you may want to repeat the procedure.




A forehead lift can smooth the forehead, raise the upper eyelids, and minimize the frown lines that come with aging.




In preparation for a forehead lift, the hair is tied back with rubber bands in front of and behind the incision area. An
incision is usually made across the top of the head, just behind the hairline.
Forehead skin is gently lifted and portions of facial muscle and excess skin are removed. The incision is then closed
with stitches or clips.




The result of a forehead lift is a younger, more rested look.




CAMOUFLAGE COSMETICS
MAKEUP TECHNIQUES
Looking better after plastic surgery

Most people are eager to return to work and social activities after plastic surgery. How quickly you do so depends on
two factors: how you feel and how you look. Your surgeon will let you know when it's physically safe to resume your
normal activities. But only you can decide how comfortable you feel with the way you look.

Almost everyone has some temporary cosmetic side effects from plastic surgery, such as swelling, bruising, or
visible incision marks. It may be days, weeks, or even months before these signs disappear and you can fully
appreciate the results of your surgery. But there's no need to sit at home and wait. There are a variety of makeup
products and techniques that can be used by men, women, and teens to camouflage the temporary side effects of
surgery and help you face the world with confidence and ease.
Here we will introduce you to the kinds of products available and show you how to use them to your best advantage.
It may take some practice. But the skills you learn now will serve you well right after surgery and in the long term,
helping you to enhance the permanent effects of your cosmetic surgery.
WHEN TO START

It's best to ask you surgeon's advice before you start using camouflage cosmetics. Most people can begin applying
makeup to cover bruising or disguise swelling as early as a day or two after surgery. If you want to hide incision
lines, you'll need to wait until the stitches have been removed and the incision is completely closed.

After nose surgery, you can normally use makeup as soon as the cast is removed. With a chemical peel or
dermabrasion, if a crust has formed you'll need to wait until it's completely gone.
WHAT TO LOOK FOR

You may use special camouflage products recommended by your plastic surgeon, commercial camo uflage products
available in many large department stores, or even a standard makeup that you already use.

The important thing is to look for products that are hypoallergenic and fragrance free. If you're happy with the
products you currently use, you can continue using them after surgery --but buy fresh ones with new applicators so
they'll be as clean as possible.

There are three basic approaches to camouflage cosmetics: concealing--hiding incision lines and bruises; color
correcting--neutralizing color in reddened or yellowish skin; and contouring--disguising swelling and creating the
illusion of highlights and shadows.
CONCEALING

Concealers are thicker and more opaque than regular foundation makeup. They can cover healed incision lines as
well as scars or bruises on your face or body.

Choose a concealer that's opaque and waterproof, but creamy enough that it doesn't pull on your skin when you apply
it. If you can find a concealer that closely matches your skin tone, you may not have to use a foundation on t op of it.

It's not a good idea to use concealer on the thin, delicate skin around your eyes, since concealer is thick and will
collect in the creases. Instead, try using a normal fluid foundation, color corrector, or eye makeup alone.
COLOR CORRECTING

Color correctors are used to disguise the yellowish shade of a bruise or the overall redness that follows chemical
peel and dermabrasion. They come in tints: lavender corrector neutralizes yellow tones, while green corrector
removes red.

Less opaque than conce alers, color correctors have the same consistency and sheerness as foundation. They're
generally used under your foundation.
CONTOURING

Contouring can be applied anywhere on the face, but it's most often used to disguise the swelling that accompanies
nose surgery and facial implants. Contouring creates dimension using light and shadow: lighter areas appear to come
forward, while darker areas recede.

You'll need two separate products for contouring: a highlighter, which is about two shades lighter than your normal
foundation; and a contour shadow, about two shades darker than your foundation. (You probably won't find products
labeled highlighter and contour shadow. Just look for the appropriate shades of foundation makeup or pressed
power.)

Blending is the key to successful contouring: you want to create the illusion of angles without seeing stripes of
makeup. The techniques of contouring are subtle and take some practice. Once you're adept, however, you can use
contouring to create "higher" cheekbones, narrow your nose, or minimize a swollen chin.
REMOVING CAMOUFLAGE COSMETICS

Camouflage cosmetics tend to be thicker and more adherent than everyday makeup, so it's important to remove them
every night. First, use a cleansing cream that removes all of your makeup . Then use a gentle, alcohol-free toner
applied with a cotton ball to remove any cleanser residue. Follow this with a moisturizer formulated for your skin
type: oily, dry, or combination.
Concealer can be used to hide the visible incision lines, along with the surrounding discoloration, that may follow
facelift or eyelid surgery.




Using highlighter and contour shadow, you can create the appearance of higher, better defined cheekbones.
Contouring can also make a swollen nose appear narrower, or minimize a swollen chin.




CHEMICAL PEEL
If you're considering chemical peel...

Chemical peel uses a chemical solution to improve and smooth the texture of the facial skin by removing its damaged
outer layers. It is helpful for those individuals with facial blemishes, wrinkles and uneven skin pigmentation. Phenol,
trichloroacetic acid (TCA) and alphahydroxy acids (AHAs) are used for this purpose. The precise formula used may
be adjusted to meet each patient's needs. Although chemical peel may be performed in conjunction with a facelift, it
is not a substitute for such surgery, nor will it prevent or slow the aging process. This brochure provides basic
information about certain types of chemical peel treatments and the results you might expect. It won't answer all
your questions, since a lot depends on your individual circumstances. Once you and your plastic surgeon have
decided on a specific peel program, be sure to ask about any details that you do not understand.

Deciding if chemical peel is right for you Chemical peel is most commonly performed for cosmetic reasons -- to
enhance your appearance and your self confidence. Chemical peel may also remove pre -cancerous skin growths,
soften acne facial scars and even control acne. In certain cases, health insurance may cover the peel procedure. Be
sure to check your policy and contact your insurance company before the procedure is performed.

Alphahydroxy acids (AHAs), such as glycolic, lactic, or fruit acids are the mildest of the peel formulas and produce
light peels. These types of peels can provide smoother, brighter-looking skin for people who can't spare the time to
recover from a phenol or TCA peel. AHA peels may be used to treat fine wrinkling, areas of dryness, uneven
pigmentation and acne. Various concentrations of an AHA may be applied weekly or at longer intervals to obtain the
best result. Your doctor will make this decision during your consultation and as the treatment proceeds. An
alphahydroxy acid, such as glycolic acid, 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.

Trichloroacetic acid (TCA) can be used in many concentrations, but it is most commonly used for medium-depth
peeling. Fine surface wrinkles, superficial blemishes and pigment problems are co mmonly treated with TCA. The
results of TCA peel are usually less dramatic than and not as long-lasting as those of a phenol peel. In fact, more
than one TCA peel may be needed to achieve the desired result. The recovery from a TCA peel is usually shorter
than with a phenol peel.

Phenol is the strongest of the chemical solutions and produces a deep peel. It is used mainly to treat patients with
coarse facial wrinkles, areas of blotchy or damaged skin caused by sun exposure, or pre -cancerous growths. Since
phenol sometimes lightens the treated areas, your skin pigmentation may be a determining factor as to whether or
not this is an appropriate treatment for you. Phenol is primarily used on the face; scarring may result if it's applied to
the neck or other body areas.

All chemical peels carry some uncertainty and risk Chemical peel is normally a safe procedure when it is performed
by a qualified, experienced plastic surgeon. However, some unpredictability and risks such as infection and scarring,
while infrequent, are possible.

AHA peels may cause stinging, redness, irritation and crusting. However, as the skin adjusts to the treatment
regimen, these problems will subside.

With a TCA peel, your healed skin will be able to produce pigment as always; the peel will not bleach the skin.
However, TCA-peel patients are advised to avoid sun exposure for several months after treatment to protect the
newly formed layers of skin. Even though TCA is milder than phenol, it may also produce some unintended color
changes in the skin.

With a phenol peel, the new skin frequently loses its ability to make pigment (that is, tan). This means that not only
will the skin be lighter in color, but you'll always have to protect it from the sun. Phenol may pose a special risk for
patients with a history of heart disease. It's important that you make your surgeon aware of any heart problems when
your medical history is taken.

It is also possible that phenol will cause some undesired cosmetic results, such as uneven pigment changes. Certain
modified phenol peels are gentler and may be preferred in some circumstances.
PEEL FORMULAS AT A GLANCE
Alphahydroxy                                                acids                                           (AHAs)
Uses:


     •    Smooths rough, dry skin
     •    Improves texture of sun-damaged skin
     •    Aids in control of acne
     •    Can be mixed with bleaching agent to correct pigment problems
     •    Can be used as TCA pre-treatment


Considerations:


     •    A series of peels may be needed
     •    As with most peel treatments, sunblock use is recommended


Trichloroacetic                                               acid                                               (TCA)
Uses:


     •    Smooths out fine surface wrinkles
     •    Removes superficial blemishes
     •    Corrects pigment problems


Considerations:


     •    Can be used on neck or other body areas
     •    May require pre-treatment with Retin-A or AHA creams
     •    Treatment takes only 10-15 minutes
     •    Preferred for darker-skinned patients
     •    Peel depth can be adjusted
     •    Repeat treatment may be needed to maintain results
     •    Sunblock must be used for several months
     •    Healing is usually quick, much quicker than with a phenol peel


Phenol
Uses:


     •    Corrects blotches caused by: sun exposure, birth-control pills, aging
     •    Smooths out coarse wrinkles
     •    Removes pre-cancerous growths


Considerations:


     •    Used on the face only
     •    Not recommended for dark-skinned individuals
     •    Procedure may pose risk for patients with heart problems
     •    Full-face treatment may take one hour or more
     •    Recovery may be slow - Complete healing may take several months
     •    May permanently remove facial freckles
     •    Sun protection, including sunblock, must always be used
     •    Results are dramatic and long-lasting
     •    Permanent skin lightening and lines of demarcation may occur


PLANNING FOR A CHEMICAL PEEL

In some states, no medical degree is required to perform a chemical peel - even the strongest phenol peels. Many
states have laws that permit non-physicians to administer certain peel solutions, but regulate the strengths which
they are pe rmitted to apply. You should be warned that phenol and TCA peels have been offered by inadequately
trained practitioners claiming "miracletechniques" to rejuvenate the skin.

It is very important that you find a physician who has adequate training and experience in skin resurfacing. Your
plastic surgeon may offer you a choice of peel techniques or suggest a combination of peels to obtain the best result
for you.

During your initial consultation, it is important that you discuss your expectations with your plastic surgeon. Don't
hesitate to ask any questions or express any concerns that you may have. Expect your plastic surgeon to explain the
planned procedure in detail, including its risks and benefits, the recovery period and the costs. If you have a history
of herpes, you should inform your physician prior to the procedure. Remember, chemical peel treatments are usually
not covered by medical insurance unless they are performed for medically related problems.
PREPARING FOR YOUR CHEMICAL PEEL

Your plastic surgeon will instruct you on how to prepare for your peel treatment.

Sometimes Retin A - a prescription medication derived from Vitamin A - is used to pre-treat the skin. This thins out
the skin's surface layer, allowing the TCA solution to penetrate more deeply and evenly. If your skin won't tolerate
Retin-A pre-treatment, an AHA cream may be used instead. Hydroquinone, a bleaching agent, is sometimes used in
conjunction with Retin-A or AHA pre -treatment, especially if you have blotchy skin areas or pigmentat ion problems.
You may have to spend a month or more in the pre-treatment phase before the doctor will schedule your actual peel.

You will need to arrange for someone to drive you home and help you out for a day or two if you are having a phenol
or deeper TCA peel. You probably won't need any extra assistance if you're having an AHA peel or superficial TCA
peel.
WHERE YOUR PEEL WILL BE PERFORMED

Most chemical peels may be safely performed in a plastic surgeon's office, office -based surgical facility or outpatient
surgical center. Your plastic surgeon may want you to stay overnight in a facility or hospital if other cosmetic
procedures are performed simultaneously.
TYPES OF ANESTHESIA

Anesthesia isn't required for phenol or TCA peels because the chemical solution acts as an anesthetic. However,
sedation may be used before and during the procedure to relax you and keep you comfortable.

No anesthesia is needed for AHA peels since they cause only a slight stinging sensation during application.
THE PEEL

AHA peels/treatments: Your doctor will apply the AHA solution to your cleansed facial skin, a process that usually
takes no more than 10 minutes. No "after-peel" ointment or covering is required. Depending on the strength of the
peel, periodic treatmentsmay be necessary until the desired effects are achieved.

For some patients, the application of an AHA-based face wash or cream once or twice a day at home will be
sufficient to accomplish the desired goal. Your plastic surgeon may add Retin -A or a bleaching agent to your at -
home treatment schedule. After several weeks of at -home use, your doctor will examine your skin to determine if
your regimen needs adjustment.

Phenol and TCA peels: Typically, the skin is first thoroughly cleansed. Then, the surgeon will carefully ap ply the
phenol or TCA solution. You may feel a stinging sensation as the peel solution is applied, but this feeling will quickly
pass.

A full-face TCA peel usually takes no more than 15 minutes. Two or more TCA peels may be needed to obtain the
desired result, and those may be spaced out over several months. Mild TCA peels may be repeated as often as every
month.

If phenol solution has been used, your plastic surgeon may coat the treated area with petroleum jelly or a waterproof
adhesive tape. With lighter peels, no covering is necessary.

A full-face phenol peel generally takes one or two hours to perform, while a phenol peel to a smaller facial region
(perhaps the skin above the upper lip) may take only 10 or 15 minutes. A single treatment usually suffices.
AFTER YOUR TREATMENT

After an AHA peel, it is common to experience some temporary flaking or scaling, redness and dryness of the skin.
However, these conditions will disappear as the skin adjusts to treatment.

After a phenol or TCA peel, your doctor may prescribe a mild pain medication to relieve any tingling or throbbing you
may feel. If tape was used to cover your face, it will be removed after a day or two. A crust or scab will form on the
treated area. To help your face heal properly, it is essential that you follow your doctor's specific post -operative
instructions.

A TCA peel may also cause significant swelling, depending on the strength of the peel used.
If you've had a phenol peel, your face may become quite swollen. Your eyes may even be swollen shut temporarily.
You will need someone to help care for you for a day or two. You may also be limited to a liquid diet and advised not
to talk very much during the first few days of recovery.
GETTING BACK TO NORMAL

With an AHA peel, the temporary redness, flaking and dryness that you experience will not prevent you from working
or engaging in your normal activities. A fresher and improved skin texture will result with continued AHA treatments.
Remember, protecting your skin from the sun is also important following these mild acid peels. Ask your doctor to
recommend a sunblock with adequate UVA and UVB protection and use it every day.

With a TCA peel, the moderate discomfort and mild swelling you may experience will subside within the first week.
In about a week to ten days, your new skin will be apparent and you should be healed sufficiently to return to your
normal activities. It is best to avoid sun exposure unless you are adequately protected.

With a phenol peel, new skin will begin to form in about seven to ten days. Your face will be very red at first,
gradually fading to a pinkish color over the following weeks to months. During this time, it is especially important
that you use a sunblock or blotchy, irregular skin coloring may result.

About two weeks after treatment, you may return to work and resume some of your normal activities. Your skin will
be healed enough for you to wear makeup. (For makeup tips, ask your plastic surgeon for the ASPS brochure on
camouflage cosmetics.)
YOUR NEW LOOK

Improvements from AHA peels may be very subtle at first. You may detect a healthier glow to your skin. With
continued treatments, you will notice a general improvement in the texture of your skin.

The results of a TCA peel are usually not as long-lasting as those of phenol peel. However, your skin will be
noticeably smoother and fresher-looking.

If you're planning a phenol peel, you can expect dramatic improvement in the surface of your skin - fewer fine
wrinkles, fewer blemishes and more even-toned skin. Your results will be long -lasting, although not immune to the
effects of aging and sun exposure.

Research in plastic surgery assures continued advances in effective patient treatment. You may support research in
plastic and reconstructive surgery with a tax -deductible co ntribution to the Plastic Surgery Educational Foundation
Research Fund. Contributions or inquiries may be directed to the PSEF Development Officer, 444 East Algonquin
Road, Arlington Heights, IL 60005-4664, 847-228-9900.
Chemical peel is especially useful for the fine wrinkles on cheeks,
forehead, and around the eyes, and the vertical wrinkles around the
mouth.




The chemical solution can be applied to the entire face, or to a specific
area -for example, around the mouth - sometimes in conjunction with a
facelift.




At the end of a phenol peel, a thick layer of petroleum jelly may be
applied to the treated area.
A protective crust may be allowed to form over the new skin. When it's removed, the skin underneath will be a bright
pink.




After healing, the skin is lighter in color, tighter, smoother, and younger looking.




CHIN SURGERY
COSMETIC PLASTIC SURGERY
PROCEDURES AT A GLANCE
Chin Surgery

Chin surgery, also known as mentoplasty, is a surgical procedure to reshape the chin either by enhancement with an
implant or reduction surgery on the bone. Many times a plastic surgeon may recommend chin surgery to a patient
having nose surgery in order to achieve facial proportion, as the size of the chin may magnify or minimize the
perceived size of the nose. Chin surgery helps provide a harmonious balance to your facial features so that you feel
better about the way you look.




COMPUTER IMAGING
COSMETIC PLASTIC SURGERY
PROCEDURES AT A GLANCE
Computer Imaging

Many plastic surgeons use a computer imaging machine during consultations to show patients an estimate of post -
operative appearance. A photograph of the patient is transferred to a computer screen and then altered by the
surgeon to approximate the post -operative result. Physicians who use imaging find that computer-generated pictures
can enhance doctor-patient communication. It's important to realize that a computer image may not match reality and
represents no guarantee of outcome. No computer can take into account a patient's skin elasticity, bone structure,
blood supply and healing ability.




DERMABRASION
SKIN REFINISHING
If you're considering a skin-refinishing treatment...

Dermabrasion and dermaplaning help to "refinish" the skin's top layers through a method of controlled surgical
scraping. The treatments soften the sharp edges of surface irregularities, giving the skin a smoother appearance.

Dermabrasion is most often used to improve the look of facial skin left scarred by accidents or previous surgery, or
to smooth out fine facial wrinkles, such as those around the mouth. It's also sometimes used to remove the pre -
cancerous growths called keratoses. Dermaplaning is commonly used to treat deep acne scars.

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

If you're considering surgery to refinish the skin, this information will give you a basic understanding of the
procedure-when it can help, how it's performed, and what results you can expect. It can't answer all of your
questions, since a lot depends on your individual circumstances. Please ask your doctor about anything you don't
understand.
CONSIDERING ALTERNATIVE PROCEDURES

If you're planning "surface repairs" on your face, you may also be considering chemical peel, an alternative method of
surgically removing the top layer of skin. However, dermabrasion and dermaplaning use surgical instruments to
remove the affected skin layers, while chemical peel uses a caustic solution.

Many plastic surgeons perform all three procedures, selecting one or a combination of procedures to suit the
individual patient and the problem. Others prefer one technique for all surface repairs. In general, chemical peel is
used more often to treat fine wrinkles, and dermabrasion and dermaplaning for deeper imperfections such as acne
scars. A non-chemical approach may also be preferred for individuals with slightly darker skin, especially when
treating limited areas of the face, since dermabrasion and dermaplaning are less likely to produce extreme changes
and contrasts in skin color.

If you'd like more information on chemical peel, ask your plastic surgeon for the ASPS brochure on that topic.
THE BEST CANDIDATES FOR DERMABRASION

Dermabrasion and dermaplaning can enhance your appearance and your self-confidence, but neither treatment will
remove all scars and flaws or prevent aging. Before you decide to have a skin-refinishing treatment, think carefully
about your expectations and discuss them with your surgeon.

Men and women of all ages, from young people to older adults, can benefit from dermabrasion and dermaplaning.
Although older people heal more slowly, more important factors are your skin type, coloring, and medical history. For
example, black skin, Asian skin, and other dark complexions may become permanently discolored or blotchy after a
skin-refinishing treatment. People who develop allergic rashes or other skin reactions, or who get frequent fever
blisters or cold sores, may experience a flare-up. If you have freckles, they may disappear in the treated area.

In addition, most surgeons won't perform treatment during the active stages of acne because of a greater risk of
infection. The same may be true if you've had radiation treatments, a bad skin burn, or a previous chemical peel.
ALL SURGERY CARRIES SOME UNCERTAINTY AND RISK

Dermabrasion and dermaplaning are normally safe when they're performed by a qualified, experienced board -
certified physician. The most common risk is a change in skin pigmentation. Permanent darkening of the skin, usually
caused by exposure to the sun in the days or months following surgery, may occur in some patients. On the other
hand, some patients find the treated skin remains a little lighter or blotchy in appearance.

You may develop tiny whiteheads after surgery. These usually disappear on their own, or with the use of an abrasive
pad or soap; occasionally, the surgeon may have to remove them. You may also develop enlarged skin pores; these
usually shrink to near normal size once the swelling has subsided.

While infection and scarring are rare with skin-refinishing treatments, they are possible. Some individuals develop
excessive scar tissue (keloid or hypertrophic scars); these are usually treated with the application or injection of
steroid medications to soften the scar.

You can reduce your risks by choosing a qualified plastic surgeon and closely following his or her advice.
PLANNING YOUR SURGERY

Because these treatments have sometimes been offered by inadequately trained practitioners, it's especially
important that you find a doctor (generally a plastic surgeon or a dermatologist) who is trained and experienced in
the procedure. After all, dermabrasion and dermaplaning usu ally involve the most visible part of your body-your
face.

In your initial consultation, be open in discussing your expectations with your surgeon, and don't hesitate to ask any
questions or express any concerns you may have. Your surgeon should be equally open with you, explaining the
factors that could influence the procedure and the results-such as your age, skin condition, and previous plastic
surgeries.

The surgeon will discuss your medical history, conduct a routine examination, and photograph your face. He or she
should explain the procedure in detail, along with its risks and benefits, the recovery period, and the costs. Insurance
usually doesn't cover cosmetic procedures, however, it may cover dermabrasion or dermaplaning when performed to
remove precancerous skin growths or extensive scars. Check your policy or call your carrier to be sure.
PREPARING FOR YOUR SURGERY

Your surgeon will give you specific instructions on how to prepare for surgery, including guidelines on eating and
drinking, and on av oiding aspirin and other medications that affect blood clotting. You may also be given special
instructions regarding the care and treatment of your skin prior to surgery. If you smoke, you'll probably be asked to
stop for a week or two before and after su rgery, since smoking decreases blood circulation in the skin and impedes
healing.

While you're making preparations, be sure to arrange for someone to drive you home after your surgery, and to help
you out for a day or two if needed.
WHERE YOUR SURGERY WILL BE PERFORMED

Your treatment may be performed in a surgeon's office -based facility, an outpatient surgery center, or a hospital. It's
usually done on an outpatient basis, for cost containment and convenience. However, if you're undergoing extensive
work, you may be admitted to the hospital.
TYPES OF ANESTHESIA

Dermabrasion and dermaplaning may be performed under local anesthesia, which numbs the area, combined with a
sedative to make you drowsy. You'll be awake but relaxed, and will feel minimal discomfort. Sometimes a numbing
spray, such a freon, is used along with or instead of local anesthesia. Or, in more severe cases, your surgeon may
prefer to use general anesthesia, in which case you'll sleep through the procedure.
THE SURGERY

Dermabrasion and dermaplaning can be performed fairly quickly. The procedures usually take from a few minutes to
an hour and a half, depending on how large an area of skin is involved. It's not uncommon for the procedure to be
performed more than once, or in stages, especially when scarring is deep or a large area of skin is involved.

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

In dermaplaning, the surgeon uses a hand-held instrument called a dermatome. Resembling an electric razor, the
dermatome has an oscillating blade that moves back and forth to evenly "skim" off the surface layers of skin that
surround the craters or other facial defects. This skimming continues until the lowest point of the acne scar becomes
more even with the surrounding skin.

The surgeon may then treat the skin in a number of ways, including ointment, a wet or waxy dressing, dry treatment,
or some combination of these.
AFTER YOUR SURGERY

Right after the procedure, your skin will be quite red and swollen, and eating and talking may be difficult. You'll
probably feel some tingling, burning, or aching; any pain you feel can be controlled with medications prescribed by
your surgeon. The swelling will begin to subside in a few days to a week.

If you remember the scrapes you got when you fell down as a child, you'll have an idea of what to expect from this
type of surgery. A scab or crust will form over the treated area as it begins to heal. This will fall off as a new layer
of tight, pink skin forms underneath. Your face may itch as new skin starts to grow, and your surgeon may
recommend an ointment to make you more comfortable. If ointment is applied immediately after surgery, little or no
scab will form.

In any case, you surgeon will give you detailed instructions to care for your skin after surgery. For men, this will
include delaying shaving for a while, then using an electric razor at first. It's very important that you understand your
doctor's instructions and follow them exactly, to ensure the best possible healing.

If you notice the treated area beginning to get worse instead of better-for example, if it becomes increasingly red,
raised, and itchy after it has started to heal-it may be a sign that abnormal scars are beginning to form. Call your
surgeon as soon as possible, so that treatment can begin early.
GETTING BACK TO NORMAL

Your new skin will be a bit swollen, sensitive, and bright pink for several weeks. During this time, you can begin
gradually resuming your normal activities.
You can expect to be back at work in about two weeks. Your surgeon will probably advise your to avoid any activity
that could cause a bump to your face for at least two weeks. More active sports-especially ball sports-should be
avoided for four to six weeks. If you swim, stick to indoor pools to avoid sun and wind, and keep your face out of
chlorinated water for at least four weeks. It will be at least three to four weeks before you can drink alcohol without
experiencing a flush of redness.

Above all, it's important to protect your skin from the sun until the pigment has completely returned to your skin- as
long as six to twelve months.
YOUR NEW LOOK

Refinishing treatments can offer dramatic improvements in the surface of your skin, but it will take some time before
you see the final results.

The pinkness of your skin will take about three months to fade. In the meantime, you'll probably want to wear non-
allergenic makeup when you go out. (For tips on hiding your condition while it heals, ask your surgeon for the ASPS
brochure on camouflage cosmetics.) When your new skin is fully repigmented, the color should closely match the
surrounding skin, making the procedure virtually undetectable.




Dermabrasion and dermaplaning can smooth scars left by acne, accidents, or previous surgery, as well as fine facial
wrinkles, especially those around the mouth.




In dermabrasion, the surgeon scrapes away the top layers of skin using an electrically operated instrument with a
rough wire brush or diamond-impregnated burr.
This cross section shows how dermabrasion smooths irregularities in the outermost layer of skin.




Dermaplaning uses a dermatone to skim off surface layers of skin that surround facial defects.




Several months after your procedure, pigmentation returns and the skin is much smoother than before.
OTOPLASTY
EAR SURGERY
If you're considering ear surgery...

Ear surgery, or otoplasty, is usually done to set prominent ears back closer to the head or to reduce the size of large
ears.

For the most part, the operation is done on children between the ages of four and 14. Ears are almost fully grown by
age four, and the earlier the surgery, the less teasing and ridicule the child will have to endure. Ear surgery on adults
is also possible, and there are generally no additional risks associated with ear surgery on an older patient.

If you're considering ear surgery for yourself or your child, this information will give you a basic understanding of
the procedure -when it can help, how it's performed, and what results you can expect. It can't answer all of your
questions, since a lot depends on your individual circumstances. Please be sure to ask your doctor if there is
anything you don't understand about the procedure.
ALL SURGERY CARRIES SOME UNCERTAINTY AND RISK

When ear surgery is performed by a qualified, experienced surgeon, complications are infrequent and usually minor.
Nevertheless, as with any operation, there are risks associated with surgery and specific complications associated
with this procedure.

A small percentage of patients may develop a blood clot on the ear. It may dissolve naturally or can be drawn out
with a needle.

Occasionally, patients develop an infection in the cartilage, which can cause scar tissue to form. Such infections are
usually treated with antibiotics; rarely, surgery may be required to drain the infected area.
PLANNING FOR SURGERY

Most surgeons recommend that parents stay alert to their child's feelings about protruding ears; don't insist on the
surgery until your child wants the change. Children who feel uncomfortable about their ears and want the surgery are
generally more cooperative during the process and happier with the outcome.

In the initial meeting, your surgeon will evaluate your child's condition, or yours if you are considering surgery for
yourself, and recommend the most effective technique. He or she will also give you specific instructions on how to
prepare for surgery.
WHERE THE SURGERY WILL BE PERFORMED

Ear surgery is usually performed as an outpatie nt procedure in a hospital, a doctor's office -based surgical facility, or
a freestanding surgery center. Occasionally, your doctor may recommend that the procedure be done as an inpatient
procedure, in which case you can plan on staying overnight in the hospital.
TYPES OF ANESTHESIA

If your child is young, your surgeon may recommend general anesthesia, so the child will sleep through the
operation. For older children or adults, the surgeon may prefer to use local anesthesia, combined with a sedative, so
you or your child will be awake but relaxed.
THE SURGERY

Ear surgery usually takes about two to three hours, although complicated procedures may take longer. The technique
will depend on the problem.

With one of the more common techniques, the surgeon makes a small incision in the back of the ear to expose the ear
cartilage. He or she will then sculpt the cartilage and bend it back toward the head. Non-removable stitches may be
used to help maintain the new shape. Occasionally, the surgeon will remove a larger piece of cartilage to provide a
more natural-looking fold when the surgery is complete.

Another technique involves a similar incision in the back of the ear. Skin is removed and stitches are used to fold the
cartilage back on itself to reshape the ear without removing cartilage.

In most cases, ear surgery will leave a faint scar in the back of the ear that will fade with time. Even when only one
ear appears to protrude, surgery is usually performed on both ears for a better balance.
GETTING BACK TO NORMAL

Adults and children are usually up and around within a few hours of surgery, although you may prefer to stay
overnight in the hospital with a child until all the effects of general anesthesia wear off.

The patient's head will be wrapped in a bulky bandage immediately following surgery to promote the best molding
and healing. The ears may throb or ache a little for a few days, but this can be relieved by medication.

Within a few days, the bulky bandages will be replaced by a lighter head dressing similar to a headband. Be sure to
follow your surgeon's directions for wearing this dressing, especially at night.

Stitches are usually removed, or will dissolve, in about a week.
Any activity in which the ear might be bent should be avoided for a month or so. Most adults can go back to work
about five days after surgery. Children can go back to school after seven days or so, if they're careful about
playground activity. You may want to ask your child's teacher to keep an eye on the child for a few weeks.
OTHER EAR PROBLEMS

Besides protruding ears, there are a variety of other ear problems that can be helped with surgery. These include:
"lop ear," when the tip seems to fold down and forward; "cupped ear," which is usually a very small ear; and "shell
ear," when the curve in the outer rim, as well as the natural folds and creases, are missing. Surgery can also improve
large or stretched earlobes, or lobes with large creases and wrinkles. Surgeons can even build new ears for those
who were born without them or who lost them through injury.

Sometimes, however, the correction can leave a scar that's worse than the original problem. Ask your surgeon about
the effectiveness of surgery for your specific case.
MORE NATURAL-LOOKING EARS

Most patients, young and old alike, are thrilled with the results of ear surgery. But keep in mind, the goal is
improvement, not perfection. Don't expect both ears to match perfectly-perfect symmetry is both unlikely and
unnatural in ears. If you've discussed the procedure and your expectations with the surgeon before the operation,
chances are, you'll be quite pleased with the result.




Ears that appear to stick out or are overly large can be helped by ear surgery.




An incision is made in the back of the ear so cartilage can be sculpted or folded. Stitches are used to close the
incision and help maintain the new shape.
Creating a fold in the cartilage makes the ear lie flatter against the head and appear more normal.




ENDOSCOPY
ENDOSCOPIC PLASTIC SURGERY
If your doctor has recommended endoscopy . . .

Endoscopy is a surgical technique that involves the use of an endoscope, a special viewing instrument that allows a
surgeon to see images of the body's internal structures through very small incisions.

Endoscopic surgery has been used for decades in a number of different procedures, including gallbladder removal,
tubal ligation, and knee surgery. However, in the world of plastic surgery, endoscopic instruments have recently been
introduced. Plastic surgeons believe the technique holds great promise, but further study is needed to establish its
effectiveness, especially over the long-term. As important research continues, endoscopy is being used on a limited
basis for both cosmetic and reconstructive procedures.

This brochure will give you a basic understanding of endoscopy in plastic surgery --how it's performed, what risks
are involved, and the type of surgical training to look for in a surgeon. Please ask your doctor if there is anything you
don't understand about the specific procedure you're planning to have.
The endoscope

An endoscope consists of two basic parts: A tubular probe fitted with a tiny camera and bright light, which is inserted
through a small incision; and a viewing screen, which magnifies the transmitted images of the body's internal
structures. During surgery, the surgeon watches the screen while moving the tube of the endoscope through the
surgical area.

It's important to understand that the endoscope functions as a viewing device only. To perform the surgery, a
separate surgical instrument--such as a scalpel, scissors, or forceps--must be inserted through a different point of
entry and manipulated within the tissue.
Advantages of endoscopy

All surgery carries risks and every incision leaves a scar. However, with endoscopic surgery, your scars are likely to
be hidden, much smaller and some of the after effects of surgery may be minimized.

In a typical endoscopic procedure, only a few small incisions, each less than one inch long, are needed to insert the
endoscope probe and other instruments. For some procedures, such as breast augmentation, only two incisions may
be necessary. For others, such as a forehead lift, three or more short incisions may be needed. The tiny "eye" of the
endoscope's camera allows a surgeon to view the surgical site almost clearly as if the skin were opened from a long
incision.
Because the incisions are shorter with endoscopy, the risk of sensory loss from nerve damage is decreased. Also,
bleeding, bruising and swelling may be significantly reduced. With the endoscopic approach, you may recover more
quickly and return to work earlier than if you had undergone open surgery.

Endoscopic surgery may also allow you to avoid an overnight hospital stay. Many endoscopic procedures can be
performed on an outpatient basis under local anesthesia with sedation. Be sure to discuss this possibility with your
doctor.

In endoscopic surgery, a probe with a tiny camera transmits images inside the body to a video monitor.
Uses in plastic surgery

As research continues, it's expected that many new uses for endoscopy will be developed. In the meantime, some
plastic surgeons are using the technique on carefully selected patients. Some procedures that may be assisted by
endoscopy are:
Cosmetic surgery

Abdominoplasty (tummy tuck) -- Endoscopy is sometimes used as an adjunct for selected patients who have lost
abdominal muscle tone. Guided by the endoscope, the muscles that run vertically down the length of the abdomen
may be tightened through several short incisions. Endoscopy is generally not used in patients who have a significant
amount of loose abdominal skin.

Breast augmentation -- Inserted through a small incision in the u nderarm or the navel, an endoscope can assist the
surgeon in positioning breast implants within the chest wall. Endoscopy may also assist in the correction of capsular
contracture (scar tissue that sometimes forms around an implant, causing it to feel firm), and in the evaluation of
existing implants.

Facelift -- Although the traditional facelift operation is still the best choice for most patients -- especially those
with a significant amount of excess skin -- certain selected individuals may benefit from an endoscopically assisted
procedure. When an endoscope is used, the customary incision along, or in the hairline is usually eliminated. Instead,
small incisions may be strategically placed in areas where the most correction is needed. If the muscles and skin of
the mid-face need to be smoothed and tightened, incisions may be hidden in the lower eyelid and in the upper
gumline. To tighten the loose muscles of the neck, incisions may be concealed beneath the chin and behind the ears.
The endoscope may also assist in the positioning of cheek and chin implants.

Forehead lift -- Of all the cosmetic procedures that use endoscopy, forehead lift is the one which plastic surgeons
more commonly perform. Instead of the usual ear-to-ear incision, three or more "puncture-type" incisions are made
just at the hairline. The endoscope helps guide the surgeon, who removes the muscles that produce frown lines, and
repositions the eyebrows at a higher level.
Reconstructive surgery:

Flap surgery -- Endoscopy can assist in repairing body parts that are damaged from injury or illness. Often, healthy
tissue is "borrowed" from one part of the body to help repair another. Using an endoscope, the tissue or flaps can be
removed from the donor site with only two or three small incisions.

Placement of tissue expanders -- Used frequently in reconstructive surgery, tissue expanders are silicone "balloons"
that are temporarily implanted to help stretch areas of healthy skin. The newly expanded skin is then used to cover
body areas where skin has been lost due to injury (such as a burn) or disease. Using an endoscope, a surgeon can
help ensure that a tissue expander is precisely positioned beneath the surface to bring the greatest benefit to the
patient.

Sinus surgery -- An endoscope can assist a surgeon in pinpointing and correcting sinus-drainage problems. It can
also help locate nasal polyps (growths) or other problems within the sinus cavity, and assist in full rhino-septal
surgery.

Carpal tunnel release -- After the endoscope is inserted through a small incision in the wrist area, the surgeon
locates the median nerve, which runs down the center of the wrist. A separate incision may be made in the palm to
insert scissors or scalpel to cut the ligament putting pressure on the nerve.
Finding a well-trained surgeon

Because endoscopy is a relatively new technique in plastic surgery, it's extremely important that you select a board -
certified plastic surgeon who has adequate training and experience.

Many endoscopic procedures do not require a hospit al stay and are performed in a surgeon's office or an out -patient
surgery center. If you're planning to have out-patient surgery, be sure that the surgeon you've selected has
privileges to perform your particular endoscopic procedure at an accredited hospital. This assures you that your
surgeon has been evaluated by the hospital's quality-assurance review committee and is generally considered to
have the needed training.

Be sure to find out if the surgeon's hospital privileges cover both the endoscopic and the open version of the
procedure you plan to have, since your doctor may have to switch to a traditional open procedure if a complication
occurs during surgery.

Keep in mind that many plastic surgeons in practice today received endoscopy training as part of their plastic
surgery or general surgery residency training. And, all board -certified plastic surgeons are continually being trained
in new procedures.
Special consideration and risks
It's important to keep in mind that the endoscopic approach has only recently been applied to plastic surgery
procedures. There are some known risks, which vary in severity depending on the procedure being performed.
These include infection, fluid accumulation beneath the skin (which must be drained), blood vessel damage, nerve
damage or loss of feeling, internal perforation injury, and skin injury.

And, keep in mind that if a complication occurs at any time during the operation your surgeon may have to switch to
an open procedure, which will result in a more extensive scar and a longer recovery period. However, to date, such
complications are rare--estimated to occur in less that 5 percent of all endoscopy procedures.
Deciding if endoscopic surgery is right for you

Although much is still unknown about endoscopic plastic surg ery, you may want to focus on what is known as you
make your decision. Considering the following:

For decades, endoscopy has been used successfully in orthopedic, urologic, and gynecologic procedures. Improved
technology now permits endoscopy to be used by plastic surgeons.

If performed by an experienced, well-trained plastic surgeon, endoscopic procedures may provide the same results
as open-method procedures, but with less scarring.

In some cases, endoscopic surgery may require less recovery time than is usually required for open procedures.

Patients who tend to be the best candidates for cosmetic endoscopic procedures are those who don't have large
amounts of loose hanging skin. Patients with loose facial or abdominal skin may benefit from a combination of classic
and endoscopic techniques, in face or forehead lift, or abdominoplasty.




BLEPHAROPLASTY
EYELIDS
If you're considering eyelid surgery...

Eyelid surgery (technically called blepharoplasty) is a procedure to remove fat --usually along with excess skin and
muscle from the upper and lower eyelids. Eyelid surgery can correct drooping upper lids and puffy bags below your
eyes - features that make you look older and more tired than you feel, and may even interfere with your vision.
However, it won't remove crow's feet or other wrinkles, eliminate dark circles under your eyes, or lift sagging
eyebrows. While it can add an upper eyelid crease to Asian eyes, it will not erase evidence of your ethnic or racial
heritage. Blepharoplasty can be done alone, or in conjunction with other facial surgery procedures such as a facelift
or browlift.

If you're considering eyelid surgery, this information will give you a basic understanding of the procedure -when it
can help, how it's performed, and what results you can expect. It can't answer all of your questions, since a lot
depends on the individual patient and the surgeon. Please ask your surgeon about anything you don't understand.
THE BEST CANDIDATES FOR EYELID SURGERY

Blepharoplasty can enhance your appearance and your self -confidence, but it won't necessarily change your looks to
match your ideal, or cause other people to treat you differently. Before you decide to have surgery, think carefully
about your expectations and discuss them with your surgeon.

The best candidates for eyelid surgery are men and women who are physically healthy, psychologically stable, and
realistic in their expectations. Most are 35 or older, but if droopy, baggy eyelids run in your family, you may decide
to have eyelid surgery at a younger age.

A few medical conditions make blepharoplasty more risky. They include thyroid problems such as hypothyroidism
and Graves' disease, dry eye or lack of sufficient tears, high blood pressure or other circulatory disorders,
cardiovascular disease, and diabetes. A detached retina or glaucoma is also reason for caution; check with your
ophthalmologist before you have surgery.
ALL SURGERY CARRIES SOME UNCERTAINTY AND RISK

When eyelid surgery is performed by a qualified plastic surgeon, complications are infrequent and usually minor.
Nevertheless, there is always a possibility of complications, including infection or a reaction to the anesthesia. You
can reduce your risks by closely following your surgeon's instructions both before and after surgery.

The minor complications that occasionally follow blepharoplasty include double or blurred vision for a few days;
temporary swelling at the corner of the eyelids; and a slight asymmetry in healing or scarring. Tiny whiteheads may
appear after your stitches are taken out; your surgeon can remove them easily with a very fine needle.
Following surgery, some patients may have difficulty closing their eyes when they sleep; in rare cases this condition
may be permanent. Another very rare complication is ectropion, a pulling down of the lower lids. In this case, further
surgery may be required.
PLANNING YOUR SURGERY

The initial consultation with your surgeon is very important. The surgeon will need your complete medical history, so
check your own records ahead of time and be ready to provide this information. Be sure to inform your surgeon if
you have any allergies; if you're taking any vitamins, medications (prescription or over-the-counter), or other drugs;
and if you smoke.

In this consultation, your surgeon or a nurse will test your vision and assess your tear production. You should also
provide any relevant information from your ophthalmologist or the record of your most recent eye exam. If you wear
glasses or contact lenses, be sure to bring them along.

You and your surgeon should carefully discuss your goals and expectations for this surgery. You'll need to 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.

Your surgeon will explain the techniques and anesthesia he or she will use, the type of facility where the surgery will
be performed, and the risks and costs involved. (Note: Most insurance policies don't cover eyelid surgery, unless you
can prove that drooping upper lids interfere with your vision. Check with your insurer.)

Don't hesitate to ask your doctor any questions you may have, especially those regarding your expectations and
concerns about the results.
PREPARING FOR YOUR SURGERY

Your surgeon will give you specific instructions on how to prepare for surgery, including guidelines on eating and
drinking, smoking, and taking or avoiding certain vitamins and medications. Carefully following these instructions will
help your surgery go more smoothly.

While you're making preparations, be sure to arrange for someone to drive you home after your surgery, and to help
you out for a few days if needed.
WHERE YOUR SURGERY WILL BE PERFORMED

Eyelid surgery may be performed in a surgeon's office -based facility, an outpatient surgery center, or a hospital. It's
usually done on an outpatient basis; rarely does it require an inpatient stay.
TYPES OF ANESTHESIA

Eyelid surgery is usually performed under local anesthesia--which numbs the area around your eyes--along with
oral or intravenous sedatives. You'll be awake during the surgery, but relaxed and insensitive to pain. (However, you
may feel some tugging or occasional discomfort.) Some surgeons prefer to use general anesthesia; in that case, you'll
sleep through the operation.
THE SURGERY

Blepharoplasty usually takes one to three hours, depending on the extent of the surgery. If you're having all four
eyelids done, the surgeon will probably work on the upper lids first, then the lower ones.

In a typical procedure, the surgeon makes incisions following the natural lines of your eyelids; in the creases of your
upper lids, and just below the lashes in the lower lids. The incisions may extend into the crow's feet or laugh lines at
the outer corners of your eyes. Working through these incisions, the surgeon separates the skin from underlying
fatty tissue and muscle, removes excess fat, and often trims sagging skin and muscle. The incisions are then closed
with very fine sutures.

If you have a pocket of fat beneath your lower eyelids but don't need to have any skin removed, your surgeon may
perform a transconjunctival blepharoplasty. In this procedure the incision is made inside your lower eyelid, leaving no
visible scar. It is usually performed on younger patients with thicker, more elastic skin.
AFTER YOUR SURGERY

After surgery, the surgeon will probably lubricate your eyes with ointment and may apply a bandage. Your eyelids
may feel tight and sore as the anesthesia wears off, but you can control any discomfort with the pain medication
prescribed by your surgeon. If you feel any severe pain, call your surgeon immediately.

Your surgeon will instruct you to keep your head elevated for several days, and to use cold compresses to reduce
swelling and bruising. (Bruising varies forn person to person: it reaches its peak during the first week, and generally
lasts anywhere from two weeks to a month.) You'll be shown how to clean your eyes, which may be gummy for a
week or so. Many doctors recommend eyedrops, since your eyelids may feel dry at first and your eyes may burn or
itch. For the first few weeks you may also experience excessive tearing, sensitivity to light, and temporary changes
in your eyesight, such as blurring or double vision.

Your surgeon will follow your progress very closely for the first week or two. The stitches will be removed two days
to a week after surgery. Once they're out, the swelling and discoloration around your eyes will gradually subside, and
you'll start to look and feel much better.
GETTING BACK TO NORMAL

You should be able to read or watch television after two or three days. However, you won't be able to wear contact
lenses for about two weeks, and even then they may feel uncomfortable for a while.
Most people feel ready to go out in public (and back to work) in a week to 10 days. By then, depending on your rate
of healing and your doctor's instructions, you'll probably be able to wear makeup to hide the bruising that remains.
You may be sensitive to sunlight, wind, and other irritants for several weeks, so you should wear sunglasses and a
special sunblock made for eyelids when you go out.

Your surgeon will probably tell you to keep your activities to a minimum for three to five days, and to avoid more
strenuous activities for about three weeks. It's especially important to avoid activities that raise your blood pressure,
including bending, lifting, and rigorous sports. You may also be told to avoid alcohol, since it causes fluid retention.
YOUR NEW LOOK

Healing is a gradual process, and your scars may re main slightly pink for six months or more after surgery.
Eventually, though, they'll fade to a thin, nearly invisible white line.

On the other hand, the positive results of your eyelid surgery -the more alert and youthful look-will last for years.
For many people, these results are permanent.




As people age, the eyelid skin stretches, muscles weaken, and fat accumulates around the eyes, causing "bags"
above and below.




The surgeon closes the incisions with fine sutures, which will leave nearly invisible scars.




Before surgery, the surgeon marks the incision sites, following the natural lines and creases of the upper and lower
eyelids.
Underlying fat, along with excess skin and muscle, can be removed during the operation.




In a transconjunctival blepharoplasty, a tiny incision is made inside the lower eyelid and fat is removed with fine
forceps. No skin is removed, and the incision is closed with dissolving sutures.




After surgery, the upper eyelids no longer droop and the skin under the eyes is smooth and firm.
RHYTIDECTOMY
FACELIFT
If you're considering a facelift...

As people age, the effects of gravity, exposure to the sun, and the stresses of daily life can be seen in their faces.
Deep creases form between the nose and mouth; the jawline grows slack and jowly; folds and fat deposits appear
around the neck.

A facelift (technically known as rhytidectomy) can't stop this aging process. What it can do is "set back the clock,"
improving 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 alone, or in conjunction with other procedures such as a forehead
lift, eyelid surgery, or nose reshaping.

If you're considering a facelift, this brochure will give you a basic understanding of the procedure when it can help,
how it's performed, and what results you can expect. It can't answer all of your questions, since a lot depends on the
individual patient and the surgeon. Please ask your surgeon about anything you don't understand.
THE BEST CANDIDATES FOR A FACELIFT

The best candidate for a facelift is 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. Most patients are in their forties to sixties, but
facelifts can be done successfully on people in their seventies or eighties as well.

A facelift can make you look younger and fresher, and it may enhance your self- confidence in the process. But it
can't give you a totally different look, nor can it restore the health and vitality of your youth. Before you decide to
have surgery, think carefully about your expectations and discuss them with your surgeon.
ALL SURGERY CARRIES SOME UNCERTAINTY AND RISK

When a facelift is performed by a qualified plastic surgeon, complications are infrequent and usually minor. Still,
individuals vary greatly in their anatomy, their physical reactions, and their healing abilities, and the outcome is
never completely predictable.

Complications that can occur include hematoma (a collection of blood under the skin that must be removed by the
surgeon), injury to the nerves that control facial muscles (usually temporary), infection, and reactions to the
anesthesia. Poor healing of the skin is most likely to affect smokers.

You can reduce your risks by closely following your surgeon's advice both before and after surgery.
PLANNING YOUR SURGERY

Facelifts are very individualized procedures. In your initial consultation the surgeon will evaluate your face, including
the skin and underlying bone, and discuss your goals for the surgery.

Your surgeon should check for medical conditions that could cause problems during or after surgery, such as
uncontrolled high blood pressure, blood clotting problems, or the tendency to form excessive scars. Be sure to tell
your surgeon if you smoke or are taking any drugs or medications, especially aspirin or other drugs that affect
clotting.

If you decide to have a facelift, your surgeon will explain the techniques and anesthesia he or she will use, the type
of facility where the surgery will be performed, and the risks and costs involved. Don't hesitate to ask your doctor
any questions you may have, especially those regarding your expectations and concerns about the resu lts.
PREPARING FOR YOUR SURGERY

Your surgeon will give you specific instructions on how to prepare for surgery, including guidelines on eating and
drinking, smoking, and taking or avoiding certain vitamins and medications. Carefully following these instructions will
help your surgery go more smoothly. If you smoke, it's especially important to stop at least a week or two before and
after surgery; smoking inhibits blood flow to the skin, and can interfere with the healing of your incision areas.

If your hair is very short, you might want to let it grow out before surgery, so that it's long enough to hide the scars
while they heal.

Whether your facelift is being done on an outpatient or inpatient basis, you should arrange for someone to drive you
home after your surgery, and to help you out for a day or two if needed.
WHERE YOUR SURGERY WILL BE PERFORMED

A facelift may be performed in a surgeon's office -based facility, an outpatient surgery center, or a hospital. It's
usually done on an outpatient basis, but some surgeons may hospitalize patients for a day when using general
anesthesia. Certain conditions such as diabetes or high blood pressure should be monitored after surgery, and may
also require a short inpatient stay.
TYPES OF ANESTHESIA
Most facelifts are performed under local anesthesia, combined with a sedative to make you drowsy. You'll be awake
but relaxed, and your face will be insensitive to pain. (However, you may feel some tugging or occasional
discomfort.)

Some surgeons prefer a general anesthesia. In that case, you'll sleep through the operation.
THE SURGERY

A facelift usually takes several hours-or somewhat longer if you're having more than one procedure done. For
extensive procedures, some surgeons may schedule two separate sessions.

Every surgeon approaches the procedure in his or her own way. Some complete one side of the face at a time, and
others move back and forth between the sides. The exact placement of incisions and the sequence of events depends
on your facial structure and your surgeon's technique.

Incisions usually begin above the hairline at the temples, extend in a natural line in front of the ear (or just inside the
cartilage at the front of the ear), and continue behind the earlobe to the lower scalp. If the neck needs work, a small
incision may also be made under the chin.

In general, the surgeon separates the skin from the fat and muscle below. Fat may be trimmed or suctioned from
around the neck and chin to improve the contour. The surgeon then tightens the underlying muscle and membrane,
pulls the skin back, and removes the excess. Stitches secure the layers of tissue and close the incisions; metal clips
may be used on the scalp.

Following surgery, a small, thin tube may be temporarily placed under the skin behind your ear to drai n any blood
that might collect there. The surgeon may also wrap your head loosely in bandages to minimize bruising and swelling.
AFTER YOUR SURGERY

There isn't usually significant discomfort after surgery; if there is, it can be lessened with the pain medication
prescribed by your surgeon. (Severe or persistent pain or a sudden swelling of your face should be reported to your
surgeon immediately.) Some numbness of the skin is quite normal; it will disappear in a few weeks or months.

Your doctor may tell you to keep your head elevated and as still as possible for a couple of days after surgery, to
keep the swelling down.

If you've had a drainage tube inserted, it will be removed one or two days after surgery. Bandages, when used, are
usually removed after one to five days. Don't be surprised at the pale, bruised, and puffy face you see. Just keep in
mind that in a few weeks you'll be looking normal.

Most of your stitches will be removed after about five days. Your scalp may take longer to heal, and the stitches or
metal clips in your hairline could be left in a few days longer.
GETTING BACK TO NORMAL

You should be up and about in a day or two, but plan on taking it easy for the first week after surgery. Be especially
gentle with your face and hair, since your skin will be both tender and numb, and may not respond normally at first.

Your surgeon will give more specific guidelines for gradually resuming your normal activities. They're likely to
include these suggestions: Avoid strenuous activity, including sex and heavy housework, for at least two weeks
(walking and mild stretching are fine); avoid alcohol, steam baths, and saunas for several months. Above all, get
plenty of rest and allow your body to spend its energy on healing.

At the beginning, your face may look and feel rather strange. Your features may be distorted from the swelling, your
facial movements may be slightly stiff and you'll probably be self-conscious about your scars. Some bruising may
persist for two or three weeks, and you may tire easily. It's not surprising that some patients are disappointed and
depressed at first.

By the third week, you'll look and feel much better. Most patients are back at work about ten days to two weeks after
surgery. If you need it, special camouflage makeup can mask most bruising that remains.
YOUR NEW LOOK

The chances are excellent that you'll be happy with your facelift -especially if you realize that the results may not be
immediately apparent. Even after the swelling and bruises are gone, the hair around your temples may be thin and
your skin may feel dry and rough for several months. Men may find they have to shave in new places-behind the
neck and ears-where areas of beard- growing skin have been repositioned.

You'll have some scars from your facelift, but they're usually hidden by your hair or in the natural creases of your
face and ears. In any case, they'll fade within time and should be scarcely visible.

Having a facelift doesn't stop the clock. Your face will continue to age with time, and you may want to repeat the
procedure one or more times-perhaps five or ten years down the line. But in another sense, the effects of even one
facelift are lasting; years later, you'll continue to look better than if you'd never had a facelift at all.
A facelift can improve the deep cheek folds, jowls and loose, sagging skin around the neck that come with age.




Incisions usually begin above the hairline at the temples, follow the natural line in front of the ear, curve behind the
earlobe into the crease behind the ear, and into or along the lower scalp.




Facial, neck tissue and muscle may be separated; fat may be trimmed or suctioned and underlying muscle may be
tightened.
After deep tissues are tightened, the excess skin is pulled up and back, trimmed and surured into place.




Most of the scars will be hidden within your hair and in the normal creases of your skin.




After surgery, you'll present a fresher, more youthful face to the world.




FACIAL IMPLANTS
CHIN, CHEEKS & JAW SURGERY
If you're considering facial surgery...

Plastic surgeons use facial implants to improve and enhance facial contours. Frequently, these implants will help
provide a more harmonious balance to your face and features so that you feel better about the way you look.

There are many implants available, manufactured from a variety of materials. They may help strengthen a jawline or
bring the chin or cheekbones into balance with the rest of the face.

This brochure describes some of the facial implants currently available as well as the techniques for their use. It will
familiarize you with these procedures but cannot provide all the details which may be relevant to your particular
needs.

If you feel that one or more of the procedures described in this brochure may be of benefit, be sure to ask your
plastic surgeon for more information.
WHAT TO EXPECT FROM A FACIAL IMPLANT

Facial implants can enhance your appearance and bolster your self esteem. If you are looking for improvement, not
perfection, in your appearance and are realistic in your expectations, you may find that a facial implan t is the right
choice for you.

Plastic surgeons will frequently use such implants to bring better balance to the features of a younger patient. For
instance, a teenage girl may want her nose reshaped or her chin brought forward so that these traits are better
proportioned. The more mature patient may choose to have an implant placed in conjunction with another cosmetic
procedure. For example, during a facelift, a patient may wish to have implants placed over the cheekbones to help
restore a more youthful appearance. Implants may also be selected to fill out a face that appears "sunken" or tired.
ALL SURGERY CARRIES SOME UNCERTAINTY AND RISK

Facial implants can produce some remarkable changes. Problems rarely occur, but you need to be informed about
such possibilities. This brochure will touch upon a few, but is not intended to provide a detailed or complete
inventory of potential risks.

A facial implant can shift slightly out of alignment and a second operation my be necessary to replace it in its proper
position. Infection can occur with any operation. If infection were to occur around a facial implant and did not clear up
after treatment with antibiotics, the implant might have to be temporarily removed and replaced at a later time. Other,
less-frequent risks may be associated with certain implants. Be sure to ask your plastic surgeon for a description of
the risks associated with the procedure in which you are interested.

Some of the implant materials are made of a solid silicone. Currently, there is no scientific evidence that this is a
harmful substance. Your plastic surgeon will be happy to discuss any current scientific findings concerning the type
of implant you're considering.
PLANNING YOUR SURGERY

When you discuss your surgery with your plastic surgeon, be certain that you clearly express your expectations.
Your plastic surgeon will help you determine what it is possible to achieve. It may be helpful to provide your surgeon
with photos of people who have facial features similar to those you would like to have.

Be sure you understand the details of the proposed surgery, including the cost and what to expect during your
recovery.

If the surgery will entail an incision inside your mouth, it is important that you inform your physician if you smoke or
if you have any dental or gum problems. Your plastic surgeon will advise you on these matters.

In preparing for your surgery, be sure to find out if you'll be able to drive home afterward or will require
transportation. You should also ask if you'll need to refrain from eating or drinking the night before your surgery, and
if you should stop taking any medications, including aspirin and similar drugs. You may be instructed to take oral
antibiotics both before and after the procedure to help guard against infection.

Your plastic surgeon will provide information about these important matters during your pre-operative consultation.
WHERE YOUR SURGERY WILL BE PERFORMED

Your operation may take place in an office -based facility, a freestanding surgical center or a hospital outpatient
facility. Sometimes, your plastic surgeon may require that you stay overnight. Your doctor will make such a
recommendation based on your overall medical condition and whether another cosmetic procedure was performed
simultaneously with the facial implant surgery.
TYPES OF ANESTHESIA

In some cases, facial implant surgery may require only local anesthesia combined with a sedative. However, more
frequently, a general anesthesia may be recommended.
CHIN SURGERY

Insertion of a chin implant may take anywhere from 30 minutes to an hour. During the procedure, the surgeon selects
the proper size and shape implant to enhance your appearance and inserts it into a pocket over the front of the
jawbone. The small incision to create the pocket and insert the implant is placed inside the mouth (along the lower
lip) or in the skin just under the chin area.

Usually, the chin is taped after surgery to minimize swelling and discomfort. Sutures in the skin will be removed in
five to seven days. If an intra-oral incision is used, the sutures will dissolve.
RECOVERING FROM CHIN SURGERY

You will experience some discomfort and swelling in the affected area for several days. It's normal to experience
some temporary difficulty with smiling and talking. Black and blue marks may be visible around the chin and neck.
Your plastic surgeon will instruct you about dental hygiene, eating and any restrictions to your activities after
surgery.
CHEEK SURGERY

Cheek implant surgery usually takes about 30 to 45 minutes. When cheek implan ts are being placed in conjunction
with another cosmetic procedure, such as a facelift, forehead lift or eyelid surgery, the implants may be inserted
through the incisions made for those procedures. Otherwise, an incision will be made either inside your upper lip or
your lower eyelid. A pocket is then formed and an implant is inserted.

After surgery, a dressing will be applied to minimize discomfort and swelling. The severity and duration of such side
effects may vary, especially if another cosmetic procedure was performed at the same time.
RECOVERING FROM CHEEK SURGERY

Your plastic surgeon will provide you with instructions about post -operative care. There will be dietary restrictions
as well as limitations to your activities. Again, these instructions will vary, especially if another procedure was
performed along with your implant surgery. However, you should be aware that your ability to move your mouth and
lips may be diminished temporarily. Stitches used to close the incisions inside your mouth usually dissolve within
about 10 days.
LOWER-JAW SURGERY

Insertion of a jaw implant usually takes about one to two hours. Internal incisions are made on either side of the
lower lip to provide access for creating a pocket into which the lower-jaw implant can be inserted. Dissolving
sutures are used to close the incisions.
RECOVERING FROM JAW SURGERY

Swelling is sometimes significant immediately following surgery, usually peaking 24 to 48 hours afterward. Although
most of the significant swelling will subside over a period of several days, prolonged mild swelling may prevent your
final facial contour from becoming apparent for several months.

During the healing phase, your activities and diet will be restricted. Your ability to smile, talk or move your mouth in
any way may be limited for several days to weeks following surgery. Your plastic surgeon will instruct you about
dental and oral hygiene during your recovery.
GETTING BACK TO NORMAL

Remember, with any facial surgery, you may feel and look better in a short period of time. However, it may not be
advisable to participate in certain activities -- especially activity that may result in the face being jarred or bumped
-- for several weeks. It's best to check with your plastic surgeon about such matters.
YOUR NEW LOOK

You may not be able to accurately evaluate your appearance for weeks, or perhaps even months. Give yourself
plenty of time to get used to your new look.

You may be surprised to find that most people won't recognize that you've had facial implant surgery -- only that you
look better.




Facial surgery is most often done to bring the face into balance by building up the chin, the cheeks, or the jaw.
A short incision under the chin or inside the mouth allows the surgeon to place a chin implant directyly on the bone.




Cheek implants are usually inserted through an incision in the mouth and placed directly on (or even below) the
cheekbone. These implants can vary in size and shape.
Jaw implants are placed directly on the jawbone to create a stronger, more defined jawline.




Facial implants help change the basic structure of the face to give a fuller, more balanced look.




PLASTIC SURGERY
INDICATIONS FOR MEN
Men and cosmetic surgery

Our society places a high value on looking young and fit. Today, men of all ages and all walks of life are requesting
plastic surgery for cosmetic reasons. Men's goals include a more balanced nose, a rejuvenated face, a trimmer
waistline. The procedures used to achieve these goals must take into consideration factors such as skin thickness,
beard growth, or body type.

This brochure reviews some of the special considerations for men contemplating a cosmetic procedure. It won't
answer all of your questions, since a lot depends on your individual circumstances. Be sure to ask your doctor if
there is anything you don't understand about the procedure you plan to have.
PLANNING YOUR SURGERY

Good communication between you and your plastic surgeon is essential when planning your surgery. In your initial
consultation, you'll be asked to explain in detail why you want the procedure and how you hope to look and feel
afterward. It's important to set aside any awkwardness you might feel, and speak candidly about the changes you'd
like to see. You should feel completely assured that you and your surgeon understand one another.

Your doctor will also evaluate your health, conduct a physical exam, take pre -operative photographs, and explain
which surgical techniques are most appropriate for you. You'll discuss the type of anesthesia to be used, the type of
facility where the surgery will be performed, the possible risks, and the costs involved. Medical insurance usually
doesn't cover cosmetic procedures. However, some plastic surgeons offer special financing plans for cosmetic
surgery or accept credit cards.

Tell your surgeon if any part of the consultation makes you uncomfortable, or if you have any special privacy
requests. Above all, it's important to have realistic expectations about your surgery. Remember, your doctor can
offer significant improvement, but not perfection. Keep in mind that your age and health may play a role in the quality
of the outcome.
THE SURGERY

Extensive information about the particular procedure you plan to have will be provided during your consultation.
While going over the steps of the procedure, your doctor will discuss a number of issues that may influence your
surgery. Make sure you fully understand these considerations.
Facial surgery: If you are planning facial surgery or neck surgery, your doctor will evaluate your entire head -face-
neck region. Is the hairline receding? How full are the sideburns? Does the beard -growing skin extend up the chee ks
or down the neck? Are there facial scars? Is the skin sun-damaged? Is the neck skin loose or drooping?

In general, it's known that male facial skin has a richer blood supply than female facial skin. Male faces bleed more
during surgery and are at greater risk for forming a temporary collection or pooling of blood under the skin, called a
hematoma, after surgery.

Also, any scarring that may result from surgery may be more difficult for men to hide, since they don't wear make-up
or style their hair toward their faces, as many women do.

Hair growth and beard growth may play a major role in the outcome of a facelift. If you are balding or have thinning
hair, surgical artistry may be required to hide the facelift incision, especially in the temple area. If the hair-bearing
skin of your upper neck is pulled behind your ears during surgery, you may find that you must shave behind your
ears or the back of your neck. However, sometimes electrolysis can correct this problem. Be sure to discuss these
possibilities with your surgeon.

A fatty or "jowly" area beneath the chin is also a concern for many men. In younger patients, liposuction alone may
be sufficient to correct the problem. Older patients may require a full facelift and necklift, which may include the
removal of excess skin and tightening the platysma muscles, which run down each side of the neck. These muscles
are usually thicker in men than they are in women, but do not pose a greater challenge for your plastic surgeon.

                                    kin: Shaving must be postponed for about 3 weeks after a skin-smoothing
"Refinishing" treatments for facial s
treatment such as chemical peel or dermabrasion. Because these procedures strip away the surface layers of skin,
you can expect your face to remain sensitive, swollen, and bright pink for several weeks after surgery.

Some men are happy that the beard growth helps conceal the pinkness of their recovering skin -- especially if they
feel uncomfortable using camouflage make-up.

Men who feel self -conscious about their condition are also advised to give up alcoholic drinks for about 4 weeks.
Alcohol causes the areas of treated facial skin to become noticeably red and flushed.

Changing the facial features: Cosmetic procedures such as eyelid surgery, nose surgery, and facial-implant surgery
are performed essentially the same way for men and women. However, it's important to let your surgeon know if you
are seeking a more masculine look to your facial features -- a chin with better projection, more prominent
cheekbones, a stronger nose.

Hair replacement: The primary consideration for men contemplating hair-replacement surgery is the time involved.
Natural-appearing hair replacement usually requires multiple surgical procedures, with long recovery intervals. A full
regimen of hair transplants may last anywhere from 18 months to 2 years or more.

You should be aware that incisions or transplant sites may be noticeable to others, especially in the early stages of
the hair transplant process. If your work or lifestyle isn't compatible with a long treatme nt period, ask your surgeon
about alternatives to hair-transplant options, such as flap surgery or scalp reduction.

Liposuction/body contouring:The ideal male body shape is considered to be trim and athletic-looking, with broad
shoulders and chest, a flat abdomen, and a narrow hip-thigh area. However, as men age, areas of fat tend to
accumulate around the abdomen, the flanks ("love handles"), the breast area (a condition called gynecomastia), and
along the chin and neck. Men sometimes seek liposuction to re move these fatty areas that are resistant to diet and
exercise.

In many cases, liposuction alone can effectively correct these problem areas. Men retain their skin elasticity longer
than women do, and the areas of fat beneath the skin tend to be firmer and more vascular than those in women.
Because of these and other factors, liposuction in men is usually very effective.

Men who have some loose, hanging skin as well as areas of excess fat may opt for a traditional excision procedure
(surgical skin removal) in addition to liposuction. An excision may also be performed on gynecomastia patients whose
breast enlargement is made up of mostly glandular tissue, rather than fat.

Abdomen reduction: A full abdominoplasty or "tummy tuck" may be chosen by men who have hanging abdominal skin
(usually the result of massive weight loss), loose abdominal muscles, and/or neglected hernias. It is a major surgical
procedure that removes excess fat, tightens the muscles of the abdominal wall, and trims the waistline. Men who
have a full abdominoplasty are often surprised at the long recovery period. Some patients aren't able to return to
work up to 4 weeks after surgery.

Men with good skin elasticity who have only a moderate amount of excess abdominal fat may benefit from liposuction
alone.

Muscle-enhancing surgery: In recent years, plastic surgeons have developed ways of improving muscle contour with
cosmetic implants and "sculpting" techniques.

Calf implants, which were originally developed to restore leg contour in accident or polio victims, are now sometimes
used to create cosmetic fullness in the lower leg. Similarly, pectoral implants, which are used to build the chests of
men with Poland's syndrome, can also be used to "bulk out" the existing pectoral muscles of healthy men.

A small number of doctors have begun offering their male patients abdominal etching, a new liposuction technique
that creates a muscular, rippled appearance in the abdominal area.
Men who consider cosmetic muscle enhancement should keep in mind that these procedures are still relatively new.
It is best to seek out a board-certified plastic surgeon who has received adequate training in these methods.
AFTER YOUR SURGERY

The days and weeks immediately following your surgery are critical to obtaining a good final result. Therefore, it's
essential that you follow your doctor's orders to the letter. Following orders may mean taking adequate time off
work; wearing bandages or tight compression garments; getting enough rest; staying out of the sun; saying no to
alcohol and cigarettes; and avoiding strenuous activity, exercise, sports, and even sex.

However, plastic surgeons understand that it's sometimes difficult for men, who are programmed by society to be
stoic, to remain in bed for very long or to accept help from others during recovery. Studies have shown that men
often deny their pain and feel foolish about asking for help after surgery. Men who reject help may have an especially
difficult recovery if post-operative depression sets in during the weeks following surgery.

To avoid post -operative problems, it's important that you arrange to have a support person available to help you --
both physically and emotionally -- for about a week after surgery. If you get the help and rest you need, you'll
improve your chances of a quicker recovery -- and you may see your results a lot sooner.




Prior to facial surgery, your surgeon will evaluate the entire head -neck region-hairline, beard growth, and skin
condition.




For men, common sites for liposuction include under the chin and around the waist, and in the reduction of enlarged
male breasts, a condition known as gynecomastia.
An essential part of a successful recovery includes following your surgeon's instructions to the letter.




During the weeks following surgery you will adjust to your new look. Patience is the key to recovery -your final
results may take days or weeks to appear.




INJECTABLE FILLERS
IMPROVING SKIN TEXTURE
If you're considering injectables...

As we age, our faces begin to show the effects of gravity, sun exposure and years of facial muscle movement, such
as smiling, chewing and squinting. The underlying tissues that keep our skin looking youthful and plumped up begin
to break down, often leaving laugh lines, smile lines, crow's feet or facial creases over the areas where this muscle
movement occurs.

Soft-tissue fillers, most commonly injectable collagen or fat, can help fill in these lines and creases, temporarily
restoring a smoother, more youthful-looking appearance. When injected beneath the skin, these fillers plump up
creased and sunken areas of the face. They can also add fullness to the lips and cheeks. Injectable fillers may be
used alone or in conjunction with a resurfacing procedure, such as a laser treatment, or a recontouring procedure,
such as a facelift.

If you're considering a facial-rejuvenation treatment with collagen or fat, this brochure will give you a basic
understanding of the procedure - when injectables can help, how the procedure is performed, and what results you
can expect. It may not answer all of your questions, since a lot depends on your individual circumstances. Please ask
your doctor if there is anything about the procedure you don't understand.
KNOWING YOUR OPTIONS

Injected collagen and fat are primarily used to improve the appearance of the skin's texture. They can help fill out
deep facial wrinkles, creases and furrows, "sunken" cheeks, skin depressions and some types of scars. They can also
be used to add a fuller, more sensuous look to the lips.

Injectables are usually not sufficient for severe surface wrinkles on the face, such as multiple vertical "lipstick lines"
that sometimes form around the mouth. Instead, your plastic surgeon may suggest a resurfacing technique, such as
chemical peel, dermabrasion or laser treatments. Rather than filling in facial lines, resurfacing methods strip away the
outer layers of the skin to produce a smoother appearance.

Deep folds in the face or brow caused by overactive muscles or by loose skin may be more effectively treated with
cosmetic surgery, such as a facelift or browlift. Injectables are sometimes used in conjunction with facial surgery
procedures; however, injectables alone cannot change facial contour the way surgery can.

Keep in mind that a plastic surgeon is a specialist that can offer you the full gamut of the most advanced treatments
ranging from cosmetic surgery, refinishing techniques, laser therapy, injectables and the use of other fillers. You and
your surgeon may determine that a single procedure or a combination of procedures is the best choice for you.

ASPS brochures are available on chemical peel, dermabrasion, laser treatments, facelift and browlift. If you and your
doctor think that one of these other procedures might be more appropriate for you, ask your plastic surgeon to
provide you with a copy.
A WORD ABOUT OTHER TYPES OF FILLERS

This brochure deals with the two most commonly used types of injectable fillers, collagen and fat. However, to a
lesser extent, a number of other filler materials are also being used for facial-rejuvenation purposes. They include:
Fibril, a gelatin powder compound that's mixed with a patient's own blood and is injected to plump up the skin (similar
to injectable collagen); and Gortex, a thread -like material that is implanted beneath the skin to add soft-tissue
support.

Each of these options has its own set of risks and benefits. If you're considering any of these alternative filler
treatments, tell your doctor.
WHAT TO EXPECT FROM TREATMENT

The most important fact to remember about injectable fillers is that the results are not permanent. Injected material
is eventually metabolized by the body. You should not expect the same long-lasting results that may be gained from
cosmetic surgery.

In some individuals, the results may last only a few weeks; in others, the results may be maintained indefinitely.
Researchers believe that age, genetic background, skin quality and lifestyle as well as the injected body site may all
play a role in the injected material's "staying power." However, the precise reason for the variation of results among
patients has yet to be identified.

If you've had short -lived results from fat injections, you shouldn't necessarily assume that collagen injections will
work better for you. And, conversely, if you've had disappointing results from collagen, don't assume that injected fat
is the answer. Although it's true that some individuals' bodies are more receptive to one substance than the other,
others may find that neither substance produces long-lasting results. Sometimes one substance may work better than
the other for a specific problem.
RISKS RELATED TO INJECTABLES

When injectables are administered by a qualified plastic surgeon, complications are infrequent and usually minor in
nature. Still, individuals vary greatly in their anatomy, their physical reactions and their healing abilities. The
outcome of treatment with injectables is never completely predictable.

Collagen: Allergic reaction is the primary risk of collagen. To help determine if you are allergic to the substance,
your surgeon will perform an allergy skin test about a month before the procedure. After the test is performed, the
test site should be watched carefully for three or four weeks, or as long as your surgeon advises. Any sign of
redness, itching, swelling or other occurrences at the test site should be reported to your surgeon.

Risks not necessarily related to allergies include infection, abscesses, open sores, skin peeling, scarring and
lumpiness, which may persist over the treated area. Reports of these problems are very rare.

Fat: Allergic reaction is not a factor for fat because it's harvested from a patient's own body. However, there is still a
small risk of infection and other infrequent complications.
PLANNING FOR TREATMENT

Facial rejuvenation is very individualized. That's why it's important to discuss your hopes and expectations with a
board-certified plastic surgeon who has experience with many diff erent types of surgical and non-surgical facial
procedures.

In your initial consultation, your plastic surgeon will evaluate your face - the skin, the muscles and the underlying
bone - and discuss your goals for the surgery. Your doctor will help you select a treatment option based on your
goals and concerns, your anatomy and your lifestyle.

Your surgeon will ask you about your medical history, drug allergies, and check for conditions that could cause
problems, such as active skin infections or non-healed sores from injuries. Collagen injections are generally off limits
for pregnant women, individuals who are allergic to beef or bovine products, patients who suffer from autoimmune
diseases, and those who are allergic to lidocaine (the anesthetic agent contai ned in the syringe with the collagen
material). For more specific information about the contraindications and risks of collagen use, ask your doctor for the
manufacturer's brochure for patients.

Insurance usually doesn't cover cosmetic procedures. However, if your injectable treatment is being performed to
treat a scar or indentation from an accident or injury, you may be reimbursed for a portion of the cost. Check with
your insurance carrier to be sure.
WHERE YOUR TREATMENT WILL BE PERFORMED

Injectables are usually administered in a surgeon's office -based facility. If, however, you are being hospitalized for a
facelift, necklift, browlift, or any other procedure, your injections may be administered in the hospital as well.
TYPES OF ANESTHESIA

Collagen: Because the anesthetic agent lidocaine is mixed in with collagen, additional anesthetic is usually not used.
However, if you are especially sensitive to pain, your doctor may use a topical cream anesthetic or a freon spray to
numb the injected area. Or, you may elect to have an injected local anesthetic or sedative drugs.

Fat: Both the donor and recipient sites are numbed with local anesthesia. Sedation can be used as well. If you elect to
use sedation, be sure to arrange for a ride home after your treatment.
THE TREATMENTS

Collagen
Collagen is a naturally occurring protein that provides support to various parts of the human body: the skin, the
joints, the bones and the ligaments. Injectable collagen, patented by the Collagen Corporation under the trade names
Zyderm and Zyplast, is derived from purified bovine collagen. The purification process creates a product similar to
human collagen. Injectable collagen received approval from the Food and Drug Administration in1981. It is produced
in various thicknesses to meet individual patient needs.

Collagen is used primarily to fill wrinkles, lines and scars on the face and sometimes the neck, back and chest.

The procedure: Treatment with collagen can begin after a skin test determines that you're not allergic to the
subsstance. The collagen is injected using a fine needle inserted at several points along the edge of the treatment
site. If a local anesthesia has not been used, you may feel some minor stinging or burning as the injections are
administered.

Since part of the substance is salt water that will be absorbed by the body within a few days, your doctor will slightly
overfill the area. You may be asked to hold a hand mirror during the procedure to help your doctor decide when
you've had enough.

After treatment: Immediately following treatment, you may notice some minor discomfort, stinging or throbbing in the
injected area. Occasionally some bruising or swelling will occur, but it is usually minor. Any redness that appears in
the injected site usually disappears within 24 hours. However, in some individuals, particularly fair-skinned patients,
this redness may persist for a week or more. Tiny scabs may also form over the needle-stick areas; these generally
heal quickly.

No bandaging is needed and you are free to eat, drink, and wear makeup with sunblock protection shortly thereafter.
There may be some temporary swelling and redness in the treated area which should dissipate within a few days. If
these symptoms persist, contact your surgeon.

Results: As stated earlier, the duration of results from collagen injections is variable. Collagen's longevity depends on
the patient's lifestyle and physical characteristics as well as the part of the body treated. In general, the injected
material is likely to disappear faster in areas that are more affected by muscle movement.

Your doctor can help you determine how long you can go between treatments to best maintain your results.

Fat
In the medical world, the fat -injection procedure is known as autologous fat transplantation or microlipoinjection. It
involves extracting fat cells from the patient's abdomen, thighs, buttocks or elsewhere and reinjecting them beneath
the facial skin. Fat is most often used to fill in "sunken" cheeks or laugh lines between the nose and mouth, to correct
skin depressions or indentations, to minimize forehead wrinkles and to enhance the lips.

The procedure: After both the donor and recipient sites are cleansed and treated with a local anesthesia, the fat is
withdrawn using a syringe with a large-bore needle or a cannula (the same instrument used in liposuction) attached
to a suction device. The fat is then prepared and injected into the recipient site with a needle. Sometimes an adhesive
bandage is applied over the injection site.

As with collagen, "overfilling" is necessary to allow for fat absorption in the weeks following treatment. When fat is
used to fill sunken cheeks or to correct areas on the face other than lines, this overcorrection of newly injected fat
may temporarily make the face appear abnormally puffed out or swollen.

After treatment: If a larger area was treated, you may be advised to curtail your activity for a brief time. However,
many patients are able to resume normal activity immediately. You can expect some swelling, bruising or redness in
both the donor and recipient sites. The severity of these symptoms depends upon the size and location of the treated
area. You should stay out of the sun until the redness and bruising subsides - usually about 48 hours. In the
meantime, you may use makeup with sunblock protection to help conceal your condition.

The swelling and puffiness in the recipient site may last several weeks, especially if a large area was filled.

Results: The duration of the fat injections varies significantly from patient to patient. Though some patients have
reported results lasting a year or more, the majority of patients find that at least half of the injected fullness
disappears within 3-6 months. Therefore, repeated injections may be necessary. Your doctor will advise you on how
to maintain your results with repeat treatments.
YOUR NEW LOOK

If you're like most patients, you'll be very satisfied with the results of your injectable treatments. You may be
surprised at the pleasing results that can be gained from this procedure.




Injectable collagen or fat can help improve the skin's texture by filling in the laugh lines and facial creases that often
occur with aging.
Years of squinting and other facial muscle movements can take their toll on the eye area, leaving crow's feet and
other noticeable lines.




After treatment, the skin around the eye area appears smoother and more taut.




Lines and creases that form around the mouth are usually caused by gravity and a breakdown of tissues beneath the
skin.
The lower face appears firmer and smoother after treatment with injectables. Lines around the mouth are filled in and
nearly imperceptible.




With regular follow-up treatments, your refreshed look can be easily maintained.




LASER SKIN RESURFACING
SKIN MANAGEMENT
SURFACE-REPAIR TREATMENTS
Laser Skin Resurfacing

In laser skin resurfacing a laser is used to remove areas of damaged or wrinkled skin, layer by layer. The procedure
is most commonly used to minimize the appearance of fine lines, especially around the mouth and the eyes. However,
it is also effective in treating facial scars or areas of uneven pigmentation. Laser resurfacing may be performed on
the whole face or in specific regions. Often, the procedure is done in conjunction with another cosmetic operation,
such as a facelift or eyelid surgery.




LIPOPLASTY OR LIPOSUCTION
If you're considering liposuction...

Liposuction is a procedure that can help sculpt the body by removing unwanted fat from specific areas, including the
abdomen, hips, buttocks, thighs, knees, upper arms, chin, cheeks and neck. During the past decade, liposuction, which
is also known as "lipoplasty" or "suction lipectomy," has benefited from several new refinements. Today, a number of
new techniques, including ultrasound-assisted lipoplasty (UAL), the tumescent technique, and the super-wet
technique, are helping many plastic surgeons to provide selected patients with more precise results and quicker
recovery times. Although no type of liposuction is a substitute for dieting and exercise, liposuction can remove
stubborn areas of fat that don't respond to traditional weight-loss methods.

If you're considering liposuction, this brochure will give you a basic understanding of the procedure -- when it can
help, how it is performed and how you might look and feel after surgery. It won't answer all of your questions, since
much depends on your individual circumstances. Please ask your doctor if there is anything about the procedure you
don't understand.
THE BEST CANDIDATES FOR LIPOSUCTION

To be a good candidate for liposuction, you must have realistic expectations about what the procedure can do for
you. It's important to understand that liposuction can enhance your appearance and self confidence, but it won't
necessarily change your looks to match your ideal or cause other people to treat you differently. Before you decide
to have surgery, think carefully about your expectations and discuss them with your surgeon.

The best candidates for liposuction are normal-weight people with firm, elastic skin who have pockets of excess fat
in certain areas. You should be physically healthy, psychologically stable and realistic in your expectations. Your age
is not a major consideration; however, older patients may have diminished skin elasticity and may not achieve the
same results as a younger patient with tighter skin.

Liposuction carries greater risk for individuals with medical problems such as diabetes, significant heart or lung
disease, poor blood circulation, or those who have recently had surgery near the area to be contoured.
PLANNING YOUR SURGERY

In your initial consultation, your surgeon will evaluate you r health, determine where your fat deposits lie and assess
the condition of your skin. Your surgeon will explain the body -contouring methods that may be most appropriate for
you. For example, if you believe you want liposuction in the abdominal area, you m ay learn that an abdominoplasty or
"tummy tuck" may more effectively meet your goals; or that a combination of traditional liposuction and UAL would
be the best choice for you.

Be frank in discussing your expectations with your surgeon. He or she should be equally frank with you, describing
the procedure in detail and explaining its risks and limitations.
GETTING THE ANSWERS YOU NEED

Individuals considering liposuction often feel a bit overwhelmed by the number of options and techniques being
promoted today . However, your plastic surgeon can help. In deciding which is the right treatment approach for you,
your doctor will consider effectiveness, safety, cost and appropriateness for your needs. This is called surgical
judgment, a skill that is developed through surgical training and experience. Your doctor also uses this judgement to
prevent complications; to handle unexpected occurrences during surgery; and to treat complications when they
occur.

Your surgeon's education and training have helped to form his or her surgical judgement, so take the time to do some
background checking. Patients are encouraged to consider a doctor certified by the American Board of Plastic
Surgery ("ABPS"). By choosing a plastic surgeon who is certified by the ABPS, a patient can be assured that the
doctor has graduated from an accredited medical school and completed at least five years of additional residency -
usually three years of general surgery (or its equivalent) and two years of plastic surgery. To be certified by the
ABPS, a doctor must also practice surgery for two years and pass comprehensive written and oral exams.
PREPARING FOR YOUR SURGERY

Your surgeon will give you specific instructions on how to prepare for surgery, including guidelines on eating and
drinking, smoking, and taking or avoiding vitamins, iron tablets and certain medications. If you develop a cold or an
infection of any kind, especially a skin infection, your surgery may have to be postponed.

Though it is rarely necessary, your doctor may recommend that you have blood drawn ahead of time in case it is
needed during surgery.

Also, while you are making preparations, be sure to arrange for someone to drive you home after the procedure and,
if needed, to help you at home for a day or two.
WHERE YOUR SURGERY WILL BE PERFORMED

Liposuction may be performed in a surgeon's office -based facility, in an outpatient surgery center, or in a hospital.
Smaller-volume liposuction is usually done on an outpatient basis for reasons of cost and convenience. However, if a
large volume of fat will be removed, or if the liposuction is being performed in conjunction with other procedures, a
stay in a hospital or overnight nursing facility may be required.
ANESTHESIA FOR LIPOSUCTION

Various types of anesthesia can be used for liposuction procedures. Together, you and your surgeon will select the
type of anesthesia that provides the most safe and effective level of comfort for your surgery.

If only a small amount of fat and a limited number of body sites are involved, liposuction can be performed under
local anesthesia, which numbs only the affected areas. However, if you prefer, the local is usually used along with
intravenous sedation to keep you more relaxed during the procedure. Regional anesthesia can be a good choice for
more extensive procedures. One type of regional anesthesia is the epidural block, the same type of anesthesia
commonly used in childbirth.

However, some patients prefer general anesthesia, particularly if a large volume of fat is being removed. If this is the
case, a nurse anesthetist or anesthesiologist will be called in to make sure you are completely asleep during the
procedure.
THE SURGERY

The time required to perform liposuction may vary considerably, depending on the size of the area, the amount of fat
being removed, the type of anesthesia and the technique used.

There are several liposuction techniques that can be used to improve the ease of the procedure and to enhance
outcome.

Liposuction is a procedure in which localized deposits of fat are removed to recontour one or more areas of the body.
Through a tiny incision, a narrow tube or cannula is inserted and used to vacuum the fat layer that lies deep beneath
the skin. The cannula is pushed then pulled through the fat layer, breaking up the fat cells and suctioning them out.
The suction action is provided by a vacuum pump or a large syringe, depending on the surgeon's preference. If many
sites are being treated, your surgeon will then move on to the next area, working to keep the incisions as
inconspicuous as possible.

Fluid is lost along with the fat, and it's crucial that this fluid be replaced during the procedure to prevent shock. For
this reason, patients need to be carefully monitored and receive intravenous fluids during and immediately after
surgery.
TECHNIQUE VARIATIONS

The basic technique of liposuction, as described above, is used in all patients undergoing this procedure. However, as
the procedure has been developed and refined, several variations have been introduced.

Fluid Injection, a technique in which a medicated solution is injected into fatty areas before the fat is removed, is
commonly used by plastic surgeons today. The fluid -- a mixture of intravenous salt solution, lidocaine (a local
anesthetic) and epinephrine (a drug that contracts blood vessels) -- helps the fat be removed more easily, reduces
blood loss and provides anesthesia during and after surgery. Fluid injection also helps to reduce the amount of
bruising after surgery.

The amount of fluid that is injected varies depending on the p reference of the surgeon.

Large volumes of fluid -- sometimes as much as three times the amount of fat to be removed -- are injected in the
tumescent technique. Tumescent liposuction, typically performed on patients who need only a local anesthetic,
usually takes significantly longer than traditional liposuction (sometimes as long as 4 to 5 hours). However, because
the injected fluid contains an adequate amount of anesthetic, additional anesthesia may not be necessary. The name
of this technique refers to the swollen and firm or "tumesced" state of the fatty tissues when they are filled with
solution.

The super-wet technique is similar to the tumescent technique, except that lesser amounts of fluid are used. Usually
the amount of fluid injected is equal to t he amount of fat to be removed. This technique often requires IV sedation or
general anesthesia and typically takes one to two hours of surgery time.

Ultrasound-Assisted Lipoplasty (UAL). This technique requires the use of a special cannula that produces ultrasonic
energy. As it passes through the areas of fat, the energy explodes the walls of the fat cells, liquefying the fat. The
fat is then removed with the traditional liposuction technique.

UAL has been shown to improve the ease and effectiveness of liposuction in fibrous areas of the body, such as the
upper back or the enlarged male breast. It is also commonly used in secondary procedures, when enhanced precision
is needed. In general, UAL takes longer to perform than traditional liposuction.
ALL SURGERY CARRIES SOME UNCERTAINTY AND RISK

Liposuction is normally safe, as long as patients are carefully selected, the operating facility is properly equipped and
the physician is adequately trained.

As a minimum, your surgeon should have basic (core) accredited surgical training with special training in body
contouring. Also, even though many body-contouring procedures are performed outside the hospital setting, be
certain that your surgeon has been granted privileges to perform liposuction at an accredited hospital.

Your doctor must have advanced surgical skills to perform procedures that involve the removal of a large amount of
fat (more than 5 liters or 5,000 ccs); ask your doctor about his or her other patients who have had similar procedures
and what their results were. Also, more extensive liposuction procedures require attentive after-care. Find out how
your surgeon plans to monitor your condition closely after the procedure.

However, it's important to keep in mind that even though a well-trained surgeon and a state-of-the art facility can
improve your chance of having a good result, there are no guarantees. Though they are rare, complications can and
do occur. Risks increase if a greater number of areas are treated at the same time, or if the operative sites are larger
in size. Removal of a large amount of fat and fluid may require longer operating times than may be required for
smaller operations.

The combination of these factors can create greater hazards for infection; delays in healing; the formation of fat clots
or blood clots, which may migrate to the lungs and cause death; excessive fluid loss, which can lead to shock or fluid
accumulation that must be drained; friction burns or other damage to the skin or nerves or perforation injury to the
vital organs; and unfavorable drug reactions.

There are also points to consider with the newer techniques. For example, in UAL, the heat from the ultrasound
device used to liquefy the fat cells may cause injury to the skin or deeper tissues. Also, you should be aware that
even though UAL has been performed successfully on several thousand people worldwide, the long-term effects of
ultrasound energy on the body are not yet known.

In the tumescent and super-wet techniques, the anesthetic fluid that is injected may cau se lidocaine toxicity (if the
solution's lidocaine content is too high), or the collection of fluid in the lungs (if too much fluid is administered).

The scars from liposuction are small and strategically placed to be hidden from view. However, imperfections in the
final appearance are not uncommon after lipoplasty. The skin surface may be irregular, asymmetric or even "baggy,"
especially in the older patient. Numbness and pigmentation changes may occur. Sometimes, additional surgery may
be recommended.
AFTER YOUR SURGERY
After surgery, you will likely experience some fluid drainage from the incisions. Occasionally, a small drainage tube
may be inserted beneath the skin for a couple of days to prevent fluid build -up. To control swelling and to help your
skin better fit its new contours, you may be fitted with a snug elastic garment to wear over the treated area for a few
weeks. Your doctor may also prescribe antibiotics to prevent infection.

Don't expect to look or feel great right after surgery. Even though the newer techniques are believed to reduce some
post-operative discomforts, you may still experience some pain, burning, swelling, bleeding and temporary
numbness. Pain can be controlled with medications prescribed by your surgeon, though you may still feel stiff and
sore for a few days.

It is normal to feel a bit anxious or depressed in the days or weeks following surgery. However, this feeling will
subside as you begin to look and feel better.
GETTING BACK TO NORMAL

Healing is a gradual process. Your surgeon will probably tell you to start walking around as soon as possible to
reduce swelling and to help prevent blood clots from forming in your legs. You will begin to feel better after about a
week or two and you should be back at work within a few days following your surgery. The stitches are removed or
dissolve on their own within the first week to 10 days.

Activity that is more strenuous should be avoided for about a month as your body continues to heal. Although most of
the bruising and swelling usually disappears within three weeks, some swelling may remain for six months or more.

Your surgeon will schedule follow-up visits to monitor your progress and to see if any additional procedures are
needed.

If you have any unusual symptoms between visits -- for example, heavy bleeding or a sudden increase in pain -- or
any questions about what you can and can't do, call your doctor.
YOUR NEW LOOK

You will see a noticeable difference in the shape of your body quite soon after surgery. However, improvement will
become even more apparent after about four to six weeks, when most of the swelling has subsided. After about three
months, any persistent mild swelling usually disappears and the final contour will be visible.

If your expectations are realistic, you will probably be very pleased with the results of your surgery. You may find
that you are more comfortable in a wide variety of clothes and more at ease with your body. And, by eating a healthy
diet and getting regular exercise, you can help to maintain your new shape.
Women may have liposuction performed under the chin, on their hips, thighs, and stomach, and in the under arm and
breast area.




For men, common sites include under the chin and around the waist. Liposuction may also be used in the reduction of
enlarged male breasts, a condition known as gynecomastia.




Healthy, normal-weight people with elastic skin and pockets of excess fat are good candidates for surgery.
The best candidates for liposuction are of normal weight with localized areas of excess fat -- for example, in the
buttocks, hips, and thighs.




The surgeon inserts a cannula through small incisions in the skin. At the other end of the tube is a vacuum-pressure
unit that suctions off the fat.




A snug compression garment worn after surgery helps reduce swelling.
Improvement will become apparent after about six weeks, when most of the swelling has subsided.




As healing progresses, a more proportional look will emerge.




A slimmer body contour can help you feel more confident and comfortable.




MICRODERMABRASION
SKIN MANAGEMENT
SURFACE-REPAIR TREATMENTS
Microdermabrasion

Microdermabrasion is a skin-freshening technique that helps repair facial skin that takes a beating from the sun and
the effects of aging. The plastic surgeon uses a device like a fine sandblaster to spray tiny crystals across the face,
mixing gentle abrasion with suct ion to remove the dead, outer layer of skin. As with other skin rejuvenation
techniques, more than one treatment may be needed to reduce or remove fine wrinkles and unwanted pigmentation.




RHINOPLASTY
SURGERY OF THE NOSE
If you're considering rhinoplasty...

Rhinoplasty, or surgery to reshape the nose, is one of the most common of all plastic surgery procedures.
Rhinoplasty can reduce or increase the size of your nose, change the shape of the tip or the bridge, narrow the span
of the nostrils, or change the angle between your nose and your upper lip. It may also correct a birth defect or injury,
or help relieve some breathing problems.

If you're considering rhinoplasty, this information will give you a basic understanding of the procedure -when it can
help, how it's performed, and what results you can expect. It can't answer all of your questions, since a lot depends
on the individual patient and the surgeon. Please ask your surgeon about anything you don't understand.
THE BEST CANDIDATES FOR RHINOPLASTY

Rhinoplasty can enhance your appearance and your self-confidence, but it won't necessarily change your looks to
match your ideal, or cause other people to treat you differently. Before you decide to have surgery, think carefully
about your expectations and discuss them with your surgeon.

The best candidates for rhinoplasty are people who are looking for improvement, not perfection, in the way they
look. If you're physically healthy, psychologically stable, and realistic in your expectations, you may be a goo d
candidate.

Rhinoplasty can be performed to meet aesthetic goals or for reconstructive purposes-to correct birth defects or
breathing problems.

Age may also be a consideration. Many surgeons prefer not to operate on teenagers until after they've completed
their growth spurt -around 14 or 15 for girls, a bit later for boys. It's important to consider teenagers' social and
emotional adjustment, too, and to make sure it's what they, and not their parents, really want.
ALL SURGERY CARRIES SOME UNCERTAINTY AND RISK

When rhinoplasty is performed by a qualified plastic surgeon, complications are infrequent and usually minor.
Nevertheless, there is always a possibility of complications, including infection, nosebleed, or a reaction to the
anesthesia. You can reduce your risks by closely following your surgeon's instructions both before and after surgery.

After surgery, small burst blood vessels may appear as tiny red spots on the skin's surface; these are usually minor
but may be permanent. As for scarring, when rhinoplasty is performed from inside the nose, there is no visible
scarring at all; when an "open" technique is used, or when the procedure calls for the narrowing of flared nostrils, the
small scars on the base of the nose are usually not visible.

In about one case out of ten, a second procedure may be required-for example, to correct a minor deformity. Such
cases are unpredictable and happen even to patients of the most skilled surgeons. The corrective surgery is usually
minor.
PLANNING YOUR SURGERY

Good communication between you and your physician is essential. In your initial consultation, the surgeon will ask
what you'd like your nose to look like, evaluate the structure of your nose and face, and discuss the possibilities with
you. He or she will also explain the factors that can influence the procedure and the results. These factors include
the structure of your nasal bones and cartilage, the shape of your face, the thickness of your skin, your age, and your
expectations.

Your surgeon will also explain the techniques and anesthesia he or she will use, the type of facility where the
surgery will be performed, the risks and costs involved, and any options you may have. Most insurance policies don't
cover purely cosmetic surgery; however, if the procedure is performed for reconstructive purposes, to correct a
breathing problem or a marked deformity, the procedure may be covered. Check with your insurer, and obtain pre -
authorization for your surgery.
Be sure to tell your surgeon if you've had any previous nose surgery or an injury to your nose, even if it was many
years ago. You should also inform your surgeon if you have any allergies or breathing difficulties; if you're taking any
medications, vitamins, or recreational drugs; and if you smoke.

Don't hesitate to ask your doctor any questions you may have, especially those regarding your expectations and
concerns about the results.
PREPARING FOR YOUR SURGERY

Your surgeon will give you specific instructions on how to prepare for surgery, including guidelines on eat ing and
drinking, smoking, taking or avoiding certain vitamins and medications, and washing your face. Carefully following
these instructions will help your surgery go more smoothly.

While you're making preparations, be sure to arrange for someone to drive you home after your surgery and to help
you out for a few days if needed.
WHERE YOUR SURGERY WILL BE PERFORMED

Rhinoplasty may be performed in a surgeon's office -based facility, an outpatient surgery center, or a hospital. It's
usually done on an outpatient basis, for cost containment and convenience. Complex procedures may require a short
inpatient stay.
TYPES OF ANESTHESIA

Rhinoplasty can be performed under local or general anesthesia, depending on the extent of the procedure and on
what you and your surgeon prefer.

With local anesthesia, you'll usually be lightly sedated, and your nose and the surrounding area will be numbed; you'll
be awake during the surgery, but relaxed and insensitive to pain. With general anesthesia, you'll sleep through the
operation.
THE SURGERY

Rhinoplasty usually takes an hour or two, though complicated procedures may take longer. During surgery the skin of
the nose is separated from its supporting framework of bone and cartilage, which is then sculpted to the desired
shape. The nature of the sculpting will depend on your problem and your surgeon's preferred technique. Finally, the
skin is redraped over the new framework.

Many plastic surgeons perform rhinoplasty from within the nose, making their incision inside the nostrils. Others
prefer an "open" procedure, especially in more complicated cases; they make a small incision across the columella,
the vertical strip of tissue separating the nostrils.

When the surgery is complete, a splint will be applied to help your nose maintain its new shape. Nasal packs or soft
plastic splints also may be placed in your nostrils to stabilize the septum, the dividing wall between the air passages.
AFTER YOUR SURGERY

After surgery-particularly during the first twenty-four hours-your face will feel puffy, your nose may ache, and you
may have a dull headache. You can control any discomfort with the pain medication prescribed by your surgeon. Plan
on staying in bed with your head elevated (except for going to the bathroom) for the first day.

You'll notice that the swelling and bruising around your eyes will increase at first, reaching a peak after two or three
days. Applying cold compresses will reduce this swelling and make you feel a bit better. In any case, you'll feel a lot
better than you look. Most of the swelling and bruising should disappear within two weeks or so. (Some subtle
swelling-unnoticeable to anyone but you and your surgeon-will remain for several months.)

A little bleeding is common during the first few days following surgery, and you may continue to feel some stuffiness
for several weeks. Your surgeon will probably ask you not to blow your nose for a week or so, while the tissues heal.

If you have nasal packing, it will be removed after a few days and you'll feel much more comfortable. By the end of
one or, occasionally, two weeks, all dressings, splints, and stitches should be removed.
GETTING BACK TO NORMAL

Most rhinoplasty patients are up and about within two days, and able to return to school or sedentary work a week or
so following surgery. It will be several weeks, however, before you're entirely up to speed.

Your surgeon will give you more specific guidelines for gradually resuming your normal activities. They're likely to
include these suggestions: Avoid strenuous activity (jogging, swimming, bending, sexual relations-any activity that
increases your blood pressure) for two to three weeks. Avoid hitting or rubbing your nose, or getting it sunburned,
for eight weeks. Be gentle when washing your face and hair or using cosmetics.

You can wear contact lenses as soon as you feel like it, but glasses are another story. Once the splint is off, they'll
have to be taped to your forehead or propped on your cheeks for another six to seven weeks, until your nose is
completely healed.

Your surgeon will schedule frequent follow-up visits in the months after surgery, to check on the progress of your
healing. If you have any unusual symptoms between visits, or any questions about what you can and can't do, don't
hesitate to call your doctor.
YOUR NEW LOOK

In the days following surgery, when your face is bruised and swollen, it's easy to forget that you will be looking
better. In fact, many patients feel depressed for a while after plastic surgery-it's quite normal and understandable.
Rest assured that this stage will pass. Day by day, your nose will begin to look better and your spirits will improve.
Within a week or two, you'll no longer look as if you've just had surgery.

Still, healing is a slow and gradual process. Some subtle swelling may be pre sent for months, especially in the tip.
The final results of rhinoplasty may not be apparent for a year or more.

In the meantime, you might experience some unexpected reactions from family and friends. They may say they don't
see a major difference in your nose. Or they may act resentful, especially if you've changed something they view as a
family or ethnic trait. If that happens, try to keep in mind why you decided to have this surgery in the first place. If
you've met your goals, then your surgery is a success.




Before surgery, these rhinoplasty patients have large, slightly hanging noses, with a hump and an enlarged tip.




If your nostrils are too wide, the surgeon can remove small wedges of skin form their base, bringing them closer
together.




Incisions are made inside the nostrils or at the base of the nose, providing access to the cartilage and bone, which
can then be sculpted into shape.
The surgeon removes the hump using a chisel or a rasp, then brings the nasal bones together to form a narrower
bridge. Cartilage is trimmed to reshape the tip of the nose.




Trimming the septum improves the angle between the nose and upper lip.




A splint made of tape and an overlay of plastic, metal, or plaster is applied to help the bone and cartilage of the nose
maintain their new shape.




After surgery, the patient has a smaller nose, a straighter bridge, a well defined nasal tip, and an improved angle
between the nose and upper lip.
COSMETIC PLASTIC SURGERY
PROCEDURES AT A GLANCE
Permanent Eyeliner

Permanent eyeliner is possible through a procedure called micropigmentation in which an organic pigment is
embedded beneath the skin to add permanent co lor. The procedure involves the use of a hand-held device that
punctures the skin hundreds of times per minute with a very thin needle and pushes the pigment into the desired
location. In addition to defining the eyes, micropigmentation is used to enhance eyebrows and lips and can
permanently create the look of blush and eye shadow.




SKIN MANAGEMENT
SURFACE-REPAIR TREATMENTS
Managing healthy skin

From early on, we learn that having a smooth, clear complexion is an attribute of physical attractiveness. However,
as we age, maintaining that healthy glow becomes more difficult.

The face is the most exposed part of the body, vulnerable to the harsh rays of the sun. The face is also subject to
acne, rashes, allergic reactions, and injuries that may leave permanent scars.

This brochure will give you a basic understanding of commonly used treatments for managing skin-when they can
help, what they involve, and what results you can expect. It can't answer all of your questions, since a lot depends on
your individual circumstances.

Ask your doctor anything you don't understand about the treatment you're considering.

A number of non-surgical "refinishing" treatments are available for individuals who want to eliminate or soften
imperfections on their facial skin and a  chieve a clearer, fresher look. These treatments include glycolic acids
(sometimes called "fruity acids"), which are natural fruit substances blended into facial preparations and are used to
eliminate rough or dried surface skin, and Retin -A®, a vitamin A        -enriched cream that changes the cellular
metabolism of the skin's surface and is used to combat fine facial wrinkles and blotches from sun damage.

Each of these treatments can be used alone, or are frequently prescribed in conjunction with an aesthetic surgery
procedure, such as a facelift or a chemical peel.
WHAT TO EXPECT FROM SKIN-SURFACE TREATMENTS

"Surface-repair" treatments can enhance your appearance and give your skin a smoother, fresher look, but they
won't remove deep scars and flaws or prevent ag ing. These treatments should not be thought of as mini-facelifts.
Generally speaking, Retin -A® and glycolic acid treatments offer less dramatic results than surgical approaches like
dermaplaning, dermabrasion, or chemical peel.

Before you decide to have a skin-rejuvenating treatment of any type, think carefully about your expectations and
discuss them with your plastic surgeon.
PLANNING FOR TREATMENT

Whether you're planning a surgical or nonsurgical skin treatment, it's important that you find a doctor who has
training and experience with a variety of skin-management techniques. You'll want a doctor who can give you the
best possible single treatment or treatment combination. Look elsewhere if your doctor tells you that he or she has
perfected a single technique that promises unbelievable results. The choice is yours, but be certain your doctor is
qualified to prescribe such treatments. After all, these treatments involve the most visible part of your body - your
face.

In your initial consultation, be open in discussing your treatment goals with your doctor and don't hesitate to ask any
questions or express any concerns you may have. Your surgeon should be equally open with you and explain the
factors that could influence your choice of treatment options such as age, skin condition, and previous plastic
surgeries.

The surgeon will ask about your medical history and conduct a routine examination. If you're having a surgical
procedure in conjunction with your skin treatment, your doctor should explain the process in detail, including the
risks and benefits, the recovery period, and the costs. Insurance usually doesn't cover aesthetic procedures.
WHERE YOUR TREATMENT WILL BE PERFORMED

It is unlikely that you'll have to spend time in the hospital for your skin treat ment unless the treatment is performed
in conjunction with a facelift or some other more complex procedure. Your initial application of Retin-A® or glycolic
acid will probably be performed in a doctor's office or an outpatient facility.
THE TREATMENTS

Retin-A®
Best candidates. In general, Retin-A® is most effective in older patients who have some fine facial wrinkles, or
blotchy pigmented areas caused by sun damage. However, Retin -A® is often prescribed to younger, active
individuals who want to combat the aging effects of sun exposure. Patients who are planning to have a chemical peel
treatment are often instructed by their doctors to use Retin-A® as a preparation treatment; Retin-A® thins the skin's
outer layer, allowing the acid solution used in a peel treatment to penetrate more deeply and evenly. Retin -A® is not
recommended for pregnant women or nursing mothers, because its effects on the fetus and nursing infant are still
being studied.

Reactions/side-effects. Although no serious medical problems have been associated with Retin-A®, it's possible that
its use could result in temporary skin irritation and redness. If this happens, your doctor may recommend a milder
formulation.

As late as 1993, Retin-A® had not received approval for use as an anti-aging treatment from the Food and Drug
Administration (FDA). It has received FDA approval as an acne treatment, and doctors have been safely using it for
this purpose for more than two decades. However, the full scope of Retin -A®'s effects and potential benefits
continues to investigated.

Beginning treatment. Your initial application of Retin-A® will include a lesson on how to continue your skin-care
routine at home. After your face has been washed thoroughly, a small amount of Retin-A®, in either cream or gel
form, is rubbed over your face and nose. It's likely that a very gentle formula will be used at the beginning -
especially if you are younger or have a fair complexion. You may be switched to a stronger formula after your skin
becomes accustomed to treatment.

Only a very small amount of Retin-A® - a pea-sized dab - is needed to cover the entire face. You will be instructed
to apply Retin-A® every night before you go to bed. Because Retin-A® is drying to the skin, your doctor may also
recommend that you apply a moisturizer once or twice a day. This routine is usually continued for about eight months
to a year, after which you'll be switched to a less -frequent schedule of maintenance, with Retin-A® applications only
two or three times per week. At periodic follow-up visits, your doctor may adjust the strength of your prescription or
its frequency of use. To maintain the benefits of Retin-A®, its use must be continued for a lifetime.

After treatment. It's normal to experience some redness, irritation, itching, sting ing, or skin dryness once you begin
to use Retin-A®. However, you can expect these symptoms to gradually disappear as the skin becomes acclimated to
the treatment.

Caring for your new skin. Because Retin-A® thins out the skin's outer layer, you will need t o consistently use a sun-
block to protect yourself from ultraviolet light, and you may have to discontinue using certain products or cosmetics
on your face.

Though the degree of change varies from person to person, with continued use of Retin-A®, you will begin to see
subtle improvements in the texture and tone of your skin. Retin-A® users notice a rosy glow during the beginning
months of use, followed by the disappearance of fine lines and the shrinking of large pores. After about six months,
many Retin-A® users report that wrinkles are barely visible and that age spots have faded.

Glycolic                                               acid                                           treatments
Best candidates. Glycolic or "fruity acid" treatments can offer smoother skin to people of all ages. This type of
treatment seems to work best on patients who have rough, sun-damaged skin. Glycolic acids are sometimes
formulated with bleaching chemicals to correct areas of uneven pigmentation.

Reactions/side-effects. It's important to remember that side-effects may occur even with non-surgical treatments.
No serious medical problems have been associated with glycolic acids, but their use may cause temporary skin
irritation and redness. Switching to a milder formula may remedy the problem.

Beginning treatment. Your initial application of glycolic acid cream will include a lesson on how to continue your
skin-care routine at home. The way in which glycolic acid is applied to the face depends upon what form it's in.

Two common forms are cream or facial wash. Both forms contain about 12 percent glycolic acid, which helps slough
away dry, sun-damaged skin on the face's surface. Each also contains a special moisturizer and, if needed, a
bleaching agent. In most cases, the acid is applied to the face twice daily, either by smoothing on the cream or using
the facial wash. Your doctor may adjust the strength of the acid formulation or the frequency of its use after
evaluating your skin's condition in follow-up visits.
After treatment. It's normal to experience some redness, irritation, itching, stinging, or skin dryness once you begin
to use glycolic acid. However, you can expect these symptoms to gradually disappear as the skin adjusts to the
treatment.

Caring for your new skin. Because glycolic acid thins the skin's outer layer, you will need to consistently use a sun-
block to protect yourself from ultraviolet light, and you may have to discontinue using certain products or cosmetics
on you face.

Though the degree of change varies from person to person, with continued use of glycolic acid preparations, you will
begin to see subtle improvements in the texture and tone of your skin. In most cases, glycolic acid users notice an
overall freshness and smoothness. After a while, pigmented blotches fade or disappear as the bleaching effect begins
to work. The time necessary for visible results depends on the degree of pigmentation and individual circumstances.
Some patients see results in as little as six weeks.
YOUR NEW ROUTINE

Most people find that maintaining their new look is easier than expected. Using the cream or facial wash will become
a natural part of your morning or evening routine - and the difference you'll see will be worth the extra effort.




The appearance of fine facial wrinkles can be improved with Retin-A® treatment.
Glycolic acid treatment can smoothe rough, sun-damaged skin and fade age spots.




SCLEROTHERAPY
SPIDER VEINS
Diminishing unsightly 'spider veins'

Millions of women are bothered by spider veins - those small yet unsightly clusters of red, blue or purple veins that
most commonly appear on the thighs, calves and ankles. In fact, it's estimated that at least half of the adult female
population is plagued with this common cosmetic problem.

Today, many plastic surgeons are treating spider veins with sclerotherapy. In this rather simple procedure, veins are
injected with a sclerosing solution, which causes them to collapse and fade from view. The procedure may also
remedy the bothersome symptoms associated with spider veins, including aching, burning, swelling and night cramps.

Although this procedure has been used in Europe for more than 50 years, it has only become popular in the United
States during the past decade. The introduction of sclerosing agents that are mild enough to be used in small veins
has made sclerotherapy predictable and relatively painless.

If you're considering sclerotherapy to improve the appearance of your legs, this brochure will give you a basic
understanding of the procedure - when it can help, how it's performed and what results you can expect. It won't
answer all of your questions, since a lot depends on your individual circumstances. Please ask your doctor if there is
anything about the procedure you don't understand.
WHAT ARE SPIDER VEINS?

Spider veins - known in the medical world as telangiectasias or sunburst varicosities - are small, thin veins that lie
close to the surface of the skin. Although these super-fine veins are connected with the larger venous system, they
are not an essential part of it.

A number of factors contribute to the development of spider veins, including heredity, pregnancy and other events
that cause hormonal shifts, weight gain, occupations or activities that require pro longed sitting or standing, and the
use of certain medications.

Spider veins usually take on one of three basic patterns. They may appear in a true spider shape with a group of
veins radiating outward from a dark central point; they may be arborizing and will resemble tiny branch-like shapes;
or they may be simple linear and appear as thin separate lines. Linear spider veins are commonly seen on the inner
knee, whereas the arborizing pattern often appears on the outer thigh in a sunburst or cartwheel distribution.

Varicose veins differ from spider veins in a number of ways. Varicose veins are larger - usually more than a
quarter-inch in diameter, darker in color and tend to bulge. Varicose veins are also more likely to cause pain and be
related to more serious vein disorders. For some patients, sclerotherapy can be used to treat varicose veins.
However, often surgical treatment is necessary for this condition.
THE BEST CANDIDATES FOR SCLEROTHERAPY

Women of any age may be good candidates for sclerotherapy, but most fall in the 30-to-60 category. In some
women, spider veins may become noticeable very early on - in the teen years. For others, the veins may not become
obvious until they reach their 40s.

If you are pregnant or breastfeeding, you may be advised to postpone sclerotherapy treatment. In most cases, spider
veins that surface during pregnancy will disappear on their own within three months after the baby is born. Also,
because it's not known how sclerosing solutions may affect breast milk, nursing mothers are usually advised to wait
until after they have stopped breastfeeding.

Spider veins in men aren't nearly as common as they are in women. Men who do have spider veins often don't
consider them to be a cosmetic problem because the veins are usually concealed by hair growth on the leg. However,
sclerotherapy is just as effective for men who seek treatment.
WHAT TO EXPECT FROM SCLEROTHERAPY

Sclerotherapy can enhance your appearance and your self confidence, but it's unrealistic to believe that every
affected vein will disappear completely as a result of treatment. After each sclerotherapy session, the veins will
appear lighter. Two or more sessions are usually required to achieve optimal results.
You should also be aware that the procedure treats only those veins that are currently visable; it does nothing to
permanently alter the venous system or prevent new veins from surfacing in the future.

Before you decide to have sclerotherapy, think carefully about your expectations and discuss them with your doctor.
RISKS RELATED TO TREATMENT

Serious medical complications from sclerotherapy are extremely rare when the procedure is performed by a qualified
practitioner. However, they may occur. Risks include the formation of blood clots in the veins, severe inflammation,
adverse allergic reactions to the sclerosing solution and skin injury that could leave a small but permanent scar.

A common cosmetic complication is pigmentation irregularity - brownish splotches on the affected skin that may take
months to fade, sometimes up to a year. Another problem that can occur is "telangiectatic matting," in which fine
reddish blood vessels appear around the treated area, requiring further injections.

You can reduce the risks associated with treatment by choosing a doctor who has adequate training in sclerotherapy
and is well versed in the different types of sclerosing agents available. A qualified doctor can help you select which
type of sclerosing medication is most appropriate for your needs.
PLANNING YOUR TREATMENT

During your initial consultation, your legs will be examined. Your doctor may draw a simple sketch of your legs,
mapping out the areas affected by spider veins or other problems. During the examination, you will be checked for
signs of more serious "deep vein" problems, often indicated by swelling, sores, or skin changes at the ankle. A hand-
held Doppler ultrasound device is sometimes used to detect any backflow within the venous system.

If such problems are identified, your surgeon may refer you to a different specialist for further evaluation. Problems
with the larger veins must be treated first, or sclerotherapy of the surface veins will be unsuccessful.

Your doctor will ask you about any other problems you may have with your legs, such as pain, aching, itching or
tenderness. You will also be asked about your medical history, medications you take, or conditions that would
preclude you from having treatment. Individuals with hepatitis, AIDS or other blood-borne diseases may not be
candidates for sclerotherapy. Patients with circulatory problems, heart conditions, or diabetes may also be advised
against treatment.

It's important to be open in discussing your history and treatment goals with your doctor. Don't hesitate to ask any
questions or express any concerns you may have. Your doctor should explain the procedure in detail, along with its
risks and benefits, the recovery period and the costs. (Medical insurance usually doesn't cover cosmetic procedures.)
PREPARING FOR THE PROCEDURE

You will receive specific instructions from your physician on how to prepare for your treatment. Carefully following
these instructions will help the procedure go more smoothly.

You'll be instructed not to apply any type of moisturizer, sunblock or oil to your legs on the day of your procedure .
You may want to bring shorts to wear during the injections, as well as your physician -prescribed support hose, and
slacks to wear home.

When scheduling your procedure, keep in mind that your legs may be bruised or slightly discolored for some weeks
afterward. You probably won't be comfortable wearing shorts, a swimsuit or a mini skirt until after your legs have
cleared up a bit.
WHERE YOUR TREATMENT WILL BE PERFORMED

Sclerotherapy of spider veins is a relatively simple procedure that requires no anesthesia, so it will be performed in
an outpatient setting, most likely your doctor's office.
THE PROCEDURE

A typical sclerotherapy session is relatively quick, lasting only about 15 to 45 minutes. After changing into shorts,
your legs may be photographed for your medical records. You will be asked to lie down on the examination table and
the skin over your spider veins will be cleaned with an antiseptic solution. Using one hand to stretch the skin taut,
your doctor or nurse will begin injecting the sclerosing agent into the affected veins. Bright, indirect light and
magnification help ensure that the process is completed with maximum precision.

Approximately one injection is administered for every inch of spider vein - anywhere from five to 40 injections per
treatment session. A cotton ball and compression tape is applied to each area of the leg as it is finished.

During the procedure, you may listen to music, read, or just talk to your practitioner. You will be asked to shift
positions a few times during the process. As the procedure continues, you will feel small needle sticks and possibly a
mild burning sensation. However, the needle used is so thin and the sclerosing solution is so mild that pain is usually
minimal.
AFTER YOUR TREATMENT

In addition to the compre ssion tape applied during the procedure, tight -fitting support hose may be prescribed to
guard against blood clots and to promote healing. The tape and cotton balls can be removed after 48 hours. However,
you may be instructed to wear the support hose for 72 hours or more.

It's not uncommon to experience some cramping in the legs for the first day or two after the injections. This
temporary problem usually doesn't require medication.

You should be aware that your treated veins will look worse before they begin to look better. When the compression
dressings are removed, you will notice bruising and reddish areas at the injection sites. The bruises will diminish
within one month. In many cases, there may be some residual brownish pigmentation which may take up to a year to
completely fade.
GETTING BACK TO NORMAL

Although you probably won't want to wear any leg-baring fashions for about two weeks, your activity will not be
significantly limited in any other way from sclerotherapy treatment.

You will be encouraged to walk to prevent clots from forming in the deep veins of the legs. However, during the
period of time to complete your treatment program, prolonged sitting and standing should be avoided, as should
squatting, heavy weight lifting and "pounding" type exercises, including jogging.

A one-month healing interval must pass before you may have your second series of injections in the same site. After
each treatment, you will notice further improvement of your legs' appearance.
YOUR NEW LOOK

Most patients are pleased with the difference sclerotherapy makes. The skin of your legs will appear younger,
clearer and more healthy-looking. If you've been wearing long skirts and slacks to hide your spider veins, you'll now
be able to broaden your fashion horizons. Often, patients are surprised at the dramatic difference in appearance
between a treated leg and an untreated one.

Although sclerotherapy will obliterate the noticeable veins for good, it's important to remember that treatment will
not prevent new spider veins f rom emerging in the future. As time passes, you may find that you need "touch -ups" or
full treatments for new veins that surface. But even if you choose not to have further sclerotherapy, your legs will
look better than if you never had treatment at all.




Spider veins on the leg usually appear in one of three patterns: (a) simple linear (b) arborizing, which appear branch -
like, and (c) spider, which appear as a cartwheel shape with a dark center point.
Before treatment, spider veins are quite noticeable, contrasting sharply with the surrounding skin.




The skin is held taut while the injection of sclerosing solution is administered under bright light and magnification.




A cotton ball and compression tape are applied to each treated area. Elastic bandages or stockings may be used to
help further the action of the injected medication.




One month after the first treatment, spider veins are distinctly lighter, yet still somewhat visible.
After two or more treatments, the leg appears noticeably clearer and more attractive.




TUMESCENT TECHNIQUE
NEW LIPOSUCTION METHOD
If your surgeon recommends the tumescent technique...

The tumescent techni que is a relatively new liposuction method that can reduce post operative bruising, swelling and
pain. Because blood loss is minimized during tumescent liposuction, use of the technique reduces the chance that a
blood transfusion will be needed.

In the tumescent technique, areas of excess fat are injected with a large amount of anesthetic liquid before
liposuction is per-formed. The liquid causes the compartments of fat to become swollen and firm or "tumesced." The
expanded fat compartments allow the liposuction cannula to travel smoothly beneath the skin as the fat is removed.
CANDIDATES FOR TUMESCENT LIPOSUCTION

Any person who is a candidate for traditional liposuction is also a good candidate for the tumescent technique.
Although the technique can be used on any area of the body, it is commonly used on areas that require enhanced
precision, such as the face, neck, arms, calves and ankles.

Individuals who have large areas of excess fat may also be good candidates for tumescent liposuction.
UNDERSTANDING THE RISK

Although the anesthesia requirements are lessened and blood loss is minimized with tumescent liposuction, patients
undergoing the procedure still face the same risks and cosmetic complications associated with tradi-tional liposuction
surgery.

          re
T h e r e a also risks specifically associated with the tumescent technique. These rare complications include
pulmonary edema (the collection of fluid in the lungs), which may occur if too much fluid is administered; and
lidocaine toxicity, which occurs if the solution's lidocaine content is too high.

You can reduce your risks by choosing a board -certified plastic surgeon who has adequate experience with the
technique.
ANESTHESIA

For many patients, general anesthesia is the best option. For others, the anesthetic co ntained in the solution
combined with sedation may provide sufficient comfort during the procedure. Or, if your doctor feels it's appropriate,
the tumescent solution itself may serve as the sole means of anesthesia.
THE SURGERY

In tumescent liposuction, the warmed tumescent liquid -- a dilute solution containing lidocaine, epinephrine and
intravenous fluid -- is injected into the area to be treated. As the liquid enters the fat, it becomes swollen, firm and
blanched. Liposuction is then performed on the tumesced areas.
AFTER SURGERY
The long-acting effects of the anesthetic solution help to provide pain relief after the procedure and decrease the
need for additional pain medication.

For the first day or two after surgery, most patients experience swelling in the treated areas, as well as some fluid
drainage from the incision sites.

Light activity is usually resumed within the first few days after tumescent liposuction; normal activity can be resumed
within a few weeks.
YOUR NEW LOOK

Patients are usually able to see a noticeable difference almost immediately after surgery. However, more
improvement can be seen after three weeks, when most of the swelling has subsided. After about three months, any
persistent mild swelling will disappear and the final contour will be visible.

Patients are usually very pleased with the results of the procedure. By eating a healthy diet and getting regular
exercise, you can help to maintain your slimmer figure or leaner physique.




ABDOMINOPLASTY
TUMMY TUCK
If you're considering abdominoplasty...

Abdominoplasty, known more commonly as a "tummy tuck," is a major surgical procedure to remove excess skin and
fat from the middle and lower abdomen and to tighten the muscles of the abdominal wall. The procedure can
dramatically reduce the appearance of a protruding abdomen. But bear in mind, it does produce a permanent scar,
which, depending on the extent of the original problem and the surgery required to correct it, can extend from hip to
hip.

If you're considering abdominoplasty, this will give you a basic understanding of the procedure-when it can help, how
it's performed, and what results you can expect. It can't answer all of your questions, since a lot depends on the
individual patient and the surgeon. Please ask your surgeon about anything you don't understand.
THE BEST CANDIDATES FOR ABDOMINOPLASTY

The best candidates for abdominoplasty are men or women who are in relatively good shape but are bothered by a
large fat deposit or loose abdominal skin that won't respond to diet or exercise. The surgery is particularly helpful to
women who, through multiple pregnancies, have stretched their abdominal muscles and skin beyond the point where
they can return to normal. Loss of skin elasticity in older patients, which frequently occurs with slight obesity, can
also be improved.

Patients who intend to lose a lot of weight should postpone the surgery. Also, women who plan future pregnancies
should wait, as vertical muscles in the abdomen that are tightened during surgery can separate again during
pregnancy. If you have scarring from previous abdominal surgery, your doctor may recommend against
abdominoplasty or may caution you that scars could be unusually prominent.

Abdominoplasty can enhance your appearance and your self-confidence, but it won't necessarily change your looks
to match your ideal, or cause other people to treat you differently. Before you decide to have surgery, think carefully
about your expectations and discuss them with your surgeon.
ALL SURGERY CARRIES SOME UNCERTAINTY AND RISK

Thousands of abdominoplasties are performed successfully each year. When done by a qualified plastic surgeon who
is trained in body contouring, the results are generally quite positive. Nevertheless, there are always risks associated
with surgery and specific complications associated with this procedure.

Post-operative complications such as infection and blood clots are rare, but can occur. Infection can be treated with
drainage and antibiotics, but will prolong your hospital stay. You can minimize the risk of blood clots by moving
around as soon after the surgery as possible.

Poor healing, which results in conspicuous scars, may necessitate a second operation. Smokers should be advised to
stop, as smoking may increase the risk of complications and delay healing.

You can reduce your risk of complications by closely following your surgeon's instructions before and after the
surgery, especially with regard to when and how you should resume physical activity.
PLANNING YOUR SURGERY
In your initial consultation, your surgeon will evaluate your health, determine the extent of fat deposits in your
abdominal region, and carefully assess your skin tone. Be sure to tell your surgeon if you smoke, and if you're taking
any medications, vitamins, or other drugs.

Be frank in discussing your expectations with your surgeon. He or she should be equally frank with you, describing
your alternatives and the risks and limitations of each.

If, for example, your fat deposits are limited to the area below the navel, you may require a less complex procedure
called a partial abdominoplasty, also know as a mini-tummy tuck, which can often be performed on an outpatient
basis. You may, on the other hand, benefit more from partial or complete abdominoplasty done in conjunction with
liposuction to remove fat deposits from the hips, for a better body contour. Or maybe liposuction alone would create
the best result.

In any case, your surgeon should work with you to recommend the procedure that is right for you and will come
closest to producing the desired body contour.

During the consultation, your surgeon should also explain the anesthesia he or she will use, the type of facility where
the surgery will be performed, and the costs involved. In most cases, health insurance policies do not cover the cost
of abdominoplasty, but you should check your policy to be sure.
PREPARING FOR YOUR SURGERY

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

If you smoke, plan to quit at least one to two weeks before your surgery and not to resume for at least two weeks
after your surgery. Avoid overexposure to the sun before surgery, especially to your abdomen, and do not go on a
stringent diet, as both can inhibit your ability to heal. If you develop a cold or infection of any kind, your surgery will
probably be postponed.

Whether your surgery is done on an outpatient or inpatient basis, you should arrange for someone to drive you home
after your surgery, and to help you out for a day or two after you leave the hospital, if needed.
WHERE YOUR SURGERY WILL BE PERFORMED

Many surgeons perform both partial and complete abdominoplasties in an outpatient surgical center or an office -
based facility. Others prefer the hospital, where their patients can stay for several days.
TYPES OF ANESTHESIA

Your doctor may select general anesthesia, so you'll sleep through the operation.

Other surgeons use local anesthesia, combined with a sedative to make you drowsy. You'll be awake but relaxed, and
your abdominal region will be insensitive to pain. (However, you may feel some tugging or occasional discomfort.)
THE SURGERY

                                                                   n
Complete abdominoplasty usually takes two to five hours, depending o the extent of work required. Partial
abdominoplasty may take an hour or two.

Most commonly, the surgeon will make a long incision from hipbone to hipbone, ,just above the pubic area. A second
incision is made to free the navel from surrounding tissue. Wi th partial abdominoplasty, the incision is much shorter
and the navel may not be moved, although it may be pulled into an unnatural shape as the skin is tightened and
stitched.

Next, the surgeon separates the skin from the abdominal wall all the way up to your ribs and lifts a large skin flap to
reveal the vertical muscles in your abdomen. These muscles are tightened by pulling them close together and
stitching them into their new position. This provides a firmer abdominal wall and narrows the waistline.

The skin flap is then stretched down and the extra skin is removed. A new hole is cut for your navel, which is then
stitched in place. Finally, the incisions will be stitched, dressings will be applied, and a temporary tube may be
inserted to drain excess fluid from the surgical site.

In partial abdominoplasty, the skin is separated only between the incision line and the navel. This skin flap is
stretched down, the excess is removed, and the flap is stitched back into place.
AFTER YOUR SURGERY

For the first few days, your abdomen will probably be swollen and you're likely to feel some pain and discomfort
which can be controlled by medication. Depending on the extent of the surgery, you may be released within a few
hours or you may have to remain hospitalized for two to three days.

Your doctor will give you instructions for showering and changing your dressings. And though you may not be able to
stand straight at first, you should start walking as soon as possible.

Surface stitches will be removed in five to seven days, and deeper sutures, with ends that protrude through the skin,
will come out in two to three weeks. The dressing on your incision may be replaced by a support garment.
GETTING BACK TO NORMAL

It may take you weeks or months to feel like your old self again. If you start out in top physical condition with strong
abdominal muscles, recovery from abdominoplasty will be much faster. Some people return to work after two weeks,
while others take three or four weeks to rest and recuperate.
Exercise will help you heal better. Even people who have never exercised before should begin an exercise program
to reduce swelling, lower the chance of blood clots, and tone muscles. Vigorous exercise, however, should be
avoided until you can do it comfortably.

Your scars may actually appear to worsen during the first three to six months as they heal, but this is normal. Expect
it to take nine months to a year before your scars flatten out and lighten in color. While they'll never disappear
completely, abdominal scars will not show under most clothing, even under bathing suits.
YOUR NEW LOOK

Abdominoplasty, whether partial or complete, produces excellent results for patients with weakened abdominal
muscles or excess skin. And in most cases, the results are long lasting, if you follow a balanced diet and exercise
regularly.

If you're realistic in your expectations and prepared for the consequences of a permanent scar and a lengthy
recovery period, abdominoplasty may be just the answer for you.




An incision just above the pubic area is used to remove excess skin and fat from the middle and lower abdomen.
Skin is separated from the abdominal wall all the way up to the ribs.




The surgeon draws underlying muscle and tissue together and stitches
them, thereby narrowing the waistline and strengthening the abdominal
wall.




Abdominal skin is drawn down and excess is removed. With complete
abdominoplasty, a new opening is cut for the navel. Both incisions are
stitched closed.
After surgery, the patient has a flatter, trimmer abdomen. Scars are
permanent, but will fade with time.




COSMETIC PLASTIC SURGERY
PROCEDURES AT A GLANCE
BRACHIOPLASTY
Brachioplasty

An arm lift, also known as brachioplasty, is a surgical procedure to remove loose skin and excess fat deposits in the
upper arm. With age, upper arm skin can become loose and flabby. Plastic surgeons will discuss brachioplasty with
patients who want to tighten this skin and look as good as they feel. In some cases your plastic surgeon may suggest
that liposuction be used alone or in conjunction with an arm lift to remove excess fat in the upper arms.

				
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