Below, find answers to some of your most frequently asked questions about cosmetic surgery and aesthetic procedures. Remember that your surgeon is best able to answer questions and elaborate based on his or her evaluation of your needs.
Do I need a facelift or can a less invasive procedure meet my expectations?
Up to a certain age, a patient can obtain good improvement with noninvasive treatments such as Botox and fillers, or less invasive procedures such as a ThreadLift. Past a certain age, the skin excess of the jowls and neck requires a facelift for significant improvement. A person’s age is only one factor, with the quality of the skin also entering into the decision making process.
Are there different types of facelifts?
Yes. The terminology can be confusing, with words such a “necklift” , “S-lift” and “mini-lift” appearing in articles and advertising. Procedures advertised as “mini” often give “mini” results. Remember that the aging process generally involves the entire face, and simply tightening the neck will not address aging changes in the brow or eye area.
What procedures can be done with a facelift?
A browlift and/or eyelid surgery (blepharoplasty) can be combined with a facelift. A laser resurfacing procedure for wrinkles can be done as well. Procedures on the face are not generally combined with body contouring procedures such as breast surgery or liposuction. Patient safety issues figure into limits on multiple procedures and operative time.
How much down time is needed for a facelift?
It depends what you do. If your job has you meeting the public, it may take about two weeks before you can get by with just a bit of makeup. If your daughter is getting married, you’d want to allow about six weeks so there is no chance of the slightest remaining bruising being seen on the wedding
How long does the improvement from a facelift last?
The aging process resumes the day after surgery. One should expect the results of a facelift to last about 7 to 10 years. The age at which a patient has her facelift is an issue, as well as factors such as sun exposure. Maintenance procedures may be needed earlier, and the Contour ThreadLift shows promise with prolonging the facelift results.
What is the “facelift look”?
You don’t want people to immediately know that you’ve had a facelift when they see you for the first time after surgery. Skin pulled too tightly or in the wrong direction, an excessively elevated hairline, or earlobe tugged down are all facelift stigmata to be avoided. The highest compliment you can be paid after surgery is for someone to think that you look different, but they can’t exactly put their finger on it. A refreshed, rejuvenated look is our goal. Of course, the results of a facelift in a 70 year old patient will be more dramatic than that in a 50 year old person.
EYELID SURGERY (BLEPHAROPLASTY)
What is the best procedure to rejuvenate the area around the eyes?
There probably isn’t an area in plastic surgery that has seen more advances than with periorbital surgery. Procedures that used to simply remove extra skin from the upper eyelids and extra fat from the lower eyelids have become much more sophisticated. The eyelids can now be reshaped to restore a youthful appearance, and most lower eyelid surgery now involves a scarless technique.
What is the recovery from eyelid surgery like?
The eyelid skin is the thinnest on the body, and it heals faster that any other area. Sutures come out in only a few days, and patients can then start wearing makeup. Many patients have surgery mid-week, and are back to work the following Monday. We ask patients to refrain from driving and bending over for 24 hours following surgery, but after that most normal activities are OK.
Will eyelid surgery help the dark circles under my eyes?
Generally no. Some people have changes in the pigmentation of the lower eyelids, and other patients have a hollow or tear trough where the eyelid meets the cheek. The typical lower eyelid procedure sometimes needs to be combined with fat or Sculptra injections to help with this hollow. The pigmentary changes may need a bleaching medication, laser treatment or a chemical peel for improvement.
Are any patients not good candidates for eyelid surgery?
Patients with thyroid problems, dry eyes or hypertension can be at increased risk for postoperative problems. Lower eyelids that have lost their youthful elasticity also need to be approached with extra caution. All of this will be discussed in your consultation.
What does a browlift do?
In addition to helping sagging brows, a browlift improves the skin excess below the eyebrows. This is an area that an eyelid lift alone will not help. A browlift can also improve the wrinkles of the forehead and between the eyebrows.
What are the different types of browlifts?
The traditional or open browlift involves an incision across the top of the scalp. Patients with normal hair thickness heal this incision quite well. There are also limited incision procedures that are well suited for patients who do not have significant forehead wrinkles. The newest approach involves the Endotine™ fixation device (click on What’s New to view this procedure).
What is the down time for a browlift?
Taking a week off of work is generally considered enough following a browlift.
Should I bring in photos of celebrities whose noses I like?
Only if you don’t like the magazines in our waiting room. Rhinoplasty can reshape your nose, not replace it. The nature of your nasal skin and the arrangement of the bone and cartilage in your nose can be very important in the degree of improvement possible. A person’s nose must be proportional to their face. You would not want a tiny nose if you have a long face, for example. Artistry and surgical judgement play a big role in this procedure, the most technically demanding of all cosmetic surgery operations.
Are there any visible scars from a rhinoplasty?
If you are simply having a small hump on your nose smoothed down, the incisions are hidden inside of your nose. Nasal tip reshaping generally involves an open rhinoplasty technique, in which a small scar underneath the nose is combined with the incisions inside the nostrils.
How long does it take for my nose to look normal following surgery?
Within a week or two, you’ll no longer look as though you’ve had nasal surgery. The skin of the nose is fairly thick, and it can take months for every last bit of swelling to subside and for the final results of your surgery to become apparent.
Will people know that I’ve had a rhinoplasty?
One goal of surgery is to avoid the typical appearance of a “nosejob”. We’ve all seen people who have a very upturned nasal tip or too small a nose. That is to be avoided. We want you to see a big difference following surgery and to feel better about yourself. We want other people to scratch their heads and wonder why you look better.
BREAST AUGMENTATION (Augmentation Mammaplasty)
How do I sort out all of the options with the different types, shapes and sizes of implants, pocket location and incision type?
Every surgeon has particular preferences with regard to this operation, and there is probably no more important consultation for a cosmetic surgery procedure. A woman’s chest (not breast) dimensions and abundance of soft tissue coverage (translate: fat) are the keys to decision making, and we are usually able to settle on an implant and surgical technique that gives you the best results.
- Can I pick what cup size I want to be?
Yes and no. If you are petite, chances are there simply isn’t enough space on your chest wall for large implants. Most women want the largest possible implant before they start looking artificial. Concerns about appearances at work are usually unnecessary, because of the ability to conceal things in business attire. While there is the occasional patient who wishes she had picked a bit larger implant, we have never had a patient who felt that she was too big after surgery.
Are silicone gel implants available?
After rigorous scientific review, the FDA approved the marketing of silicone gel-filled breast implants in November 2006 for women ages 22 and older. The products are manufactured by Allergan Corp. and Mentor Corp., which was recently acquired by Johnson & Johnson. Now that the products have been determined to be safe and effective, the FDA will continue to monitor them by requiring each company to conduct a large postapproval study following about 40,000 women for 10 years after receiving breast implants.
Are silicone gel implants better that saline?
Silicone gel implants are better than saline implants in women with thinning of the soft tissues in the upper chest. Saline implants in such women can cause visible wrinkles. Silicone gel implants require a slightly larger incision for insertion because unlike saline implants, they are prefilled with silicone gel. Saline implants are preferred when there is breast asymmetry because the implant size can be adjusted in the operating room. Finally, there is the cost issue, with silicone implants costing about twice as much as saline implants.
How long do the implants last?
There is no good data on the lifespan of breast implants. We would tell a 25 year old woman that she will need a second operation at some point in her lifetime. If you are 50, you have less to worry about with respect to implant replacement.
What is the down time following breast augmentation?
Most patients can return to a desk job within a week. You can expect some soreness for up to a month, particularly if your implants were placed under the pectoralis muscle. Plan on a month or so before getting back to the gym for upper body exercise.
BREAST LIFT (Mastopexy)
What are the reasons for having a mastopexy or breast lift?
Pregnancy or weight loss can result in descent of the nipple below the breast fold. The degree of breast drooping or ptosis determines the appropriate operation. Moderate degrees of ptosis are often treated with an implant alone.
More significant drooping requires skin excision to elevate the nipple and areola, and much of your consultation will involve a discussion of the resulting scars on the breast.
Are there different types of mastopexies?
A number of different procedures exist, with different degree of scarring. Many women ask about incisions that are limited to the areola, but there are a number of trade-offs with this approach. Sometimes the best cosmetic appearance results from the inverted -T design, the scars from which are usually quite acceptable.
What about combining a breast augmentation with mastopexy?
It certainly can be done, but the potential for complications increases with an implant putting pressure on skin flaps sutured together. There are many opinions on how to best treat a woman who has both small breasts and breast ptosis. These options will be discussed in your consultation.
LIPOSUCTION (Lipoplasty/Suction Lipectomy)
What areas of the body are best suited for liposuction?
Liposuction improves localized areas of fat. The abdomen, flanks, saddle bags and inner thighs are the most commonly treated areas. If there is excess skin in an area such as the inner thighs, liposuction may not work well. If you have excess skin or a bulge of the abdomen, you may need a tummy tuck.
Can I have liposuction if I am overweight?
Liposuction is a body contouring procedure, not a weight reduction plan. Liposuction complements other lifestyle changes such as diet modification and exercise. A major liposuction procedure may only remove about 10 pounds of fat. Depending on your body frame, being a bit overweight does not rule you out as a surgical candidate. It is simply not safe to perform liposuction on someone who is significantly overweight.
Does the suctioned fat ever come back?
Essentially no, unless you were to gain a good deal of weight. In that case, the fat gets redistributed everywhere, including those areas that were suctioned.
What is the down time following liposuction?
Given the anesthesia (local with intravenous sedation) and the small incisions, most people can plan on being back at work in a matter of 2 to 3 days. There is always some bruising and swelling, which is helped by wearing a compression garment for a few weeks following surgery. Your appearance continues to improve for up to 2 to 3 months following surgery.
What about all the media stories about liposuction complications?
Liposuction is surgery, not some lunchtime procedure. There are numerous potential risks of the surgery, including those relating to the anesthesia and the cannulas used to suction the fat. Safety is our highest priority with this procedure. We will spend a good deal of time during your consultation to discuss what you may have read or seen on TV with regard to the risks of liposuction
ABDOMINOPLASTY (Tummy Tuck)
Do I have to stay overnight in the hospital following a tummy tuck?
A mini or modified abdominoplasty can be done as an outpatient in our office surgical facility. This procedure is suitable for those patients whose skin excess and bulge is confined to that area below the belly button. If your problem extends above the belly button, you will likely need a standard abdominoplasty, which is done under general anesthesia in the hospital. Given the extent of this operation, most patients are much more comfortable by staying overnight in the hospital.
Where does liposuction fit into an abdominoplasty?
An abominoplasty corrects sagging skin of the abdomen or a bulging abdominal wall. Liposuction can complement this procedure by additionally removing excess fat of the flanks and thighs. If there is significant fat excess of the upper abdomen, or simply a large amount of fat to be suctioned, we often recommend a staged procedure in which liposuction is done first, followed by a tummy tuck in four to six weeks. There are significant safety benefits in this approach, and this will be discussed in detail during your consultation.
Can I have an abdominoplasty if I am a cigarette smoker?
No. Cigarette smokers present too great a risk with blood circulation to the newly tightened abdominal skin.
What is the recovery time?
We recommend about two weeks off of work. If you have young children, you will want to make sure that you have a lot of help for the first week following surgery.
Should I have this operation if I am planning on having more children?
No. Your abdomen may respond well to another pregnancy, but there is no guarantee that you will not gain a lot of weight or otherwise weaken your abdominal wall. You only want to have one abdominoplasty.