Aesthetic Plastic Surgical Procedures

Aesthetic Plastic Surgical Procedures refers to surgical procedures that represent a blend of art and science. The word aesthetic has been defined as “the appreciation of beauty or good taste”. The word plastic is derived from the Greek word plastikos, meaning to mold or shape. Aesthetic Plastic Surgery refers to procedures that are designed to reshape normal structures of the body so that one’s appearance and self esteem will be improved. Typically, all Plastic Surgery procedures including reconstructive procedures have an aesthetic component as restoring form and function are best accomplished when the surgeon has a true sense of what is beautiful and therefore aesthetically pleasing. There are three main categories of Aesthetic Plastic Surgery Procedures and these categories can be subdivided as follows:

A. Aesthetic Plastic Surgical Procedures of the face

a. Browlift

b. Blepharoplasty (Eyelid rejuvenation)

c. Rhinoplasty (Nasal cosmetic procedure)

d. Facelift and Necklift

e. Midface Lift (Rejuvenation of the lower lid/cheek junction)

f. Otoplasty (Procedures to reposition protruding ears)

g. Alloplastic augmentation (facial implants designed to enhance facial volume)

h. Fat grafting (techniques to add volume by removal and injection of a patient’s fat)

i. Other soft tissue fillers (Examples: Restylane, Perlane, Juvederm, Hylaform, Cosmederm, Cosmeplast, Artefill, Radiesse, Sculptra)*

*The listing of these products on the ISAPS website is not an endorsement.

B. Aesthetic Plastic Surgical Procedures of the breast

a. Augmentation Mammoplasty (Breast enlargement)

b. Mastopexy (Breast lift often combined with Breast Augmentation)

c. Reduction Mammoplasty (Reduce the size of the breast often for functional as well as aesthetic improvement)

C. Aesthetic Plastic Surgery Procedures for Body Contouring

a. Liposuction (removal of deposits of fat by traditional suction techniques or the adjunctive use of ultrasonic energy to aid in fat removal)

b. Abdominoplasty (tummy tuck / modified or full depending upon the degree of laxity of the abdominal wall)

c. Thigh lift (lifting the inside and / or outside of the thighs for improved shape)

d. Belt lipectomy (typically performed after significant weight loss)

e. Lower body lift (typically performed after significant weight loss)

f. Brachioplasty (reduction of size of the arms from the axilla to the elbow)

g. Implant augmentation of the chest muscles, buttocks, and calves (may include silastic implants or fat grafting)

ABDOMINOPLASTY

Procedure

The excess skin and fat are removed surgically from the abdominal area. Depending on the needs of the patient, the muscles of the abdominal wall are tightened. The incision is a half moon shape (length dependant on the mass of skin and fat to be removed), and is usually made directly under the overhanging skin.

Length

Approximately two to four hours.

Anesthesia

Most commonly patients are placed under general anesthesia. This procedure can also be performed with a regional nerve block obtained with local anesthetic agents.

Inpatient/Outpatient

Either is possible and depends on the patient’s health and the doctor’s preference.

Possible Side Effects:

Temporary discomfort, post-operative swelling, soreness or tenderness in the surrounding areas, numbness of abdominal skin and bruising are possible side effects.

Risks:

Infection, bleeding under the skin flap or at the incision site, pulmonary embolism (a blood clot that travels to the lung), scarring (keloids), delayed healing, or the need for a second reversionary operation are potential risks:

Recovery:

The patient may return to work within two to four weeks. Upon re-evaluation by the physician, the patient – may return to more strenuous activity after approximately four to six weeks. Scars should fade and flatten anywhere from three months to one year after surgery

The outcome varies from patient to patient, but results are essentially permanent. The overall effect is an enhancement of the deficient contours of the face with an improved appearance.

ALLOPLASTIC AUGMENTATION OF THE FACE

Procedure

Improves the size and appearance of different areas in the face by implanting a pre-shaped three dimensional object in solid material, resulting in a more harmonious appearance. There are different types of material used to achieve this contour change. There are also different shapes of implants according to the area to be enhanced (chin, jaw, nose and cheeks and paranasal).

Length

Approximately one and a half hours.

Anesthesia

General anaesthesia or intravenous sedation and local anaesthesia are commonly used.

Inpatient/Outpatient

This is an outpatient procedure.

Temporary discomfort and swelling, mild bruising.

Risks:

The implant may need to be removed and/or replaced to treat problems including: implant rupture, infection and implant misplacement. Implant rejection is a risk but is extremely rare.

Recovery:

The patient can return to work and normal activities within in few days. The patient should not consume alcohol after surgery. Bruising and swelling should have disappeared after several weeks.

The outcome varies from patient to patient, but results are essentially permanent. The overall effect is an enhancement of the deficient contours of the face with an improved appearance.

BARBED SUTURE LIFT

Procedure

These are non-surgical procedures whereby barbed sutures are inserted into the face to create a lifting effect or a tightening and firming of the soft facial tissues. This is useful for those with flabby faces or aging of the mid-face, jowls, brow and neck. Selective regional lifting is possible. Threads come in various configurations: Short, bi-directional threads (APTOS, Feather lift); or Long bi-directional slings (BARBED SUTURE LIFT), or Long uni-directional threads (Contour threads). Different threads create different effects (e.g., firming vs. lifting). These threads can be used in conjunction with traditional open facelift surgery or endoscopic techniques.

Length

Approximately two to four hours.

Anesthesia

Most commonly patients are placed under general anesthesia. This procedure can also be performed with a regional nerve block obtained with local anesthetic agents.

Inpatient/Outpatient

Either is possible and depends on the patient’s health and the doctor’s preference.

Possible Side Effects:

Temporary discomfort, post-operative swelling, soreness or tenderness in the surrounding areas, numbness of abdominal skin and bruising are possible side effects.

Risks:

Infection, bleeding under the skin flap or at the incision site, pulmonary embolism (a blood clot that travels to the lung), scarring (keloids), delayed healing, or the need for a second reversionary operation are potential risks:

Recovery:

The patient may return to work within two to four weeks. Upon re-evaluation by the physician, the patient – may return to more strenuous activity after approximately four to six weeks. Scars should fade and flatten anywhere from three months to one year after surgery

These are excellent techniques for achieving a temporary facelift effect. The results last one to two years after which new threads need to be inserted to maintain or enhance the effect. These threads should be viewed in the same way as other temporary procedures and fillers such as Botox or temporary fillers where loss of result after a period of time is not considered a failure. Together with other non-surgical techniques such as Botox injections, Hyaluronic acid soft tissue fillers, and IPL (intensed pulse light laser therapy,or Thermage (the use of radio frequency to tighten the dermis of the skin), the rejuvenation can be powerful but is temporary

BELT LIPECTOMY

Procedure

Belt Lipectomy or Trunkal Body Lift is a circumferential removal of loose hanging skin and fat from around the waist or “belt” line of an individual. It could be considered an extensive tummy tuck that continues around the sides to remove the loose “love handle” skin that continues onto the lower back. The advantage to this extensive removal of skin is that the looseness above the buttocks is removed which has the effect of lifting the buttocks as well. Sometimes the fat in this area is used to augment the buttocks during belt lipectomy, restoring the flattened buttocks to a more youthful and projecting shape. The surgery typically begins with the patient in the prone position (belly down) and requires the body be turned onto the back once the initial posterior buttocks and lower back area surgery is completed so that the stomach or abdominal area “tummy tuck” can be performed which completes the “belt” lipectomy.

Length

3.5 to 5 hours

Anesthesia

Typically general anaesthesia but spinal anaesthesia is also an option.

Inpatient/Outpatient

Because of the extensive nature of the procedure an overnight stay is usually required.

Breakdown of the suture line above the buttocks (because of patient’s tendency to bend at the waist when performing normal hygiene which strains the suture closure pulling it apart). This usually leads to a wider scar in the posterior surgical area. Some numbness of the area above and sometimes below the incisions, residual looseness and irregularity of the skin, and all the usual common side effects of any surgical procedure.

Risks:

Risks of surgery are the same as with conventional abdominoplasty.

Recovery:

Recovery is prolonged because of the requirement of avoiding bending at the waist for a month until adequate healing has occurred.

Results are typically very gratifying.

BOTULINUM TOXIN (BOTOX)

Procedure

Botulinum toxin type A, better known as botox, is a product used in aesthetic surgery to correct annoying expression lines in the face. The correction occurs because botulinum toxin temporarily paralyzes the muscles responsible for these lines. This allows the skin to recover from years of squinting and frowning.

Since the early 1990s, botulinum toxin has been used to treat disorders such as exaggerated blinking, facial spasms, and muscle contractions affecting partly paralyzed patients.

These applications have provided sufficient experience to know the product well. It is perfectly safe so long as it is used properly. The aesthetic effects of botulinum toxin were discovered over a decade ago. Since then it has also been successfully used for this purpose.

There are several brands of botulinum toxin available. The best indications for treatment with botulinum toxin lie in the upper third of the face, for correction of vertical frown lines between the eyebrows, horizontal furrows on the forehead and crow’s feet. Other uses are less common, and are best performed by experienced users. Light under-treatment is usually preferred. Over-treatment can result in a diminished expression in the face.

Length

10-30 minutes.

Anesthesia

None or topical anaesthetic cream.

Inpatient/Outpatient

Outpatient.

Possible Side Effects:

Immediately after treatment only the small pinpricks are visible. Light bruising. Some patients experience a slight headache during the first week.

Risks:

There are no permanent risks in healthy individuals. Myasthenia Gravis is a contraindication. Asymmetry. Drooping of the eyelid can occur in 1-5% ; it always recovers spontaneously within 3-4 weeks.

Recovery:

The effect only arises after 3-4 days, and lasts for 4-6 months. When treatment is not repeated the original movement always comes back spontaneously.

Correction of expression wrinkles, which improves with repetition of the treatment. More relaxed facial expression.

BRACHIOPLASTY

Procedure

The surgical rejuvenation of the upper arm remains a persistent problem for both the patient and the surgeon, despite the many techniques that have been proposed for its improvement. The goal of the brachioplasty is to reduce skin redundancy and to reduce the circumference of the arm. When there is good skin tone or minimal skin sagging, fat deposits can be reduced by liposuction. But marked skin redundancy or laxity can only be improved by surgery. The incision has to be placed in an axillar crease and in the internal aspect of the arm along a line extending from the axilla to the epicondyle of the elbow. Then a piece of skin-dermis and fat is removed and the subcutis and skin are closed using routine aesthetic suturing.

Length

Two to three hours.

Anesthesia

The anaesthesia can be general or local with sedation.

Inpatient/Outpatient

Both options are possible.

In some cases oedema or lymphedema of the arms can result.

Risks:

Highly visible or keloid scars and cutaneous nerve injuries.

Recovery:

The healing process may take 7-10 days. An elastic bandage or compression garment may be recommended for several months.

Good and stable results can be achieved in young patients with adiposities and good skin tone as well as in adults of older age, sometimes with the help of several months of postoperative elastic compression.

BREAST AUGMENTATION

Procedure

Improves the size and appearance of the breasts by implanting saline or silicone implants if applicable (the use of gel-filled implants may be government regulated) either under or over the chest muscle, thus producing a cosmetic enhancement

Length

This procedure takes approximately two hours.

Anesthesia

A general anaesthesia is administrated and the patient is completely asleep, or an intravenous sedation is used, combined with local anaesthesia.

Inpatient/Outpatient

Either – depending on the patient’s doctor’s decisions.

Possible Side Effects:

Mild, temporary discomfort, mild to moderate swelling, a change in nipple sensation (either more or less), and temporary bruising. Breasts may be sensitive to stimulation for a few weeks.

Risks:

The implants may need to be removed and/or replaced to treat problems including: deflation, implant rupture, the formation of scar tissue around the implant (capsular contracture), which may cause the breast to feel tight or hard, bleeding and/or infection. Other risks are an increase or decrease in sensitivity of the nipples or breast skin, which occasionally may be permanent.

Recovery:

The patient can return to work within a few days. She should avoid any physical contact with breasts (excluding her bra) for approximately three to four weeks. Scars should fade and flatten anywhere from three months to two years after surgery, depending upon how an individual heals.

The outcome varies from patient-to-patient. However the overall effect is enhancement of breast size for improved appearance

BREAST LIFT

Procedure

This operation removes excess skin in and around the breast that has been stretched during pregnancy or weight fluctuations. Breast implants may also be used in conjunction with this procedure to achieve the desired result.

Length

Approximately two to three hours.

Anesthesia

General anaesthesia is administered and the patient is completely asleep. The procedure can also be performed under intravenous sedation and local anaesthesia.

Inpatient/Outpatient

Either is possible depending on the patient’s medical condition and the preference of the surgeon.

Temporary bruising, swelling, some mild discomfort, numbness, and dry/tender breast skin.

Risks:

Unfavourable scarring with keloid formations is possible. In addition skin loss, infection, unevenly positioned nipples (asymmetry), and the possibility of permanent loss of feeling in the nipples and/or the breasts.

Recovery:

The patient can return to work within one week or more and may resume strenuous activities after one month. The fading of scars may take several months to one year.

The outcome varies from patient-to-patient. Other factors that may influence results are: gravity, pregnancy, ageing, and weight changes which may cause new sagging. Results may last longer or be enhanced when breast implants are inserted as part of the procedure adding support to the newly positioned breast tissue.

BREAST REDUCTION

Procedure

A breast reduction, also referred to as a reduction mammoplasty, is a surgical procedure to reduce the size and improve the shape of the breasts. Typically, women who are candidates for this procedure have physical symptoms related to the weight or shape of their breasts. These symptoms include back pain, neck pain, and bra strap grooves. The incisions vary based upon the breast size before the operation and the final post operative size.

An incision is made around the nipple and areola accompanied by a vertical incision below the areola with or without a horizontal incision made in the crease below the breast. Short scar techniques are frequently applicable in breast reduction surgery and allow excellent reduction of size with improved shape while limiting the extent of the incisions.

For reduction of very large breasts, in some cases the nipple and areola may need to be surgically removed and reapplied as a graft. Removing and reapplying the nipple/areola tissue will result in the loss of nipple sensation and the inability to breastfeed.

Length

The procedure usually requires 2-4 hours of operating time depending upon the technique chosen and the size of the breasts.

Anesthesia

The procedure is typically performed under general anaesthesia supplemented with local anaesthesia. Smaller reductions can be performed under intravenous sedation without the need for general anaesthesia.

Inpatient/Outpatient

Depending on the size of the breasts, type of anaesthesia selected, and length of the surgical procedure, patients may return home on the same day as their surgery or spend the night at an aftercare facility or hospital.

Possible Side Effects:

Prolonged swelling and delayed healing.

Risks:

Risks associated with breast reduction include: unfavourable scarring, loss of nipple sensation, loss of ability to breastfeed, loss of nipple and breast tissue, unsatisfactory shape, and failure to achieve aesthetic goals.

Recovery:

Typically one to two weeks is required for recovery. Most patients return to normal activities in that period of time. Strenuous physical activities are discouraged for three to six weeks after the operation.

Most patients who undergo a reduction mammoplasty are pleased with the size and the shape of their breasts and are delighted with the improvement and lessening of the symptoms of pain and discomfort that they experienced due to the weight of their breasts. Breast reduction makes physical activities easier and patients enjoy their new appearance and ability to wear clothing that was uncomfortable or unattractive before the surgery was performed.

CALF IMPLANT

Procedure

Improves the size and appearance of the calf area of the leg by inserting a silicone implant producing a cosmetic enhancement.

Length

Approximately one and a half hours.

Anesthesia

General anaesthesia, epidural blockage, or intravenous sedation and local anaesthesia are used.

Inpatient/Outpatient

This is an outpatient procedure.

Mild to moderate temporary discomfort and swelling, mild bruising.

Risks:

The implant may need to be removed and/or replaced to treat problems including: implant rupture, formation of scar tissue around the implant (capsular contraction), which may cause the calf to feel tight or hard, bleeding, infection and implant misplacement.

Recovery:

The patient must wear a compression bandage for 2 weeks after the surgery and do no exercise for several weeks. The patient should not consume alcohol after surgery. Alcohol consumption may be resumed after three weeks. Bruising and swelling should be gone after several weeks.

The outcomes vary from patient to patient; however, the overall effect is the enhancement of the calf size for an improved appearance.

CHEMICAL PEEL

Procedure

Restores wrinkled, blemished, unevenly pigmented, or sun-damaged facial skin, using a chemical solution to peel away the skin’s top layers. This procedure works best on fair, thin skin with superficial wrinkles.

Length

The procedure takes approximately one hour for regional areas and two hours for the full face.

Anesthesia

Topical aesthetic or sedation combined with local anaesthesia are used. When sedation is given frequently, EKG monitoring is used.

Inpatient/Outpatient

Usually this is an outpatient procedure. Full-face Phenol Peel may require hospital admission for a short period of time.

Possible Side Effects:

Both Phenol and TCA can cause temporary throbbing, tingling, swelling, redness and acute sensitivity to sun.
Phenol: may cause permanent lightening of treated skin and permanent loss of the ability to tan.

Risks:

Phenol and TCA: Tiny whiteheads (temporary), infection, scarring, flare-up of skin allergies and cold sores, excessive temporary skin pigmentation.
Phenol: Abnormal color changes (which may be permanent) and heart irregularities (these are extremely rare and occur during the procedure)

Recovery:

Phenol: Formation of new skin takes seven to twenty-one days. The patient may resume normal activities: two to four weeks. Full healing and fading of redness may take three to six months. TCA:New skin forms within five to ten days. The redness will fade over several weeks

Phenol: Permanent, although new wrinkles may form as skin ages.
TCA: Results vary and the effect is temporary.

EAR SURGERY

Procedure

Sets prominent ears back closer to the head and/or reduces the size of large ears. This procedure is most often performed on children between the ages of four and fourteen and may be covered by insurance.

Length

Approximately two hours.

Anesthesia

Young children: usually general anaesthesia is given. For older children or adults: a general or local anaesthesia is used with sedation.

Inpatient/Outpatient

Temporary throbbing, aching, swelling, redness and/or numbness.

Temporary throbbing, aching, swelling, redness and/or numbness.

Risks:

Infection of cartilage, excessive scarring, blood clots that may need to be drained, mismatched or artificial-looking ears, or the recurrence of the protrusion which requires repeat surgery.

Recovery:

The patient may return to school or work within five to seven days, and resume strenuous activity, such as contact sports in one to two months.

Usually permanent.

EYELID SURGERY

Procedure

Alters drooping upper eyelid skin and the puffy bags below the eyes by removing excess fat, skin and muscle.

Length

Approximately two hours.

Anesthesia

General anaesthesia or intravenous sedation and local anaesthesia are used.

Inpatient/Outpatient

This is an outpatient procedure.

Possible Side Effects:

Temporary discomfort, feeling of “tightness” in the eyelid area, swelling or bruising. Excessive tearing and sensitivity to light for the first few weeks should be expected. Temporary dryness, burning, or itching of eyes may also occur but these side effects are rare.

Risks:

Temporary blurred or double vision, infection, bleeding, swelling at the corners of the eyelids, dry eyes, formation of whiteheads, slight asymmetry in healing or scarring, difficulty in closing eyes completely (which is rarely permanent), and a lowered position of the lower eyelid of the lower lids which may require further surgery. Permanent loss of vision is a risk but this is extremely rare.

Recovery:

The patient may begin reading after about two to three days and can expect to return to work at approximately five to ten days. Use of contact lens may be resumed after two weeks (upon re-evaluation by the physician). The patient should not consume alcohol after the surgery. More strenuous activities and alcohol consumption may be resumed after three weeks. Bruising and swelling should be gone after several weeks.

For some, this procedure will last several years and for others it may be permanent

FACELIFT

Procedure

Improves sagging facial skin, jowls and loose neck skin by removing excess fat, tightening muscles and re-draping skin.

Length

Approximately 4 hours.

Anesthesia

Usually general anaesthesia is used or the patient may elect to have sedation and local anaesthesia.

Inpatient/Outpatient

Usually this is an outpatient procedure, although some patients may require a short hospital stay

Temporary bruising, swelling, numbness and tenderness of the skin, as well as a tight feeling and dry skin. For men, permanent need to shave behind ears, where beard-growing skin is repositioned.

Risks:

Injury to the nerves that control facial muscles or feeling (which is usually temporary but in rare cases may be permanent), infection, bleeding, poor healing, excessive scarring, asymmetry and a change in the hairline.

Recovery:

The patient may return to work after ten to fourteen days. More strenuous activity may be resumed after two weeks or more. Bruising should begin to disappear after seven to ten days. Sun exposure must be limited for several months after surgery. The use of a sun block that provides both UVA and UVB (Ultraviolet )protection is recommended.

Most facelifts can be expected to maintain optimum appearance for up to five to ten years.

FILLERS

Procedure

Soft tissue fillers, or “fillers” in short, are products which are intended to fill up defects in the soft tissues, typically wrinkles, folds and dents in the face. Some fillers are intended to add volume, for example to the cheekbone or the chin and are often used for lip enhancement. There are many products on the market. The most important distinction is between non-permanent fillers, which disappear spontaneously after a while, and the permanent fillers, which stay embedded in the tissues forever. Most non-permanent fillers are quite safe to use, but here also it is advisable to demand fillers that are generally accepted, or FDA approved, such the ones based on hyaluronic acid, collagen and calcium hydroxylapatite microspheres. Fillers are injected directly into the area to be treated, often after application of a topical anaesthetic cream. The effect is immediate, and lasts between 2-18 months, depending on the type of product and the treated area.

  • Always demand to know which product your physician is going to use.

Length

10-20 minutes

Anesthesia

Usually topical anaesthetic cream, sometimes a local anaesthetic injection.

Inpatient/Outpatient

Outpatient.

Possible Side Effects:

Transient swelling (mainly lips), redness, tenderness, bruising. Cold application after treatment can minimise these side effects.

Risks:

There is widespread consensus that, although they may seem appealing, permanent fillers are not to be recommended lightly as they sometimes induce adverse reactions which are very difficult if not totally impossible to treat without surgery. For all fillers, risks include irregularities or lumpiness, over- or under-correction, asymmetry and infection. Permanently visible lumps or late reactions with some permanent fillers can result.

Recovery:

If present, swelling and redness usually settles after 24-48 hours. Most patients can go back to their activities immediately with some make-up.

Partial or complete correction of wrinkles and folds. Enhancement of facial features

FOREHEAD LIFT

Procedure

Minimises forehead creases, drooping eyebrows, hooding over the eyes, furrowed forehead and frown lines by removing excess tissue, altering muscles and tightening the forehead skin. This procedure may be performed using the traditional technique, with an incision across the top of the head just behind the hairline, or with the use of an endoscope, which requires three to five short incisions, but allows access to the relevant areas to be treated incorporating a camera and a monitor to visualize the dissected areas.

Length

One to two hours

Anesthesia

General anaesthesia or intravenous sedation and local anaesthesia are options.

Inpatient/Outpatient

This is most often an outpatient procedure

When an endoscope is used: Temporary swelling, numbness, headaches, and bruising.
When using the traditional method, there is the possibility of itching and hair loss.

Risks:

Injury to facial nerves causing loss of motion, muscle weakness, or an asymmetrical look, persistent areas of numbness and broad and occasionally excessive scarring.

Recovery:

The patient usually returns to work in seven to ten days and even sooner with an endoscopic forehead lift. The patient must limit more strenuous activities for several weeks. Full recovery from bruising takes from two to three weeks. One should limit sun exposure for several months to avoid hyper pigmentation of the forehead which can occur as a result of sunlight exposure during the first 3-6 months after the procedure has been performed.

This procedure usually last up to five to ten years

GLUTEAL IMPLANT

Procedure

Improves the size and appearance of the gluteal area (buttocks) by placing silicone implants either under, in between or above the gluteal muscle producing a cosmetic enhancement.

Length

Approximately one and a half hours.

Anesthesia

General anaesthesia or epidural blockage is used.

Inpatient/Outpatient

Either, depending on the patient and doctor decision.

Possible Side Effects:

Mild to moderate temporary discomfort, mild swelling or bruising.

Risks:

The implant may need to be removed and/or replaced to treat problems including: implant rupture, formation of scar tissue around the implant (capsular contraction), which may cause the gluteus to feel tight or hard, bleeding, infection and implant misplacement.

Recovery:

The patient must sit as little as possible for the first 72 hours after surgery and should lie on their stomach or stand up most of the time. They can start sitting down but putting their weight on the back of their thighs rather than on their gluteal area. Some doctors may recommend special devices for sitting down for the first 10 to 15 days after surgery. The patient should wear a tight garment on the gluteal area and should not do any exercise or lift weight for several weeks. The patient should not consume alcohol after surgery. Alcohol consumption may be resumed after three weeks. Bruising and swelling should be gone after several weeks.

The outcome varies from patient to patient; however, the overall effect is the enhancement of the gluteus (buttocks) size for an improved appearance

LABIA MINORA REDUCTION

Procedure

Labia minora reduction, or labioplasty, is a remodelling of the enlarged inner lips of the vulva. Enlargement of the labia minora may be apparent from childhood, but most often it is acquired, caused by childbirth, age or infection. It may bother the patient in a functional (wearing clothes, during sports) or in an aesthetic way. The procedure removes skin and mucosa in a way that the scar is barely visible. The procedure may be combined with a clitoral hood reduction (removal of the skin excess around the clitoris) and labia minora surgery.

Length

The procedure typically takes between 1 – 3 hours depending on the additional surgeries that are performed as mentioned above.

Anesthesia

For better results and more comfort, general anaesthesia is the rule for this surgery. However, in some patients, local anaesthesia may be chosen.

Inpatient/Outpatient

The patient can leave the surgical facility the same day after recovery from anaesthesia.

When meticulous technique is applied, the procedure is without major side effects. Sometimes (<5% of cases) breakdown of the wound may occur, but healing with local wound care resolves the problem. In some patients, the scar tends to broaden, which can be corrected later.

Risks:

No important risks are correlated to this type of surgery.

Recovery:

The area may be swollen for 4-6 weeks. Depending on the technique, there may be a color mismatch that tends to fade after some time. Return to work is possible after 1 week. Sexual activity is allowed after 6-8 weeks.

With good technique, the results are very satisfying with an improved body image and greater physical comfort.

LASER FACIAL RESURFACING

Procedure

Smoothes fine lines and wrinkles are removed using a carbon dioxide (CO2) Erbium laser, or other laser devices, that resurfaces several layers of damaged skin. These procedures also helps to soften lines around the eyes and mouth and minimize facial scars and unevenly pigmented areas

Length

The procedure takes approximately one hour – depending on the area to be treated. Some cases may require more than one session – six at most.

Anesthesia

A general anaesthesia is used or intravenous sedation and local anaesthesia are used.

Inpatient/Outpatient

This is an outpatient procedure.

Possible Side Effects:

Temporary swelling of the resurfaced area along with mild discomfort, lightening or darkening of treated skin (hypo/hyper-pigmentation), acute sun sensitivity and/or increased sensitivity to makeup and skin care products. A pinkness or redness of the skin may persist for up to six months.

Risks:

Burns or injuries caused by the laser’s heat, scarring, abnormal changes in skin color, flare-up of viral infections (cold sores) and rarely, other infections.

Recovery:

The patient may return to work after approximately two weeks. More strenuous activities may be resumed after four to six weeks. Complete fading of redness can take up to six months. The patient should avoid ultraviolet light exposure for three to six months. The use of sun blocks that contain UVA and UVB protection is very helpful and strongly recommended.

Long lasting, but this procedure does not stop the ageing process. New wrinkles and expression lines may form as the skin continues to age.

LIPOFILLING

Procedure

Using a person’s own fat to fill in irregularities and grooves is now a well-established technique which was perfected in the early nineties to a predictable procedure.

Aesthetic indications for undergoing lipofilling include sunken cheeks, the disappearance of fat from the cheekbones, deep grooves running from the nose to the corners of the mouth, and in some instances of lines between the lower eyelids and the cheek. It is also one of the most common methods used for lip enhancement. In addition, lipofilling can be used to smooth out all types of irregularities such as those resulting from poorly performed liposuction or injuries.

The necessary fat is obtained by a limited liposculpture through one or several 3-5 mm incisions. It is normally taken from the abdomen or inner thigh. The aspirated fat is processed by centrifuging, filtering or rinsing. Pure liquid fatty tissue ready for injection is the result.

The fat is then injected where needed. The fat is evenly distributed into the area by injecting minute amounts in the tissues so that the injected fat is well surrounded by healthy tissue. This ensures that the transplanted fat remains in contact with the surrounding tissues which must supply it with oxygen and nutrients.

Length

About an hour, depending on the size of the areas to be treated.

Anesthesia

Local infiltration anaesthesia of the donor area and the area to be treated.

Inpatient/Outpatient

Either

Donor area: bruising, swelling, tenderness, up to 24 hours drainage of anaesthetic liquid.

Treated area: bruising, swelling (especially the lips if treated), tenderness.

The areas that have been treated will be rather swollen immediately after the operation, especially the lips if they have been treated. It is therefore important to use a cold pack and a compress in the first few hours to minimize the swelling. A cold pack is a freezer bag filled with ice cubes and water.

The swelling will increase until about the third day, but will then gradually subside. After about a week to ten days patients feel confident about going out and resuming a normal social life. If any bruises have developed, they might remain visible for a little longer but can be hidden reasonably well with makeup.

Patients should have a check-up with the surgeon after five to seven days and again three weeks later. By then most of the swelling will have subsided, but the correction may still look rather exaggerated. Surgeons usually over-correct, which means injecting more fat than is actually needed because 25 to 30% of the transplanted fat cells do not survive. The final result is assessed after three months. The surgeon will then take photographs to be compared with those taken before the procedure. A second session may be scheduled to top up any shortfall in volume.

Risks:

Asymmetry, irregularities, overcorrection, infection.

Recovery:

Swelling usually diminishes from the third day on, and social activities can be restarted after about one week, sometimes with the help of some make-up.

Correction of deep wrinkles and folds. Correction of the treated irregularities and dents. Volume augmentation of the treated areas such as cheekbone, cheek, chin. Improved quality of the overlying skin can be a positive side-effect. After initial resorption of a percentage of the fat (between 20 and 50%) the correction can be considered permanent.

LIPOSUCTION

Procedure

Improves body shape by removing exercise-resistant fat deposits with a tube and a vacuum device. This procedure can be performed using the tumescent or the super-wet techniques. Liposuction techniques typically are performed after targeted fat cells are infused with a saline solution containing a local anaesthetic and adrenalin to decrease blood loss, allow an easier removal of the fat, as well as diminish postoperative discomfort. This also reduces post-operative bruising and swelling. The most common locations for liposuction are: chin, cheeks, neck, and upper arms, the area above the breasts, abdomen, buttocks, hips, thighs, knees, calves, and ankles.
There are two types of techniques commonly used: the “Traditional Technique” and the “Ultrasonic Technique (UA)”. The Traditional Technique utilizes a hollow tube to remove the fat and the Ultrasonic Technique utilizes ultrasonic energy to dissolve that fat before it is removed. (See your Physician regarding which technique would be best for you)

Length

Traditional: One to two hours or more
UAL is peel out: 20-40% longer than Traditional liposuction

Anesthesia

General anaesthesia can be used or intravenous sedation and local anaesthesia are used.

Inpatient/Outpatient

This is an outpatient procedure.

Possible Side Effects:

Temporary bruising, swelling, numbness, soreness or burning sensations.

Risks:

Infection, asymmetry, rippling of the skin, pigmentation changes (hypo/hyper), injury to the skin, fluid retention and/or excessive loss of blood and fluids.

Recovery:

The patient usually returns to work after five to fourteen days. More strenuous activity may be resumed after two to four weeks. Full recovery from swelling and bruising may take one to six months depending upon the amount of fat that is removed and the areas that were treated.

The effect is permanent and must be augmented with a sensible diet and consistent exercise.

MALE BREAST REDUCTION

Procedure

Reduces enlarged, female-like breasts in men using liposuction and/or surgically removing excess glandular tissue.

Length

Approximately one and one-half to three hours

Anesthesia

Either general anaesthesia is used or intravenous sedation and local anaesthesia are used.

Inpatient/Outpatient

This is an outpatient procedure.

Temporary bruising, swelling, numbness, soreness, and/or a burning sensation are possible.

Risks:

Infection, fluid build-up, injury to the skin, rippling or looseness of the skin, asymmetry, pigmentation changes, excessive scarring if tissue was cut away, loss of nipple sensation, contour irregularities and in some instances the need for a second procedure to remove additional tissue is required.

Recovery:

The patient may go back to work after seven days. More strenuous activity may be resumed after two to three weeks. Most of the swelling and bruising will disappear after three to six months.

Permanent, although weight gain may cause the breast area to once again become larger.

MID FACE LIFT

Procedure

Rejuvenates the central section of the face from the lower eyelid to the upper lip, by repositioning sagging tissues and enhancing the volume of soft tissue that is lost in the mid-face with age, sun exposure, and gravity.

Length

The procedure takes approximately one to two hours.

Anesthesia

General anaesthesia can be used or intravenous sedation and local anaesthesia are used.

Inpatient/Outpatient

May be either depending upon whether other procedures are being performed at the same time

Possible Side Effects:

Temporary swelling, numbness, weakness of facial muscles or dry eyes

Risks:

Infection, persistent swelling, persistent dry eyes, permanent muscle weakness or areas of permanent numbness are possible.

Recovery:

The patient may resume work in seven to fourteen days. More strenuous activities may be resumed after three weeks.

The results are usually permanent.

MINI ABDOMINOPLASTY

Procedure

A mini-abdominoplasty is limited supra-pubic skin removal using liposuction. The patient must have minimal to moderate skin redundancy, a small amount of abdominal fat, and minor to moderate muscle flaccidity. The surgeon aspirates the abdominal fat, removes the supra-pubic skin redundancy, and in cases of muscle flaccidity, the medial part of the abdominal skin is removed. Finally the skin is sutured with the umbilicus preserved.

Length

One to three hours.

Anesthesia

This surgery can be performed under general, epidural or local anaesthesia with sedation, according to surgeon/patient preference.

Inpatient/Outpatient

Either

Possible Side Effects:

Infection, bruising, delayed healing of the wound or keloid scaring in patients with this predisposition, and post-operative complications. Numbness of abdominal skin will recover after several months.

Risks:

In young, healthy patients the risk is low. Pulmonary embolism is possible but very rare.

Recovery:

Post-operative pain relief is achieved with the use of long-duration effect local anaesthetic. The same attention should be taken as for a general or gynaecological surgery: 7-10 days of post-operative care. Elastic compression of the abdomen must be used for 4 weeks.

The result will last many years, unless the patient gains weight or becomes pregnant.

NOSE SURGERY

Procedure

Reshapes the nose by reducing or increasing the size, removing humps, changing the shape of tip or bridge, narrowing the span of the nostrils, or changing the angle between the nose and upper lip. This procedure may also relieve some breathing difficulties when combined with surgery performed on the nasal septum.

Length

Surgery takes approximately one hour or more.

Anesthesia

General or intravenous sedation and local anaesthesia are used.

Inpatient/Outpatient

This is an outpatient procedure

Possible Side Effects:

Temporary swelling, bruising around the eyes, and/or nose and some bleeding and nasal stuffiness.

Risks:

Infection, persistent swelling, persistent dry eyes, permanent muscle weakness or areas of permanent numbness are possible.

Recovery:

The patient may go back to work after one week. More strenuous activities may be resumed after two to three weeks. The patient should avoid any activity that could impact on the nose or becoming sunburned for at least eight weeks. The use of a sunblock that provides both UVA and UVB protection is useful. The final results may take up to one year and sometimes longer to achieve. (Why longer? The nose seems to be the part of the body that takes the longest to completely assume the final appearance after cosmetic plastic surgical procedures. This is related to the time required for reestablishment of lymphatic drainage pathways which are responsible for the resolution of swelling)

Permanent

PERIORAL REJUVENATION

Procedure

This procedure improves the appearance of the lips by restoring volume and/or reduction of wrinkles around the mouth. Improving the volume of the lips can be achieved with fillers (see section on “Fillers”) or with lipofilling (see section on “Lipofilling”). Techniques to reduce or eliminate wrinkles include resurfacing using options such as lasers or peels. One can distinguish between ablative (removing a thin layer of wrinkled skin) and non-ablative procedures. Ablative procedures include CO2 laser, Erbium-YAG laser and chemical or mechanical peels and some non-ablative procedures are intense pulse light (IPL) and radio frequency techniques which typically require several sessions to achieve the desired result.

Length

Approximately 30 minutes to one hour.

Anesthesia

The surgeon will decide what type of anaesthesia is best according to the chosen procedure. It will vary from topical to local, local plus sedation, or general anaesthesia.

Inpatient/Outpatient

These are outpatient procedures.

Possible Side Effects:

Most procedures on the lips will cause a varying degree of temporary swelling. Mild temporary discomfort is normal, rarely mild bruising. When ablative techniques are used, one often sees skin peeling and/or redness according to the chosen technique. See the specific sections on “Laser Facial Resurfacing” and “Chemical Peel” for more detailed information.

Risks:

Infection, overcorrection in size, irregularities and/or asymmetry with fillers, changes in skin pigmentation, or fever blisters (Herpes Simplex) with resurfacing techniques.

Recovery:

In most cases, the patient can return to work and normal activities the same day. Bruising and swelling should have resolved after several days. When an ablative procedure is used, the recovery time can be several days. Changes in color of the skin can be present for several days or weeks, but can be camouflaged with makeup. When using ablative procedures, it is recommended to use sun screen for several weeks.

The outcome varies from patient to patient. One can expect a restoration of a youthful appearance of the mouth area and an enhancement of lip shape. When using non-permanent fillers, results will be lost after several months. Reduction to complete disappearance of wrinkles around the mouth after resurfacing varies by patient.

THIGH LIFT

Procedure

A thigh lift refers to a variety of operations that remove skin and fat from the upper leg (thigh) area in order to improve contours by removing bulk and or loose soft tissues.

Length

2 to 4.5 hours depending on the amount of tissue to be removed. Usually requires at least one position change and re-prepping and draping as patients are switched from front to back or vice versa.

Anesthesia

General or intravenous sedation and local anaesthesia are used.

Inpatient/Outpatient

This is an outpatient procedure

Possible Side Effects:

Most common is wound breakdown at the intersection of suture lines in the groin because of excessive stretch of the tight closure caused by patient movement.
Widened scars can occur because of tension in these areas as well.

Risks:

Similar to risks associated with any surgery, including infection, hematoma and fluid collection. Pulmonary embolism is a remote possibility.

Recovery:

Requires 3-4 weeks of restricted movement: no spreading of the legs or excessive flexion. Best done in colder months of the year because special post-operative garment wear for support is important.

This type of surgery is generally well tolerated and appreciated by patients.

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