Southern California Center for Surgical Arts

Products And Services

• Blepharoplasty

  Blepharoplasty (eyelid surgery) is a plastic surgery procedure for correcting sagging or drooping eyelids. The eyelid, because its skin is much thinner than that in other parts of the face, is often one of the first facial areas to exhibit signs of aging. Eyelids that sag or droop can affect peripheral vision, making daily activities such as driving more difficult. Blepharoplasty may become necessary when various factors, which include aging, sun damage, smoking and obesity, cause the muscles and tissue that support the eyelids to weaken. Reasons for Blepharoplasty Blepharoplasty tightens the eyelid's muscles and tissue, and removes excess fat and skin. Blepharoplasty eliminates the drooping of skin into the visual field, greatly improving peripheral vision. It is also performed for strictly cosmetic reasons. Functional Blepharoplasty If the eyelids begin sagging into the field of vision, a functional blepharoplasty may be required. The procedure may be covered by medical insurance if it is deemed medically necessary. A determination of how much vision is affected is done by checking the peripheral visual field with an instrument called the Humphrey Visual Field (HVF) Analyzer. Cosmetic Blepharoplasty Blepharoplasty can be performed on either the upper or lower eyelid, or on both, for cosmetic purposes. For a lower eyelid that needs fat rather than skin removed, a transconjunctival blepharoplasty is performed. During transconjunctival blepharoplasty, an incision is made inside the lower eyelid, so there are no visible scars, and the fat is removed. This procedure has no effect on vision, but results in a person's looking younger and more refreshed. It is important for a patient to have realistic expectations before undergoing cosmetic blepharoplasty. Although the procedure can enhance appearance and improve self-confidence, it does not radically alter the face. Candidates for Blepharoplasty The best candidates for blepharoplasty are those who are in good overall health, do not smoke, do not have any serious eye conditions, and have healthy facial tissue and muscle. People with eye disease, including glaucoma or retinal detachment, thyroid disorders, diabetes, cardiovascular disease or high blood pressure are not good candidates for blepharoplasty. The Blepharoplasty Procedure Blepharoplasty is typically performed as an outpatient procedure requiring local anesthesia and sedation. General anesthesia may be used for anxious patients. Patients can choose to have this procedure on their upper or lower eyelids, or both. The procedure can take anywhere from 45 minutes to 2 hours, depending on whether both the upper and lower eyelids are operated on. If the upper eyelid is being operated on, an incision is typically made along its natural crease. Once the incision is made, fat deposits are repositioned or removed, muscles and tissue are tightened, and excess skin is removed. For the lower eyelid, an incision is usually made just below the lash line so that excess skin can be removed. After the procedure, the incisions are closed with sutures, tissue glue or surgical tape, and usually loosely covered with gauze so the area can heal. Recovery After Blepharoplasty After blepharoplasty, patients may be advised to apply lubricating drops/ointment and cold compresses to aid in healing and minimize side effects. Most patients return to work within a few days to a week, but should avoid exercise and strenuous activities for at least 2 weeks. Stitches are usually removed after 3 or 4 days. Most swelling and other side effects typically subside within 2 weeks. Contact lenses and eye makeup may not be worn for 2 weeks after surgery. Patients are typically advised to wear dark sunglasses outside or in bright light for 2 weeks to protect their eyes from sun and wind. Risks of Blepharoplasty Although there may be swelling and bruising around the surgical site, they will subside on their own, and the eyelids will improve in appearance for up to a year. Uncommon side effects include infection, reaction to anesthesia, and double or blurred vision. Eyes may be irritated and dry due to a temporary change in tear distribution. Side effects such as uneven healing and permanent scarring are rare but, if they occur, may require surgical correction. The scars from blepharoplasty are well-concealed, and usually fade with time until they are virtually undetectable. Although the eyelids are still subject to aging, blepharoplasty produces long-lasting results.

  Link: Blepharoplasty

• Brow Lift

  Also known as a forehead lift, a brow lift is a surgical procedure performed to reduce signs of aging in the forehead area. It aims to remove or minimize deep horizontal creases across the forehead and bridge of the nose, and the frown lines between the eyebrows. It also lifts the eyebrows, making the eyes look more open. Common Brow-Lift Techniques There are two techniques used for performing brow lifts. The classic lift requires a long incision that runs across the top of the head, at the hair line, and down to the ears. However, for a woman who has a high forehead, a coronal incision, which is made behind the hairline, may be used. The endoscopic lift requires three to five small incisions that are made across the forehead, at the hairline. These shorter incisions mean a shorter recovery time and less scarring than those from a traditional brow lift. Which technique is chosen depends on the thickness, texture and elasticity of the skin, the bone structure of the face, the overall appearance of eyebrows and eyelids, and the position of the eyebrows. The Brow-Lift Procedure Brow-lift surgery usually takes about one to two hours to perform, and takes place at a hospital, an office-based surgical suite, or an ambulatory center. Either general anesthesia or intravenous sedation is used. Depending on the surgical technique used, one long incision or a series of small incisions is made. Tissue and muscle underneath the skin are moved or repositioned as necessary. At the end of the procedure, the incision(s) is closed with sutures, screws, adhesives or surgical tape; a drain may be put in to collect excess blood and fluid. Postsurgery, the patient is moved to a recovery area for observation. Recovery from a Brow Lift A patient typically returns home on the day of the brow-lift surgery, although an overnight stay may be necessary for some. Swelling may be pronounced for the first day or two after surgery, although most swelling goes away within 2 weeks. To prevent post-operative bleeding, bending and heavy lifting should be avoided for a few days. It can take up to 6 months for swelling to fully subside and scars to fade. Results of a Brow Lift Depending on the patient's presurgical appearance and goals, a brow lift's results, which can be seen immediately, can be either subtle or dramatic. Eyes will appear more "open," and creases across the forehead, bridge of the nose, and between the eyes will be much less prominent. Risks Associated with a Brow Lift Prior to scheduling surgery, the patient and surgeon should fully discuss the risks associated with a brow lift. In addition to those associated with any type of surgery, a brow lift's risks include the following: Hair loss around the incision site(s) Facial asymmetry Higher hairline Injury to facial nerves Eye dryness/irritation The chance of complications is minimized by choosing a board-certified plastic surgeon who has experience in performing brow lifts.

  Link: Brow Lift

• Facelift

  Over time, gravity and sun exposure take their toll on the face and neck. Deep creases that run from each side of the nose to the corners of the mouth appear; the jawline slackens; and the neck develops loose folds and fat deposits. Rhytidectomy (facelift) counteracts these signs of aging by tightening muscle, removing fat, and trimming excess skin. Rhytidectomy improves the look of the lower and middle areas of the face, and the neck. It is most effective for correcting the following: Mid-face sagging Deep creases under the eyes Nasolabial folds Jowls Sagging fat Loose skin and fat under the chin and jaw Although rhytidectomy removes or reduces signs of aging, over time, they will gradually reappear. Rhytidectomy does not improve the look of the brow, eyelids and nose, and some parts of the mid-face. A patient who wants to improve those areas might combine rhytidectomy with a brow lift or eyelid surgery, and/or with injectable soft-tissue fillers, facial implants and skin resurfacing. Candidates for Rhytidectomy The best candidates for rhytidectomy want to correct one or more of the signs of aging indicated above; have some facial sagging, but still have elasticity in their skin; are generally healthy; do not smoke; and have realistic expectations about what rhytidectomy can do. It is very important that the surgeon ascertains whether the patient is only interested in rhytidectomy because of pressure from someone else. Types of Rhytidectomy Rhytidectomy is typically performed as an outpatient procedure in an office-based facility, surgery center or hospital. Patients may have a choice of IV sedation or general anesthesia. The procedure takes about 2 hours. The way a facelift is performed depends on the surgeon, the patient's facial structure, and the extent of correction desired. Traditional Rhytidectomy A traditional rhytidectomy is a "full" facelift that rejuvenates the face, jowls and neck, and includes sculpting and redistributing of fat; lifting and repositioning of muscle and deeper tissues; and trimming and re-draping of skin. The incision begins at the temples and travels down to the front of the ear, around the earlobe and behind the ear to the lower scalp at the hairline. Sometimes, another incision is made under the chin. Limited-Incision Rhytidectomy A limited-incision rhytidectomy improves the area around the eyes and mouth by reducing nasolabial folds and other deep creases. Short incisions are made at the temples and around the ear, and possibly in the lower eyelids and/or under the upper lip. In both methods, incisions are closed with stitches or tissue glue. Scars are hidden in the hairline and natural contours of the face. Recovery from Rhytidectomy After rhytidectomy, the surgeon wraps the incisions in bandages, and may insert drainage tubes; if so, they are taken out the next day. If surgical clips are holding some incisions closed, they are removed, along with any stitches, 1 week after the procedure. Post-rhytidectomy, swelling, numbness, bruising and a feeling of tightness or tension in the face and neck may be felt. The face may look uneven or distorted, and facial muscles may feel stiff. Most of these side effects resolve within 3 to 6 weeks, and sensation typically returns to normal within a few months. Scars become less red, raised, lumpy and itchy over time. Many patients return to work by the third week. Camouflage cosmetics can be used to minimize the appearance of bruising. Results of Rhytidectomy Results of rhytidectomy are not permanent, and some patients choose to undergo another in 5 or 10 years. In some sense, however, effects are permanent; years later, the face continues to look better than if rhytidectomy had not been performed. Risks Associated with Rhytidectomy Possible complications of rhytidectomy include bleeding, infection, bruising, swelling or discoloration, allergic reaction to the anesthesia, skin blistering (usually only in smokers), nerve injury, and temporary or permanent loss of sensation in the face.

  Link: Facelift

• Rhinoplasty

  Rhinoplasty (nose surgery) is one of the most frequently performed plastic surgery procedures. During rhinoplasty, the nose is reshaped, reduced or augmented to improve its appearance. Rhinoplasty may be performed to correct a birth defect, or repair an injury such as a broken nose. It is also often performed strictly for cosmetic reasons. For a patient with ongoing sinusitis, rhinoplasty is sometimes performed in conjunction with endoscopic sinus surgery; for a patient with a deviated septum, it is often performed along with septoplasty, a procedure that corrects a deviated septum. In such cases, rhinoplasty effectively treats health and breathing problems, in addition to improving the patient's appearance. Candidates for Rhinoplasty Candidates for rhinoplasty have finished their facial growth. Girls should typically be at least 15 or 16 years old; boys should be at least 17 or 18. Patients considering rhinoplasty should be in overall good health and not smoke. It is important that candidates have realistic expectations about what rhinoplasty can do. Although undergoing rhinoplasty may boost self-confidence, it should not be viewed as a cure-all for personality or relationship issues, and should not be the result of social pressure. Goals of Rhinoplasty There are several goals of rhinoplasty; they include facilitating breathing as well as improving appearance. During rhinoplasty, the surgeon may attempt to do one or more of the following: Remove a hump Modify the bridge Reshape the tip Reshape or resize the nostrils Repair an injury Open breathing passages Increase or decrease size Rhinoplasty can involve modifying bone, skin or cartilage, or all three. The Rhinoplasty Procedure Rhinoplasty, which takes from 1 to 2 hours, is usually an outpatient procedure performed under IV sedation or general anesthesia. Two techniques are typically used. In closed rhinoplasty, incisions are made within the nostrils. In open rhinoplasty, an incision is made across the columella, the tissue between the nostrils. With both methods, the soft tissues covering the nose are gently lifted, and the bone and cartilage are sculpted to the desired shape. If additional cartilage is needed to augment the nose, it is frequently taken from the patient's nasal septum. If larger sections of tissue are required, cartilage may be surgically removed from the ear or other parts of the body as well. If the patient has a deviated septum, the septum and inner structures of the nose are adjusted to improve breathing. The tissues are then redraped and stitched closed. If necessary, nostrils are reshaped in the final stage of rhinoplasty. Recovery from Rhinoplasty Immediately after surgery, the patient's nose and eye area are usually bruised and swollen. Splints and nasal packing remain in the nose for a few days. During this period, the patient may experience some nasal pain or a dull headache, as well as some bleeding and drainage from the nose. Most patients feel like themselves within a few days and are able to return to regular activities in about a week. To increase comfort, and decrease bleeding and swelling, rhinoplasty patients are advised to follow these post-surgical directives: Avoid strenuous activities Take baths instead of showers Avoid blowing the nose Avoid becoming constipated Avoid exaggerated facial expressions Brush the teeth gently Avoid pulling clothing over the head Use sunscreen that has an SPF of 30 or higher Limit dietary sodium Do not use ice packs Although the patient usually looks "normal" a week or two after surgery, minimal swelling may be present for as much as a year. Risks of Rhinoplasty Complications associated with rhinoplasty are rare and, when they occur, usually minor. Surgical risks in general include infection or adverse reaction to anesthesia. In the case of rhinoplasty, specific risks include the following: Recurring nosebleeds Difficulty breathing through the nose Permanent numbness in or around the nose Persistent pain Discoloration of skin on the nose Scarring Perforation of the nasal septum It is possible that a patient is not satisfied with the results of the rhinoplasty. In such a case, a second surgery, called a revision rhinoplasty, may be performed at a later date.

  Link: Rhinoplasty

• Otoplasty

  Otoplasty (ear surgery) is a cosmetic procedure to improve the appearance of the ears. Otoplasty does not affect hearing, and provides significant psychological benefits to anyone who is teased about ear size and/or shape, has had a serious ear injury, or simply wants to improve his or her appearance. Otoplasty is most often performed to set unusually protruding ears closer to the head (ear pinning) or to reduce the size of abnormally large ears. Otoplasty may also be helpful in repairing the following: Abnormal constructions (lop ear) Cauliflower ear (which results from repeated trauma) Large, stretched or torn earlobes Earlobes with large creases and wrinkles Microtia (abnormally small ears) New ears or parts of ears can be constructed for patients who are missing them from causes that include birth defects, severe injuries and skin cancers. Candidates for Otoplasty People of any age who feel self-conscious about their ears may be good candidates for otoplasty, although it is typically performed on children between 4 and 14 years old. Ears are almost fully developed by the of age 4, so early surgery can help create self-confidence when a child begins going to school. Not everyone is a candidate for otoplasty; a patient must be in good general health, and have realistic expectations about what it can do. Otoplasty Procedure Otoplasty generally takes 2 to 3 hours, and is performed on an outpatient basis. The type of anesthesia used typically depends on the age of the patient, with general anesthesia recommended for very young patients, and local anesthesia and a sedative recommended for older children and adults. Otoplasty begins with a small incision's being made behind the ear, in the natural crease where the ear meets the head. The cartilage is then sculpted and bent to achieve the desired appearance. In some types of otoplasty, skin is removed, but the cartilage is left in one piece and merely bent back on itself to create a less protruding ear. After sculpting the cartilage to the desired shape, sutures and a bandage are used to hold the ear in position until healing is complete. To make sure they are as symmetrical as possible, both ears may be operated on even if only one has a problem. Recovery After Otoplasty Although the ears may ache or throb for a few days, a patient usually feels normal within hours of the surgery's completion. Medication is prescribed to help alleviate any discomfort. A few days after otoplasty, the bandages around the head are replaced with a surgical dressing that is worn for about a week, at which point the stitches are removed. Otoplasty patients should avoid sleeping on their sides for the first 2 weeks after surgery. About 1 week following otoplasty, most patients are able to return to their normal routines. After the ears have healed completely, they usually have faint scars on their backs, which typically fade with time and, because of their strategic placement, are virtually invisible. Risks and Complications of Otoplasty Complications of otoplasty are rare and usually minor. A small percentage of otoplasty patients develops a blood clot on the ear or an infection in the cartilage. These issues may resolve on their own or be treated medically through intervention or antibiotics. Other possible complications include a change in skin sensation at the surgical site. There is also a possibility that a patient will not be satisfied with the appearance of the ears postsurgery. A patient should not expect the ears to match exactly; even natural ears are not entirely symmetrical.

  Link: Otoplasty

• Hair Loss

  Hair loss, or alopecia, is a common condition which may be a consequence of natural aging, a side effect of medication, or a manifestation of a health disorder. It can result in total baldness, thinning of the hair, or patchy bald spots and may be confined to the scalp or affect other areas of the body. Hair loss may be temporary or permanent, depending on its cause. Some of the causes of hair loss include: Male pattern baldness Fungal infections of the scalp Severe infections or high fevers Poor nutrition Certain medications Traumatic stress Trichotillomania, a psychiatric disorder involving compulsive hair-pulling Thyroid or pituitary disorders Certain skin disorders, such as eczema or psoriasis Autoimmune diseases, such as lupus or polycystic ovary syndrome Chemotherapy or radiation therapy Alopecia areata, an autoimmune disorder Telogen effluvium, in which too many hair follicles remain in a resting state Treatment for Hair Loss Treatment for hair loss is usually based on the cause of the condition. When hair loss results from a fungal infection, it may be treated with anti-fungal medication. Hair loss that results from cancer treatment is usually temporary. For other types of hair loss, one of the following treatments may be considered: Hair transplant surgery, hair plugs, scalp reduction Over-the-counter medications, such as Rogaine or Nizoral External laser comb Hair-stimulating treatments For some patients, wigs or hairpieces may be useful in creating an attractive appearance and reducing self-consciousness about hair loss.

  Link: Hair Loss

• Breast Augmentation

  Augmentation mammaplasty (breast enlargement) is performed to increase breast size and/or fix breast asymmetry. Candidates include women who want larger breasts, and those who want to restore the breast volume often lost as a result of pregnancy or significant weight loss. Breasts can be enlarged with implants or by fat transplantation. Augmentation mammaplasty is not a substitute for mastopexy, which is a procedure to "lift" breasts that sag significantly. Augmentation Mammaplasty with Implants Silicone and saline are the two implant types most commonly used in augmentation mammaplasty. Silicone implants feel more like natural breasts than saline ones. However, if a saline implant ruptures, the saline is naturally absorbed by the body, whereas if a silicone implant has an extracapsular rupture (a rupture to the outer capsule), silicone filler leaks into the body, possibly resulting in inflammatory nodules or enlarged lymph glands. Implants are placed behind each breast, underneath either breast tissue or the chest-wall muscle. The procedure lasts 1 to 2 hours, and is typically performed with general anesthesia, although local anesthesia combined with a sedative may be used. Incisions are made in inconspicuous places (in the armpit, in the crease on the underside of the breast, or around the areola) to minimize scar visibility. The breast is then lifted, creating a pocket into which the implant is inserted. Advantages of implant placement behind the chest-wall muscle include a possible reduced risk of capsular contracture (hardening of scar tissue around implant), and less interference during mammograms. Disadvantages include the possible need for drainage tubes, and a longer recovery period. Advantages of implant placement beneath breast tissue include that the breasts move more naturally as the patient uses her chest muscles, and that slight breast sagging is corrected. Other types of implants include "gummy bear," round, smooth and textured. Augmentation Mammaplasty with Fat Transplantation Augmentation mammaplasty with fat transplantation (fat transfer) uses liposuction to harvest excess fat from other parts of the body; the fat is then injected into the breasts. Augmentation mammaplasty is appropriate for women who are not looking for a dramatic increase in breast size, and want breasts that look and feel as natural as possible. For a number of weeks prior to augmentation mammaplasty, tissue expanders may be placed below the muscles of the chest wall to expand the breasts, and increase the amount of fat they can hold. When the tissue has expanded enough, augmentation using fat transfer can begin. First, fat is removed using liposuction, in which a cannula (a thin, hollow tube) is inserted through small incisions, and then moved back and forth to loosen excess fat, which is suctioned out using a vacuum or a cannula-attached syringe. The harvested fat cells are then purified. In the second procedure, which takes place on the same day, the fat is injected into the breast through small incisions. The procedure takes approximately 4 to 5 hours. Recovery from Augmentation Mammaplasty After augmentation mammaplasty with implants, drainage tubes may be inserted; incisions are stitched, taped and bandaged. A surgical bra is typically put over the bandages to minimize swelling and support the breasts. For a few days postsurgery, most patients feel tired and sore, but many return to work within a week. Stitches are removed in 1 week to 10 days; postoperative pain, swelling and sensitivity diminish during the first few weeks. Scars begin to fade in a few months. After augmentation mammaplasty with fat transplantation, recovery time is short, with normal activities being resumed as soon as the patient feels comfortable. Compression garments are typically worn over the areas that received liposuction. Risks of Augmentation Mammaplasty In addition to the risks associated with surgery and anesthesia, those related to augmentation mammaplasty using implants include the following: Capsular contracture Implant leaks and ruptures Implant deflation or shifting Temporary or permanent change in nipple/breast sensation Irregularities in breast contour/shape Asymmetry Partial or total loss of nipple/areola The risks related to augmentation mammaplasty using fat transplantation include those related to liposuction, as well as the following: Calcification Fat embolism Fat necrosis Oil cysts Loss of volume Because of the loss of volume that occurs when fat is reabsorbed by the body, touch-up injections of fat are often necessary. Injections can be performed using local anesthesia.

  Link: Breast Augmentation

• Breast Lift

  Mastopexy (breast lift) is a surgical procedure for lifting and reshaping sagging breasts. Aging, pregnancy, weight loss and gravity can all cause breasts to sag. By trimming excess skin and tightening supporting tissue, breasts can be made to sit higher on the chest and be firmer to the touch. In addition, the nipple and areola can be repositioned or resized to further enhance breast appearance. Because mastopexy does not change breast size, it is often combined with breast augmentation or reduction. Candidates for Mastopexy An eligible mastopexy candidate is in good overall health, maintains a stable weight, and has realistic expectations about what mastopexy can do. A woman who chooses to undergo mastopexy has one or more of the following: Sagging breasts Breasts that have lost shape or volume Breasts that are flat or elongated Nipples or areolas pointing downward One breast lower than the other A woman planning to have (more) children should not undergo mastopexy because pregnancy and nursing can counteract its benefits. The Mastopexy Procedure Mastopexy is performed on an outpatient basis under general anesthesia, and usually takes 1 to 3 hours. Depending on the size and shape of the breasts, as well as the degree of sagging and amount of excess skin, one of the following types of incisions is often used: Two rings, one larger than the other, around the areola A keyhole shape, around the areola and down to the breast crease An anchor shape, beginning in the breast crease, and extending up to and around the areola The first type of incision (above) is used for small breasts and leaves the least amount of scarring; the third type is used for breasts with significant sagging. After the incisions are made, breast tissue is removed and reshaped to achieve the desired breast contour. The nipple and areola are usually moved higher on the breast or resized. Excess skin is trimmed to create a tighter, more defined appearance. Incisions are closed with stitches. Recovery from Mastopexy For a few days following mastopexy, patients are likely to have bruising, soreness and swelling. Breasts are usually wrapped in an elastic bandage or a surgical bra for about a week; a support bra is then worn continuously for a month. Stitches are removed after 1 to 2 weeks. Most patients return to work within a week; exercise and other strenuous activity should be avoided for about a month. Results of Mastopexy Mastopexy produces immediate results. As swelling subsides and scars fade, breasts continue to improve in appearance. Patients who thoroughly discussed their goals prior to surgery, and had realistic expectations of what it could provide, report high satisfaction levels. Although the breasts are still subject to the effects of aging, mastopexy produces long-lasting results. Risks of Mastopexy In addition to the usual risks associated with surgery and anesthesia, risks specific to mastopexy include the following: Temporary or permanent change in nipple/breast sensation Irregularities in breast contour/shape Asymmetry Partial or total loss of nipple/areola Depending on the incision type used, mastopexy can produce visible scars. Although some incisions can be concealed in the natural breast contours, others cannot. In most cases, however, scars fade over time, becoming much less apparent.

  Link: Breast Lift

• Breast Reduction

  Women who are unhappy about having large breasts and/or want to treat symptoms such as back pain, breathing problems and poor posture, may benefit from reduction mammaplasty (breast reduction), during which fat, glandular tissue and skin are removed from the breasts. The resultant smaller breasts increase patient comfort, and look more in proportion to the rest of the body. Ideal candidates for reduction mammaplasty are women with oversized breasts that are causing medical problems, low self-esteem, and/or physical or social discomfort. Women who are pregnant or breastfeeding cannot undergo reduction mammaplasty. The Reduction Mammaplasty Procedure Reduction mammaplasty is performed under general anesthesia. Depending on the technique used and the individual case, it takes from 2 to 5 hours to perform. One of the following incisions is often used: Two rings, one larger than the other, around the areola A keyhole shape, around the areola and down to the breast crease An anchor shape, beginning in the breast crease, and extending up to and around the areola Liposuction alone is sometimes used to reduce breast size. One advantage is that it leaves little-to-no scarring. However, because liposuction removes only fatty tissue, patients must have more fatty than glandular tissue in their breasts. Liposuction is also often used on men whose breasts are enlarged. Recovery from Reduction Mammaplasty After reduction mammaplasty, patients typically experience soreness, swelling and bruising for several days. Bandages are removed after 2 days, and replaced with a surgical bra. Physical activity should be limited for 1 to 2 weeks, while exercise and other strenuous activity should be avoided for at least 4 weeks. Stitches are removed after 2 to 3 weeks, at which point most patients return to work and other regular activities. The results of reduction mammaplasty are noticeable immediately after surgery. As swelling and bruising subside, the breasts' appearance improves. Scars fade with time, and usually cannot be seen when a patient wears a bathing suit or low-cut top. Risks of Reduction Mammaplasty In addition to the risks associated with any surgery, risks related to reduction mammaplasty, depending on the technique used, include the following: Loss of sensation Scarring Asymmetry Excessive firmness Inability to breast-feed Loss of skin/tissue where incisions meet Partial or total loss of areola and nipple Although reduction mammaplasty provides long-lasting results, breasts are still subject to the effects of aging and gravity.

  Link: Breast Reduction

• Fat-Transfer Breast Reconstruction

  Breast reconstruction surgery replaces the breast that is removed when a woman has a mastectomy to treat breast cancer. Although breast reconstruction often involves inserting a synthetic implant, there is an alternative, more natural treatment for rebuilding the breast(s). "Autologous fat transfer" removes fat from an area of the body that has fat to spare, and places it in the reconstructed breast for results that look and feel natural. By using the patient's own fat, the hard look and feel often associated with implants is eliminated. Many women also like the idea that a foreign material has not been inserted in their bodies. The cosmetic benefit of fat transfer is that the area, usually the abdomen, from which the fat is taken becomes slimmer and more contoured. Fat-transfer breast reconstruction is ideal for nearly any woman who wants a breast reconstructed, does not want to use a saline or silicone implant, and has enough body fat available to sufficiently rebuild the breast. Benefits of Fat-Transfer Breast Reconstruction Breast reconstruction using autologous fat transfer has a number of benefits over breast reconstruction with implants, including the following: No risk of implant rejection Ability to shape and sculpt the breasts Minimal number of incisions Reduced scarring No risk of capsular contracture In general, a breast reconstructed from a patient's own tissue is more similar in shape, contour and feel to a natural breast than one reconstructed using an implant. Fat-Transfer Breast-Reconstruction Procedure For a number of weeks or months prior to fat transfer, a tissue expander is placed below the pectoralis major muscle of the chest wall to create a new breast "pocket." When the tissue has expanded enough, breast reconstruction using fat transfer can begin. First, fat is removed using liposuction, in which a cannula (a thin, hollow tube) is inserted through small incisions, and then moved back and forth to loosen excess fat, which is suctioned out using a vacuum or a cannula-attached syringe. The harvested fat cells are then purified. In the second procedure, which takes place on the same day, the fat is injected into the breast through small incisions. The procedure takes 4 to 6 hours to perform under general anesthesia, or local anesthesia with sedation, depending on the preference of the patient and surgeon. Because some of the injected fat is reabsorbed by the body, some people may require two to five fat-transfer procedures to achieve satisfactory results. Postoperative pain and swelling, which can be managed with prescription medication, are typical. A patient can return to work and other light activity after a few weeks. Risks of Fat-Transfer Breast Reconstruction Aside from the risks associated with any surgery, those related to fat-transfer breast reconstruction include the following: Calcification Fat embolism Fat necrosis Oil cysts Loss of volume Although there was initial concern in the medical community that using fat to reconstruct the breast might increase the risk of breast cancer's recurring, studies indicate that it does not.

  Link: Fat-Transfer Breast Reconstruction

• Breast Reconstruction

  Breast reconstruction is performed on women who have lost one or both breasts to mastectomy, or who lack breasts due to congenital or developmental abnormalities. The goal of breast reconstruction is to create a breast and nipple that resemble the natural breast as closely as possible in shape, size and position. A long as a woman is healthy, age is not a factor in whether she is a good candidate for breast reconstruction. However, women with health problems such as obesity and high blood pressure, and those who smoke, are advised to wait rather than have breast reconstruction immediately following mastectomy. Types of Breast Reconstruction Breast reconstruction is performed in several steps, and there are essentially two types. Which one is used depends on whether there is enough tissue on the wall of the chest to cover/hold an implant. Whichever type is used, a woman's breast surgeon and plastic surgeon should work as a team during reconstruction. Implant/Tissue-Expansion Breast Reconstruction Implant/tissue-expansion breast reconstruction involves inserting an implant in the chest after the skin has been stretched enough by an expander to contain it. First, the surgeon inserts a balloon expander beneath the skin and chest muscle where the reconstructed breast will be built. Then, during the next few weeks or months, a saline solution is injected through a tiny valve beneath the skin into the expander. As the expander fills with saline, it stretches the skin and creates a pocket for the implant. The expander is left in place to serve as the implant or replaced with a another one, which can be made of saline or silicone gel. A final procedure reconstructs the areola and nipple. Some patients do not require tissue expansion, which can take up to a year to complete, and begin reconstruction with insertion of the implant. Autologous-Tissue Breast Reconstruction Autologous-tissue breast reconstruction is used if there is not enough tissue left post-mastectomy to create a new breast using tissue expansion, or a woman does not want implants. During autologous-tissue breast reconstruction, a breast is created using skin, fat and, sometimes, muscle from other parts of the body. The abdomen, back, buttocks or thighs are all donor sites. The donor tissue, which is called a "flap," is either surgically removed and reattached (free flap) to the chest, or left connected to its original blood supply and "tunneled" through the body to the chest (pedicle flap). There are a number of different flap techniques; which one is used depends on the individual patient. Factors taken into consideration include how much extra tissue is available for transfer; the width and flexibility of blood vessels; and how large the breast(s) needs to be. Implants may or may not be used with autologous-tissue breast reconstruction. Constructing a nipple and areola is performed in a separate surgery. It is essential that a patient have reasonable expectations about the results reconstruction provides. Recovery from Breast Reconstruction Recovery varies widely based upon the type of procedure used for breast reconstruction, as well as whether reconstruction immediately follows mastectomy. Hospital stays range from 1 to 6 days. Patients are tired and sore for 1 to 2 weeks, and recovery takes 3 to 6 weeks. Compression garments are typically worn, and stitches are taken out in a week to 10 days. A surgical drain may be left in place to prevent a buildup of fluid in the reconstructed breast; if so, it is removed within 1 or 2 weeks. Risks of Breast Reconstruction In addition to the risks associated with surgery and anesthesia, those related to implant/tissue-expansion breast reconstruction include infection around the implant, implant leaks and ruptures, and implant deflation or shifting. Risks related to autologous breast reconstruction, depending upon the technique used, include fat necrosis, abdominal weakness, hernia and a mismatch between chest tissue and donor tissue. Correcting reconstructive problems typically requires additional surgery. Results of Breast Reconstruction A reconstructed breast will not look the same as the original breast. And although a surgeon attempts to match the size, shape, position and other attributes of the remaining breast, an exact match is not possible. To achieve symmetry, the remaining breast may be operated on to make it bigger or smaller, or to lift it. In addition to not looking the same as the original, a reconstructed breast has little sensation, although there may be more when autologous tissue rather than an implant is used.

  Link: Breast Reconstruction

• Abdominoplasty

  Abdominoplasty (tummy tuck) helps flatten the abdomen by removing excess fat and skin, and tightening muscles. The best candidates for abdominoplasty are in good physical condition, with pockets of fat or loose skin that have not responded well to diet and exercise. Abdominoplasty can also be appropriate for slightly obese people whose skin has lost some of its elasticity, and for women with skin and muscles stretched from pregnancy. Anyone planning on losing a significant amount of weight, and women planning on having (more) children, should wait before undergoing abdominoplasty. The Abdominoplasty Procedure Abdominoplasty takes approximately 2 to 5 hours to perform; the patient is placed under general anesthesia. Two incisions are made: one from hipbone to hipbone close to the pubic area, and another around the navel. Skin is separated from the abdominal muscles, which are then pulled together and stitched into place for a firmer abdomen and narrower waist. The skin flap is then stretched down over the newly tightened muscles, excess skin is removed, and the navel is reattached where it looks natural. The incisions are then closed, and sterile surgical dressings are applied over the sutured areas. Recovery After Abdominoplasty After surgery, a temporary tube may be inserted to drain excess fluid from the surgical site. An overnight hospital stay may be necessary. Recovery time ranges from 2 weeks to 2 months. Abdominoplasty leaves a scar spanning the lower abdomen from hip to hip, although it is low enough to be concealed by a bikini. Maintaining weight with a balanced diet and regular exercise provides long-lasting results. Risks of Abdominoplasty In addition to the usual risks associated with surgery and anesthesia, risks associated with abdominoplasty include the following: Asymmetry Poor aesthetic result Unsightly scarring Loose skin Numbness in skin sensation Need for revisional surgery Patients who have had previous abdominal surgery may find that their old scars look more raised, have stretched or are more noticeable in general. Undergoing a scar revision may minimize their prominence.

  Link: Abdominoplasty

• Buttock Augmentation

  Buttock augmentation (a type of gluteoplasty) is performed to enlarge, and possibly reshape, buttocks that have not responded to diet or exercise. Candidates for buttock augmentation are unhappy with the lack of fullness, roundness and projection of their buttocks, and/or with having asymmetrical buttocks; they should also have realistic expectations about the results that surgery can provide. Significantly more women than men seek to have their buttocks augmented, but in recent years, the number of men has increased. Types of Buttock Augmentation Buttock augmentation is usually performed with implants or fat transfer, or a combination of the two. Which method is used depends primarily on the shape and size of the buttocks, the skin's quality and elasticity, and the amount of body fat available for transfer. Buttock Implants for Buttock Augmentation Typically, incisions for buttock implants are made in one of four areas: in each gluteal crease; overlying the tailbone at the top of the buttocks; in the crease between the buttocks; and at the side of each buttock, near the crease. After the incision or incisions are made, a silicone implant is inserted in each buttock within or above the gluteal muscle. The tissue within the buttocks is sutured, and the incisions are closed using sutures, adhesive or tape. Drains are usually inserted to prevent fluid from building up, and are left in place for about 7 days. During surgery, either general anesthesia or intravenous sedation is typically used. The results of buttock augmentation using implants is permanent, and are immediately apparent after surgery. Final results are evident after 3 months, at which point most of the swelling has subsided and the implants have "settled." Fat Transfer for Buttock Augmentation The fat used for buttock augmentation is usually taken from the patient's abdomen, hips, thighs or lower back. Fat is removed using liposuction, in which a cannula (a thin, hollow tube) is inserted through small incisions, and then moved back and forth to loosen excess fat, which is suctioned out using a vacuum or cannula-attached syringe. The fat is then purified, and injected into the buttocks at different depths for maximum absorption. It can take up to a year to see the final results of fat-transfer buttock augmentation, because the fat needs time to be completely absorbed. The results of buttock augmentation using fat transfer are often more natural-looking than those from implants, but a downside of the fat-transfer method is that the body reabsorbs part of the fat over time, so some of the initial fullness is lost. According to the American Society of Plastic Surgeons, patients tend to retain 60 to 80 percent of fat that has been transferred. Recovery from Buttock Augmentation After buttock augmentation with fat transfer or implants, a compression garment must be worn for 2 to 3 weeks. For at least 2 weeks, patients should not sit directly on the buttocks; placing a pillow beneath the back of the legs to raise the buttocks and keep pressure off them is required. Sleeping facedown or on the side is also recommended. Patients typically experience pain/discomfort, bruising and swelling after the procedure. Implant patients typically go back to work in 2 or 3 weeks, but may not be able to resume exercising for 8 to 10 weeks. Recovery time for fat-transfer patients is slightly quicker, with most going back to work within 10 to 14 days, and resuming exercise after 8 weeks. Risks of Buttock Augmentation In addition to the risks associated with any surgery, those related to buttock augmentation using implants include the following: Implant migration Implant rupture Nerve damage Excessive firmness Sciatic-nerve pressure Fluid accumulation (seroma) In addition to the risks associated with any surgery, those related to buttock augmentation using fat transfer include the following: Cellulite Stretch marks Asymmetry Fat embolism Buttock augmentation with fat transfer includes the risks related to liposuction, which include indentations in the skin, scarring and contour irregularities.

  Link: Buttock Augmentation

• Gynecomastia

  Gynecomastia (overdevelopment of male breasts) is a common condition characterized by an excess of localized fat and/or glandular tissue in the breast. It is sometimes caused by disease, hormonal changes, heredity or certain medications, although, in most cases, its cause is unknown. It can occur in one or both breasts, and can affect babies, preteens, teenagers and grown men. Symptoms of gynecomastia include enlarged breasts, breasts that feel rubbery or firm and, in young boys, nickel- or quarter-sized breast "buds." Breast buds are common in adolescents, and tend to go away on their own. Treatment of Gynecomastia As long as breast development is complete, plastic surgery can be used to treat gynecomastia that is not caused by disease or medication. Treatment choices include liposuction or surgery, or a combination of the two; which technique is chosen depends on the amount and type of tissue in the breasts. If the breasts consist mostly of fatty tissue, liposuction can be used to suction out fat through incisions made in the nipples or underarm areas. For breasts with an excessive amount of glandular tissue, excision surgery, which requires cutting away excess fat, skin and tissue, can be performed. This requires a larger incision than is used with liposuction.

  Link: Gynecomastia

• Labiaplasty

  Labiaplasty is a surgical procedure that is performed on the labia major (the outer lips of the vagina) and/or the labia minor (the inner lips of the vagina). It is used to reduce the size of labia that are too large, and to reshape labia that are uneven, improving their appearance and reducing associated discomfort. A relatively minor surgical procedure, it is performed for cosmetic, hygienic, pain-relief and/or functional reasons. Labiaplasty can be performed alone or in conjunction with procedures such as vaginoplasty and liposuction. Labiaplasty specialists are often plastic surgeons, obstetricians/gynecologists, or urologists. Candidates for Labiaplasty Candidates for labiaplasty may not like the appearance of their labia; be bothered by labial irritation while conducting normal activities; find it difficult to keep the labial area clean; or experience pain during sexual intercourse or vigorous activity. Candidates should be in good overall health, and not planning on having (more) children, because the birthing process can cause operated-on tissue to reopen. The Labiaplasty Procedure Labiaplasty is generally performed just after the patient has had her period. The patient receives anesthesia or IV sedation, as well as medications to block nerve signals and minimize bleeding. The surgeon trims, using scissors, a scalpel or laser, excess labial tissue, closes the incision with absorbable stitches, and applies antibiotic cream. Labiaplasty takes 1 to 2 hours, and most patients return home the same day. Recovery from Labiaplasty Post-labiaplasty, most patients have swelling, and mild-to moderate pain, for which painkillers are prescribed. Patients typically return to work in 2 to 4 days, and are able to use tampons or resume sexual activity in 6 weeks. Post-operative care involves carefully washing the area, and using antibiotic creams to prevent infection. Risks of Labiaplasty Complications from labiaplasty are rare, but there are risks. They include bleeding, infection, poor healing, labial asymmetry, labia that are smaller or larger than desired, loss of sensation, and the need for a second surgery.

  Link: Labiaplasty

• Liposuction

  Liposuction is a minimally invasive cosmetic procedure that uses a thin, hollow tube called a cannula to remove localized areas of body fat. The cannula is inserted through extremely small incisions, and then moved back and forth to loosen excess fat, which is suctioned out using a vacuum or a cannula-attached syringe. Treated areas look slimmer and more contoured, and in better overall proportion to the rest of the body. However, liposuction is not a method for losing weight, and is not effective in eliminating cellulite, or tightening loose and sagging skin. The ideal candidate for liposuction is in good overall health, but has one or more areas of fat that do not respond to diet or exercise. Areas that are often treated with liposuction include the thighs, abdomen, arms, back, hips, buttocks, chest, face, calves and ankles. Liposuction can be performed alone, or in conjunction with other cosmetic procedures, such as thighplasty and abdominoplasty. The Liposuction Procedure One of the most common liposuction techniques is tumescent liposuction, which may get an assist from ultrasound or laser. It is performed on an outpatient basis. During tumescent liposuction, a solution comprising saline solution, lidocaine (an anesthetic) and epinephrine (a blood-vessel contractor) is injected into the area being treated. The solution causes the targeted tissue swell and become firm, which makes it easier to remove via the cannula. The advantages to this technique are that the anesthetic is built in, so there is no need for general or IV sedation, and blood loss is minimized because the epinephrine constricts blood vessels. In laser-assisted tumescent liposuction, a laser is used to liquefy the fat, which makes removing it easier. The laser can also be used to tighten treatment-area skin after fat is removed. Similarly, ultrasound-assisted liposuction uses ultrasound energy to liquefy fat. Recovery from Liposuction After liposuction, patients experience mild swelling, bruising and discomfort in the treated area. Compression garments or elastic bandages are typically worn to help reduce these symptoms as the area heals. Patients can return to work and other regular activities as soon as they feel comfortable, which is usually after a few days. Exercise and other strenuous activities should be avoided for a few weeks. Risks of Liposuction In addition to the usual risks associated with surgery, risks associated with liposuction include the following: Loose or rippled skin Worsening of cellulite Asymmetry Contour irregularities Pigmentation irregularities When large amounts of fat are removed, surgery to remove excess skin may be necessary. Results of Liposuction Results of the liposuction procedure may not be apparent until swelling and bruising subside, which usually takes a week; swelling should completely subside within a few months. Incisions are rarely sutured, and scarring is almost nonexistent, because the incisions used for the cannula are so small. The results of liposuction are long-lasting, unless a substantial amount of weight is gained.

  Link: Liposuction

• Scar Revision

  Scar revision reduces the prominence of scars that result from injury or previous surgery. Although many scars fade over time and become barely noticeable, disruptions to the healing process can cause them to become red, raised, indented or otherwise deformed. The prominence of a scar depends on the type and severity of the injury that caused it, and the patient's age, overall health and ability to heal. For people who are unhappy with or embarrassed by their scars, there are a number of procedures available to make scars less apparent. Scar-Revision Treatments Scars are by definition permanent, but certain treatments can narrow, fade and otherwise make them less noticeable, which is especially helpful when they form on conspicuous areas such as the face and hands. Although there are many surgical scar-revision methods, including surgical excision, skin grafts and flap surgery, not all are appropriate for treating all types of scars. The best procedure for scar revision varies depending on the location and severity of the scar, the age and overall health of the patient, and the extent of revision the patient wants. Subcision Subcision is a procedure for treating scars that are indented. A needle is directed into the skin to break up the fibers that attach the scar to below-the-surface tissue, raising it back to the elevation of surrounding skin. It also promotes healing by creating new connective tissue that repairs and smooths the skin. Excision Surgical excision is most often used for severe contracture (skin-tightening) scars, and involves using a scalpel to surgically cut away the scar and surrounding damaged tissue. A skin flap or graft may be used to restore the appearance of the skin in the treated area, and also improve movement and flexibility that may have been affected by the contracture. Punch Elevation Particularly effective for certain types of acne scars, punch elevation uses a punch tool rather than a typical scalpel to precisely remove small quantities of tissue without affecting nearby skin. The punch tool is used to elevate the base of the scar, making it appear much less recessed or pronounced. Surface Treatments Many cosmetic procedures, such as microdermabrasion, chemical peels and skin bleaching, effectively treat discolorations and mild surface irregularities by gently removing the top layers of skin and rejuvenating the underlying layers. Multiple treatments may be needed, however, to achieve noticeable results. Laser Treatments Similar to surface treatments, laser treatments gently remove damaged layers of skin to reveal new unblemished skin underneath, while stimulating collagen production for further gradual improvements. The precision of laser treatments ensures that only damaged tissue is treated, while healthy surrounding tissue remains intact. Fillers Dermal fillers are quite successful at "filling in" depressed scars and creating a smoother skin surface. Fillers are U.S. Food and Drug Administration-approved, and safe for most patients. Many fillers are made from substances found naturally in the body, or are synthetically made to mimic natural substances or stimulate collagen production. Fillers are injected directly into the skin of the targeted area to restore volume to the scar. However, results from fillers are not permanent, and followup injections are necessary to maintain the improvement they provide. Prior to undergoing scar revision, patients are advised to stop smoking, and to avoid any medications that can cause an increase in bleeding. Results and Recovery from Scar Revision Most scar-revision treatments are minimally invasive, and do not require any downtime, although there may be mild swelling, discoloration and discomfort in the treated area for 1 to 2 weeks. Results are often immediate and noticeable, although it may take several months for maximum results to be achieved. The effectiveness of scar revision depends on a number of factors, including the nature of the injury, the body's healing ability, the size and depth of the wound, and the thickness and color of the skin.

  Link: Scar Revision

• Injectables

  BOTOX® Cosmetic BOTOX® Cosmetic is a prescription drug that, when injected, temporarily paralyzes muscles. It contains a purified and safe form of botulinum toxin A, which is produced by the microbe that causes botulism. Manufactured by Allergan, Inc., it is used to treat permanent furrows and deep wrinkles in the skin that are formed by the continual contraction of facial muscles. In addition to its cosmetic applications, it is used to treat a number of medical problems, including excessive sweating, overactive bladder, neck spasms, crossed eyes, chronic back and jaw pain, and migraines. Dysport® Prescription Dysport® injectable is a U.S. Food and Drug Administration-approved treatment for temporarily lessening or eliminating moderate-to-severe frown lines between the eyebrows. Like BOTOX® Cosmetic, Dysport injectable is placed directly into the muscle underneath a furrow, weakening the muscle to the point where it cannot contract. JUVÉDERM® JUVÉDERM® XC injectable gel is a U.S. Food and Drug Administration-approved dermal filler that, according to its manufacturer, Allergan, Inc., is designed to "temporarily treat moderate to severe facial wrinkles and folds such as nasolabial folds" in people older than 21. Unlike the original JUVÉDERM injectable gel, JUVÉDERM XC is infused with lidocaine to make its injection more comfortable. Kybella® One of the most flattering things of a person’s profile is having a chiseled, defined chin. If you have excess fat under your chin or a double chin, then you may feel a bit self-conscious about your profile and overall appearance. But, unless you want to undergo surgery, you may think that you are stuck with your double chin. One thing that you may not realize is that you have another option to choose from including an injection called Kybella. RADIESSE® RADIESSE® volumizing filler is a synthetic injectable filler that has been U.S. Food and Drug Administration (FDA)-approved for reducing moderate-to-severe wrinkles, folds and creases around the nose and mouth by augmenting the skin's natural collagen supply. It is a safe, effective and long-lasting alternative to injectable collagen and other dermal fillers for smoothing wrinkles and adding facial volume and contour. Restylane® U.S. Food and Drug Administration (FDA)-approved Restylane® injectable gel is a cosmetic "filler" that contains hyaluronic acid (HA), a natural substance that is found in the body. HA gives volume and elasticity to the skin, but as the body ages, HA levels decrease, resulting in loose skin and wrinkling. When injected, Restylane gel is designed to plump the skin beneath lines and wrinkles, smoothing them out and making them less noticeable. Sculptra® Sculptra® Aesthetic injectable is used to reverse the signs of facial fat loss that occur with aging. By restoring collagen, which decreases as the body ages, it fills out shallow-to-deep wrinkles and folds that run from the sides of the nose to the corners of the mouth (nasolabial folds). It is not appropriate for use in the eye and lip areas.

  Link: Injectables

• Non-Surgical

  Cellulite Cellulite is a cosmetic skin condition involving the accumulation of fatty deposits under the skin. It presents as areas of dimpled or puckered skin, most often appearing on the thighs, hips, buttocks and abdomen. This condition affects nearly 8 out of 10 women over the age of 20, as well as some men. Women more commonly develop cellulite because of the way fat is distributed in the lower half of the female body. Cellulite appears to have a genetic component since individuals who have family members with cellulite are more prone to develop the problem. Chemical Peels Chemical peels remove damaged outer layers of skin to make skin smoother, reduce scarring and remove blemishes. Ranging from mild to strong, there are three types of chemical peels: alphahydroxy acid (AHA), trichloroacetic acid (TCA) and phenol. The strength of each peel is tailored to the patient. Peels can be combined with other procedures, such as facelifts, for additional improvement to skin. Chemical peels may be covered by insurance if they are performed for medical rather than cosmetic reasons. CoolSculpting® CoolSculpting® treatment is a breakthrough, non-invasive procedure that uses patented cooling technology to eliminate fat without surgery. This clinically proven technique is designed to selectively reduce the fat in problem areas that has proven resistant to reduction through diet and exercise. CoolSculpting gently cools targeted cells in the body to induce a natural, controlled elimination of these unwanted fat cells. Laser Skin Resurfacing Modern technology provides a variety of successful laser resurfacing treatments for improving the condition of the skin. Laser skin treatments employ focused beams of light energy to counteract the effects on the skin of acne, aging, sun damage, hyperpigmentation, scars, or poor nutrition. Resurfacing laser treatments are safe and efficient, requiring little downtime to provide effective results. Spider Veins Spider veins (telangiectasias) are small, thin blood vessels visible beneath the skin. They usually develop on the face or legs, and may look like a series of thin tree branches or strands of a spider web. Although most spider veins are only a cosmetic issue, for some people they can cause uncomfortable symptoms such as aching, burning, swelling and leg-cramping. Thermage® Thermage® therapy uses a unique form of radiofrequency energy to tighten loose or sagging skin. According to its manufacturer, Solta Medical, Inc., benefits of Thermage treatment "include the smoothing of wrinkly or uneven skin, better definition of facial features around the eyes, jaw and neckline, and even the smoothing and toning of unsightly bulges, dimples and wrinkles on the face and body." Thermage radiofrequency therapy is U.S. Food and Drug Administration-approved for eyelid treatments. Ultherapy® Using ultrasound energy, Ultherapy® treatment lifts and tightens skin on the face and neck. Ultherapy treatment works on the deep layers of tissue usually targeted during a facelift or neck lift, but leaves surface skin alone. By heating tissue with sound waves, collagen production increases, resulting in younger-looking skin. According to its manufacturer, Ulthera, Inc., Ultherapy treatment "is the only noninvasive procedure FDA-cleared to lift skin on the neck, chin and brow."

  Link: Non-Surgical

• Oral and Maxillofacial Surgery

  Oral and maxillofacial surgery is the treatment of problems affecting the mouth, teeth, gums, jaws and related facial structures. Procedures are often performed on patients with skeletal and dental irregularities that occur as a result of congenital defects, injury, disease or other factors. Maxillofacial surgery is also performed to treat patients with oral cancer and jaw cysts. Patients with these conditions may have an abnormal or unbalanced facial appearance, and may have difficulty chewing, swallowing or speaking. The goal of oral and maxillofacial surgery is to treat the problem while achieving the most aesthetically pleasing result possible. Oral and maxillofacial surgery may include tooth extractions, reconstructive jaw surgery, and treatment for temporomandibular joint disorders (TMD). Depending on the patient's condition and the surgical repair necessary, oral maxillofacial surgeons may work in conjunction with plastic surgeons to achieve the best results. Dental Bone Grafts Bone grafting is a regenerative treatment option for patients who have lost quality and quantity of supporting bone tissue as a result of periodontal disease. This procedure is often needed before dental implants can be placed. It also helps protect the teeth from bacteria, trauma and further degeneration. Gum Grafting Gum grafting is a surgical procedure that helps protect the tooth roots and improve the appearance of the smile for patients who are self-conscious about receded gums caused by gingivitis. The gums help protect the mouth from bacteria and trauma while also covering the ends of the teeth for a pleasing smile. Gum recession can therefore be both a cosmetic and a medical concern. Impacted Tooth An impacted tooth is a tooth that has not broken through the gums. This condition is most commonly associated with wisdom teeth. Wisdom teeth may remain in the gums causing no symptoms or side effects, however, in many cases, an impacted tooth can cause swelling and pain. Types of Orthognathic Surgery Orthognathic surgery involves correcting jaws that do not meet correctly, or teeth that do not align properly. In most cases, teeth are straightened, or properly aligned, with orthodontics before corrective jaw surgery can be performed to reposition misaligned jaws. This not only improves facial appearance, but ensures that teeth meet correctly and function properly. Orthognathic surgery allows for the repositioning of teeth and facial bones to create a jaw that works and functions properly, and has a more balanced appearance. There are a number of types of orthognathic surgery. Laser Gum Treatment Laser gum treatment is a noninvasive, painless procedure that uses advanced laser technology to treat a wide range of gum conditions. More commonly used than they once were to treat certain types of gum problems, lasers allow many procedures to be performed with great precision, few complications and little pain. Neuromuscular Dentistry Neuromuscular dentistry is an area of dentistry that focuses not only on the teeth as they relate to the jaw, but on the nerves, muscles and joints as they relate to the jaw. By combining the principles of anatomy and physiology, neuromuscular dentistry works to achieve an optimal bite (occlusion) and jaw alignment. Neuromuscular dentists examine how all parts of the mouth and jaw work together. The objective of a neuromuscular dentist is to relax the jaw muscles in order to identify the true resting position of the jaw. They focus on determining the optimal position of the jaw in order to correct misalignment and jaw disorders. Oral and Maxillofacial Pathology Oral and maxillofacial pathology concentrates on diagnosing and understanding the nature of diseases and abnormal conditions in the oral and facial areas. Oral and maxillofacial pathology is a branch of dentistry concerned with the nature and identification of characteristics, causes and effects of diseases affecting the mouth and oral cavity, including the teeth, jaws, soft tissue and salivary glands. Wisdom Teeth Extraction The wisdom teeth, also known as the third molars, develop during early adulthood, most often between the ages of 15 and 25. Most mouths are too small to support these additional molars, making an ex109traction procedure necessary. If not removed, the wisdom teeth may cause pain, infection and swelling of the face or gum line, as well as the development of cysts and tumors. Sedation Dentistry A great many people experience anxiety in relation to undergoing dental work or to visiting the dentist at all, a fear known as dental phobia. Surgical Dental Extractions A dental extraction, also known as exodontia, is one of the most common procedures performed at a dentist's office. The procedure involves removing or pulling a tooth. A surgical extraction may be necessary on certain teeth.

  Link: Oral and Maxillofacial Surgery

• Sedation Dentistry

  A great many people experience anxiety in relation to undergoing dental work or to visiting the dentist at all, a fear known as dental phobia. Unfortunately, such fear keeps too many individuals from getting regular dental care, compromising not only their dental health and appearance, but often their overall health as well. In almost every case of dental phobia, sedation dentistry, in which the patient's anxiety is totally relieved by the use of medication, is the solution. Reasons for Sedation Dentistry In addition to being very helpful to patients who experience dental phobia, sedation dentistry in useful for patients who: Gag easily Have difficulty sitting still Have sensitive teeth or gums Require a large amount of dental work Have a low threshold for pain During sedation dentistry, varying degrees of sedation may be used, depending on the needs of the patient and the type of procedure being performed. Levels of Sedation The point of sedation dentistry is to provide peace of mind to the patient undergoing treatment. In most cases, it does not involve anesthesia, but simply puts the patient into a very relaxed state. Because in most cases the patient is still awake to a degree, a local anesthetic must still be employed to deaden any anticipated pain. In anxious patients, sedation is administered prior to the anesthetic so the patient won't have heightened anxiety about the injection. Sedation for dental patients may be administered in a number of ways, depending on the procedure being performed and on the physical and emotional needs of the patient. Inhaled Minimal Sedation One way of administering sedation is by having the patient breath in nitrous oxide ("laughing gas") through a mask placed over the nose. Although the nitrous oxide will definitely put the patient into a relaxed state, the gas wears off quickly. For this reason, adult patients who have been treated with nitrous oxide are able to drive themselves home from the procedure. Nitrous oxide is sometimes used as a safe alternative on children who are phobic or uncooperative about dental treatment. Patients under minimal sedation are groggy and slur their speech, but can be easily roused. Oral Sedation Oral sedation is the most common type used in sedation dentistry. It ranges from minimal to moderate and is administered in pill form. When only minimal sedation is required, the patient is usually given a Halcion tablet, a medication similar to Valium, which takes full effect in approximately one hour. Once the pill takes effect, the patient becomes drowsy, but is still awake. When a slightly greater degree of sedation is required, the patient is administered a somewhat larger, or moderate, dose of the medication. With the moderate dose of this medication, most patients remain fully asleep, although they can be awakened with minimal effort. Children are sometimes given a mild dose of oral medication which is carefully administered according to the child's age and weight. IV Moderate Sedation Because this type of moderate sedation is administered intravenously, it works almost immediately. It also has the advantage that the dentist can adjust the dosage as needed during the procedure. Deep Sedation and General Anesthesia Patients under deep sedation or general anesthesia are almost or completely unconscious during the entire dental procedure. They cannot be awakened until the effects of the anesthesia have worn off. Sedation dentistry is very helpful for patients who experience discomfort and anxiety about visiting the dentist. Whichever type of sedation they receive enables them to feel comfortable in the dentist's chair, even when undergoing lengthy or complicated procedures. As a matter of fact, patients under sedation frequently experience the sensation that a prolonged procedure has only last a minute or two. Sedation dentistry also has the advantage of allowing the dentist to perform a great deal of work during only a few sessions because the patient is comfortably at rest.

  Link: Sedation Dentistry