Reconstructive Surgery Frequently Asked Questions

General Questions

Are you a Good Candidate for Cosmetic Surgery?

Ans.: The ideal candidate for aesthetic surgery is an individual who recognizes a specific area in which his or her appearance could be improved and has a strong personal desire to make a change. This personal desire may be influenced to some degree by the individual’s role in society. Because our culture is youth-oriented, people seek ways to counter the effects of aging on their appearance. Many elect surgery to look as young as they feel, to build confidence after a lifestyle change or to retain their edge against younger competitors.

Whatever your reasons for choosing aesthetic surgery, it is important to have realistic expectations The best surgeon in the world can’t help you if your motivation is wrong, or if your expectations are unrealistic. Most importantly, you should be doing it for yourself. Not for your spouse, your children, your friends or anyone else.

Secondly, you should be doing it for the right reasons. Cosmetic surgery cannot save a bad marriage. It won’t turn you into a movie star, and it won’t turn an unhappy life into a happy one. But there’s a lot it can do.

It can improve your looks. It can help you look as young as you feel. And sometimes it can even boost your self-esteem and self-confidence. The rest is up to you. You should be realistic about what you’ll look like afterwards. Cosmetic surgery deals in improvement – not in perfection. If you can accept that, your surgery will be successful. If your expectations are realistic and you’re doing it for the right reasons, the chances are excellent that you will be happy with your results.

Why should I choose a Cosmetic Surgery Centre

Ans.: A Cosmetic Surgery Center is a surgical facility dedicated only to Cosmetic Surgery and therefore, offers high quality in the nursing team, anesthesia and post-op care available. Having surgery in a surgical facility gives you peace of mind, as the staff is completely geared up to deal with cosmetic surgery patients and every procedure & protocol is worked up to its minutest detail. A centre dedicated to Cosmetic Surgery also has less patient traffic thus maintaining complete confidentiality and greater testability.

How should I select a surgeon?

Ans.: Anyone can call themselves a “Cosmetic surgeon.” What is the doctor’s background? Is the doctor Board Certified in Plastic Surgery ( MCh or D.N.B Plastic Surgery) or is he/she a General Surgeon(M.S.), Dentist(B.D.S.,M.D. S.), Dermatologist (M.D,D.V.D) , or Ears Nose and Throat (M.S.ENT) Surgeon. Any doctor may be trained in doing some aspects of cosmetic surgery or plastic surgery. Ask specific questions about the doctor’s training. Insist on certain qualifications. Has he done a fellowship training or specialized training in the procedures you want performed? A specialist does the same procedures far more often and therefore has greater experience and skill than most surgeons.

Board Certification by the Indian Board of Plastic Surgery takes years of education,careful testing of skills and broad training in the field of plastic surgery for another 3 years, following the 3 years basic training in the above mentioned specialities. Carefully evaluate the proposed surgery and the surgeon himself before proceeding.It would be wise to do some homework as your awareness is your greatest protection. Interview several and choose one who has credentials and certification in Plastic Surgery recognised by The Medical Council of India.

During your consultation, it is important to establish a rapport with the surgeon since you place total confidence in that doctor’s ability. Select a surgeon who compares alternatives, explains clearly what will be done for you and the rationale for the approach selected. Be sure he discusses convalescence, possible risks and complications. Choose a surgeon who communicates,has an aesthetic taste and an artistic sense compatible with yours & has a clear understanding of your desired result.

What Anaesthesia will be used?

Ans.: Whichever cosmetic surgical procedure you have done, it will require anesthesia as it is an integral part of your surgical experience to make it painless and anxiety-free. With general anesthesia the patient is put to sleep. This anesthesia is usually associated with “bigger” operations. With local anesthesia , a specific area of the body is numbed by the local injection of medication at the site where the surgery will be performed.

Today, with the great advances in anesthesia, an entire spectrum exists between local and general anesthesia to eliminate pain and minimize anxiety. Here’s how it works:

Before the operation, an anesthesiologist visits the patient. A sedative or tranquilizer(Valium, for example), may be given orally. This induces a pleasant state of drowsiness.A thin intravenous catheter is inserted into a vein in the arm. This open pipeline is imperative during any surgery, should the patient require additional medication for any reason. Additional sedation may be given through the intravenous catheter. This allows the local anesthesia (given in the operating room) to be injected without any unpleasant sensations. The local anesthesia is then injected into the area where the operation will take place, along with a small amount of adrenaline, which causes the blood vessels of the area to constrict. This helps to minimize bleeding, while the anesthetic “blocks” or “freezes” the tissues so no pain is felt.

The drowsiness induced by the intravenous sedative may become a twilight sleep. Some patients experience a sense of well-being bordering on euphoria. Others may feel completely unconscious, even though, medically speaking, they are only lightly anesthetized. They can respond to commands and even answer questions. When performing cosmetic surgery on the face, most surgeons prefer this state to total unconsciousness because the operation is done on a face that is not completely relaxed.(The muscles of a deeply anesthetized face are so relaxed that they lose their usual tone.) The patients wakefulness also allows the surgeon to give commands (look up; look down; open your mouth; show me your teeth, raise your eyebrows), and the amount of excess tissue to be removed is more easily estimated.

Another advantage of sedation is that medications may be used to block out all memory of the operation. The patient recalls either a pleasant twilight state or remembers nothing. The patient is comfortably relaxed during the operation. Breathing, heartbeat, and other vital functions remain strong and steady the entire time. Some patients prefer being put to sleep. They want their surgery in a state of complete oblivion, wishing to wake up without any memory of the operation.

Others prefer being fully aware of everything in the operating room. They want to retain a sense of control over mind and body, wishing to recall the surgery clearly and completely. These patients may request minimal sedation – enough for relaxation – but not enough to cause drowsiness.

A pain-free procedure does not guarantee that there will be no anxiety. Some find lying or sitting back (in a dental chair in an operating room) very trying, even though it is painless. There is no need to endure anxiety during an operation! It is important to know that the combination of anesthetics can alleviate this. By regulating the amount of sedative given, the patient can be made to feel comfortably anxiety-free while surgery proceeds painlessly.

What are the possible after effects of Anesthesia?

Ans.: There may be some after effects of anesthesia. Some people have a slight feeling of nausea during the immediate postoperative period. This will pass quickly. Some people may vomit, but this is infrequent. Some patients may feel slightly lethargic for the first few hours after surgery. This will wear off.

These possible consequences of anesthesia are not necessarily dose-related. Rather, they depend on how much you individually react to the anesthesia. Some people may have after effects even with slight amounts of sedation. These minor problems make it mandatory that you be observed during the immediate post-operative period by a trained nursing staff.

What are the risks involved following cosmetic surgery?

Ans.: Although some of the procedures described appear to be relatively simple operations, it is essential for you to understand that aesthetic surgery, like all surgery, has attendant risks.Plastic surgeons perform thousands of successful aesthetic procedures each week, but in some cases a patient can have an adverse reaction to the anesthetic or be affected by postoperative complications such as blood clots, infection or poor healing. These problems can occur even when the surgeon has performed the operation with the utmost skill. Occasionally, surgical revisions may be desirable to achieve optimal results.

It is important to remember that aesthetic surgery molds and reshapes living tissue, and the results are not absolutely predictable. Even the best surgeon cannot offer risk-free surgery nor guarantee a perfect result.

How long will my recovery be?

Ans.: Your surgeon will inform you of any restrictions to your normal activities following surgery. In general, you should curtail strenuous exercise and other activities that raise your blood pressure, including bending, for several days to weeks (depending on what type of surgery was performed). The most common concern is an uncomfortable feeling, not pain. Pain is surprisingly minimal and easily controlled with medication. Mild analgesics are used in most cases, but stronger medication is given when necessary.

It takes time as well for the visible signs of healing to subside. .Do not expect to see the final results of your surgery right away. Complete maturation of the surgical area takes more than one year, though in most cases after one or two weeks, only the patient and physician can detect the surgical incision. Plan your social activities to allow sufficient time for recovery. Remember,Time is the greatest healer.

How long will the results last?

Ans.: The results achieved in some aesthetic procedures, such as surgery of the nose, ears and chin, are permanent. In others, particularly those that diminish the effects of aging, results may be long-lasting but not permanent. Your aesthetic plastic surgeon may be able to turn back the clock but cannot stop it from running.

Dispelling the Myths

Have you ever wanted to improve your appearance? Cosmetic surgery can give you that increased confidence, helping you feel more attractive and improving your quality of life. There may be one reason or another that has caused you to dismiss cosmetic surgery as a viable option. At our office, your needs and concerns come first. With that in mind, we’ve developed this information to dispel some common myths and misconceptions, and show you what Plastic and Cosmetic surgery have to offer you.

“Exercise and diet alone can solve my problems.”

Ans.: While reducing caloric intake and engaging in regular exercise can lower your weight, you still may find areas of your body that do not react the way you want. Structural change requires something more. Cosmetic surgery can be used in conjunction with proper diet and regular exercise to shape that fat on your body that just won’t go away. We’ll work with you to discuss your specific needs and show you how cosmetic surgery can help you. Each patient begins their experience with a detailed, in-depth consultation with our team to examine problem areas and determine what kinds of options are available.

“I am going to look so different that people will know I have had cosmetic surgery.”

Ans.: Cosmetic surgery is as much an art as it is a science. We practice using advanced techniques that allow us to enhance your appearance in a variety of ways, from subtle to drastic.

“Cosmetic surgery is only for old people.”

Ans.: The benefits of cosmetic surgery can be enjoyed by people of all ages. Early correction of developmental abnormalities such as cleft lip or protruding ears can save a child from the psychosis of years of taunting. Adults can greatly boost their self-confidence and improve quality of life at any age. We take pride in making people of all ages and all walks of life feel good.

“All surgeries leave nasty scars.”

Ans.: Not true any more. Because of recent developments and inventions, incisions can be very small and placed in hard-to-see locations. The resulting scars are often virtually invisible. We will advise regarding a post op protocol to help heal the scars in a better way.

However one should remember these points:

Scars take up to a year to fully heal. Different individuals have different scarring responses, partly dependent on genetics. A scar which heals up in a faulty way can often be corrected by follow-up surgery.

“Cosmetic surgery is just too expensive.”

Ans.: It’s difficult to put a price on happiness or on the quality of life. Cosmetic surgery is a choice that will allow you to realize your full potential, and to become the “you” you always wanted to be.

In order to calculate the true value of cosmetic surgery, it’s necessary to consider all the costs — financial, physical and emotional — associated with the alternative. Cosmetic surgery is very affordable in India and costs are much lower when compared to the US, UK and other countries. And while most insurance policies and Medicare do not cover cosmetic surgery, some reconstructive plastic surgery is covered under insurance. Call us for pricing. See how affordable cosmetic surgery can be for you.

“A surgeon is a surgeon, so shop around for the cheapest one you can find.”

Ans.: Two of the most frequently asked, contested and debated questions when considering cosmetic surgery are,”How much?” & ‘How much less?”.Often, patients choose their surgeon on the basis of price. This would be risky. There’ s no mandated training for a general surgeon to hang out his shingle as a cosmetic surgeon. It would be wise to do some homework. Interview several and choose one who has credentials and certification in Plastic Surgery recognised by The Medical Council of India {MCh or D.N.B.(Plastic Surgery)}

When considering expense, do remember:

A surgeon asking a low fee may well be offering less care ,services or facilities. Your good health and appearance are precious, so why would you toss them into the hands of an unqualified person?

Acquiring and maintaining a high quality, state of the art surgical facility is expensive, as is using the best anesthetics and instruments. These costs have to be figured into the surgical fees charged. You surely would want the best for yourself and nothing else.

Cosmetic surgery is very affordable in India and costs are much lower when compared to the US,UK or any other country the world over. Thus, although price is one of the considerations in your choice of surgeon, it is important to remember that the main consideration should be your surgeon’s professional qualifications and experience, especially when one is considering Cosmetic Surgery in India. Your surgeon’s skill can make all the difference between a good result and one which will require subsequent correction and additional expense.

“The latest cosmetic surgery technique must be the best one.”

Ans.: Not necessarily true. Innovations are constantly being tried, but to determine which technique is best, studies must be done over a period of time, on enough patients, then peer-reviewed and published in reputable journals. Publication leads to more surgeons trying it out, which leads to more results that can be further studied and in this way we arrive at more certain knowledge of which techniques work the best, and for which purposes. Therefore we need to give the newer techniques & technology some time to prove themselves. Having said that,

“Everything new may not necessarily be good, but, everything good was once new.”

Miscellaneous FAQs

Ans.: “I can get by using make-up, or by wearing my hair a certain way to cover up the features. I’m not happy with.”

Life is more than just “getting by.” Cosmetic surgery can provide you with real, positive changes in your appearance. Rather than being limited by daily maintenance, you’ll find the freedom you need to start living your life the way you want to live it.

“I don’t like the way I look, but just the thought of visiting the doctor makes me uncomfortable and nervous.”

Our staff works very hard to make our patients comfortable before, during and after surgery. From your initial consultation to your final follow-up visit, we go the extra step for your safety, privacy and comfort. The surgical techniques we use allow for more rapid healing. We also provide all of our patients with the utmost in privacy and discretion, including an in-office state-of-the-art operating room.

Breast Augmenation

Who should perform my breast augmentation surgery?

Ans.: The surgeon most qualified to perform breast augmentation surgeries are certified Plastic surgeons. It is important to get information regarding the surgeon’s training. Can the surgeon perform this procedure in a major hospital in your city? What do other patients say about the surgeon’s ability to communicate and his level of care post-operatively? What I try to emphasize most to anyone considering breast augmentation is that you TRUST your plastic surgeon, and that you and your plastic surgeon have EXACTLY the same idea of how you want your breasts to turn out. Finally, you must feel they can accomplish the result you desire; the result that will make you happy.

Is it necessary to wait until after having children before having breast augmentation surgery? No, it is a matter of choice for each woman. More than half of patients perform the surgery before having children and the majority of them have no problems breast feeding afterwards. The incisions used are small and the surgeon attempts to minimise the amount of disruption of the glands to the nipple/areola (which occurs especially following the peri areolar approach) The underlying breast implant does not harm the breast fed baby in any way.

Who is too old to get a breast augmentation?

Ans.: Breast augmentation can be performed on 18 years old and older, and older. You are NEVER too old to improve the appearance of your breasts.

If I get pregnant will my breast implants have an affect on me?

Ans.: It can be feasible for breast implants to have a negative affect in regards to breast-feeding ( following a peri areolar approach).A postpartum lift may be needed since pregnancy can change the look of augmented breasts.

What are the risks concerning breast augmentation and mammograms?

Ans.: When a woman has breast implants there is generally a partially obstructed view of some breast tissue and, therefore, there is a theoretical possibility of interference with breast cancer detection (detection of a lump). In practice, however, women with implants do not have a higher chance of a missed cancer detection.

Women with breast implants should have their mammograms performed by a mammography technologist who is experienced in performing mammograms on women with breast implants. Be sure to tell your technologist that you have breast implants so that they will know to take additional views of the breast and additional care with the implants. With or without breast implants, the major reasons for non-detection are a) not performing self-examination, b) not having regular mammograms and c) denial.

Does insurance pay for the cost of a breast augmentation procedure?

Ans.: Because it is a cosmetic surgery, breast augmentation is usually not covered by insurance; however if it is used after a mastectomy (removal of breast following a diagnosis of Ca Breast) for the purpose of breast reconstruction some companies may offer some sort of coverage.

What makes up implants and what different styles are there?

Ans.: Nowadays, implants typically contain a silicone shell and are generally full of a saline solution. Only in particular cases are silicone gel-filled implants used as they are restricted by the US FDA. Styles of implants include difference in size, shape and consistency. The implants shape can be contoured like a tear-drop or round. The consistency can be silky or grainy. Which style is best suited for you depends on personal situation. Your surgeon can help you with deciding.

What is a gummy bear implant?

Ans.: A generally new sort of implant that has an inner substance close to the texture of a gummy bear are called gummy bear implants. They are technically recognized as cohesive gel implants and designed like this to lessen the wrinkling effect. Also, they are known to keep their shape and reliability should they leak or break.

Where are the likely sites of the incisions and other sites

Ans.: The many possible sites incisions are put are: periareolar (around the nipple); inframammary (within the crease beneath the breast); or axillary (below the armpit). Depending on a few factors, your incisions will be determined with the help from your surgeon.

How do I decide the size of the implants?

Ans.: The size that a patient decides to achieve is a very personal decision. Many a time the patient wishes to achieve a “natural look” to simply improve the proportionality of the upper and lower body. Some patients, however, want a “round” look. For these patients a “natural look” is not a priority and they are not concerned if other people know that they have had a breast augmentation. There are a lot of things to consider when thinking of implant size and because of that, your surgeon is there to help you make the right choice.

Yet, many patients find that size choosing is the most hardest decision. An idea to to help you decide may be to begin looking at photos in magazines to help yourself better determine the shape and size that you think is eye-catching. Another idea may be to get a few different sized bras and fill them with padding to see which size you feel most comfortable in. Often discussing “cup size” is useful but one must be careful since “cup size” depends on the manufacturer of the bra.

What are the dangers of getting extremely big implants?

Ans.: When deciding on the extent of the implant, it is imperative that you consider what amount your own body can make room for. Those that do not have tissue that exists and opt for an extremely big implant may have results that can effortlessly be noticed and felt through the skin. Also, breasts that have very big implants can become droopy too early just like naturally big breasts do.

What choices are there for implant placement and which one is the better choice?

Ans.: Two choices for the implant placement is subglandular (above the chest muscle) and submuscular(below the chest muscle). There are benefits to them both and picking the correct one is figured out with the help of your surgeon.

How long do implants last?

Ans.: Not meant to last forever, implants may over time need surgery to remove and/or be replaced. They can give way any given moment even though there are people who consider they have a life span of about 10 years. There are a few implant manufacturers that give some form of guarantee that could consist of replacing the implant if required.

What are the dangers linked with breast augmentation?

Ans.: With every sort of surgical procedure there are dangers linked and the same goes for breast augmentation. The dangers might include bleeding, infection, mammography interference, capsular contracture, deflation, breast or nipple sensation changes, or implant removal and/or implant replacement.

Can silicone gel move outside the pocket, or scar capsule?

Ans.: Yes, according to the US FDA, it is possible for silicone to migrate away from the breast. The free silicone may cause granulomas to form in areas in and around the breast, as well as other areas of the body that the silicone has migrated to, such as the abdomen, arm, armpit, and chest wall. Usually, the free silicone stays within the scar capsule, and does not migrate to other areas.

Can sensation of the nipple/areola be lost after breast augmentation surgery?

Ans.: Yes, a small percentage (1%) of patients have permanent nipple/areola sensation loss after breast augmentation surgery. Many patients have temporary loss or hyper-sensitivity of the nipple/areola complex. The surgeon takes great care during the operation to avoid injury to the nerve supply to the nipple/areola complex.

How do I know if I need a breast lift?

Ans.: A breast lift (mastopexy) is an operation used to treat ptotic (sagging) breasts. A consultation with us can help answer this question for you. In general, evaluating the position of the nipple/areola complex in relation to the fold under the breast (infra-mammary fold) will help determine the need for lifting. Different types of breast lifting operations are available depending on the severity of the sagging. A breast lift can be combined with breast implants if indicated to give an excellent result.

What is a “tubular breast”?

Ans.: Tubular breasts, otherwise known as constricted breasts, are associated with some breast tissue deficiency especially medially (around the cleavage area). The appearance of the breasts can vary greatly from a very severe deficiency of breast tissue to mild deficiency. Often times, the patient will have different size and shape between the right and left breast. This is a correctable condition. Often, implants can be used to improve the size, shape and symmetry of the breasts.

After surgery, how will my implants feel?

Ans.: Breasts with Breast Implants are likely to feel firmer than those breasts that are natural. However, the majority of patients think that it’s a good thing. Factors that may impact how breasts naturally feel after breast augmentation are: the placement of the implants, the implant’s surface and filler, the feel of the skin and the amount of current tissue that’s left.

Is there pain following breast augmentation post-operatively?

Ans.: There is always some type of anesthesia used for the procedure, yet depending on the patient, they might have some sort of pain. Unfortunately, most patients experience a moderate to significant discomfort post-operatively. This seems to be increased with sub-muscular breast augmentation compared to sub-glandular breast augmentation. Many patients are unable to sleep because they are not used to sleeping on their backs. Soreness of the back and neck may be related to this difficulty finding a comfortable position. Some patients choose to use 2 pillows and sleep in a reclined position. In about a couple of days, with medication prescribed for pain by your surgeon, the hurt should go away.

Will my breast be more sensitive after breast augmentation?

Ans.: Though short-term, the breast or nipple can have some sensitivity after breast augmentation. A few patients feel an enhanced sensitivity, others may feel a decrease, and a tiny amount of patients may have lost all feeling in their breast or nipple. There have been some unusual situations where these types of experiences are permanent, having a lasting affect on breast-feeding as well as a response sexually.

How long is the recovery?

Ans.: Every patient is different in their recovery. Most patients are able to resume the majority of their normal activities 4-6 weeks after the procedure. After the stitches are removed, the patient is allowed to shower.The stitches are all inside but for the ends which usually come out 5-7 days after surgery. Special exercises to massage the implants will be reviewed with you by us and our staff.

How long will I have to wear the special bra?

Ans.: Normally, the bra will need to be worn for 2-4 weeks. There are reasons why the bra is important and following the surgeon’s directions will give you the best possible results. Each patient is different and so the recovery will also be different.

When can I start to exercise?

Ans.: Doctors do not recommend heavy weight lifting or strenuous exercise until 6 weeks after the procedure. Patients may walk and do leg exercises soon after the procedure.

How long do I need to be off work?

Ans.: It is recommended that you take one week off from work after breast augmentation surgery and continue to avoid strenuous activity and heavy lifting for 4 weeks after the surgery. We also ask the patients to not drive for 2 weeks after the surgery.

How long is the recovery for scars to become pale?

Ans.: After breast augmentation, the scars will become pale within several months to a full year.

Is it true that breasts make noises after breast augmentation?

Ans.: Noises such as buzzing, cracking, squeaking, gurgling or sloshing coming from the breasts after augmentation is common amongst some women. It’s a result of air bubbles in the implant pocket, a build up of fluid or the implants just trying to settle. Within several weeks, the noises should stop.

What are the symptoms of a ruptured silicone implant?

Ans.: Some women may notice a decreased size and/or shape in their breast, pain and/or tenderness in the breast, numbness, tingling, burning, swelling, or hard knots (also known as nodules). Sometimes silicone implants can silently rupture, meaning that the patient has no idea she has experienced a rupture. An MRI (Magnetic Resonance Imaging) with equipment specifically designed for imaging the breast may be utilized for evaluating patients who have a “suspected” rupture or leakage of a silicone gel breast implant.

What is capsular contracture?

Ans.: This is scar tissue that forms around the breast implants causing the breasts to harden. This hardening may be associated with tenderness and pain. This is the most common complication with breast augmentation. Sub-muscular breast augmentation helps to deter capsular contracture. Massage may be useful, especially for implants placed above the muscle. If severe capsular contracture occurs, it may be necessary to remove the scar tissue and replace the implant (preferably in a sub-muscular position).

What is synmmastia?

Ans.: This is when the two breasts communicate in the midline (cleavage area). Cleavage does not occur naturally, and this may occur following an overzealous attempt to “increase cleavage” or “create a cleavage” by dividing the soft tissue or muscle fibers at the medial edges of the breast. This can be occur with implants placed over or under the muscle. It is a correctable problem.

What is rippling and how does it happen?

Ans.: One of the main reasons of a disappointing breast augmentation is rippling. It’s when waves or notches appearing on the shell of the implant and could be felt or visible through the skin. It us typically necessary to take the implant out and replace it, but some times the rippling is only short-term. It can happen for a few reasons, such as: the subglandular placement of the implant (specially in patients that have little or no tissue coverage and thin skin), implants that are textured, or the underfilling of the implant.

Miscellaneous FAQs

Ans.: If I develop a capsule and the implants have to be removed, will I be able to have them put back again?

Most of the time, patients wish to have implants replaced after removal of capsules (capsulotomy).

If I have to have the surgery re-done later in life, will the incision be made in the same place as the original?

Usually, yes. The incision would be made in the same area.

Liposuction

The concept of liposuction is surprisingly simple. Liposuction is a surgical technique that improves the body’s contour by removing excess fat deposits located between the skin and muscle. Liposuction involves the use of a small stainless steel tube, called a cannula (from the Latin word for reed, tube, cane). The liposuction cannula, typically connected to a powerful suction pump, is inserted into the fat through small incisions in the skin, and fat is removed by suction as the cannula creates tiny tunnels through the fat. During the healing process after liposuction, these tiny tunnels shrink and disappear, resulting in an improved body contour.

Are there different types of liposuction? (Liposuction Techniques)

Ans.: Some offices use different names which mean the same thing. You may hear words such as “lipoplasty” “liposuction” or “suction lipectomy” — they all mean the same thing. Procedure can be eased by help of SAL, UAL and power liposuction.

Who is a good candidate for liposuction?

Ans.: A good candidate for liposuction is defined as any patient who is likely to be happy with the results of liposuction. The best candidates for liposuction are in good health and have realistic expectations of what liposuction can accomplish. Liposuction can provide a good candidate with a significant improvement, but it is unlikely to achieve perfection. There is no definite age or weight limit for patients who are “good candidates” for liposuction. Many liposuction patients are of average size but are concerned about localized accumulations of fat. However, some of the happiest patients have been individuals who are somewhat obese. A good candidate usually has one or more localized accumulations of fat that can be removed by liposuction.

Who is not a good candidate for liposuction?

Ans.: A person who expects absolute perfection is not a good candidate for liposuction. Excessively obese patients are usually not good candidates for liposuction. A person who has a serious medical problem is not a good candidate for liposuction.

What regions of the body can I have liposuction?

Ans.: Many areas of the face and body can receive liposuction. The common areas are the cheeks, chin, neck, upper arms, abdomen, hips, buttocks, thighs, knees, calves, and ankles.

Can I do multiple areas at the same time?

Ans.: Yes. We will discuss what procedures may be performed at the same time while still being safe. Many patients will opt to have liposuction and breast augmentation surgery OR liposuction and tummy tuck surgery at the same time. Combination or “Makeover” surgeries can give dramatic results.

Is liposuction a reasonable treatment for obesity?

Ans.: Liposuction is not a good treatment of obesity. Liposuction is not effective, even as a last resort, for people who are unable to lose weight by dieting and exercise. Obese patients almost always regain the weight that is removed by liposuction unless there is a dramatic reduction in calorie intake (by dieting) or a significant increase in calorie expenditure (by exercising). Whenever large-volume liposuction has been used in an attempt to treat obesity by surgery, there has been a significant increase in the incidence of serious surgical complications. It is not safe to remove huge amounts of fat by liposuction. It is dangerous to remove more than 8 to 10 litres of fat by liposuction in a single day. Thus, liposuction will not be of any significant benefit for an obese patient who believes that liposuction will aid in the effort to lose weight.On the other hand, an overweight person whose weight has been stable for many years and has certain problem-areas of fat may be a good candidate for liposuction. Liposuction in an obese patient is reasonable when the goal is to improve a troublesome body contour area. It is not reasonable to use liposuction as a surgical technique for weight loss.

What is a successful liposuction surgery?

Ans.: A liposuction surgery is a success when the patient is happy with the results. The surgeon’s goal is to obtain an optimal aesthetic result rather than to maximize the amount of fat removed. One of the most common causes for disappointment in the results of liposuction surgery is the removal of too much fat, which produces an abnormal or unusual appearance. The cosmetic success of a liposuction surgery is often the result of removing an amount of fat equivalent to less than a pound or two of butter from a woman’s saddlebag area or from a man’s love handle area. While this amount of fat is relatively small compared to a person’s total body weight, it does produce a dramatic change in the patient’s silhouette.

Does liposuction always remove cellulite?

Ans.: Liposuction improves the silhouette of the body, but does not necessarily eliminate the pre-existing subtle “puckering” of the skin that is often referred to as “cellulite.” Liposuction does reduce the degree of cellulite to a minor degree but it is unlikely to produce a significant improvement or to completely eliminate cellulite.

Can loose skin be treated with liposuction?

Ans.: Liposuction improves the silhouette of the body, but does not necessarily eliminate the pre-existing subtle “puckering” of the skin that is often referred to as “cellulite.” Liposuction does reduce the degree of cellulite to a minor degree but it is unlikely to produce a significant improvement or to completely eliminate cellulite.

Does liposuction produce permanent results?

Ans.: After liposuction the body’s new shape is more or less permanent. If a patient does gain a moderate amount of weight after liposuction, then the figure will simply be a larger version of the new body shape. Fat cells that are removed by liposuction do not grow back. As long as the patient does not gain excessive amounts of weight, the new, more pleasing silhouette is permanent. Of course after liposuction the clock keeps ticking, and advancing age will produce the usual changes in the shape of the body associated with the aging process. If a person gains weight after liposuction, she/he will not accumulate as much fat in the treated areas as would have happened if liposuction had not been done.

Does the fat come back in other spots after liposuction?

Ans.: If a patient does not gain weight after liposuction, then fat does not accumulate in other areas of the body. However, if a patient gains a significant amount of weight, say more than 10 pounds (5 kg), after liposuction, then the fat must go somewhere. In fact, the fat accumulates in every area of the body in proportion to the amount of fat cells in each area. Areas where fat cells have been removed by liposuction will accumulate relatively little fat, while areas not treated by liposuction will collect relatively more fat. For example, if a woman gains weight after liposuction of her hips, outer thighs, and abdomen, then most of the fat will be deposited elsewhere such as the woman’s breasts, face, back and legs.

Does liposuction cause dimpling or indentations in the skin?

Ans.: Dimpling and indentations in the skin is a known risk of liposuction. However skin irregularities are unusual in the hands of a skilled surgeon. The use of large diameter cannulas tends to increase the risk of irregularities, while the use of microcannulas (less than 2.8 mm in outside diameter) reduces this risk. The use of microcannulas and multiple adits (very tiny 1.5 mm round holes placed in the skin) allows the surgeon to make a criss-cross pattern of tiny tunnels throughout the fat which produces smoother liposuction results compared to using larger cannulas and only two or three entrance incisions. When large cannulas are used, any inadvertent passage of the cannula too close to the skin may leave a depression or furrow, whereas one pass too close to the skin with a microcannula will not leave a visible depression.

What alternatives are there to Liposuction?

Ans.: Liposuction is never absolutely necessary. If you decide that liposuction is not for you, then you may consider the following alternatives to liposuction. Weight loss without liposuction can produce excellent aesthetic results. Weight loss can be achieved by dieting (decreased calorie intake) or by increased exercise (expenditure of calories). An alternative to abdominal liposuction is a tummy tuck.

Will I need to wear a girdle while I recover?

Ans.: Some form of compression garment, similar to a girdle, is typically required to be worn by a patient for up to 2 weeks. The garment is used to help lower the danger of hematomas and fluid collection, as well as decrease swelling and to support the area that was treated.

Does insurance cover liposuction?

Ans.: Lioposuction is usually not covered by insurance, but they may cover some of the costs if liposuction was used for reducing the breasts for instance. You should verify with your insurance company what type of coverage you can receive for this type of procedure.

What is the recovery time after liposuction?

Ans.: Recovery time is different depending on each patient. Typically, returning back to work after one or two weeks is the norm for most patients. Strenuous activities, though, should be delayed for two to four weeks.(Lipo Post-op).

How painful is liposuction?

Ans.: Immediately after tumescent liposuction, the local anesthesia persists for 12 to 24 hours, so that the only discomfort is described as soreness or tenderness. Beginning the day after tumescent liposuction totally by local anesthesia, the quality of pain is similar to that of a sunburn and to muscle soreness that one might experience after having worked-out too vigorously. This type of pain rarely requires any medication other than acetaminophen.

How long do I need to be off of work?

Ans.: It is suggested that you take off of work for 3-5 days after surgery but continue to avoid strenuous activity for one month after surgery.

When can I get back to my normal routine?

Ans.: Each patient differs with recovery times. Also, the recovery time will vary depending on how much liposuction was performed. Most patients are able to return to work 2-7 days after surgery depending on the areas treated.

When can I start exercising?

Ans.: We will assess each patient and discuss returning to their exercise regimen. We highly recommend walking within the first couple of days – this helps with the swelling, etc. Depending on the areas treated, most patients are able to resume exercise 2-4 weeks after the procedure.

Rhinoplasty

This page is under construction.

Face Lift

What is a facelift, who is it for and what is it meant to do?

Ans.: A facelift, technically called a Rhytidectomy, is a form of cosmetic surgery where the noticeable signs of aging that occurs in the lower two-thirds of the face and neck can be reduced. This is achieved by removing the excess, fat, tightening the neck muscles and removing drooping skin.

When should I have a Face Lift?

Ans.: Most people requesting surgical face lifts are between the ages of 45 and 60, although there are both younger and older patients. About three-quarters of patients are women, and most are honest about their reasons for desiring surgery. “I just don’t like looking older.” Some patients ask the surgeon to “take a few years off my face.” To many people, a distressing feature of the aging face is the sagging crepe-like neck. “It makes me look so old!”, many patients complain. Many people hope that an operation to rejuvenate their appearance will make them look as young as they feel. As a matter of fact, many people requesting face-lifts say, “Doctor, I’m tired of looking older than I feel!”. They often feel that on the inside they are young and vital, but that somehow their appearances are betraying them.

When to have a face-lift is an important question; so is the issue of when not to have surgery. We occasionally see a patient who requests face-lift surgery when there are only minimal signs of aging. While such cases are rare, they do occur. Some people may exaggerate the first signs of aging. Fearful of getting older, they view the most minor facial crease or change in skin tone with undue alarm.

In another group of patients, the request for face-lift surgery is coupled with important psychological concerns. Occasionally, men request surgery, fearing they will no longer be able to compete with younger men at the office. This must always be evaluated carefully. There are situations where a youthful appearance is vital for job advancement or to maintain one’s position. Many men, not necessarily fearful of aging, are afraid of losing their jobs to aggressive, younger men. For them (and for many people), self-esteem is tied to their work lives.

They must work in order to feel worthwhile, and they need to feel they are successful at their work. These are normal, commonly encountered feelings. Such people may be good candidates for face-lift surgery, provided they are not looking for something unrealistic in the surgery.

Occasionally, a patient will have unrealistic expectations about face-lift surgery. A patient may harbor the incorrect notion that a face-lift will not only erase years from his face, but will also turn him into a young dynamo. Unrealistic expectations about the results of facial rejuvenation can only lead to disappointment. A complete consultation will resolve such misunderstandings.

Best Facelift Candidates

Ans.: Take into consideration if a facelift is right for you – physically, mentally and emotionally. The ones who get the greatest outcomes are those who have a well-defined bone structure, or whose face and neck have begun to droop, but whose skin still has elasticity. Facelifts have proven successful on those in their 70s and 80s; however the most popular ages for facelifts are in their 40s and 60s. Younger patients may not see the results that the elder patients notice as they have less wrinkles and more skin elasticity, so those under the age of 40 should think realistically before having a facelift. Younger patients may want a consult on a facelift if they have lost a great amount of weight or have genetic problems, as they could possibly be considered a candidate.

Are there any ethnicity-related facelift concerns?

Ans.: Special considerations should be made for Caucasians, African-Americans, Asians, and other ethnic groups as the nose plays a big role for defining ethnicity and social class. It has long been a topic of debate and concern. Individuals do not want to ‘stand out in a crowd’ because of a peculiar shaped or huge nose; nonetheless they want to both unique and “normal”. And so the nose became a chief focal point for the improvement of cosmetic surgery procedures.

What to expect after a Facelift?

Ans.: After a facelift, many patients are astonished by how small of pain there is after surgery. Usually the inability to breathe through the nose for several days, due to swelling, is the most uncomfortable part of the procedure and typically gets better within one or two weeks. For several weeks, expect some swelling around the eyes; however as the swelling goes away, you’ll begin to see the surgery’s progress. Special safety measures are necessary during your recovery. Bending or lifting can extend swelling and is not suggested for three weeks after surgery. Running, cycling, or exercises should not continue for four weeks. Contact sports should be stopped for six weeks because it can take that long for the bones to totally heal. Driving is permissible when the swelling goes down and does not get in the way of your vision. After two or three weeks you may fly.

How to prepare for facelift surgery?

Ans.: Before your scheduled surgery, we will review your medical background to make sure that there are no conditions that will interfere with the surgery or recovery after the facelift. Conditions that may be of concern are:

Hypertension (High blood pressure) – specifically if it isn’t under control.
Smoking – a person who smokes does not heal as quick as those who do not smoke. You’ll most likely be informed to abstain from smoking for a number of weeks before your surgery.
Scarring problems from the past – including keloid scars and hypertrophic scars.
Bleeding problems – a history with blood clotting, or lack of clotting must be brought to the attention of your surgeon as well as any medications (including over the counter) you are taking. Also, tell your surgeon about herbs and supplements that you take. Many patients feel it helps to open up their medicine cabinets and make an inventory before they go to see their surgeon.
Plan for a ride home after your surgery.
Try to arrange for someone to stay with you for the first several days after surgery. Ask your surgeon about a visiting nurse service if you live alone. You may want to stay at an aftercare facility for the first several days after your facelift.
You should wear for both surgery and afterward clothing that has front closures (nothing than has to be pulled over your head).
Grow out your hair a little longer if your hair is very short, as longer hair will make it simple to conceal healing scars.
You should get ready a relaxed spot that you can utilize to recover from your facelift.

What is a revision facelift?

Ans.: If you’ve previously had a facelift and you are not satisfied with the results, then you can get the problems corrected with a revision procedure.

What are the facelift risks & complications?

Ans.: Complications can include a hematoma (an accumulation of blood under the skin that may need to be removed), an infection or a reaction to the anesthesia. Injury to underlying structures is possible (though usually temporary) could happen even though the plastic surgeons are trained in techniques for safely manipulating facial skin and tissue. Facelift incisions can be unpredictable depending on the way the patient heals, however most are regularly not noticeable. Listening to the advice from your surgeon can considerably reduce the risks before and after your surgery.

Is a facelift permanent?

Ans.: Meant to enhance your current look, a facelift will not halt the signs of aging, however it will ‘set back the clock’. Previous patients usually opt to repeat the surgery after a good 5 to 10 years later. To help prolong your results, there are a few things you can do: maintain your weight, avoid exposure to the sun, and keep your skin appropriately hydrated.

What is SMAS?

Ans.: SMAS is short for Submuscular Aponeurotic System, which is a layer of tissue that covers the deeper structures of the cheek area and is associated to the superficial muscle which covers the lower face and neck, called the platysma. Some methods for facelift surgery lift and reposition the SMAS along with the skin. When doing this, the jowls are lifted, the neck is pulled taunt, and the cheeks are prominent.

What is the difference between rhytidectomy and a facelift?

Ans.: Rhytidectomy, which comes from the Greek word rhytid meaning wrinkle, is the medical term for facelift surgery.

What is the best way to conceal scarring and bruising after a facelift?

Ans.: We will guide you regarding post-operative cover-up methods, such as unique camouflage cosmetics for both men and women that will assist to mask any healing bruising and scarring along the lines and discoloration.

How do I know if I need a facelift or laser resurfacing?

Ans.: A facelift lifts drooping skin and muscle as it removes extra fat. Laser surfacing fixes fine wrinkles or lines on the surface of the skin, but it will not tighten skin or correct a droopy neck. Some patients may need both.

What areas cannot be improved with a facelift?

Ans.: The lower portion of the face including the cheeks, jowls, and the neck are what a traditional facelift surgery corrects. A facelift will not enhance the upper portion of the face, such as the location of the eyebrows, wrinkling between the eyebrows, or extra skin of the upper or lower eyelids or lower eyelid bags, unless a brow lift is performed. The surgery cannot rid wrinkles around the mouth and will not do much for the smile lines.

How much pain can I expect after a facelift?

Ans.: Some patients experience a small discomfort in the back part of the neck, which usually clears up within a day; however many patients do not feel much pain following surgery. If there is any pain or discomfort, the patient can be comforted with oral medication.

Will my head be shaved?

Ans.: Your head will not be shaved, however many patients do choose to grow their hair longer in order to easily conceal any scars and stitches during the recovery phase.

After a facelift, are bandages applied?

Ans.: Yes, bandages may be applied to the head and neck with the purpose of maintaining the area and keeping it stationary. The bandages are usually removed a day after the procedure. Another light bandage may be positioned around the chin.

Lip Augmentation

How many techniques are there to augment the lips?

Ans.: Seriously, a lot. Such options are…

Lip implants:

  • Advanta
  • AlloDerm
  • Dermis grafts
  • Fascia Grafts
  • Gore-Tex
  • SoftForm
  • Tendon Grafts
  • UltraSoft
  • Plus a few more

What types of injectables are out there and what are the differences?

Ans.: The benefit of an injectable is the volume it can give the lips. The poutiness it can give is significant compared to the implants which gives a more subtle, defined lip. The downfall is, you really need an experienced injector. This is imperative, especially with the permanent products!

Most available injectables are temporary. Collagen, which has been the industry leader for a very long time, usually lasts only 3 to 4 months and requires a skin/allergy test. Fascian lasts a little longer although not by much. It is made up of fascia lata, strips of the tough covering that surrounds the outer thigh muscle. It is harvested from cadavers. It reportedly lasts longer than collagen.

Cymetra is a particulated, Injectable version of AlloDerm. LifeCell’s product, AlloDerm (cadaveric dermis graft) seems to last a lot longer itself, but the injectable is somewhat “broken down” already. There are a few injectable products which are permanent, such as Artecoll, Aquamid, Metacrill, Silicone oil (Silikon 1000, Adatosil 5000 which are used off-label), etc. Artecoll is made from PMMA (polymethylmethacrylate) beads suspended in bovine (cow) collagen. The polymethylmethacrylate is formulated into microspheres (extremely small round balls) and suspended in a mixture of with 0.3% lidocaine for comfort and bovine collagen (3.5%) as well. The method of operation is that the PMMA is delivered into the dermis by the collagen vector, the collagen is then broken down by the body over time, yet the PMMA microspheres are left behind to be encapsulated by the body’s own collagen. These microspheres are “networked” together by your body’s collagen structure, therefore creating augmentation. Aquamid, Bio-Alcamid, Argiform, and other polyacrylamide implants are made from a polymer that holds moisture.

Are there any permanent options in lip augmentation?

Ans.: There are permanent and reversible options like Gore-Tex , SoftForm, UltraSoft and Advanta soft tissue augmentation implants made from expanded polytetrafluoroethylene (ePTFE). These implants are made from a white material which could be described best as a foam-rubber type of material. ePTFE has been used for decades in the body for all sorts of applications. These are the most popular and the only FDA approved, synthetic implants which are considered permanent, yet they possess the benefit of being removed in the event of a problem.

There are permanent injectable permanent options which include, Artecoll, Metacrill, Aquamid, Silicone oil (off-label use), etc.

The downfall with these implants are their permanent nature.

How is lip augmentation with lip implants performed?

Ans.: The surgery is not at all complex nor does it take a substantial amount of time to perform. You’re injected with local shots of Lidocaine for pain relief and epinephrine, a vasoconstrictor, to restrict the amount of bleeding and bruising. After making the necessary 4 incisions at each corner of the mouth, the surgeon inserts the implant using either an implant pre-threaded on trocar or using a pair of alligator forceps. After insertion, the surgeon cuts the implant to the size best for the patient’s individual lip and trims the ends of the implant if necessary. The incision areas are then sutured with a thin, either dissolving or non-dissolving suture material.

What should I expect post-operatively?

Ans.: You should expect to be swollen, tender and very full-lipped post-operatively. You may also difficulty drinking or eating without spilling as well. There will be pain, especially to pressure. You may feel numb in the lips for several days from the swelling putting pressure on the nerves in your lips. Your pain relievers prescribed by your doctor should alleviate any discomfort.

You will have your sutures removed in about 5 – 7days. You will be accustomed to the extreme swelling and once this swelling subsides you may wish for a little more fullness — this is normal. For a reality check, compare your befores with an updated after before passing judgment.

Is it quite painful? Is there much bruising?

Ans.: It takes about a week for most of the swelling to subside, although it will be sensitive to light to medium pressure for about 3 weeks. There is really not too much bruising with average cases, although it should be looked upon as individual. Some patients are prone to bruising more than others.

When will I be able to see the results?

Ans.: The results are usually immediate. For implants, fat grafting and most injectables, your lips will be quite large and swollen and you will see a difference in the swelling as it subsides in the first week post-operatively (or post-injection). You should take photos before and after to compare and look back on your old lip’s size. After viewing the before and after photos you should be able to appreciate a change in the lip volume.

What are the risks of lip augmentation?

Ans.: There are not too many risks associated with lip augmentation in comparison to other elective procedures, but there are enough to pay attention and have concern. It typically depends on the chosen implant or filler…. Let’s start with Gore-Tex, SoftForm, UltraSoft and Advanta: There can be infection and irritation if the ends of the implant are too long for the cavity or not rounded, if needed. The good thing is that it is reversible and can be readily removed. UltraSoft is hollow, allowing your own tissues to grow into the implant. When tissue ingrowth occurs, infection and rejection are less likely. Extrusion from the body attempting to reject the foreign material, palpability and lessened mobility of the treatment areas are possible. Migration can be an issue as well, although tissue ingrowth can decrease this risk significantly. There may be permanent discolorations from the bruising. Possible hematomas resulting in additional surgeries and excessive scarring from delayed healing or trauma. Deformity from excess scar tissue arising from an infection or the hands of an unskilled doctor is also a possibility.

Fascian, AlloDerm, CosmoDerm, CosmoPlast and other forms of cadaveric grafts or tissue derivatives supposedly are absorbed within your body with no after-effects. Newer injectable fillers like Restylane, Perlane and Hylaform supposedly have no side effects. However, some patients have reported prolonged swelling and inflammation, and nodules at the injection sites with Perlane.

With Artecoll, Metacrill, Silicone and other permanent injectables; not only do the risks include infection, necrosis, granuloma formation, nidus, severe inflammation, palpability, and extrusion; but they are not easily removed. In the event of a problem, Injections of Kenalog, a corticosteroid, can help alleviate inflammation and reduce fibrous tissue. If the need for repeat injections persists, excision is usually the only option to lessen the amount of product in the tissue which is triggering an inflammatory response.

Injectable products made from hydrophilic polyacrylamide gel do have some questionable issues, one such being residual unpolymerized acrylamide. Acrylamide is a known carcinogen, mutagen, neurotoxin and also a reproductive toxin. However, the manufacturers do report that the levels are extremely small, less than what you would receive on a daily basis in drinking water and foods. The other issue is the ability to sustain bacteria. Bacteria can and does thrive within polyacrylamide implants. Aspiration, and or excision, may be necessary in some cases.

I have heard that the risk of infection is quite high in lip implants, is this true?

Ans.: The reason the risk of infection is high is the incision site and location of the procedure – as well as it is a synthetic material.

Although many implants are made of a well-tolerated material such as expanded polytetrafluoroethylene, infections can and do happen to the best of us. The mouth is a very dirty place on the body and is a prime habitat for bacterial growth . Plus, your mobile tissues take longer to heal than those of which are not very mobile. If you try and keep your mouth clean, rising regularly with Listerine and not “pick” at the incision sites, your wounds will have less of a chance of becoming infected. Good oral hygiene is imperative and any cavities and other dental work should be tended to well before any lip augmentation procedures.

How are lip implants comparable with injectables?

Ans.: Many injectables wear off but give wonderful, voluptuous and immediate results. Many injectables are cheaper, but more expensive in the long run. Implants and permanent injectables (injectable micro implants), such as silicone, Artecoll, and Aquamid give results which are long lasting yet are more invasive than a regular injection of say, Perlane or collagen. It’s really your call. If you would like permanent, yet reversible results, get the regular non-injectable synthetic implants. Such as Gore-Tex, UltraSoft or the Advanta Facial Implant. However, a very full and bumpy lip may not be possible with these implants. They create more of a smooth, full Julia Roberts type lip. If it is a very full, pouty mouth that you desire and don’t want anything permanent, get the temporary injectables, but be prepared to spend a lot of money on touch ups and maintenance. It’s really your call and your body. Choose your products wisely.

Is lip augmentation reversible?

Ans.: Lip augmentation with most injectables is temporary so, yes, figuratively, it is reversible. Lip augmentation with an ePTFE implant is reversible. Permanent injectables are more difficult to remove, so consider this when you make your choice.

Will my significant other be able to feel it when we kiss?

Ans.: It really depends on whether or not you had very thin lips beforehand. If you had very thin lips and had a large implant or or a lot of a firmer injectable into a tight space it is quite possible for he or she to be able to feel the change. But! the good thing is, you get used to it very quickly. You will usually grow very accustomed to it and no longer feel as though it is foreign.

Will the movement of my lips be hindered or look “odd” when animated?

Ans.: It is quite possible that you will notice a difference in your smile, how you speak and sensation after a lip enhancement procedure. Especially during the healing stage. Lip implants can feel very stiff and immobile; it takes some getting used to. NO WONDER this surgery is delicate and causes discomfort even when you try not to move. The muscles of the lips move involuntary as well, any change to this area be it surgical or injectable is bound to change or affect its movements either slightly or hinder them severely.

What is the best lip implant or procedure for me? Which do you recommend?

Ans.: This is a choice only you can make as many factors are involved.

  • Remember to think ahead, and go for what is safe and proven – not some whim. The choice is yours and you must make it.
  • Price may be an issue for you. But remember, doctors offer deals to those patients they are practicing on with a newer product. Be careful about this.
  • The material or product that you may want may not be available. New and improved products are developed all the time, it is only a matter of waiting for that material. What look do you want? More define a total lip change? Less nose to lip ratio? Angelina Jolie? Take this into account before you make a choice.
  • Risks. What are you willing to chance? Do you want something reversible?

Hair Transplants

What are the reasons for male pattern balding?

Ans.: The tendency towards male pattern balding is genetic and can be inherited from either the mother or father. While there are several causes of hair loss, nearly 95% of all hair loss is caused by a condition known as “androgenetic alopecia”.

What is Androgenetic Alopecia?

Ans.: Androgenetic Alopecia is the most common form of hair loss and is known more readily in men as “male pattern baldness”. It is a progressive disease which, once begun, worsens with age. There are several factors which lead to the onset of this condition, including genetics, age, and the presence of the male hormone dihydrotestosterone (DHT).

Why are some women not candidates for Hair Restoration surgery?

Ans.: Hair transplantation involves the movement of hair from an area of greater density and fullness in the back of your scalp to an area of hair loss in the front, top or crown. Women who have generalized thinning (Diffuse Unpatterned Alopecia) have hair that is thin all over the head, and it may not be beneficial to transplant hair that has been weakened by the balding process. When hair is transplanted into a part of the scalp that is thin, but not completely bald, there is a risk that some of the hair that is weak will not regrow in its new location. There is also the possibility that the hair in the recipient area is more fragile and some or all of the original hair in this area may be lost. This process is called “telogen effluvium” and when it occurs, it is usually reversible in a 3-6 month time frame when the hair that has been lost has been weakened by balding. Also, when the donor area continues to thin, then the transplanted hair will also thin over time, since it came from the same area. In hair transplantation, as in all surgical procedures, it is important to balance the potential gain against the possible risks when making a decision to go forward with the treatment.

Is a hair transplant even necessary with things like Minoxidil & Finasteride on the market?

Ans.: While Finasteride ( to be taken orally)and Minoxidil (for topical application)have been proven to regrow hair, they will not grow all your hair back. Unfortunately, they tend to fall short of many patients’ expectation with a higher grade of hair loss. Their greatest benefit seems to be in slowing down hair loss.It becomes repeatedly apparent that the best route for Finasteride and Minoxidil is as a complement to a hair transplant. They provide the ideal enhancement for the results of hair transplantation.

What is hair weaving, hair bonding, and hair fusion?

Ans.: Hair weaving is tying a wig on the head with silk thread knots. Hair bonding is holding the wig on the head with clips and hair fusion is sticking a light weight nylon wig with a double sided sticking tape. These are all temporary methods. Prolonged use causes bad hygiene, pull out and avulsion of the anchoring hair and excoriation of skin. These methods are not practised by any plastic surgeons or any doctors.

How do I know Hair Transplantation surgery will work?

Ans.: Hair transplantation has actually been around for quite awhile. For over 40 years, balding men and women have been turning to variations of this procedure, and finding successful results. However, the procedure is now better than ever. Heightened understandings of growth patterns and advancements in follicular unit grafting techniques have helped to produce remarkably natural results.

Even in the most extreme balding patterns, a permanent ‘wreath’ of hair exists on the sides and back of the head (Donor Hair). This hair is unaffected by the balding process. Once transplanted, this hair behaves as it was programmed to behave in the original area it came from and will grow naturally for the rest of your life.

Is there a minimum age for hair loss surgery?

Ans.: Since hair loss does not place age restrictions on who it hits, there is no limit on when you can begin treating it. Patients actually range from 21-80 years old. If you are noticing hair loss at a young age, you are encouraged to address it sooner than later. Getting a head start, while you still have quite a bit of naturally growing hair, will help your surgeon more successfully cover the work while newly transplanted hair gradually grows in. What’s more, there’s really no reason to wait to treat your hair loss, since it’s not a condition that just stops at any certain age. It’s an ongoing process around which your surgical restoration can be customized. Hair loss surgery helps you stay ahead of your hairline.

Why start now?

Ans.: If you have been determined to be a candidate for restoration, and if you are uncomfortable with your hair loss, why not start now? With your restoration completed, you can get on with life without this distraction.

How much hair do I need?

Ans.: We will suggest how many grafts may be available for your first procedure (and subsequent procedures if they will be needed). This number will be based on your present balding pattern, what it may become in the future, and how much donor hair is available. When an individual has high donor density, the follicular units usually contain multiple hairs, and when an individual has low donor density the follicular units often contain only one hair. If an individual has a very loose scalp, a larger donor strip can be removed, while an individual with a tight scalp will have a smaller donor strip. When an individual has a relatively small amount of hair that can be moved, we take great pains to distribute the available hair in ways that produce the best coverage.

In one procedure, how many grafts can be provided?

Ans.: In a single procedure, we can perform as many as 3000 grafts, depending of course upon the quality of the donor hair. However, 2200 or so grafts is more common as most patients neither require nor desire more. However a 2000 – 2200 graft session (approx. 4500 hair) is more common as most patients neither require nor desire more.

Are there solutions for those with very advanced degrees of baldness?

Ans.: For men with advanced degrees of hair loss, the goal is typically to perform the maximum number of grafts that the donor site will permit. In general, this can range from 1,900 grafts to as many as 2,800. As soon as five months following the original procedure, patients will often undergo a second procedure to provide further coverage.

Will smoking affect my hair transplant procedure?

Ans.: Smoking causes constriction of blood vessels and decreased blood flow to the scalp, predominantly due to its nicotine content. The carbon monoxide in smoke decreases the oxygen carrying capacity of the blood. These factors may contribute to poor wound healing after a hair transplant and can increase the chance of a wound infection and scarring. Smoking may also contribute to poor hair growth.

The deleterious effects of smoking wear off slowly when one abstains, particularly in chronic smokers, so that smoking puts one at risk to poor healing even after smoking is stopped for weeks or even months. Although it is not known exactly how long one should avoid smoking before and after a hair transplant a common recommendation is to abstain from 1 week prior to surgery to 2 weeks after the procedure.

Do large grafts produce a better, denser result than smaller grafts?

Ans.: Can a portrait painter create a better portrait with a house painter’s equipment i.e. by using a roller rather than a brush? The use of an artist’s brush is analogous to the use of very small grafts. High-quality hair transplants require fine instruments and delicate, small grafts. These grafts must be distributed in a way that balances the facial features, hair characteristics, and goals of the individual patient. Large grafts simply can’t offer sufficient flexibility to allow this “customizing” and their unnaturally high density doesn’t take into account the progressive nature of hair loss, placing the patient at great risk of having an unnatural appearance in the future.

Is removing large amounts of donor hair unsafe?

Ans.: This is a statement commonly made by doctors who lack sufficient experience, or technique, in performing large sessions. The amount of hair needed for the average large session is well within the safe limits of what can be moved, provided that the procedure is done properly. It is the experience and judgment of the surgeon that will insure that the amount of hair that is harvested from the donor area is safe and appropriate.

Would not bare scalp be showing in the back of my head once the donor hair is taken?

Ans.: No! The elasticity of the scalp helps us ensure that it won’t. After the donor strip is removed, the skin around it is easily pulled back together and sutured. Any minor scarring that results is naturally hidden underneath the hair on the back of the head. All signs of hair transplant surgery are camouflaged.

Is it true that the blood supply of the scalp cannot support a large session?

Ans.: No! The issue is one of oxygenation, not blood supply. By their very size, large grafts over 2 mm, will result in oxygen deprivation to the hair located in their center. This has been proven over and over again by observing the phenomenon called donuting (the loss of hair follicles in the center of larger grafts). In contrast, oxygen diffuses easily into grafts 1 mm or less in size. The blood supply of the scalp is among the richest in the entire body, enabling it to support the growth of large numbers of grafts, provided that they are kept very small (FUT).

With new surgical techniques, is it possible to restore a full head of hair?

Ans.: No! All hair transplantation procedures move hair around to make you look better, but none create more hair. However, if performed properly and on the right person, it can make an incredible improvement in your appearance.

What is the medical term for “shock fall out”?

Ans.: The medical term for the very onerous sounding “shock fall out” is “effluvium” which literally means shedding. It is usually the miniaturized hair i.e. the hair that is at the end of its lifespan due to genetic balding that is most likely to be shed. Less likely, some healthy hair will be shed, but this should regrow. Rarely, but sometimes, we notice some shedding of hair from a prior transplant when transplants are spaced less than one year apart. However, this hair grows back completely.

How much fallout “typically” occurs?

Ans.: For most patients, effluvium is not a major issue and should not be a cause for concern. In the typical case, a patient looks a little thinner during the several month period following the transplant, when the transplanted hair is in its latent phase. It ends when the transplanted hair begins to grow. The thinning is often more noticeable to the patient himself, than to others. Shedding is generally noted as a thinning, rather than of “masses of hair falling out”, as the term “shock fall out” erroneously suggests.

What can be done to minimize the effects of post-op shedding?

Ans.: The first is using medication, the second is timing the transplant properly, and the third is performing a procedure using a sufficient number of grafts.

Finasteride 1mg reverses or halts the miniaturization process in many individuals and is thus the logical way to decrease the risk of shedding following a transplant. we recommend starting our medicine treatment protocol which contains Finasteride 10 days following the hair transplant surgery.

Timing and the size of the transplant are the most important issues. It is important to wait until a patient is ready to have a transplant, and then to perform one of sufficient size so that if there is some shedding, the procedure will more than compensate for it – and be worthwhile.

The better solution is to treat early hair loss with medication, but once you make a decision to begin surgery, and then have a procedure large enough to make a significant cosmetic improvement.

Effluvium is what hair naturally does when the scalp is stressed and it is stressed during a transplant from the anesthetic mixture and the recipient site creation. It cannot be totally prevented. In sum, the best way to deal with effluvium is to treat with Finasteride when hair loss is early, perform a transplant only when indicated and finally, to perform a procedure of Follicular Unit Transplantation with skill and with a sufficient number of grafts.

How long should I wait between hair-transplant procedures?

Ans.: We schedule a second surgery 8-12 months after the first for the following reasons:

At 8-12 months, hair length is adequate to see the effects of styling. With that in mind, the patient can work concomitantly with the surgeon to make many of the decisions regarding further distribution of grafts, and the process is more ‘owned’ by the patient.Occasionally, when hair first begins to grow, its texture may be slightly different from your original hair. After 8-12 months this generally returns to normal making decisions about the grooming easier, and grooming preferences may affect the way the next procedure is planned.Some patients have cyclical growth, which means that all of the growth may not be in and of adequate length at 4 or 5 months. Waiting the few extra months gives the person enough time to see hair growing and this can be a psychological advantage for the patient.Seeing the hair allows the surgeon to clearly see where to place the new grafts. For those patients with tighter scalps, the skin has a greater time to restore some of its previous laxity.

Which other parts of the body, can hair be transplanted to?

Ans.: Facial hair transplantation:

It is designed to restore hair to the beard and mustache region to thicken the existing hair or to provide hair growth where there is none. Some patients seek to have restored a full, thick beard and mustache, others desire a fuller goatee,,some have hair placed into a visible scar.

Eyebrow Hair Transplantation:

It restores growing hair to eyebrows that are overly thin, scarred, or completely missing. It typically involves the placement of 50 to as many as 325 hairs into each eyebrow, depending upon the existing amount of hair and the desired size and density.

Tummy Tuck

What is Abdominoplasty?

Ans.: Abdominoplasty, also known as a “Tummy Tuck” or simply “TT”, is the surgery of the abdomen to remove the excess skin and fat that may accumulate after pregnancy, obesity or age. With a full abdominoplasty, benefits are also tightening of the abdominal muscles that may have become stretched out or lax over time. Even a new belly button can be obtained as a result to go along with your new, taut stomach! This isn’t a simple procedure and you should definitely be aware of the risks and post-operative care and attendance that will be needed.

Am I a candidate for Abdominoplasty?

Ans.: First and foremost, an individual must be in good health, not have any active diseases or serious, pre-existing medical conditions and must have realistic expectations of the outcome of their surgery. Communication is crucial in reaching one’s goals. You must be able to voice your desires to your surgeon if he/she is to understand what your desired results are. Discuss you goals with us so that you may reach an understanding with what can realistically be achieved.You must be mentally and emotionally stable to undergo an cosmetic procedure. This is an operation which requires patience and stability in dealing with the healing period. There is sometimes a lull or depression after surgery and if there is already a pre-existing emotional problem, this low period can develop into a more serious issue. Please consider this before committing to a procedure. If the above describes you and you have the desire to rid yourself of loose sagging skin of the abdominal area, you may be a good candidate for Abdominoplasty. An “ideal” patient would have incredibly elastic skin. But, of course, we human beings are never ideal. But good elasticity certainly helps! Normally women seek this procedure after pregnancy – although it is advised to wait until you are finished having children to have this procedure as the skin and muscles can get stretched out again as well as the dangers of your newly taut skin being unable to accommodate another pregnancy. Also, if you are considering losing weight you should wait until after your desired weight is met. You may need additional surgery to remove the excess skin after you have lost the desired weight which would mean that the money spent on the previous abdominoplasty would be wasted and your skin can only be stretched so much.

Can exercise tighten the skin without abdominoplasty?

Ans.: Unfortunately no. Exercise is good for the mind and body in general, and toning the muscles can help fill out loose skin in the vicinity. By suppressing the appetite, and by slightly increasing the metabolism, exercise can assist weight loss. But there is no such thing as a “spot” exercise, to make the body lose weight in a certain area, nor to make the skin tighter. Excercise can increase muscle bulk, and that in turn can make skin look tighter in some areas, but exercise cannot tighten the loose abdominal skin. To date, only surgery can accomplish that.

Is abdominoplasty a good way to lose weight?

Ans.: While Finasteride ( to be taken orally)and Minoxidil (for topical application)have been proven to regrow hair, they will not grow all your hair back. Unfortunately, they tend to fall short of many patients’ expectation with a higher grade of hair loss. Their greatest benefit seems to be in slowing down hair loss.It becomes repeatedly apparent that the best route for Finasteride and Minoxidil is as a complement to a hair transplant. They provide the ideal enhancement for the results of hair transplantation.

Does abdominoplasty take care of cellulite?

Ans.: There is nothing mystical or special about “cellulite”, it is just fat, but it is fat located just under the skin, making a rippled look that is quite apparent. Abdominoplasty removes some of this cellulite fat also, but it is difficult to eliminate entirely. Weight loss by dieting is the best way. Sometimes, these skin irregularities can become more noticeable after abdominoplasty.

Does abdominoplasty take care of stretch marks?

Ans.: Stretch marks are scars. They are produced by distension of the skin, but only in situations in which there are various hormones circulating, as in pregnancy and puberty. Those stretch marks located on the lower abdomen (below the umbilicus) will be removed with the extra skin. Those located on the upper abdomen will be shifted downward as the skin is brought downward. The stretch marks that remain are tightened and smoothed out somewhat.

Even in the most extreme balding patterns, a permanent ‘wreath’ of hair exists on the sides and back of the head (Donor Hair). This hair is unaffected by the balding process. Once transplanted, this hair behaves as it was programmed to behave in the original area it came from and will grow naturally for the rest of your life.

Will abdominoplasty tighten up loose skin?

Ans.: Yes, that is one of the main purposes of abdominoplasty.

When is Abdominoplasty usually performed?

Ans.: The Abdominoplasty procedure is usually performed when a person is discontent with their appearance in the abdomen region. Although there is no “normal” age or time in one’s life (after 18), it is most often sought out after a woman has given birth and does not plan on having any more children. The reason that not having additional children is an important factor is that after the extra skin and muscle tissue is removed, the abdomen may not be able to accommodate another child. The skin could quite literally “split”. Although this probability will be individual-dependent. Mini tummy tucks are considered less invasive and are for minimal correction cases.

What does a typical Abdominoplasty consultation entail?

Ans.: We will measure your abdomen and general torso region for an idea of an ideal abdomen size for you. Between pictures that you have brought in and with the information of how many children you have had, we will set realistic goals on what is and isn’t possible with an Abdominoplasty. You must remember that no amount of surgery can restore your skin to its former condition.

What are the different techniques for Abdominoplasty?

Ans.: The different techniques pertaining to Abdominoplasty consist of the different incision shapes and placement. Most surgeons attempt to place the incisions in the most inconspicuous area. Some surgeons go completely horizontal and straight across, some use a ‘V’ shape, some a ‘W’ shape and still others follow along the bikini line. The incision will be marked and agreed upon with you during the pre op consultation. In our opinion an incision following the bikini line is the optimum for concealment purposes although your body’s needs will determine the incision placement.

What should I expect post-operatively?

Ans.: You are usually able to walk immediately after surgery and is in fact encouraged to do so 3 or 4 times per day for 1-2 minutes each time. However, you will more than likely not be able to stand up straight – more of a hunched over type of posture. The skin of the abdomen will be quite tight and you are usually instructed to remain bent over at least 45 degrees for the first 4 to 5 days after surgery. Patients will often note some back discomfort due to the 45 degree positioning for 4-5 days after surgery. We will prescribe muscle relaxants and pain relief medications for the same. The drains that have been placed will generally be removed 4 to14 days after surgery. At the end of 4 days the patient may begin to straighten up and by six days post-op may or may not be fully straight. You should take it easy for at least two weeks after surgery. While the drains are in, you will be on bed rest with a very small amount of walking as outline above. However if your drains are in for an extended amount of time, you will of course not be expected to sit in bed all day. An abdominal pressure garment will be placed around you during one of your post-operative appointments and you will be instructed to wear this for 3 to 6 weeks. Some swelling and discoloration are normal but generally this is minimal. Of course this is dependent upon the individual.

Is there much pain associated with Abdominoplasty?

Ans.: The amount of pain associated with this procedure is quite variable. Some patients note a moderate amount of discomfort and for some it is more intense. But certainly there is some discomfort. Patients will often note some back discomfort due to the 45 degree positioning for 4-5 days after surgery. Valium is sometimes given to alleviate muscle spasms of the back and for relaxation and a sleep aid, in general.

Where are the scars located involving an Abdominoplasty?

Ans.: This is not a scar-free surgery; in fact the scars may be quite severe depending upon the amount of skin needed to be removed, your body’s ability to heal, if you scar well, the skill of the surgeon and the technique utilized. Most surgeons choose to offer their patients lesser scarring techniques that leave a well-hidden horizontal or slightly bowed scar which can be covered by a standard bikini. We will discuss the incision types, techniques and placements at your consultation. Ideally, no scar would be wonderful, but that isn’t possible – yet.

Is there a lot of swelling involved with a Abdominoplasty?

Ans.: There is a bit of swelling involved with an Abdominoplasty. You must take into account that Abdominoplasty is surgery and with this type of surgery and depending upon the case, a lot of tissue is removed.

When can I return to work?

Ans.: An Abdominoplasty is a relatively slow-to-heal procedure. While the drains are in, you will be on bed rest with a very small amount of walking as outlined above. An abdominal pressure garment may be placed around you during one of your post-operative appointments and you may be instructed to wear this for 3 to 6 weeks. Most patients can and do return to work after 2 weeks. You simply should not have to sit at a desk for 8 hours after having had an Abdominoplasty.

When will I be able to see the results?

Ans.: After the swelling subsides and the drains are taken out you will start to see a difference. You must realize that the underlying tissues have been cut and that an Abdominoplasty is considered a very invasive procedure. Give your body time to heal and you will reap the many benefits of the procedure.

How long does an Abdominoplasty last?

Ans.: This procedure can last for many, many years.If there are no large weight gains, and no pregnancies after the tummy tuck then the changes will be relatively permanent. Certainly some relaxation of the tissues can reoccur but not to the extent prior to surgery.

Blepharoplasty

What is Blepharoplasty?

Ans.: Also known as surgery on the eyelid, blepharoplasty is an operative procedure devised to provide a younger look to the eyes. It is achieved by the removal of excess fat, skin and muscle from the upper and lower eyelids. Fat of the lower eyes may be repositioned to prevent a “hollow eye” appearance following lower eyelid fat removal. The procedure may also enhance vision in situations where excess skin of the upper eyelids has sagged to the degree that it hinders with peripheral vision.

Should I have eyelid surgery or a browlift?

Ans.: If you feel that your eyes have become tired-looking, you may be able to rejuvenate them with either procedure. Eyelid surgery is recommended when the eyelids are sagging due to excess skin. A browlift is recommended when the eyebrows have begun to droop and cause the eyelids to appear wrinkled and tired. Or how about both? The results of each may be subtle and natural looking, but together, you can have a dramatic result that can subtract years from your look!

Is eyelid surgery only for aging patients?

Ans.: No. A blepharoplasty procedure can be performed for anyone who feels that age, lifestyle, or genetics have contributed to tired-looking eyes. In order to qualify for an eyelid lift, you must have loose or excess skin in the upper or lower eyelid areas.

How will blepharoplasty help with my drooping eyebrows or crows feet?

Ans.: It will not help.There are other procedures developed for elevating a drooping eyebrow or elminating wrinkles around the eyes and Blepharoplasty is not one of them.

Will Blepharoplasty help with the dark circles under my eyes?

Ans.: Blepharoplasty can slightly help with the dark circles under the eye that are caused by large bags. But the darkness of the lower eyelid skin usually stays even after blepharoplasty. In this case, then chemical peels and laser resurfacing can help.

Are all eyelids done at the same time?

Ans.: If necessary. Usually, patients will choose to have either an upper blepharoplasty, targeting just the upper eyelids, a lower blepharoplasty, targeting only the lower eyelids, or a combination, targeting all eyelids.

How can I get even more dramatic results?

Ans.: Many of our eyelid surgery patients choose to supplement their procedure with another facial rejuvenation treatment for an incredibly refreshed, younger-looking face. Combine your surgery with a browlift, facial implants, or facelift to save time and money.

Is it necessary to stay overnight after Blepharoplasty surgery?

Ans.: Blepharoplasty is considered to be an outpatient procedure and there is not requirement to stay overnight.

After Blepharoplasty, will there be any scars?

Ans.: There are scars involved with Blepharoplasty just as there is with the majority of other types of surgery. Normally though the scars are hardly seen after a few months and this is because the incisions are put in the normal creases and folds of the upper and lower eyelids. For those patients that only have to have fat removed from their lower eyelids may have incisions made on the inside of their eyelid and therefore having scars going on detectable.

What are the complications?

Ans.: Standard early complications are a collection of blood developing under the skin. If this occurs it is drained. There is a very small chance of getting an infection of the surgical site. If this occurs it is treated with antibiotics by mouth.Specific to eyelid surgery is the possibility of the eyelids not completely closing for the first few days, particularly at night when sleeping. This can lead to a gritty uncomfortable feeling to the eyes. This requires use of either eyedrops or eye ointment on a temporary basis until the problem resolves. Uncommon late problems include having the eyelashes turning inward or outward, which would require revision surgery. The lower eyelid in particular requires support, and the surgery on the lower lid is kept conservative for that reason.As in all operations done for aesthetic purposes, the main problems are aesthetic. With eyelids, not all excess skin and fat can be safely removed. If a very aggressive eyelid fat surgery is done, it can leave the patient with an unusual hollow-eyed appearance. Equally, if the eyelid skin is pulled too tight, distortion in the contour of the lid can result.

Are the results permanent?

Ans.: Since the fat around the eyes will not regrow after being removed, the results of blepharoplasty are usually long lasting.

At what point are the stiches removed?

Ans.: 3 – 5 days following Blepharoplasty, the stiches will be removed.

How long do I need to take off from work after eyelid surgery?

Ans.: It is suggested that you take off 3-5 days from work after eyelid surgery but refrain from strenuous activity for up to one month after the surgery.

Will the shape of my eye change following blepharoplasty?

Ans.: The skin of the upper and lower eyelids are changed during blepharoplasty. Generally the shape of the eye changes so that it appears more open and less tired.

Botox

What exactly is BOTOX®?

Ans.: BOTOX® is a purified protein produced by the Clostridium botulinum bacterium. It is a nonsurgical, physician-administered treatment that can temporarily reduce moderate to severe frown lines between the brows in people 18 to 65 years of age. During treatment, very low doses of BOTOX® are administered via a few tiny injections directly into the muscles that cause those stubborn lines. The treatment is usually done in about 10 minutes, and no recovery time is needed. Within days, you may see an improvement that can last up to 4 months. Results may vary.

How does BOTOX® work?

Ans.: Those moderate to severe frown lines between your brows form over time as the result of muscle activity. BOTOX® is injected directly into the muscles. It is most often used on forehead lines, crow’s feet (lines around the eye) and frown lines. It works by blocking the transmission of nerve impulses to the injected muscles; this reduces the activity of the muscles that cause those persistent lines to form.

When will I see results from a BOTOX® treatment?

Ans.: Within days, you may see a marked improvement in the moderate to severe frown lines between your brows. Lines continue to improve for up to a month, and results can last for up to 4 months. Nearly 90% of men and women rated the improvement in their appearance as moderate to better 1 month after treatment. Results may vary.

How long does BOTOX® last?

Ans.: Results from treatment with BOTOX® can last for up to 4 months. If you discontinue treatment, the frown lines between your brows gradually will look like they did before treatment.

Who should administer BOTOX®?

Ans.: Any authorized healthcare professional can administer BOTOX®, but plastic surgeons & dermatologists, specializing in cosmetic procedures are generally more experienced. One of these physicians can help you decide if BOTOX® is right for you.

Is treatment with BOTOX® painful?

Ans.: Discomfort is usually minimal and brief. Prior to injecting, we may choose to numb the area with a cold pack or anesthetic cream. The entire procedure takes approximately 10 minutes. People are in and out of the office without downtime following BOTOX® treatment.

Who should not use BOTOX®?

Ans.: Patients who are pregnant, breastfeeding or have a neurological disease should not use Botox.. BOTOX® should not be used in the presence of infection at the proposed injection site(s) and in individuals with known hypersensitivity to any ingredient in the formulation.

What are the side effects of Botox?

Ans.: Temporary bruising is the most common side effect. Headaches, which resolve in 24-48 hours, can occur, but this is rare. A small percentage of patients may develop eyelid drooping. This usually resolves in three weeks. This development is usually caused by migration of the Botox and for this reason, you shouldn’t rub the treated area for 12 hours after injection or lay down for three to four hours. There have been no allergies associated with Botox to date.

Will my facial expressions continue to look natural?

Ans.: Although the results are visible, a treatment with BOTOX® will not radically change your facial appearance or make you look as if you “had work done.” The muscle activity that causes frown lines between the brows is simply reduced, so you can still frown or look surprised without the wrinkles and creases between your brows.

What will happen to the frown lines between my brows if I choose not to continue?

Ans.: If you do not continue treatments, the moderate to severe frown lines between your brows will gradually look like they did before treatment.

Is BOTOX® affordable?

Ans.: When considering your facial aesthetic options, BOTOX® is quite affordable. According to an American Society for Aesthetic Plastic Surgery survey, BOTOX® is one of the low-entry-cost facial aesthetic procedures in the United States. Like other appearance-related investments, such as hair coloring and cuts, teeth whitening, and chemical peels, the cost must be weighed relative to your expectations.

Laser Hair Removal

How does the laser hair removal treatment work?

Ans.: Lasers are optical devices which produce intense coherent, collimated and mono-chromatic beams of light. A laser consists of an active medium such as a crystal, gas or liquid that amplifies light when excited by an external energy source (a flash amp or electric discharge, for example). When the appropriate medium is employed, the laser can be fine-tuned to generate a very narrow band of light wavelengths (such as the individual colors of the visible spectrum). Be aware that hair removal systems that use traditional light for treatment (Intense Pulse Light machines or IPLs) are not true hair removal lasers. These devices use a highly concentrated beam of traditional incoherent light, often in conjunction with a cream or gel, to burn the hair shaft. A serious flaw with these systems is that they lack the laser’s ability to produce a selective bandwidth of light that will only affect the hair shaft (selective photothermolysis). These devices produce a wide bandwidth of light that can heat up all of the surrounding tissue. IPLs are generally cheaper devices and are used for various skin procedures first and foremost, with hair removal as more of an afterthought.

What is the difference between Laser hair removal & Electrolysis?

Ans.: Electrolysis is a tedious, invasive and painful process that involves inserting a needle into each hair follicle and delivering an electrical charge to destroy them one at a time. Electrolysis often requires years of treatments at regular intervals.A Laser delivers non-invasive light energy to hundreds of hair follicles at one time. In just a few minutes, it can effectively treat an area that would take over an hour with electrolysis.This means the treatments with Laser are much shorter less frequent and more comfortable. One of the most exciting benefits is that in between treatments you will experience long periods of being virtually hair free!

Who is a candidate for Laser hair removal?

Ans.: Both men and women seek laser hair removal services to have unwanted hair removed. Hair removal is commonly done on the hairline, eyebrow, top of the nose, lip, chin, ear lobe, shoulders, back, underarm, abdomen, buttocks, pubic area, bikini lines, thighs, face, neck, breast, arms, legs, hands, and toes. Laser works best on pale skin and dark coarse hair. The closer you are to this combination (i.e. the lighter the skin and the more coarse and dark the hair), the better the results will generally be. Since laser works by being attracted to and targeting the dark pigment, using an alexandrite or a diode laser on darker skin can result in skin burning or loss of skin pigment (hypo-pigmentation). Long pulse Nd:YAG lasers were created to cater to dark-skinned patients, so they are safer on the skin at settings that actually affect the hair than alexandrite and diode lasers. When choosing your hair removal options, select an environment whose main priorities are your safety, health, and results.

Is laser hair removal permanent?

Ans.: The general opinion is that laser hair removal is permanent, and the US FDA approved it as “permanent reduction,” but doesn’t work on everyone. Generally, this means that you shouldn’t expect laser to remove every single hair from an area. Most will need touch-up treatments 1-2 times a year after the initial set of treatments for any new growth your body develops with age.A set of at least 6-8 treatments at specified intervals are generally necessary to achieve substantial hair removal with laser. Factors that determine the length of treatment include the particular area to be treated, the texture of hair, frequency of treatments, history of temporary measures to remove hair (waxing, tweezing, shaving, and depilatories, etc.) etc.

How should I prepare for treatment and what should I expect after treatment?

Ans.: You should shave the area to be treated 1-3 days before treatment (some clinics will offer to do this for you, but beware of irritation caused by disposable razors etc). No waxing or removing hair with the root with any other way is allowed 4-6 weeks before and throughout the course of treatment as hair needs to be in place to be targeted by laser. The area should be shaved as closely as possible so that laser can target the most energy towards the hair follicle and not waste energy on the part of the hair above the skin’s surface. If your hair is the type that you can’t see where it was right after you shave, make it a bit easier on your tech not to miss the spots you want treated by shaving 1-3 days before so the outline of where hair is growing is just VERY slightly visible.

After treatment is completed (underarms take under 10 minutes, back treatment can take 1 hour or so), you should apply aloe vera to soothe the skin for a few days. Within 2-3.5 weeks, you should experience shedding of all treated hair. At first, hair will look like it’s growing back in, but it is just coming through the skin to shed. Shedding starts at about 1.5 weeks and can last until 3.5 weeks post-treatment or so. Exfoliating and/or scrubbing gently in the shower can help speed up the process. After shedding finishes, you might experience little black dots still “stuck” in the skin. These are commonly referred to as “pepperspots” and will shed eventually, but might take a bit longer. Exfoliate to help those out as well.

After shedding occurs, you should experience a hair free period for a few weeks, until next set of hair that was dormant before starts to come in. Once you have enough to justify one, go in for another treatment. This usually happens within 6-10 weeks post-treatment. Patient continues this process until he/she has reached diminishing returns and the remaining hairs are too fine for laser to target, or until you have reached you desired reduction.

How many laser hair removal treatments are required and spaced how far apart?

Ans.: Most people need at least 6-8 initial treatments spaced 6-10 weeks apart. This is because hair grows in 3 phases and is killed in the first “anagen” active growing phase. Several treatments are needed to target ALL hair in the active growth phase. Approximately 6-10 weeks after every treatment, additional treatment is required to eliminate the hairs that came out of the dormant phase and are now active. After 6-8 treatments or so, patients should experience a considerable percentage of hair reduction. Depending upon hair type and genetic factors, some clients may require additional treatments beyond these initial treatments. If it seems like the treatments are not working after 6-8 treatments, patients should look into possible underlying reasons. Usually, treatments are spaced 6-8 weeks apart to start, and gradually move to 8-10 weeks apart after the initial 2-3 treatments. Instead of following an arbitrary schedule, wait until you have experienced shedding of the treated hairs (should complete within 2-3.5 weeks) and you see enough hair come in after the hair free period to justify the next treatment.

What is the hair growth cycle and how does hair growth work?

Ans.: Under normal circumstances hair growth in each hair follicle occurs in a cycle. There are three main phases of the hair growth cycle: anagen, catagen and telogen.

Is laser hair removal treatment painful?

Ans.: In one pulse, the laser can remove all the hair on a patch of skin the size of a nickel (depending on the specific laser spot size ranging from 9-18mm on average – i.e. the “head” of the laser from which the power is coming with every pulse). Everyone’s pain threshold is different, but generally laser hair removal is not much more painful than waxing, but the sensation is different. It resembles a rubber band snapping against the skin for a quick second with each pulse. Most people do not require an anesthetic cream (like EMLA), but one may be used for very sensitive patients/areas (can be provided or prescribed at the clinic).

What things should I consider when finding a laser hair removal center near me?

Ans.:

  1. The clinic: Make sure that you go in for a consultation to see if you are happy with the way the clinic looks and feels (clean, up-to-date and informative).
  2. The laser technician: Make sure that the person treating you has extensive experience of hair removal and has knowledge of how to best kill the hair. If you are an informed consumer, you will be able to better judge whether what they’re saying is in your best interests or not.
  3. The laser: Make sure that the laser being used is best for your skin and hair type. Do not fall for “marketing hype”. Every laser can technically be used on any skin type, but you should be looking for one that will produce the most efficient results for YOU.Alexandrite long pulse and diode lasers are very effective when the skin type is light (I-III – see question #11 to determine your skin type) and the hair is dark enough to attract the laser within the follicle. Some of the most popular alexandrite lasers include GentleLASE by Candela Corporation and Apogee by Cynosure.Diode lasers work best on skin types I-IV. The most popular on the market is the LightSheer laser by Lumenus.

    Nd:YAG long pulse lasers are best for treating darker skin types (IV-VI) or patients of color such as: Afro-American, Asian, Hispanic, Mediterranean, European and Middle Eastern.

    Alexandrites and diodes are generally more effective on finer hair given higher settings than Yag lasers. So, if your skin type falls into types III-IV and the hair is finer, an alex or a diode is preferred. If your skin is darker than a type V and the hair is fine, the hair might not have enough pigment to be treated, so a test spot might be necessary before committing to a treatment.

How do I determine my Fitzpatrick Skin Type?

Ans.: In 1975, Thomas B Fitzpatrick, MD, PhD, of Harvard Medical School, developed a classification system for skin typing. This system was based on a person’s response to sun exposure in terms of the degree of burning and tanning the individual experienced. For successful removal of hair, wrinkles, veins, sun spots, and scars using LASER technology, it is necessary to determine your correct skin type.

  • TYPE I: Highly sensitive, always burns, never tans.Example: Red hair with freckles or Albino.
  • TYPE II: Very sun sensitive, burns easily, tans minimally.Example: Fair-skinned, fair-haired Caucasians.
  • TYPE III: Sun sensitive skin, sometimes burns, slowly tans to light brown.Example: Darker Caucasians, European mix.
  • TYPE IV: Minimally sun sensitive, burns minimally, always tans to moderate brown.Example: Mediterranian, European, Asian, Hispanic, American Indian.
  • TYPE V: Sun-insensitive skin, rarely burns, tans well.Example: Hispanics, Afro-American, Middle Eastern.
  • TYPE VI: Sun-insensitive, never burns, deeply pigmented.Example: Afro-American, African, Middle Eastern.

What are the brand names of some types of lasers out there?

  • Alexandrite: GentleLASE, Apogee, EpiTouch Plus.
  • Diode: LightSheer, SLP 1000, F1 Diode, MeDioStar, LaserLite, Epistar, Apex 800, Comet (w/RF technology), Palomar SLP 1000.
  • Nd:Yag: CoolGlide, GentleYAG, Lyra-i, Sciton, Apogee Elite, Medlite IV, Varia, Athos.
  • IPL: Aurora (w/RF technology), Harmony, EpiLight, PhotoDerm, Quantum, Aculight, Vasculight, Palomar Starlux and EsteLux.
  • Ruby: RubyStar, E2000.

Miscellaneous FAQs

What are the possible causes of excessive hair growth and how can it affect my treatments?

Ans.: The causes of excessive hair growth pattern are many and varied, including:

  • Heredity
  • Pregnancy
  • Glandular and/or hormonal imbalances (possible PCOD condition for women), including diseases causing these effects
    Insulin resistance issues
    Reactions to certain medications
  • Normal aging processes
  • Excessive temporary removal methods like waxing, tweezing, creams and depilatories, etc.Every laser candidate should explore a possible underlying reason of the extreme hair growth before starting laser because if there is something in the body consistently triggering hair growth, laser treatments might seem ineffective because the body will keep developing new hair. So, it will always seem like there is not reduction, when in fact it’s NEW hair your body is producing that you are seeing, not that treated by laser growing back. Women with PCOD hair growth patterns (upper lip, chin, cheeks, etc) should see an endocrinologist and have hormonal tests taken. Men can get tested for insulin resistance etc. Talk to your doctor if you suspect you might have an underlying medical condition causing excessive hair growth before starting laser hair removal. Once the condition is control through treatment/medication, laser hair removal can then be performed. Laser can affect the hair that’s currently present, but cannot prevent NEW hair from developing.