My body has really taken a hit from having my three kids. Do I need one big surgery or a few individual ones?
First, and foremost, combination surgeries can only be done on patients who are medically healthy. Once this is established certain surgeries can make a lot of sense to combine. This is due to the ability to benefit from one recovery instead of several, and for the financial savings. The cost of splitting the procedures is higher due to paying for anesthesia and operating room fees twice.
The most common combination procedure is any breast surgery with a tummy tuck. This combination is called a "Mommy Makeover" and is designed to restore a woman's figure back to her pre-childbirth state. Breast surgeries here are customized to what's needed, and can range from breast implants, to lifts, to reductions. The tummy tuck removes the extra skin and stretch marks, as well as tightening the abdominal muscles beneath. Patients should plan on taking ten days to two weeks off from work while recovering from this procedure.
I want larger breasts, but I’m afraid of looking like a porn star.
Most women looking to undergo breast enhancement mention this type of fear during the initial consultation.
In actuality prospective enhancement patients are more likely to state what they don't want their breasts to look like, than what they do want them to look like. This apprehension is probably because, we humans, notice extreme examples of Plastic Surgery more often than more subtle examples. As such, we begin to feel that these examples are the norm among enhancement patients, and we fear that by becoming a patient our Plastic Surgeon will want to make us too large.
Nothing could be further from the truth. The majority of mainstream Board Certified Plastic Surgeons aim to give patients a natural look, with the patients concerns at the forefront of their surgical planning. However because these post op patients aren't as easy to notice, even though they far outnumber the DD group, people tend to think breast enhancement equals large breasts.
Almost every Plastic Surgeon has a system to determine what the patient has in mind in terms of size. Steps are taken during the consultation, and any subsequent office visits, to size the patient to ensure a predictable surgical result that the patient will be happy with.
As always, make sure your breast enhancement surgery is being performed by a Diplomat of the American Board of Plastic Surgery.
How do I know if I need an abdominoplasty or if liposuction is enough?
This is a really common question whose answer depends on several factors.
Firstly, most Plastic Surgeons won't offer an abdominoplasty (tummy-tuck) to women who want to have children in the near future. This is because the extra skin allows the abdomen to stretch during the next pregnancy. If it's removed during an abdominoplasty further stretch marks might appear from the pregnancy that would have been prevented if the patient waited until her child bearing was over.
Secondly, the age of the patient and the skin's snappiness will also affect the surgeon's decision. This is because the skin's ability to shrink to the new size after liposuction is dependant on its tone. Older skin, or skin with poor tone, will not shrink in size after liposuction. In these instances its better to surgically remove the excess skin with a tummy-tuck to give the skin a tightened appearance.
As always the doctor performing these procedures should be a board certified Plastic Surgeon, and the patient's medical condition should be evaluated prior to surgery.
I’m starting to notice small bulges beneath my eyes. My Mom had these bags her whole life. Do I need surgery to correct this, and if so, when?
What you’re starting to notice is that the protective fat located around the eyeball is pushing forward as the lower eyelid weakens. This often can be seen occurring within family lines.
The question of whether to have surgery, or not, is a personal one. When only a small amount of this fat is noticeable it’s often camouflaged by placing fillers between the bulge and the bone of the cheek.
When more fat then this is protruding surgery is performed to remove, or reposition, it. Often the skin is also tightened at this time. As with any cosmetic surgery the hands of time are turned back, not stopped. Patients will continue to age after their surgery, younger patients may want to touch up their results about ten years later.
Do all facelifts have scars around the ears; I have a loose neck and want to know what surgery fixes that?
Surgeries to reposition these areas are called; facelifts, neck lifts, and face and neck lifts.
Often younger patients present only complaining of early skin laxity over the cheek into the jowl area. Therefore a facelift is performed, which tightens the facial tissues leaving a thin scar in front of the ear down to the earlobe. The scar is made to look like an anatomic crease that many people have naturally.
When the neck is the only problem the tightening is done from behind the ear in the crease. During a neck lift many times a small incision is made under the chin to tighten the neck tissues in the front of the neck as well.
Some patients require both their face and neck lifted. A face and neck lift surgery leaves a thin scar both if front, and behind, the ear.
The Plastic Surgeon needs to listen to the patient’s concerns and point out any associated issues about changing these areas that the patient may not be aware of. As with all cosmetic surgery the Plastic Surgeon needs to tailor the surgery to fit the patient.
My breasts are a little droopy after having my kids, do I need a lift or breast implants?
This is a really common question, and one that Plastic Surgeons consider themselves when evaluating new patients. Essentially a droopy breast can be thought of as a bag that’s not filled to its capacity. Whether the patient does, or doesn’t, want breast implants will be the starting point for the surgeon to figure out what is the best surgical option for the patient.
If no implants are desired then a lift is offered, however if the patient is an A cup a small implant is still discussed to give some fullness to the upper part of the breast that isn’t really possible with A cup sized breast tissue.
If an implant is desired then its proposed size needs to be assessed. If the implant size the patient wants is too small to take up all of the excess breast skin (aka empty bag) then some type of lifting procedure needs to be done at the same time to give the new breast a full, anatomically correct look. Breast lifting techniques range from resulting scars being located just around the nipple areola complex (NAC) when a small amount of skin is in excess, to “lollipop” scars which extend down the middle of the breast from the bottom of the NAC.
Occasionally the amount of excess skin present is taken up by the size implant the patient desires and no additional lifting scars are necessary.
As with all Plastic Surgery the surgery needs to be customized to the patient’s anatomy and desired results.
I had a full tummy tuck going on three weeks ago now. I don’t think I fully understood the extent of the recovery. I still feel incredibly worn out and tired, I can’t stand up straight, I’m swollen and my skin is stretched and tight and uncomfortable. When will I feel like myself again?
Three weeks after an abdominoplasty is usually when patients want to know how much longer they'll feel any surgical after effects. Each week after this procedure daily activities become easier. The first week involves getting over the anesthesia and caring for the surgical drains. The second revolves around getting back on your feet more and beginning to stand up straighter. Starting in the third week most people don't know how much they can do, without over doing it. Therefore people tend to do a little too much, get a reminder from their bodies like soreness or fatigue, then need to rest a little until they're ready to go on, Sometimes this is described as taking two steps forward, then one step back during the early recovery phases.
By four or five weeks most people are back in the swing of things and stop wearing their compressive garment by six weeks. The feeling over the lower abdomen slowly returns by six months and the scar continues to mature for nine months before beginning to fade.
Ive been noticing that my eyes seemed to have really aged in the last few weeks, does aging take place this rapidly or is it something else?
Although the eyes can show the signs and symptoms of certain systemic diseases, the complaint of looking aged makes systemic illness less likely here. This time of year in the Northeast the summer starts to catch up with us. Our skin can be dry and sun damaged. Our summer diets often contain more salt which can lead to puffy eyes upon waking in the morning.
Injectables such as Botox and Dysport can lessen the crow’s feet and relax the muscles around the eyes. Fillers such as Juvederm and Radiesse can be used to camouflage the lower eyelid/cheek junction giving a more youthful appearance. Blepharoplasty is the medical term for eyelift, where the bulging fat around the eyes is removed or repositioned and the excess skin is tightened. Many skin texture concerns can be addressed with lasers and chemical peels.
A lifestyle composed of a healthy diet, good skin regimen, rest and sun avoidance will allow these results to last longer.
Are there different possible locations for the arm lift and what are they? What tends to be the most concealed location?
Arm lifts are called brachioplasties (doctors have a different word for everything!)
Think of this surgery as a tailor thinks about taking in a dress, or suit. The material is the skin, therefore the more extra material (skin) there is, the longer the scar (or seam) is. The Plastic Surgeon's job is to assess how much the skin will shrink with liposuction versus having to surgically remove skin. Based on that assessment the surgeon will offer the appropriate procedure.
In a patient with excellent skin tone liposuction can be performed alone. As skin tone diminishes skin needs to be removed, resulting in scarring. If only a minimal skin resection is planned the scar can be hid in the arm pit. If more skin needs to be removed the arm pit scar can be extended slightly down the inside part of the upper arm. When a full brachioplasty is offered the scar travels down the inside of the upper arm to the elbow. Although this is a long scar it's only offered to patients who otherwise wouldn't get the cosmetic result desired with any of the smaller procedures. This group very often includes bariatric (massive weight loss) patients.
With all of these, tailoring, surgeries every effort is made to make the scar as inconspicuous as possible. This is done by using fine technique and by hiding them on the inside of the arm.
There seem to be an awful lot of facelift alternatives available these days, from threadlifts to liquid facelifts, but is there ever a time when a traditional facelift is the best option?
Today, more than ever, there are alternatives to the traditional face lift. Many potions can be found in Plastic Surgeon's cabinets across the country. Nuerotoxins, such as, Botox and Dysport can smooth out wrinkles. Fillers like Radiesse and Juvederm can backfill laugh lines and crevasses. Minimally invasive technologies are constantly being tested to tighten facial tissues without causing scars.
These products and procedures do give the patient more options than ever before, and can allow a younger patient to hold off Father Time's advances for some time. However if someone hasn't been on one of these regimens and doesn't have the genes to look like a 20-something in their 50's than a traditional face lift still has value in achieving a youthful look which will last longer than any of the potions.
Face lifting today usually centers around tightening up the face on multiple levels, possibly adding some volume to the cheeks, and smoothing the skin with a laser or peel. This multidimensional approach restores a youthful, age appropriate look to the patient. These procedures should be performed by a Board Certified Plastic Surgeon.
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Donald Roland, MD
BOARD CERTIFIED PLASTIC SURGEON