• To enhance the body contour of a woman who, for personal reasons, feels her breast size is too small.
• To correct a reduction in breast volume after pregnancy.
• To balance a difference in breast size.
• As a reconstructive technique following breast surgery. By inserting an implant behind each breast, we are able to increase a woman’s bustline by one or more bra cup sizes. If you’re considering breast augmentation, this will give you a basic understanding of the procedure -when it can help, how it’s performed, and what results you can expect. It can’t answer all of your questions, since a lot depends on your individual circumstances. Please ask us if there is anything you don’t understand about the procedure.

THE BEST CANDIDATES FOR BREAST AUGMENTATION

Breast augmentation can enhance your appearance and your selfconfidence, but it won’t necessarily change your looks to match your ideal, or cause other people to treat you differently. Before you decide to have surgery, think carefully about your expectations and discuss them with us. The best candidates for breast augmentation are women who are looking for improvement, not perfection, in the way they look. If you’re physically healthy and realistic in your expectations, you may be a good candidate.

TYPES OF IMPLANTS

A breast implant is a silicone shell filled with either silicone gel or a saltwater solution known as saline. We are using the textured silicone filled implant. The results with this are superior to saline implants. The silicone can be gel or cohesive. The type of implant depends on the goal to be achieved and approach chosen.

ALL SURGERY CARRIES SOME UNCERTAINTY AND RISK

Breast augmentation is relatively straightforward. But as with any operation, there are risks associated with surgery and specific complications associated with this procedure. The most common problem, capsular contracture, occurs if the scar or capsule around the implant begins to tighten. This squeezing of the soft implant can cause the breast to feel hard. Capsular contracture can be treated in several ways, and sometimes requires either removal or “scoring” of the scar tissue, or perhaps removal or replacement of the implant.

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

A small percentage of women develop an infection around an implant. This may occur at any time, but is most often seen within a week after surgery.

In some cases, the implant may need to be removed for several months until the infection clears. A new implant can then be inserted.

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

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

Occasionally, breast implants may break or leak. Rupture can occur as a result of injury or even from the normal compression and movement of your breast and implant, causing the man-made shell to leak. If a saline-filled implant breaks, the implant will deflate in a few hours and the salt water will be harmlessly absorbed by the body. If a break occurs in a gel-filled implant, however, one of two things may occur. If the shell breaks but the scar capsule around the implant does not, you may not detect any change. If the scar also breaks or tears, especially following extreme pressure, silicone gel may move into surrounding tissue. The gel may collect in the breast and cause a new scar to form around it, or it may migrate to another area of the body. There may be a change in the shape or firmness of the breast. Both types of breaks may require a second operation and replacement of the leaking implant. In some cases, it may not be possible to remove all of the silicone gel in the breast tissue if a rupture should occur. A few women with breast implants have reported symptoms similar to diseases of the immune system, such as scleroderma and other arthritis-like conditions. These symptoms may include joint pain or swelling, fever, fatigue, or breast pain. Research has found no clear link between silicone breast implants and the symptoms of what doctors refer to as “connective tissue disorders,”. While there is no evidence that breast implants cause breast cancer, they may change the way mammography is done to detect cancer. When you request a routine mammogram, be sure to go to a radiology center where technicians are experienced in the special techniques required to get a reliable x-ray of a breast with an implant. Additional views will be required. Ultrasound examinations may be of benefit in some women with implants to detect breast lumps or to evaluate the implant.

PLANNING YOUR SURGERY

In your initial consultation, we will evaluate your health and explain which surgical techniques are most appropriate for you, based on the condition of your breasts and skin tone. If your breasts are sagging, maybe a breast lift is indicated.

PREPARING FOR YOUR SURGERY

We will give you instructions to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications. While making preparations, be sure to arrange for someone to drive you home after your surgery and to help you out for a few days, if needed.

ABOUT THE OPERATION

I prefer to do the procedure in a clinic with general anesthesia. You will be one night in the clinic. The method of inserting and positioning your implant will depend on your anatomy and our recommendation. The incision can be made either in the crease where the breast meets the chest, around the areola (the dark skin surrounding the nipple), or in the armpit. Every effort will be made to assure that the incision is placed so resulting scars will be as inconspicuous as possible. Most of my patients choose the axillary approach, because the scar is completely hidden and the breast tissue and areola are not disturbed. I never do the crease incision. However some women prefer to have the incision in the areola rather than in the armpit. Working through the incision, the breast tissue is lifted to create a pocket, either directly behind the breast tissue or underneath your chest wall muscle (the pectoral muscle). The implants are then centered beneath your nipples. Putting the implants behind your chest muscle may reduce the potential for capsular contracture. Drainage tubes may be used for several days following the surgery. This placement may also interfere less with breast examination by mammogram than if the implant is placed directly behind the breast tissue. Placement behind the muscle however, may be more painful for a few days after surgery than placement directly under the breast tissue. The surgery usually takes one to two hours to complete. Stitches are used to close the incisions, which may also be taped for greater support. A gauze bandage is applied overnight and substituted for the bra before you leave the clinic.

AFTER YOUR SURGERY

You’re likely to feel tired and sore for a few days following your surgery, but you’ll be up and around in 24 to 48 hours. Most of your discomfort can be controlled by medication. The bra has to be worn day and night for one month. The bra helps the implant to rest within the pocket and to enhance the new inframammary fold. It has to be a sport bra with straps to regulate chest width and shoulder height. You may also experience a burning sensation in your nipples for about two weeks, but this will subside as bruising fades. Your stitches will come out in a week to 10 days, but the swelling in your breasts may take three to five weeks to disappear.

GETTING BACK TO NORMAL

You should be able to return to work within a few days, depending on the level of activity required for your job. I recommend not to do exercise in 10 days. You can resume your work in 3- 4 days. Your breasts will probably be sensitive to direct stimulation for two to three weeks, so you should avoid much physical contact. After that, breast contact is fine once your breasts are no longer sore, usually three to four weeks after surgery. Your scars will be firm and pink for at least six weeks. Then they may remain the same size for several months, or even appear to widen. After several months, your scars will begin to fade, although they will never disappear completely. Routine mammograms should be continued after breast augmentation for women who are in the appropriate age group, although the mammographic technician should use a special technique to assure that you get a reliable reading, as discussed earlier.

YOUR NEW LOOK

For many women, the result of breast augmentation can be satisfying, even exhilarating, as they learn to appreciate their fuller appearance. Regular examination by your plastic surgeon and routine mammograms for those in the appropriate age groups at prescribed intervals will help assure that any complications, if they occur, can be detected early and treated. Your decision to have breast augmentation is a highly personal one that not everyone will understand. The important thing is how you feel about it. If you’ve met your goals, then your surgery is a success.

A video showing how the procedure is performed (axillary approach with cohesive anatomic implants):

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3. Breast augmentation with fat autografting

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1. Muscular implants
2. Pec implants
3. Pec implants: on La Sexta TV

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1. Dermolipectomies

Although the silicone implants that we use (cohesive gel) are very safe and a very low percentage of complications (<1%), there are women who wish to have their breast increased without the utilization of prosthesis. There is a hialuronic acid in the market that intends to be an alternative therapeutics to fill in the breast. However the disadvantages of this product are its cost and that every 2 years it requires a re-intervention since the product is reabsorbed.

An alternative to the implant is using fat. For years this technique was considered as little safe since the fat could be reabsorbed or if it was injected into great volumes it could produce cysts. However with the procedure developed by a North American surgeon, Dr. Coleman, we can obviate these disadvantages.

The fat is obtained by liposuction of other zones of the body and undergoes a preparation to obtain only the intact cells. This process is in a basic way a centrifugation. The fat like this obtained is used to fill the breast with very fine and small syringes, so that we inject very small amounts that they have a great likelihood of survival. It is a matter of depositing thousands of micrografts of less than 2 mm of diameter, creating a scaffold that increase with every layer. The fat is placed around the gland, never in it.

In the immediate postoperative period there is inflammation that subsides in some days. The volume of the breast is considered stable in around 3 months. The grafted fat cells are part of the breast and this shows a totally natural look.

The technique is indicated in those women who undertake a treatment of the body contour (liposuction or abdominoplasty) and who wish at the same time to see the breast volume enhanced. Also in those women the priority of whom is breast augmentation and have enough donor sites (fat deposits) to be used. The third indication is in those women already that they have had a breast augmentation and have a contour irregularity or asymmetry (for example, double grooves, tuberoses mums, “rippling” of l’implant…).

It is evident that it is not indicated in thin patients without body fat.

The main disadvantages of this technique are that requires a liposuction to obtain the fat, which increases the surgical time and add the corresponding postoperative discomfort and potential complications; and that the volume that can be achieved with this technique corresponds to one bra cup. For an bigger volume we have to continue considering the utilization of implants.

Next there is a link where they can see using fat to correct a deformity of double fold after breast augmentation with implants.

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1. Breast augmentation with fat (lipofilling)
2. Fat storage banks: Cryolip partnering
3. Stem cells, fat and breast augmentation

The first step is to prepare the zone with two sessions of radio frequency to start the process of dermal repair and to start the contraction of the skin. For this, accent radio frequency, a non-invasive technique that allows to improve the contour and the texture of the skin, pulling it and reaffirming it, is used. The heat generated by the radiofrequency acts on the collagen fibers, strengthening them and producing an effect called colagenogenesis. It also compacts  the fat, although this is not the most important effect.

Next we carry out a superficial liposuction with local anesthesia, using a fine cannula since it allows us to sculpt the form of the buttock through the selective extraction of fat. We do not take out all the fat from the zone, because in this case the buttock would fall down. The fine cannula allows to detach the skin and to favor the formation of a scar that will shrink the skin. In this same surgical act the depressed zone that there is under the roll is filled with fat. This is to soften the transition with the thigh.

Finally, one month after this intervention and after the initial phase of inflammation, two sessions more are carried out of radio frequency.

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1. Fat grafting in aesthetic and reconstructive breast surgery
2. Dermolipectomies
3. Calf implants

The best candidates for rhinoplasty

Rhinoplasty can enhance your appearance and your self-confidence, but it won’t necessarily change your looks to match your ideal, or cause other people to treat you differently. Before you decide to have surgery, think carefully about your expectations. The best candidates for rhinoplasty are people who are looking for improvement, not perfection, in the way they look. If you’re physically healthy, psychologically stable, and realistic in your expectations, you may be a good candidate. Rhinoplasty can be performed to meet aesthetic goals or for reconstructive purposes-to correct birth defects or breathing problems. Age may also be a consideration. I prefer not to operate on teenagers until after they’ve completed their growth spurt-around 14 or 15 for girls, a bit later for boys. It’s important to consider teenagers’ social and emotional adjustment, too, and to make sure it’s what they, and not their parents, really want.

All surgery carries some uncertainty and risk

After surgery, small burst blood vessels may appear as tiny red spots on the skin’s surface; these are usually minor but may be permanent. As for scarring, when rhinoplasty is performed from inside the nose, there is no visible scarring at all; when an “open” technique is used, or when the procedure calls for the narrowing of flared nostrils, the small scars on the base of the nose are usually not visible. In about one case out of ten, a second procedure may be required-for example, to correct a minor deformity. Such cases are unpredictable and happen even to patients of the most skilled surgeons. The corrective surgery is usually minor.

Planning your surgery

In your initial consultation, we will ask what you’d like your nose to look like, evaluate the structure of your nose and face, and discuss the possibilities with you. He or she will also explain the factors that can influence the procedure and the results. These factors include the structure of your nasal bones and cartilage, the shape of your face, the thickness of your skin, your age, and your expectations. We will also explain the techniques and anesthesia, the type of facility where the surgery will be performed, the risks and costs involved, and any options you may have. Be sure to tell your surgeon if you’ve had any previous nose surgery or an injury to your nose, even if it was many years ago. You should also inform your surgeon if you have any allergies or breathing difficulties; if you’re taking any medications, vitamins, or recreational drugs; and if you smoke. Don’t hesitate to ask your doctor any questions you may have, especially those regarding your expectations and concerns about the results.

Preparing for your surgery

We will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, taking or avoiding certain vitamins and medications, and washing your face. Carefully following these instructions will help your surgery go more smoothly. While you’re making preparations, be sure to arrange for someone to drive you home after your surgery and to help you out for a few days if needed.

About the operation

Rhinoplasty is performed in a hospital. It’s usually done on an inpatient basis (just one night). Except for minor operations on tip, adjustments, or minor revisions, general anesthesia is preferred. Rhinoplasty usually takes an hour or two, though complicated procedures may take longer. During surgery the skin of the nose is separated from its supporting framework of bone and cartilage, which is then sculpted to the desired shape. The nature of the sculpting will depend on your problem and your surgeon’s preferred technique. Finally, the skin is redraped over the new framework. Depending in what to do, your nose will be worked from within the nose, making their incision inside the nostrils. For difficult nasal tips or complicated cases I prefer the “open” procedure: a small incision across the columella, the vertical strip of tissue separating the nostrils, is performed to access the nose. When the surgery is complete, a splint will be applied to help your nose maintain its new shape. Nasal packs or soft plastic splints also may be placed in your nostrils to stabilize the septum, the dividing wall between the air passages.

After your surgery

After surgery-particularly during the first twenty-four hours-your face will feel puffy, your nose may ache, and you may have a dull headache. You can control any discomfort with the pain medication. Plan on staying in bed with your head elevated (except for going to the bathroom) for the first day. You’ll notice that the swelling and bruising around your eyes will increase at first, reaching a peak after two or three days. Applying cold compresses will reduce this swelling and make you feel a bit better. In any case, you’ll feel a lot better than you look. Most of the swelling and bruising should disappear within two weeks or so. (Some subtle swelling-unnoticeable to anyone but you and your surgeon-will remain for several months.) A little bleeding is common during the first few days following surgery, and you may continue to feel some stuffiness for several weeks. Do not to blow your nose for a week or so, while the tissues heal. If you have nasal packing, it will be removed after a few days and you’ll feel much more comfortable. By the end of one or, occasionally, two weeks, all dressings, splints, and stitches should be removed.

Getting back to normal

Most rhinoplasty patients are up and about within two days, and able to return to school or sedentary work a week or so following surgery. It will be several weeks, however, before you’re entirely up to speed. We usually recommend to avoid strenuous activity (jogging, swimming, bending, sexual relations-any activity that increases your blood pressure) for two to three weeks. Avoid hitting or rubbing your nose, or getting it sunburned, for eight weeks. Be gentle when washing your face and hair or using cosmetics. You can wear contact lenses as soon as you feel like it, but glasses are another story. Once the splint is off, they’ll have to be taped to your forehead or propped on your cheeks for another six to seven weeks, until your nose is completely healed. Your surgeon will schedule frequent follow-up visits in the months after surgery, to check on the progress of your healing. If you have any unusual symptoms between visits, or any questions about what you can and can’t do, don’t hesitate to call us.

Your new look

In the days following surgery, when your face is bruised and swollen, it’s easy to forget that you will be looking better. In fact, many patients feel depressed for a while after plastic surgery-it’s quite normal and understandable. Rest assured that this stage will pass. Day by day, your nose will begin to look better and your spirits will improve. Within a week or two, you’ll no longer look as if you’ve just had surgery. Still, healing is a slow and gradual process. Some subtle swelling may be present for months, especially in the tip. The final results of rhinoplasty may not be apparent for a year or more. In the meantime, you might experience some unexpected reactions from family and friends. They may say they don’t see a major difference in your nose. Or they may act resentful, especially if you’ve changed something they view as a family or ethnic trait. If that happens, try to keep in mind why you decided to have this surgery in the first place. If you’ve met your goals, then your surgery is a success.

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1. Chin surgery
2. Nasal reconstruction

• Breasts that are too large in proportion to your body frame
• Heavy, pendulous breasts with nipples and areolas that point downward one breast is much larger than the other
• Back, neck or shoulder pain caused by the weight of your breasts
• Skin irritation beneath your breasts
• Indentations in your shoulders from tight bra straps
• Restriction of physical activity due to the size and weight of your breasts
• Dissatisfaction or self-consciousness about the largeness of your breasts

Breast reduction can be performed at any age, but usually we recommend waiting until breast development has stopped. Childbirth and breast-feeding may have significant and unpredictable effects on the size and shape of your breasts. Nevertheless, many women decide to undergo breast reduction before having children and feel that they can address any subsequent changes later. If you plan to breast-feed in the future, you should discuss this with us. During the consultation, you will be asked about your desired breast size as well as anything else about your breasts that you would like to see improved.

All surgery carries some uncertainty and risk

Fortunately, significant complications from breast reduction are infrequent. Every year, many thousands of women undergo successful breast reduction surgery, experience no major problems and are pleased with the results. Anyone considering surgery, however, should be aware of both the benefits and the risks. Some of the potential complications that may be discussed with you include bleeding, infection and reactions to anesthesia. Rarely, a patient may require a blood transfusion during the operation. This usually can be anticipated in advance, and your plastic surgeon may, under certain circumstances, advise you to donate your own blood in preparation for surgery. Following reduction, sometimes the breasts may not be perfectly symmetrical or the nipple height may vary slightly. If desired, minor adjustments can be made at a later time. Permanent loss of sensation in the nipples or breasts may occur rarely. Revisionary surgery is sometimes helpful in certain instances where incisions may have healed poorly. In the unlikely event of injury to or loss of the nipple and areola, they usually can be satisfactorily reconstructed using skin grafts.

Planning your surgery

We will examine your breasts, taking measurements and perhaps photographs for your medical record. The size and shape of your breasts, the quality of your skin, and the placement of the nipples and areolas will be carefully evaluated. You should come to the consultation prepared to discuss your medical history. This will include information about any medical conditions, drug allergies, medical treatments you have received, previous surgeries including breast biopsies, and medications that you currently take. It is important for you to provide complete information. You should tell us if you plan to lose a significant amount of weight, particularly if you have noticed that your breasts become smaller with weight loss.

Preparing for surgery

Depending on your age, or if you have a history of breast cancer in your family, we may recommend a baseline mammogram before surgery and another mammographic examination some months after surgery. This will help to detect any future changes in your breast tissue. Following breast reduction, you will still be able to perform breast self-examination. Breast reduction surgery will not increase your risk of developing breast cancer. If you are a smoker, you will be asked to stop smoking well in advance of surgery. Aspirin and certain anti-inflammatory drugs can cause increased bleeding, so you should avoid taking these medications for a period of time before surgery. Your surgeon will provide you with additional preoperative instructions. Whether you are released the day of surgery or the following day, you will need someone to drive you home and to stay with you for the next day or two.

About the operation

The operation is performed under general anesthesia and needs 1-2 days in the clinic. Individual factors and personal preferences will determine the specific technique selected to reduce the size of your breasts. The most common method of reducing the breasts what we are doing actually is the short vertical scar technique. This leaves a scar around the areola and vertical from this down to the inframammary crease. We try to avoid the anchor-like scar, although in very big or saggy breasts has to be done. After the excess breast tissue, fat and skin, have been removed the nipple and areola are shifted to a higher position. The areola, which in large breasts usually has been stretched, also is reduced in size. Skin that was formerly located above the nipple is brought down and together to reshape the breast. Liposuction may be used to improve the contour under the arm. Usually, the nipples and areolas remain attached to underlying mounds of tissue, and this allows for the preservation of sensation. The ability to breast-feed may also be preserved by this method, although this cannot be guaranteed. Rarely, if your breasts are extremely large, the nipples and areolas may need to be completely detached before they are shifted to a higher level. In such a case, you will need to have made the decision to sacrifice sensation and the possibility of breast-feeding in order to achieve your desired breast size. In many instances, small drain tubes will have been placed in your breasts to help avoid the accumulation of fluids. Gauze dressings will be placed on your breasts and covered with an elastic bandage.

After the surgery

The day after surgery, you will be encouraged to get out of bed for short periods of time. After several days, you will be able to move about more comfortably. Straining, bending and lifting must be avoided, however, since these activities might cause increased swelling or even bleeding. You may be instructed to sleep on your back to avoid pressure on your breasts. Any surgical drains will be removed a day or two after surgery, at which time your dressings may also be changed or removed. You will be instructed to wear a support bra for a few weeks, until the swelling and discoloration of your breasts diminishes. Generally, stitches will be removed in stages over a period of approximately three weeks, beginning about one week after surgery. You may notice that you feel less sensation in the nipple and areola areas. This usually is temporary. It may, however, take weeks, months or even more than a year before sensation returns to normal. Your breasts may also require some time to assume a more natural shape. Incisions will initially be red or pink in color. They will remain this way for many months following surgery.

Getting back to normal

After breast reduction surgery, it is often possible to return to work within just a couple of weeks, depending on your job. In many instances, you can resume most of your normal activities, including some form of mild exercise, after several weeks. You may continue to experience some mild, periodic discomfort during this time, but such feelings are normal. Severe pain should be reported to your doctor. Any sexual activity should be avoided for a minimum of one week, and your plastic surgeon may advise you to wait longer. After that, care must be taken to be extremely gentle with your breasts for at least the next six weeks.

Your new look

Breast reduction surgery will make your breasts smaller and firmer. Without the excessive weight of large breasts, you may find greater enjoyment in playing sports and engaging in physical activity. The incisions from your breast reduction surgery will heal and fade over time. It is important to realize, however, that the incision lines will be permanently visible, more so in some individuals than others. Fortunately, the incisions for breast reduction are in locations easily concealed by clothing, even low-cut necklines. Breast reduction often makes a dramatic change in your appearance. For this reason, it may take some time to adjust to your new body image. Most women, however, eventually become comfortable with their smaller breasts and feel very pleased with the results of surgery. In fact, the level of patient satisfaction resulting from breast reduction is among the highest of any plastic surgery procedure. Unless you gain or lose a significant amount of weight or become pregnant, your breast size should remain fairly constant. However, gravity and the effects of aging will eventually alter the size and shape of virtually every woman’s breasts. If, after a period of years, you become dissatisfied with the appearance of your breasts, you may choose to undergo a breast “lifting” procedure to restore their more youthful contour. Your satisfaction with a breast reduction is likely to be greater if you understand the procedure thoroughly and if your expectations are realistic

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1. Fat grafting in aesthetic and reconstructive breast surgery
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All surgery carries some uncertainty and risk

A small percentage of patients may develop a blood clot on the ear. It may dissolve naturally or can be drawn out with a needle. Occasionally, patients develop an infection in the cartilage, which can cause scar tissue to form. Such infections are usually treated with antibiotics; rarely, surgery may be required to drain the infected area.

Planning for surgery

Most surgeons recommend that parents stay alert to their child’s feelings about protruding ears; don’t insist on the surgery until your child wants the change. Children who feel uncomfortable about their ears and want the surgery are generally more cooperative during the process and happier with the outcome. In the initial meeting, we will evaluate your child’s condition, or yours if you are considering surgery for yourself, and recommend the most effective technique. He or she will also give you specific instructions on how to prepare for surgery.

About the operation

Ear surgery is usually performed as an outpatient procedure in the clinic. Occasionally, if the procedure is done as an inpatient procedure, you can plan on staying overnight in the hospital. If your child is young, we may recommend general anesthesia, so the child will sleep through the operation. For older children or adults, we use local anesthesia, combined with a sedative, so you or your child will be awake but relaxed. Ear surgery usually takes about two to three hours. The technique will depend on the problem. The commonest technique consists of making a small incision in the back of the ear to expose the ear cartilage. The cartilage is sculpted and bend it back toward the head. Non-removable stitches may be used to help maintain the new shape. Another technique involves a non-scar procedure. The ear is bent with buried stitches and no skin is removed. The technique is simpler and mainly indicated for minor anomalies. The disadvantage is that stitches can loose and classic technique should be done in this case. In most cases, ear surgery will leave a faint scar in the back of the ear that will fade with time. Even when only one ear appears to protrude, surgery is usually performed on both ears for a better balance.

Getting back to normal

Adults and children are usually up and around within a few hours of surgery, although you may prefer to stay overnight in the hospital with a child until all the effects of general anesthesia wear off. The patient’s head will be wrapped in a bulky bandage immediately following surgery to promote the best molding and healing. The ears may throb or ache a little for a few days, but this can be relieved by medication. Within a few days, the bulky bandages will be replaced by a lighter head dressing similar to a headband. Be sure to follow we’s directions for wearing this dressing, especially at night. Stitches are usually removed, or will dissolve, in about a week. Any activity in which the ear might be bent should be avoided for a month or so. Most adults can go back to work about five days after surgery. Children can go back to school after seven days or so, if they’re careful about playground activity. You may want to ask your child’s teacher to keep an eye on the child for a few weeks.

Other ear problems

Besides protruding ears, there are a variety of other ear problems that can be helped with surgery. These include: “lop ear,” when the tip seems to fold down and forward; “cupped ear,” which is usually a very small ear; and “shell ear,” when the curve in the outer rim, as well as the natural folds and creases, are missing. Surgery can also improve large or stretched earlobes, or lobes with large creases and wrinkles. Surgeons can even build new ears for those who were born without them or who lost them through injury. Sometimes, however, the correction can leave a scar that’s worse than the original problem. Ask we about the effectiveness of surgery for your specific case.

More natural-looking ears

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

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1. Facelift

The best candidates for breast lift

A breast lift can enhance your appearance and your self-confidence, but it won’t necessarily change your looks to match your ideal, or cause other people to treat you differently. Before you decide to have surgery, think carefully about your expectations and discuss them with us. The best candidates for mastopexy are healthy, emotionally-stable women who are realistic about what the surgery can accomplish. The best results are usually achieved in women with small, sagging breasts. Breasts of any size can be lifted, but the results may not last as long in heavy breasts. Many women seek mastopexy because pregnancy and nursing have left them with stretched skin and less volume in their breasts. However, if you’re planning to have more children, it may be a good idea to postpone your breast lift. While there are no special risks that affect future pregnancies (for example, mastopexy usually doesn’t interfere with breastfeeding), pregnancy is likely to stretch your breasts again and offset the results of the procedure.

All surgery carries some uncertainty and risk

Nevertheless, as with any surgery, there is always a possibility of complications or a reaction to the anesthesia. Bleeding and infection following a breast lift are uncommon, but they can cause scars to widen. You can reduce your risks by closely following your physician’s advice both before and after surgery. Mastopexy does leave noticeable, permanent scars, although they’ll be covered by your bra or bathing suit. (Poor healing and wider scars are more common in smokers.) The procedure can also leave you with unevenly positioned nipples, or a permanent loss of feeling in your nipples or breasts.

Planning your surgery

In your initial consultation, it’s important to discuss your expectations frankly with us. Every patient–and every physician, as well–has a different view of what is a desirable size and shape for breasts. We will examine your breasts and measure them while you’re sitting or standing. Deepending on your age, the size and shape of your breasts, and the condition of your skin we will recommend one or another technique–and whether an implant is advisable. The nipple and areola will be positioned higher during the procedure, and should be approximately even with the crease beneath your breast.

Preparing for your surgery

Depending on your age and family history, we may require you to have a mammogram (breast x-ray) before surgery. You’ll also get specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications. While you’re making preparations, be sure to arrange for someone to drive you home after your surgery and to help you out for a few days if needed.

About the operation

Your breast lift will be performed ina clinic, under general anesthesia and one night of admission is required. Mastopexy usually takes one and a half to three and a half hours. Techniques vary, but the most common procedure involves a periareolar incision (doghnout) or vertical. We try to avoid as much as possible the classic inverted T (anchor-like) scar. The final scar will depend on the amount of skin to be removed and if an implant is needed or not. The incision outlines the area from which breast skin will be removed and defines the new location for the nipple. When the excess skin has been removed, the nipple and areola are moved to the higher position. The skin surrounding the areola is then brought down and together to reshape the breast. Stitches are usually located around the areola, and even a vertical line extending downwards from the nipple area. If you’re having an implant inserted along with your breast lift, it will be placed in a pocket directly under the breast tissue, or deeper, under the muscle of the chest wall.

After your surgery

After surgery, you’ll wear an elastic bandage over gauze dressings. Your breasts will be bruised, swollen, and uncomfortable for a day or two, but the pain shouldn’t be severe. Any discomfort you do feel can be relieved with medications prescribed by we. Within a few days, the bandages or surgical bra will be replaced by a soft support bra. You’ll need to wear this bra around the clock for three to four weeks, over a layer of gauze. The stitches will be removed after a week or two. If your breast skin is very dry following surgery, you can apply a moisturizer several times a day. Be careful not to tug at your skin in the process, and keep the moisturizer away from the suture areas. You can expect some loss of feeling in your nipples and breast skin, caused by the swelling after surgery. This numbness usually fades as the swelling subsides over the next six weeks or so. In some patients, however, it may last a year or more, and occasionally it may be permanent.

Getting back to normal

Healing is a gradual process. Although you may be up and about in a day or two, don’t plan on returning to work for a week or more, depending on how you feel. And avoid lifting anything over your head for three to four weeks We will give you detailed instructions for resuming your normal activities. You may be instructed to avoid sex for a week or more, and to avoid strenuous sports for about a month. After that, you can resume these activities slowly. If you become pregnant, the operation should not affect your ability to breast-feed, since your milk ducts and nipples will be left intact.

Your new look

We will make every effort to make your scars as inconspicuous as possible. Still, it’s important to remember that mastopexy scars are extensive and permanent. They often remain lumpy and red for months, then gradually become less obvious, sometimes eventually fading to thin white lines. Fortunately, the scars can usually be placed so that you can wear even lowcut tops. You should also keep in mind that a breast lift won’t keep you firm forever– the effects of gravity, pregnancy, aging, and weight fluctuations will eventually take their toll again. Women who have implants along with their breast lift may find the results last longer. Your satisfaction with a breast lift is likely to be greater if you understand the procedure thoroughly and if your expectations are realistic

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

The best candidates for liposuction

To be a good candidate for liposuction, you must have realistic expectations about what the procedure can do for you. It’s important to understand that liposuction can enhance your appearance and self confidence, but it won’t necessarily change your looks to match your ideal or cause other people to treat you differently. The best candidates for liposuction are normal-weight people with firm, elastic skin who have pockets of excess fat in certain areas. You should be physically healthy, psychologically stable and realistic in your expectations. Your age is not a major consideration; however, older patients may have diminished skin elasticity and may not achieve the same results as a younger patient with tighter skin. Liposuction carries greater risk for individuals with medical problems such as diabetes, significant heart or lung disease, poor blood circulation, or those who have recently had surgery near the area to be contoured.

Planning your surgery

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

Preparing for your surgery

We will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding vitamins, iron tablets and certain medications. If you develop a cold or an infection of any kind, especially a skin infection, your surgery may have to be postponed. Though it is rarely necessary, sometimes may be necessary that you have blood drawn ahead of time in case it is needed during surgery. Also, while you are making preparations, be sure to arrange for someone to drive you home after the procedure and, if needed, to help you at home for a day or two.

About the operation

Smaller-volume liposuction is usually done on an outpatient basis for reasons of cost and convenience. However, if a large volume of fat will be removed, or if the liposuction is being performed in conjunction with other procedures, a stay in a hospital or overnight nursing facility is required. Various types of anesthesia can be used for liposuction procedures. Together, we will select the type of anesthesia that provides the most safe and effective level of comfort for your surgery. If only a small amount of fat and a limited number of body sites are involved, liposuction can be performed under local anesthesia, which numbs only the affected areas. However, if you prefer, the local is usually used along with intravenous sedation to keep you more relaxed during the procedure.

Regional anesthesia can be a good choice for more extensive procedures. One type of regional anesthesia is the epidural block, the same type of anesthesia commonly used in childbirth. However, some patients prefer general anesthesia, particularly if a large volume of fat is being removed. The time required to perform liposuction may vary considerably, depending on the size of the area, the amount of fat being removed, the type of anesthesia and the technique used.

There are several liposuction techniques that can be used to improve the ease of the procedure and to enhance outcome. Liposuction is a procedure in which localized deposits of fat are removed to recontour one or more areas of the body. Through a tiny incision, a narrow tube or cannula is inserted and used to vacuum the fat layer that lies deep beneath the skin. The cannula is pushed then pulled through the fat layer, breaking up the fat cells and suctioning them out. The suction action is provided by a vacuum pump or a large syringe, depending on the surgeon’s preference. The incisions are placed to be as inconspicuous as possible. Fluid is lost along with the fat, and it’s crucial that this fluid be replaced during the procedure to prevent shock. For this reason, patients need to be carefully monitored and receive intravenous fluids during and immediately after surgery.

Technique variations

The basic technique of liposuction, as described above, is used in all patients undergoing this procedure. However, as the procedure has been developed and refined, several variations have been introduced. Fluid Injection, a technique in which a medicated solution is injected into fatty areas before the fat is removed, is commonly used by plastic surgeons today. The fluid -a mixture of intravenous salt solution, lidocaine (a local anesthetic) and epinephrine (a drug that contracts blood vessels)- helps the fat be removed more easily, reduces blood loss and provides anesthesia during and after surgery. Fluid injection also helps to reduce the amount of bruising after surgery. The amount of fluid that is injected varies depending on the preference of the surgeon. I prefer the super-wet technique, similar to the tumescent technique, except that lesser amounts of fluid are used. Usually the amount of fluid injected is equal to the amount of fat to be removed. This technique often requires IV sedation or general anesthesia and typically takes one to two hours of surgery time.

• Neck: the turkey gobble can be managed by liposuction. Usually it is associated to lifting
• Arms : Traditional excision of fat in this area, leaving a conspicous scar is rarely performed nowadays. With liposuction, we have extirpated great amounts of fat (1000 cc) with a very good cutaneous retraction. It only needs particular postoperative rules to ease the retraction of the skin.
• Abdomen: in young patients or with good cutaneus elasticity the leftover fat can be eliminated with liposuction alone. If there is muscular weakness (diastasis of recti) due to either previous pregnancies or surgeries or where there is a great excess of skin (ie after massive weight loss) the open surgery is the solution (abdominoplasty).
• Back: In many occasions we associate it to the liposuction of abdomen.
• Hips and buttocks : it is the most popular area to treat. The important thing is to contour, to perform liposculpture. In order to obtain a good retraction of the skin it is necessary to suction very superficial leaving the skin very thin. At the same time the buttock is contoured, redefining the folds to give a more youthful look.
• Knees: it is possible to eliminate the fat in the inner and frontal aspects of the knee. • Legs : Mainly at the level of ankles and also to contour the posterior aspect of the legs.

All surgery carries some uncertainty and risks

Liposuction is normally safe, as long as patients are carefully selected, the operating facility is properly equipped and the physician is adequately trained. However, it’s important to keep in mind that even though a well-trained surgeon and a state-of-the art facility can improve your chance of having a good result, there are no guarantees. Though they are rare, complications can and do occur. Risks increase if a greater number of areas are treated at the same time, or if the operative sites are larger in size. Removal of a large amount of fat and fluid may require longer operating times than may be required for smaller operations. The combination of these factors can create greater hazards for infection; delays in healing; the formation of fat clots or blood clots, which may migrate to the lungs and cause death; excessive fluid loss, which can lead to shock or fluid accumulation that must be drained; friction burns or other damage to the skin or nerves or perforation injury to the vital organs; and unfavorable drug reactions.

In the tumescent and super-wet techniques, the anesthetic fluid that is injected may cause lidocaine toxicity (if the solution’s lidocaine content is too high), or the collection of fluid in the lungs (if too much fluid is administered). The scars from liposuction are small and strategically placed to be hidden from view. However, imperfections in the final appearance are not uncommon after lipoplasty. The skin surface may be irregular, asymmetric or even “baggy,” especially in the older patient. Numbness and pigmentation changes may occur. Sometimes, additional surgery may be recommended.

After your surgery

After surgery, you will likely experience some fluid drainage from the incisions. Occasionally, a small drainage tube may be inserted beneath the skin for a couple of days to prevent fluid build-up. To control swelling and to help your skin better fit its new contours, you may be fitted with a snug elastic garment to wear over the treated area for a few weeks. Antibiotics are prescribed to prevent infection. Don’t expect to look or feel great right after surgery. Even though the newer techniques are believed to reduce some post-operative discomforts, you may still experience some pain, burning, swelling, bleeding and temporary numbness. Pain can be controlled with medications prescribed by your surgeon, though you may still feel stiff and sore for a few days. It is normal to feel a bit anxious or depressed in the days or weeks following surgery. However, this feeling will subside as you begin to look and feel better.

Getting back to normal

Healing is a gradual process. You will have to start walking around as soon as possible to reduce swelling and to help prevent blood clots from forming in your legs. You will begin to feel better after about a week or two and you should be back at work within a few days following your surgery. The stitches are removed or dissolve on their own within the first week to 10 days. Physical activity along with massages and lymphatic drainage are started by the first week postoperatively. It helps the skin to contract and adapt to the underlying structures. Although most of the bruising and swelling usually disappears within three weeks, some swelling may remain for six months or more. If you have any unusual symptoms between visits — for example, heavy bleeding or a sudden increase in pain — or any questions about what you can and can’t do, call your doctor.

Your new look

You will see a noticeable difference in the shape of your body quite soon after surgery. However, improvement will become even more apparent after about four to six weeks, when most of the swelling has subsided. After about three months, any persistent mild swelling usually disappears and the final contour will be visible. If your expectations are realistic, you will probably be very pleased with the results of your surgery. You may find that you are more comfortable in a wide variety of clothes and more at ease with your body. And, by eating a healthy diet and getting regular exercise, you can help to maintain your new shape.

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A facelift (technically known as rhytidectomy) can’t stop this aging process. What it can do is “set back the clock,” improving the most visible signs of aging by removing excess fat, tightening underlying muscles, and redraping the skin of your face and neck. A facelift can be done alone, or in conjunction with other procedures such as a forehead lift, eyelid surgery, or nose reshaping.

The best candidates for a facelift

The best candidate for a facelift is a man or woman whose face and neck have begun to sag, but whose skin still has some elasticity and whose bone structure is strong and well-defined. Most patients are in their forties to sixties, but facelifts can be done successfully on people in their seventies or eighties as well.

A facelift can make you look younger and fresher, and it may enhance your self- confidence in the process. But it can’t give you a totally different look, nor can it restore the health and vitality of your youth.

Types of facelift

FRONTAL LIFTING

It has three main goals: to eliminate the wrinkles of the forehead, those of frowning and to raise the eyebrows. By means of this, the sad, tired or angry look are eliminated. Wrinkles occur by hyperactivity of the frontal and corrugator muscles (these are responsible for frowning). The technique consists of excising partially these muscles so that they are debilitated. At the same time forehead’s skin is stretched to raise the tail of the eyebrows and to give a youthful aspect to the face. We perform this technique with ENDOSCOPY. Instead of the classic long incision that is placed in the hair and that goes from ear to ear, we make two small cuts of 1,5 cm., within the hair, and with the aid of endoscopy and instruments specially designed, we search for these muscles to be sectioned. Because of this, a great scar is avoided, the recovery is faster and the aesthetic result is very satisfactory. Recently we have introduced the corrugator section through the upper eyelids.

Other choice may deal with a restricted treatment on the eyebrow, raising it through a limited incision in the temporal area.

Furthermore, through this temporal incision we also reach the malar area and lift the soft tissues of this area to increase the lateral fullness of the face.

However, in selected cases when there are many frontal wrinkles, flaccidity or severe skin damage after sun exposure, the classic frontal lifting is indicated. The incision in these cases remains hidden within the hair.

The actual trend is just to lift the tail of the eyebrow with a minimal scar in the hairline and using Vistabel for treatment fo the wrinkles. Recovery is faster and the results are very natural.

CERVICOFACIAL LIFTING

Indicated to treat the flaccidity and wrinkles of both neck and face inferior third. The incisions are placed around the ears trying to keep them hidden as much as possible. Both skin of the face and the thin muscular layer underneath (the SMAS) are dissected and raised. The SMAS work-up reshapes the face, giving back the natural curves of youth. Through another small incision under the chin, we can slim down the neck and stretch the platysma muscle. The neck gets a more acute angle and definition on profile. Liposuction in the neck is indicated to those patients with no skin flaccidity, no muscular bands and with fat excess in the submental area.

When performing a lifting, we try to avoid stigmata such as earlobe distortion, hairline malposition or scar stretching. The tension applied is the necessary in order to get satisfactory results but not to have such unesthetic marks.

Facelift is complemented with fat grafting to the face, that gives volume restoration and more youthful contour.

MIDFACE LIFT

To rejuvenate the area of orbits and cheeks without having to undertake complete lifting has been described. In this area there is a fat pad (named SOOF) that descends over the bone and causes a hollow eyelid increasing the interface between the eyelid and malar bone (tear-through deformity) and deepening the nasogenian fold. By lifting the malar area, the effect is astonishing, providing more lateral fullness, more projection to the malar area and smoothening the palpebral inferior boundary and the nasolabial fold. A blepharoplasty is usually perfomed at the same time.

All surgery carries some uncertainty and risk

Individuals vary greatly in their anatomy, their physical reactions, and their healing abilities, and the outcome is never completely predictable.

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

You can reduce your risks by closely following your surgeon’s advice both before and after surgery.

Planning your surgery

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

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

If you decide to have a facelift, we will explain the techniques and anesthesia he or she will use, the type of facility where the surgery will be performed, and the risks and costs involved.

Preparing for your surgery

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

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

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

About the operation

Depending on what to do the operation can be performed under general or local plus sedative anesthesia. I prefer the patient to be in the clinic for one or two days.

A facelift usually takes several hours-or somewhat longer if you’re having more than one procedure done. For extensive procedures, sometimes we have to schedule two separate sessions.

The exact placement of incisions and the sequence of events depends on your facial structure and technique chosen.

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

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

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

A type of facelift is designed to improve the middle third of the face and reposition the tissues to restore youthfulness to the malar bone and periorbita. This is achieved through incisions within the hair and the mouth.

The lines from the nose to the mouth are greatly improved with this technique.

Fat grafting is usually done to fill and enhance some areas like mandible line, malar areas, lips and lines from the nsoe to the mouth.

After your surgery

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

Your head should be elevated and as still as possible for a couple of days after surgery, to keep the swelling down.

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

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

Getting back to normal

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

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

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

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

Your new look

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

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

Having a facelift doesn’t stop the clock. Your face will continue to age with time, and you may want to repeat the procedure one or more times-perhaps five or ten years down the line. But in another sense, the effects of even one facelift are lasting; years later, you’ll continue to look better than if you’d never had a facelift at all.

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Candidates

Men of any age who are healthy and emotionally stable are considered good candidates for male breast reduction surgery. The best candidates are those who have firm, elastic skin that will reshape to the body’s new contours. In some instances, surgery may be discouraged for overweight men who have not first tried an exercise and diet regimen.

Procedure

Enlarged male breasts can be reduced by liposuction and/or by cutting out excess glandular tissue. The procedure for male breast reduction takes an average of two hours, usually on an outpatient basis, using general or local anesthesia. If excessive glandular tissue, fat and skin is present, it will be removed.

Surgery may be performed alone or in conjunction with lipoplasty, where the suction device will typically be inserted through the existing incisions. For the removal of excess fatty tissue alone, liposuction may be all that is needed; in such cases, scars will be small and barely visible (click here to watch a clip about this procedure Ginecomastia- liposuccion).
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Postoperative

Results are permanent, although subsequent obesity can create a gynecomastia-like effect. Some of the benefits of surgery include a firmer, flatter, more contoured chest which may give the male patient a boost in self-confidence. There is little downtime, and you may return to work within one week usually, unless you are involved in strenuous activities.

There will be scarring around the nipple of the breast (areola) from this procedure but will fade over a period of time and be less visible. There will be some post-operative bruising, swelling, and burning sensation. To assist with the healing process, the patient will wear an elastic pressure garment for 3-6 weeks and must avoid exposing scarred areas to the sun for at least 6 months.

Other considerations include temporary numbness or lack of sensation that could last up to a year. Infrequent complications may include infection, skin damage, fluid accumulation, bleeding, scarring or pigment changes. Post-operative asymmetry, while rare, is possible; a second procedure may be needed to remove additional tissue.

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The lower body lift surgical procedure tightens loose, sagging skin in the buttocks, posterior thighs, hips, outer thighs, and anterior thighs.  It utilizes incisions which pass from the back around the hips to the front of the thighs.  The loose skin, as well as underlying fat tissue, is removed from below the incision to allow suspension of the remaining tissues to stretch and smooth the lower body, especially the buttocks and thighs.  The surgery begins in the back and requires repositioning during the surgery to address the hips and outer thighs and front of the thighs.  It can be combined with an abdominal skin tightening if needed.  If a previous tummy tuck (abdominoplasty) has been performed or is not needed, the lower body lift can be extended to tighten the inner thighs.

The incisions are designed to be hidden by clothing and sportswear or to lie in normally occurring anatomic folds.  Layered suture techniques are used to carefully close the area of incision in order to maintain the lift, tightening and smoothing the remaining skin.

Patients who benefit from lower body lift surgery have:

• Loose skin in their buttocks and back of their thighs
• Loose skin in their hips and side of their thighs
• Loose skin in the front of their thighs
• Loose abdominal skin or in their inner thighs
• Relatively thin layers of fat below the skin of these areas
• Acceptance of the thin scars around the waist
• Patients who have had massive weight loss

Patient’s anatomy and proportions of loose skin vary from individual to individual.  The decision to utilize lower body lifting techniques depends upon your goals and expectations as well as an examination by your surgeon.  This will help determine whether the lower body lift will achieve a satisfactory outcome for you.

Lower Body Lift Standard Procedure Techniques

All lower body lift techniques tighten the buttocks/back of the thighs and hips/outer thighs.  Loose sagging skin below the incision is removed.  The remaining skin in the buttock and thighs is pulled upwards, and the skin is repaired, suspending the tissues and tightening them.  This requires positioning the patient on their tummy or side during the procedure.  Incision closure is performed in multiple layers over drains, to control stretching and swelling.

Once the back and sides of the patient have been addressed, the front of the patient is treated with the patient positioned on his/her back.  Two options are available.  These options should be discussed with you preoperatively and are chosen based upon your choice.  One option is to combine the lower body lift with abdominal contouring, otherwise known as tummy tuck (abdominoplasty).  The other option is to combine lower body lift with an inner thigh lift, if the abdomen does not require contouring, or if the patient has had previous abdominoplasty.

Candidates for body lift surgery all have extra skin which must be removed by excision.  This differs from liposuction, in that liposuction removes only fat through small quarter inch incisions, but no skin.  However, liposuction may be done in conjunction with body lifting techniques to smooth and contour areas separate from the effects of the body lift excisions.  Again, a thorough discussion and examination are essential to determining a comprehensive surgical plan.

ARM LIFT

An arm lift, or otherwise known as brachioplasty, can remove the excess skin and fat deposits, leaving the upper arms with a more pleasing and youthful contour. As a person ages, upper arm skin can become loose and flabby. Plastic surgeons will consult with patients about undergoing surgery for an arm lift if they wish to tighten this skin to look and feel more youthful. The incision extends from the elbow to the underarm, and sometimes on to the side of the chest. In some instances, your plastic surgeon may recommend that liposuction be used alone or in conjunction with an arm lift to remove excess fat in the upper arms.

Upper arm excess in a massive weight loss patient usually crosses the arm pit and involves loose skin that extends onto the chest region. Brachioplasty, or upper arm reduction surgery, usually involves reducing the skin through a scar that runs on the inner part of the upper arm, often crossing onto the arm pit.

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Am I a good candidate for cheek implants?

If you have lost volume in the malar region associated with aging, or if you were born with weak cheeks and desire a fuller, more youthful appearance, you may be a candidate for aesthetic cheek surgery.  Some patients have used temporary soft tissue fillers in the past to achieve full cheeks, and are seeking a permanent solution.  Patients undergoing cheek augmentation should be of good health, with a normally functioning immune system.

Cheek Implants Standard Procedure Techniques

Aesthetic cheek surgery can be performed alone, or in combination with other surgical procedures. Multiple shapes and sizes of implants are available to fit your particular anatomy and desired change.  Depending on the areas that are being addressed, the implants can be placed through the mouth with a small incision at the gum line, or through a lower eyelid incision if eyelid rejuvenation is being performed at the same time.  Depending on the approach and your surgeon’s preference, the cheek implants can be made of solid silicone or other non-reactive materials such as Medpor.  Surgically, a pocket is made for the implant directly over the cheek bone, and the implant placed.  The implant is secured either by designing a well fitting pocket, or affixing it to soft tissue or bone.  The incision is closed, completing the cheek augmentation.  Usually the whole operation takes about 30 to 45 minutes to complete, unless other procedures are being performed in addition to the cheek augmentation.

• Permanent way to achieve full cheeks (as opposed to temporary fillers)
• May easily be preformed at the time of other facial surgery
• Intra-oral or eyelid approach
• Multiple implant choices to achieve desired look

Other Considerations regarding Cheek Implants

If you are bothered by weak cheeks and are not sure if implants are right for you, it is best to seek consultation with a knowledgeable plastic surgeon. Implants add volume to the cheek, and in doing so provide a lift.  A similar effect can be achieved with soft tissue fillers, and these can be used as a temporary way to see if you would be happy with cheek implants.  A midface-lift may be the procedure of choice for middle aged patients who previously were happy with their midface appearance, but have noted a drop of the cheek rather than loss of volume.  With more advanced facial aging, there can be a combination of factors yielding the aging appearance, including bone resorption, loss of skin elasticity, and loss of volume with fat atrophy.  The cheek region may appear deflated and jowling can be present along the jawline.  In these cases, aesthetic cheek surgery combined with a facelift procedure may yield the ideal result in such cases.

Cheek Implants Risks / Complications / Patient Safety

• Sensation to the cheek may be temporarily or permanently changed by the implants.
• Implants can become shifted, especially in the early stages after surgery.  Avoid contact sports until you are fully healed.
• With the eyelid approach for surgery, retraction of the lower eyelid is possible, which may create dry eye sensation.
• If cheek implants become infected, removal may be necessary to clear the infection.

Cheek Surgery Recovery Process

The usual recovery after aesthetic cheek surgery depends on the type of surgical approach utilized and if other procedures are performed at the same time.  In general, from a cheek augmentation alone, you should be active the day of surgery, but your upper lip will be “asleep” similar to a visit to the dentist.  This sensation returns overnight, and the cheeks will feel mildly sore and swollen.  Prescriptions for antibiotics and pain medicines may be provided, and you should maintain light activities.  Keeping your head elevated helps the swelling resolve sooner.  If your cheek augmentation was performed through the mouth, you will be restricted to a soft diet for a few days until the gums have healed.  You will rinse your mouth after eating to keep the sutures clean, and these will dissolve on their own after several weeks.  If the eyelid approach was utilized, your surgeon will instruct you on how to rest your eyes, and utilize lubricants to prevent dryness during the post-surgery swelling phase.  During follow-up visits, skin sutures will be removed.

Will cheek surgery be painful?

Most patients do not consider aesthetic cheek surgery to be a painful surgery.  There is a period of “tightness” associated with the increased volume from the cheek implant, which is worse right after surgery due to the body’s normal swelling response.  Pain medications are usually only needed for a few days, and then only at night to help with sleep.

Will there be scarring from cheek surgery?

With the intra-oral approach for cheek augmentation, no visible external scars should be present.  If an eyelid approach is utilized for your aesthetic cheek surgery, scars will be present under the eyelash margin.  Scars in this location are usually very hard to identify, even when you are searching for them.

What are some typical short-term side-effects of cheek surgery?

It is normal to have a change in cheek sensation after aesthetic cheek surgery.  Right after surgery, your cheek will be “asleep” due to the local anesthetics utilized. After your cheek “wakes up”, sensations maybe heightened until sensory nerves near the implant get used to their new, tighter surroundings.

Why type of anesthesia, if any, will be used for cheek surgery?

Cheek augmentation surgery can be performed under sedation anesthesia, or general anesthesia, depending on the technique utilized and the preferences of the patient and surgeon.  Contact and consult your plastic surgeon to see what they suggest for your individual case.

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1. Chin surgery
2. Calf implants

Am I a good candidate for aesthetic chin surgery?

In one approach, the lower section of bone is moved forward and wired into position.

If you have a mildly weak chin and normal function of your jaw, chin augmentation with implants may be the procedure of choice for you.  Perhaps you have used temporary soft tissue fillers in the past to achieve a stronger chin, and are seeking a permanent solution.  As with any implant surgery, you should be of good health with a normally functioning immune system.

Chin Implants Standard Procedure Techniques

There are several options available for aesthetic chin surgery.  Aesthetic chin surgery augments the bony structure of your jaw, and can create a stronger chin, make the chin wider, or even slightly lengthen your face.  Implants of multiple shapes, sizes, and materials are available, and are chosen depending on the changes desired and the technique utilized.  To perform aesthetic chin surgery, the incision is made and a pocket designed to accommodate the implant directly over the bone along the lower jaw.  Solid silicon implants can be placed through a small incision under the chin.  When other rigid biocompatible materials (such as Medpor) are used for chin augmentation, an incision inside the mouth is utilized. The chin implant is secured in place either by designing a well-fitting pocket, or affixing it to soft tissue or bone.  The incision is closed, completing the chin augmentation.  Usually the entire operation takes about 30 to 45 minutes to complete, unless other procedures are being performed in addition to the aesthetic chin surgery.  Tape is often applied to the skin to assist in holding the implant in place during the normal swelling after surgery.

An alternative approach involves inserting an implant between the bone and chin tissue through a short external incision under your chin or through an incision made inside your mouth between the lower lip and gum. Similarly, your cheekbones may be built up by placing an implant over them.

• Permanent way to achieve a strong chin (as opposed to temporary fillers)
• May easily be performed with other procedures (eg: nose surgery/rhinoplasty)
• Multiple chin implant choices are available to achieve your desired look
• Intra-oral or direct surgical approaches available
• Other Considerations for Chin Implants

When considering aesthetic chin surgery with a chin implant, you should be aware that certain patients are better served with other surgical approaches.  If you have a severely weak chin, or abnormally functioning jaw, a genioplasty or mandibular advancement surgery maybe appropriate.  Although these procedures involve cutting the bone of your jaw, and have a longer recovery than chin surgery with chin implants, they can achieve results not attainable with implants alone.  To decide which procedure is right for you, it is best to seek consultation with a knowledgeable plastic surgeon.

Chin Implants Risks / Complications / Patient Safety

• Sensation to the chin may be temporarily or permanently changed by the implant
• The chin implant can be shifted, especially in the early stages after surgery
• Avoid contact sports until you are fully healed
• If the chin implant becomes infected, removal may be necessary to clear the infection

Chin Surgery Recovery Process

After surgery, you will have a more balanced profile and pleasing facial contour.

The usual recovery after aesthetic chin surgery depends on the surgical approach utilized and if other procedures are performed at the same time.  In general, from a chin augmentation alone, you will be active around the house the evening of surgery, but your lower lip will be “asleep” similar to after a visit to the dentist.  This sensation returns overnight, and your chin will feel mildly sore and swollen.  Prescriptions for antibiotics and pain medicines may be provided, and you should maintain light activities.  You may be given a garment or your chin may be taped to help maintain the chin implant position during the swelling phase after surgery.  Keeping your head elevated helps swelling resolve sooner.  If your chin augmentation was performed through the mouth, you will be restricted to a liquid or soft diet for a few days until the gums have healed.  You will rinse your mouth after eating to keep the sutures clean, and these will dissolve on their own after several weeks.  If your cosmetic chin surgery was performed with a small incision under your chin, sutures are normally removed after 4 to 7 days.

Will chin surgery be painful?

The majority of patients do not consider cosmetic chin surgery to be painful surgery.  There is a period of “tightness” associated with the increased volume from the chin implant, which is worse right after surgery due to the body’s normal swelling response.  Discomfort responds rapidly to oral pain medications, which are usually only needed for a few days.

Will there be scarring undergoing chin surgery?

If the intra-oral approach for chin augmentation is used, no visible external scars will be present.  If your surgeon places the implant through an incision under your chin, a very small scar will be present in a well-concealed region.  With usual social encounters, this scar is not visible.

What are some typical short-term side-effects of undergoing chin surgery?

It is normal to have a change in chin sensation after aesthetic chin surgery.  Right after surgery, your chin will be “asleep” due to the local anesthetics utilized.  After your chin “wakes up”, sensations maybe heightened until sensory nerves near the implant get used to their new, tighter surroundings.

Why type of anesthesia, if any, will be used for chin surgery?

Chin augmentation surgery can be performed under light sedation anesthesia or under general anesthesia.  The choice of anesthetic is up to yourself and your surgeon to decide.

Puede interesarte:

1. Cheek surgery
2. Pec implants
3. Body Implants

]]> http://www.antiaginggroupbarcelona.com/en/clinicas/cirugia-de-menton/feed/ 2 http://www.antiaginggroupbarcelona.com/en/clinicas/blefaroplastia/ http://www.antiaginggroupbarcelona.com/en/clinicas/blefaroplastia/#comments Wed, 21 Oct 2009 07:47:36 +0000 Dr. Benito http://www.antiaginggroupbarcelona.com/?p=224 Eyelid surgery (technically called blepharoplasty) is a procedure to remove fat, usually along with excess skin and muscle from the upper and lower eyelids. Eyelid surgery can correct drooping upper lids and puffy bags below your eyes – features that make you look older and more tired than you feel, and may even interfere with your vision.

However, it won’t remove crow’s feet or other wrinkles, eliminate dark circles under your eyes, or lift sagging eyebrows. While it can add an upper eyelid crease to Asian eyes, it will not erase evidence of your ethnic or racial heritage. Blepharoplasty can be done alone, or in conjunction with other facial surgery procedures such as a facelift or browlift.

The best candidates for eyelid surgery

Blepharoplasty can enhance your appearance and your self-confidence, but it won’t necessarily change your looks to match your ideal, or cause other people to treat you differently. The best candidates for eyelid surgery are men and women who are physically healthy, psychologically stable, and realistic in their expectations. Most are 35 or older, but if droopy, baggy eyelids run in your family, you may decide to have eyelid surgery at a younger age.

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

All surgery carries some uncertainty and risk

Nevertheless, there is always a possibility of complications, including infection or a reaction to the anesthesia. You can reduce your risks by closely following your surgeon’s instructions both before and after surgery.

The minor complications that occasionally follow blepharoplasty include double or blurred vision for a few days; temporary swelling at the corner of the eyelids; and a slight asymmetry in healing or scarring. Tiny whiteheads may appear after your stitches are taken out; your surgeon can remove them easily with a very fine needle.

Following surgery, some patients may have difficulty closing their eyes when they sleep; in rare cases this condition may be permanent. Another very rare complication is ectropion, a pulling down of the lower lids. In this case, further surgery may be required.

Planning your surgery

Be sure to inform us if you have any allergies; if you’re taking any vitamins, medications (prescription or over-the-counter), or other drugs; and if you smoke.

You’ll need to discuss whether to do all four eyelids or just the upper or lower ones, whether skin as well as fat will be removed, and whether any additional procedures are appropriate.

We will explain the techniques and anesthesia, the type of facility where the surgery will be performed, and the risks and costs involved.

Don’t hesitate to ask us any questions you may have, especially those regarding your expectations and concerns about the results.

Preparing for your surgery

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

While you’re making preparations, be sure to arrange for someone to drive you home after your surgery, and to help you out for a few days if needed.

About the operation

Eyelid surgery is usually performed on an outpatient basis, under local anesthesia and light sedation.Blepharoplasty usually takes one to three hours, depending on the extent of the surgery.

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

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

Recent trends are not to injury the orbicularis muscle (resposible for the eyelid function) and to remove fat through the transconjunctival incision and remove a small strip of skin only or doing a
peeling.

In some cases we use the lower bags to fill the lower aspect of the orbit, where there is sometimes a crease due to atrophy and descent of periorbital tissues (the so called tear-through deformity).

After your surgery

After surgery, we put strips to protecte the incisions and eyelids. Your eyelids may feel tight and sore as the anesthesia wears off, but you can control any discomfort with the pain medication. If you feel any severe pain, call us.

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

The stitches will be removed five days to a week after surgery. Once they’re out, the swelling and discoloration around your eyes will gradually subside, and you’ll start to look and feel much better.

Getting back to normal

You should be able to read or watch television after two or three days. However, you won’t be able to wear contact lenses for about two weeks, and even then they may feel uncomfortable for a while.

Most people feel ready to go out in public (and back to work) in a week to 10 days. After stitches have been removed you’ll probably be able to wear makeup to hide the bruising that remains. You may be sensitive to sunlight, wind, and other irritants for several weeks, so you should wear sunglasses and a special sunblock made for eyelids when you go out.

You will have to keep your activities to a minimum for three to five days, and to avoid more strenuous activities for about three weeks. It’s especially important to avoid activities that raise your blood pressure, including bending, lifting, and rigorous sports. You may also be told to avoid alcohol, since it causes fluid retention.

Your new look

Healing is a gradual process, and your scars may remain slightly pink for six months or more after surgery. Eventually, though, they’ll fade to a thin, nearly invisible white line. On the other hand, the positive results of your eyelid surgery-the more alert and youthful look-will last for years. For many people, these results are permanent.

]]> http://www.antiaginggroupbarcelona.com/en/clinicas/blefaroplastia/feed/ 18 http://www.antiaginggroupbarcelona.com/en/clinicas/aumento-de-pectorales/ http://www.antiaginggroupbarcelona.com/en/clinicas/aumento-de-pectorales/#comments Wed, 21 Oct 2009 08:47:05 +0000 Dr. Benito http://www.antiaginggroupbarcelona.com/?p=223

Pec implants: on La Sexta TV

Body Implants

Muscular implants

]]> There are men that want to be their chest enhanced. It can be because of aesthetic reasons (men that despite training do not achieve the volume they would like), medical (injuries to the muscles or congenital as the Poland’s syndrome) or patients with gynecomastia that want to have a more masculine chest after the gland removal.

The operation consists of implanting a specially designed prosthesis under the muscle. The manufactured implants are made of cohesive silicone and the volumes available are 180-240-300 cc. In some cases the implant can be also custom made.

The implants is placed under general anesthesia through a small incision in the armpit. There are some burning sensation, tightness or slight pain in the area for a few days. Press exercises and muscular activity is forbidden for one month.

Generally speaking it is an operation with fast recovery and immediate results.

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1. Pec implants: on La Sexta TV
2. Body Implants
3. Muscular implants

]]> http://www.antiaginggroupbarcelona.com/en/clinicas/aumento-de-pectorales/feed/ 8 http://www.antiaginggroupbarcelona.com/en/clinicas/aumento-de-gluteos/ http://www.antiaginggroupbarcelona.com/en/clinicas/aumento-de-gluteos/#comments Wed, 21 Oct 2009 08:46:03 +0000 Dr. Benito http://www.antiaginggroupbarcelona.com/?p=221 The objective of the operation is to enhance the shape and volume of the buttocks. The aim is a natural curve and volume, with a smooth transition to the waist and the hips. There are two forms to achieve it:

• With silicone prosthesis which are oval and semisolids, not rigids.
• With fat (lipostructure)

Anesthesia

Epidural or general

Technique

• Implant: Through an incision on the zone of coxis (in the fold between the buttocks) a pocket is dissected under the greater gluteus muscle. The implant is placed in the upper half of the buttock, to avoid injury to the great sciatic nerve.
• Lipostructure: Fat is obtained from liposuction of zones like hips, abdomen, back. This fat properly prepared is injected in multiple tunnels forming like an internal web. It is had to inject between 30-50% more volume of required, given some resorption is expected. The intervention takes longer than in the case of implants.

Postoperative

Relative rest is recommended during 2-3 day. Restarting normal work depends on the technique. For implants usually it reccomended after 7-15 day. After lipostructure it can be sooner. In the case of the prosthesis it is necessary to avoid certain types of physical exercise during 4-6 weeks. Muscular injections are to be avoides if implants are chosen.

Risks

The potential problems of implants are:

• Hematoma
• Infection
• Extrusion of the prosthesis
• Capsular contracture (hardening around the prosthesis)
• Displacement.

In the case of fat infiltration:

• Hematoma
• Infection
• Reabsortion
• Asymmetries
• Infection
• Reabsortion
• Asymmetries

]]> http://www.antiaginggroupbarcelona.com/en/clinicas/aumento-de-gluteos/feed/ 19 http://www.antiaginggroupbarcelona.com/en/clinicas/aumento-de-gemelos/ http://www.antiaginggroupbarcelona.com/en/clinicas/aumento-de-gemelos/#comments Wed, 21 Oct 2009 07:44:21 +0000 Dr. Benito http://www.antiaginggroupbarcelona.com/?p=220

Pec implants

Body Implants

Otoplasty

]]> The goal of the operation is to obtain a curvature and volume in the zone of the calves, resembling the obtained with the physical exercise (bicycle, steps). The implants are fusiform and semisolids, not rigids. This operation is indicated in those patients who have had any kind of malformation in the leg, diseases (neurological diseases, poliomielitis) or injuries (traumatisms). Also in those patients who in spite of proper training do not obtain muscular volume.

Anesthesia

It can be local plus sedation, epidural or general.

Technique

The operation consists of placing one or two implants between the muscle and the skin. The incision (4 cm long) is placed in a crease of the posterior aspect of the knee.

Postoperative Recovery

Usually one night of stay in the hospital is needed, although sometimes it is not necessary (ambulatory surgery). One to two days of rest is recommended. It is normal to have alterations of sensitivity in the zone, hematomas and swelling that can last days. Reincorporation to work can be done in 4-7 days. It is necessary to avoid physical exercise during 4-6 weeks, which is the estimated time so that the prosthesis are fixed and they do not move

Risks

The potential problems with this operation are:

• Hematoma
• Infection
• Extrusion of the prosthesis
• Capsular contracture (hardening around the implant)
• Displacement: usually it is associated with a too precocious resumption of the muscular activity.

Puede interesarte:

1. Pec implants
2. Body Implants
3. Otoplasty

]]> http://www.antiaginggroupbarcelona.com/en/clinicas/aumento-de-gemelos/feed/ 41 http://www.antiaginggroupbarcelona.com/en/clinicas/abdominoplastia/ http://www.antiaginggroupbarcelona.com/en/clinicas/abdominoplastia/#comments Wed, 14 Oct 2009 18:21:13 +0000 Dr. Benito http://www.antiaginggroupbarcelona.com/?p=191

Abdominoplasty and cesarean delivery

Dermolipectomies

About the tummy tuck, by Dr. Jesus Benito

]]> Abdominoplasty, known more commonly as a “tummy tuck,” is a major surgical procedure to remove excess skin and fat from the middle and lower abdomen and to tighten the muscles of the abdominal wall. The procedure can dramatically reduce the appearance of a protruding abdomen. But bear in mind, it does produce a permanent scar, which, depending on the extent of the original problem and the surgery required to correct it, can be quite long. However we try to place it in such way to be completely hidden by your underwear.

The best candidates for abdominoplasty

The best candidates for abdominoplasty are men or women who are in relatively good shape but are bothered by a large fat deposit or loose abdominal skin that won’t respond to diet or exercise. The surgery is particularly helpful to women who, through multiple pregnancies, have stretched their abdominal muscles and skin beyond the point where they can return to normal. Loss of skin elasticity in older patients, which frequently occurs with slight obesity, can also be improved. Patients who intend to lose a lot of weight should postpone the surgery. Also, women who plan future pregnancies should wait, as vertical muscles in the abdomen that are tightened during surgery can separate again during pregnancy. If you have scarring from previous abdominal surgery, your doctor may recommend against abdominoplasty or may caution you that scars could be unusually prominent. Abdominoplasty can enhance your appearance and your self-confidence, but it won’t necessarily change your looks to match your ideal, or cause other people to treat you differently. Before you decide to have surgery, think carefully about your expectations and discuss them with us.

All surgery carries uncertainty and risk

Thousands of abdominoplasties are performed successfully each year. Nevertheless, there are always risks associated with surgery and specific complications associated with this procedure. Post-operative complications such as infection and blood clots are rare, but can occur. Infection can be treated with drainage and antibiotics, but will prolong your hospital stay. You can minimize the risk of blood clots by moving around as soon after the surgery as possible. Poor healing, which results in conspicuous scars, may necessitate a second operation. Smokers should be advised to stop, as smoking may increase the risk of complications and delay healing. You can reduce your risk of complications by closely following our instructions before and after the surgery, especially with regard to when and how you should resume physical activity.

Planning your surgery

If, for example, your fat deposits are limited to the area below the navel, you may require a less complex procedure called a partial abdominoplasty, also know as a mini-tummy tuck. You may, on the other hand, benefit more from partial or complete abdominoplasty done in conjunction with liposuction to remove fat deposits from the hips, for a better body contour. Or maybe liposuction alone would create the best result. In any case, we will recommend you the procedure that is right for you and will come closest to producing the desired body contour.

Preparing for your surgery

We will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins, and medications. If you smoke, plan to quit at least one to two weeks before your surgery and not to resume for at least two weeks after your surgery. Avoid overexposure to the sun before surgery, especially to your abdomen, and do not go on a stringent diet, as both can inhibit your ability to heal. If you develop a cold or infection of any kind, your surgery will probably be postponed. You should arrange for someone to drive you home after your surgery, and to help you out for a day or two after you leave the hospital, if needed.

About the operation

The operation will be performed as inpatient in a clinic. You will have to stay for two nights. The anesthesia is general. Complete abdominoplasty usually takes two to five hours, depending on the extent of work required. Partial abdominoplasty may take an hour or two. Most commonly, a long incision is made just above the pubic area. The length of the scar will depends on the amount of tissue to be excised. The shape of the scar (more or less horizontal) will depend on your underwear. A second incision is made to free the navel from surrounding tissue. With partial abdominoplasty, the incision is much shorter and the navel may not be moved, although it may be pulled into an unnatural shape as the skin is tightened and stitched. Next, the skin is separated from the abdominal wall all the way up to your ribs and lifts a large skin flap to reveal the vertical muscles in your abdomen. These muscles are tightened by pulling them close together and stitching them into their new position. This provides a firmer abdominal wall and narrows the waistline. The skin flap is then stretched down and the extra skin is removed. A new hole is cut for your navel, which is then stitched in place. Finally, the incisions will be stitched, dressings will be applied, and a temporary tube may be inserted to drain excess fluid from the surgical site. In partial abdominoplasty, the skin is separated only between the incision line and the navel. This skin flap is stretched down, the excess is removed, and the flap is stitched back into place. We are doing more miniabdominoplasties combined with extensive liposuction (stomach, flanks). The result is much better than with classic abdominoplasty. It is contraindicated to heavy smokers.

After your surgery

For the first few days, your abdomen will probably be swollen and you’re likely to feel some pain and discomfort which can be controlled by medication. you will not be able to stand straight at first, but you should start walking as soon as possible. No lifting weights are allowed for 15 days. Some rest is advisable for seven days after the surgery. I do not recommend to travel before 7 days after the operation. Surface stitches will be removed in five to seven days, and deeper sutures, with ends that protrude through the skin, will come out in two to three weeks. The dressing on your incision will be replaced by a support garment, which must be worn for 2 months.

Getting back to normal

It may take you weeks or months to feel like your old self again. If you start out in top physical condition with strong abdominal muscles, recovery from abdominoplasty will be much faster. Some people return to work after two weeks, while others take three or four weeks to rest and recuperate. Exercise will help you heal better. Even people who have never exercised before should begin an exercise program to reduce swelling, lower the chance of blood clots, and tone muscles. Vigorous exercise, however, should be avoided until you can do it comfortably. Your scars may actually appear to worsen during the first three to six months as they heal, but this is normal. Expect it to take nine months to a year before your scars flatten out and lighten in color. While they’ll never disappear completely, abdominal scars will not show under most clothing, even under bathing suits.

Your new look

Abdominoplasty, whether partial or complete, produces excellent results for patients with weakened abdominal muscles or excess skin. And in most cases, the results are long lasting, if you follow a balanced diet and exercise regularly. If you’re realistic in your expectations and prepared for the consequences of a permanent scar and a lengthy recovery period, abdominoplasty may be just the answer for you.

Puede interesarte:

1. Abdominoplasty and cesarean delivery
2. Dermolipectomies
3. About the tummy tuck, by Dr. Jesus Benito

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