Cosmetic Procedures

Botox Injections Breast Augmentation Breast Lift Breast Reduction Chemical Peel Collagen Injections Eyelid Surgery Facelift Facial Implants Fat Injection Forehead Lift

Hair Transplantation Laser Hair Removal Lip Augmentation Liposuction Microdermabrasion Micropigmentation Nose Reshaping Sclerotherapy Skin Resurfacing Tummy Tuck Non-Elective

BREAST AUGMENTATION

(Breast Enlargement)

What is it?

Breast augmentation enlarges breast size using inflatable implants filled with saline. The procedure will make your breasts fuller and enhance their shape. As a result, you will find it easier to wear certain styles of clothing. Like many women who have had breast augmentation, you may have a boost in self-confidence.

Who has it done?

Many women choose to have their breasts enlarged in order to satisfy their own desire for a fuller bustline. Your breasts may not have developed to a size that meets your expectations, or one breast may be significantly smaller than the other. You may have been happy with your breasts in the past but feel that they look different now. Often, after weight loss, childbirth or as a result of aging, the breasts lose volume and their shape changes. Breast augmentation can enhance your breast size and shape, and give you the more proportional figure that you always wanted.

Will it work for me?

One or more of the following feelings or conditions may indicate that you are a good candidate for breast augmentation: You are bothered by the feeling that your breasts are too small Clothes that fit well around your hips are often too large at the bustline You feel self-conscious wearing a swimsuit or form-fitting top Your breasts have become smaller and lost their firmness after having children Weight loss has changed the size and shape of your breasts One of your breasts is noticeably smaller than the other

What is the consultation like?

Your plastic surgeon will examine your breasts and perhaps take photographs for your medical record. He or she will consider such factors as the size and shape of your breasts, the quality of your skin and the placement of your nipples and areolas (the pigmented skin surrounding the nipples). If your breasts are sagging, a breast lift may be recommended in conjunction with augmentation.

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. You will be asked whether you have a family history of breast cancer and about results of any mammograms. It is important for you to provide complete information.

If you are planning to lose a significant amount of weight, be sure to tell your plastic surgeon. He or she may recommend that you stabilize your weight prior to undergoing surgery. If you think that you may want to become pregnant in the future, you should mention this to your surgeon. Pregnancy can alter breast size in an unpredictable way and could affect the long-term results of your breast augmentation. There is no evidence that breast implants will affect pregnancy or your ability to breast-feed, but if you have questions about these matters, you should ask your plastic surgeon.

Are the implants safe?

In 1992, because further studies were needed to establish the safety of breast implants, the Food and Drug Administration decided that silicone gel-filled implants would not be generally available for cosmetic breast enlargement. Currently, all women undergoing breast augmentation receive saline-filled implants which consist of a silicone shell filled with sterile saltwater. New scientific data on the safety of breast implants is rapidly being collected. In the future, it is possible that additional types of filler materials may become available. Your plastic surgeon will be able to provide you with the latest information.

Where are the incisions placed?

Individual factors and personal preferences will help you and your plastic surgeon to determine your appropriate breast size, the location of incisions, and whether the implants will be placed on top of or underneath the chest muscle.

An incision can be made either underneath the breast, just above the crease, around the lower edge of the areola or within the armpit. The implant is placed in a pocket either directly behind the breast tissue (right) or underneath the pectoral muscle which is located between the breast tissue and chest wall. One of the advantages of a saline-filled implant is that, because it is filled with saltwater after being inserted, only a small incision is needed.

Often, an incision of less than one inch is made underneath the breast, just above the crease, where it is usually quite inconspicuous. Another possible location for the incision is around the lower edge of the areola. A third alternative is to make a small incision within the armpit. Once the incision is made, the surgeon creates a pocket into which the implant will be inserted. This pocket is made either directly behind the breast tissue or underneath the pectoral muscle, which is located between the breast tissue and chest wall.

Where does it happen and how long does it take?

Your breast augmentation surgery may be performed in a hospital, free-standing ambulatory facility or office-based surgical suite. Medications are administered for your comfort during the surgical procedure. Frequently, local anesthesia and intravenous sedation are used for patients undergoing breast augmentation, although general anesthesia may be desirable in some instances.

When surgery is completed, usually in one to two hours, you will be taken into a recovery area where you will continue to be closely monitored. Your breasts will be wrapped in gauze dressings or a surgical bra. You may be permitted to go home after a few hours, unless you and your plastic surgeon have determined that you will stay in the hospital or surgical facility overnight.

What is the recovery process?

A day or two after surgery, you should be up and about. Any dressings will be removed within several days, and you may be instructed to wear a support bra. Your plastic surgeon will probably permit you to shower between three and seven days following surgery. Stitches will be removed in about a week. Some discoloration and swelling will occur initially, but this will disappear quickly. Most residual swelling will resolve within a month.

After breast augmentation surgery, it is often possible to return to work within just a few days or a week, depending on your job. Vigorous activities, especially arm movement, may be restricted for two to three weeks. Sexual activity should be avoided for at least the first week following surgery. After that, care must be taken to be extremely gentle with your breasts for at least the next month.

How long will the results last?

Except in the event of implant deflation requiring surgical replacement with a new implant, the results of your breast augmentation surgery will be long-lasting. 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" to restore their more youthful contour.

BREAST REDUCTION

What is it?

Breast reduction surgery will make your breasts smaller and firmer by removing excess tissue and skin. Without the extra weight of large breasts, you may find greater enjoyment in playing sports and engaging in physical activity. 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.

Who has it done?

Patients who undergo breast reduction surgery frequently are seeking relief from physical symptoms caused by the excessive weight of large breasts. Breast reduction usually can solve these problems as well as improve the size and shape of your breasts. Following breast reduction, your breasts will be more proportional to the rest of your body, and clothes will fit you better.

Will it work for me? Are there age requirements?

You may be a good candidate for breast reduction if you have one or more of the following conditions: 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 plastic surgeons usually 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 your plastic surgeon.

What is the consultation like?

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. This will help your plastic surgeon to understand your expectations and determine whether they realistically can be achieved.
Your plastic surgeon 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 your plastic surgeon if you plan to lose a significant amount of weight, particularly if you have noticed that your breasts become smaller with weight loss. Your surgeon may recommend that you stabilize your weight before having surgery.

Will my insurance pay for a breast reduction?

Insurance coverage is sometimes available for breast reduction surgery. Many factors determine your eligibility, including the specific terms of your insurance policy and the amount of breast tissue to be removed. A letter of predetermination may be required by your insurance company prior to surgery. Your plastic surgeon or a staff member in your surgeon's office will discuss these matters with you.

How is breast reduction performed?

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 involves three incisions. One incision is made around the areola. Another runs vertically from the bottom edge of the areola to the crease underneath the breast. The third incision follows the natural curve of the breast crease.

After the surgeon has removed excess breast tissue, fat and skin, 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.
One common breast reduction technique removes excess breast tissue, fat and skin through the incisions shown. The nipple and areola remain attached to the underlying tissue but are shifted to a higher position. The size of the areola is often reduced at the same time. Skin that formerly was located above the nipple is brought down and together to reshape the breast.

What are some variations to the common breast reduction technique?

There are many variations to the design of the incisions for breast reduction. The size and shape of your breasts, as well as the desired amount of reduction, are factors that will help your plastic surgeon determine the best technique for you.
In some instances, it may be possible to avoid the vertical incision that runs from the bottom edge of the areola to the breast crease or the horizontal incision underneath the breast. 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.

Where does it happen and how long does it take?

Your breast reduction surgery may be performed in a hospital, free-standing ambulatory facility or office-based surgical suite. Usually, a general anesthetic is administered, so that you will be asleep throughout the procedure. When surgery is completed, in one to three hours, you will be taken into a recovery area where you will continue to be closely monitored. 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 or surgical bra.

What is the recovery process?

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.
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.

How long will the results last?

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.

COLLAGEN INJECTIONS

What is it?

Injectable Zyderm and Zyplast collagen, natural substances derived from purified bovine (cow) collagen, essentially replace the natural collagen that the skin loses over time. Collagen injections are most useful in the treatment of frown lines, "crow's feet," and nasolabial folds (smile lines). To improve deeper creases or enhance lip fullness, there also are filler materials, such as soft ePTFE (expanded polytetrafluoro-ethylene) that can be surgically implanted.
It's a safe, time-tested, effective treatment that provides immediate results

Who has it done?

Men and women seeking to pump up creased, furrowed or sunken facial or wanting to add fullness to lips and the backs of hands. It works best on thin, dry, light-colored skin. Approved by the FDA in 1981, collagen injections have proven to be a very popular non-surgical cosmetic procedure.

How does it work?

Collagen, which contains local anesthesia, is injected with a tiny needle into the skin depressions being treated. Several injections may be needed, depending on the length and depth of the wrinkle. There is no need to obtain tissue from another part of the body.

Where does it happen and how long does it take?

Implantation procedures for the lips and nasolabial areas are done with a local anesthetic on an outpatient basis. The procedure for both injections and implants takes less than an hour.

What is the recovery process?

No downtime for injectables—patients can immediately resume work and all normal activities. There may be some slight bruising. Pretreatment testing for allergic reactions is recommended. Allergic reactions can cause itching, redness, or other symptoms.

How long will the results last?

Collagen is only temporarily effective. Repeat treatments are needed every three to six months.

FACELIFT

(Rhytidectomy)

What is it and why do some people feel they need it?

As people age, the effects of gravity, exposure to the sun, and the stresses of daily life can be seen in their faces. Deep creases form between the nose and mouth; the jawline grows slack and jowly; folds and fat deposits appear around the neck.
A facelift, called 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. 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. Before you decide to have surgery, think carefully about your expectations and discuss them with your surgeon.

Who has it done?

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.

How does it work?

In general, the surgeon separates the skin from the fat and muscle below. Fat may be trimmed or suctioned from around the neck and chin to improve the contour. The surgeon then tightens the underlying muscle and membrane, 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.

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.

How long does it take?

A facelift usually takes several hours-or somewhat longer if you're having more than one procedure done. For extensive procedures, some surgeons may schedule two separate sessions. Every surgeon approaches the procedure in his or her own way. Some complete one side of the face at a time, and others move back and forth between the sides. The exact placement of incisions and the sequence of events depends on your facial structure and your surgeon's technique.

How long is recovery?

You should be up and about in a day or two, but plan on taking it easy for the first week after surgery. Dr. Nassour 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. 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.

Will it work for me?

The chances are excellent that you'll be happy with your facelift-especially if you realize that the results may not be immediately apparent. The body needs time to heal from any surgical procedure. After surgery, you'll present a fresher, more youthful face to the world.
Remember, 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.

FAT INJECTION

What is it?

Body fat makes excellent soft tissue filler material. Fat injection (also called autologous fat transplantation) transfers fat from one part of the body to another to recontour the face; diminish frown lines, crow's feet and nasolabial folds (smile lines); and provide definition to areas like the cheeks and chin. It can also be used to fill out depressed scarred areas on any part of the body. Fat injection is not permanent, and may require an effective maintenance program.
Not every area is appropriate for fat injection. Injecting fat into the breast, for example, makes cancer detection via mammography more difficult and is strongly discouraged.

How does it work?

The donor site (for example, abdomen, buttocks or thighs) and the treatment site are injected with local anesthetic. Intravenous (IV) fluids also are injected into the donor site to facilitate fat collection. Fat cells are extracted through a small needle attached to a syringe. The fat is then processed to remove excess fluids and reinjected with another needle in multiple thin strands in the desired area. "Overfilling" is a necessary corrective due to fat absorption in the weeks after treatment. Fat also can be harvested during a lipoplasty (liposuction) procedure in one area of the body, and then reinjected in another.

What are the benefits?

Fat injection is natural, non-allergenic. Because fat is from the patient's own body, no pre-testing is required and the fat cannot be rejected. It's a good alternative if the patient is allergic to bovine collagen. The procedure is cost effective, especially if combined with another procedure like lipoplasty (liposuction).

Where does it happen and how long does it take?

Fat injection is usually performed as an outpatient procedure that generally takes under an hour. Injections may last from several months to permanently.

What is the recovery process like?

There's little or nor downtime. Although discomfort is minimal and can be medication-controlled, some swelling and bruising initially results, lasting about 48 hours. Patients should avoid the sun until the condition subsides.

How long will the results last?

Longevity of results can vary significantly from patient to patient. For longest-lasting effect, patients generally receive 3 to 4 treatments over a six-month period. Results lasts longest when reinjected in relatively stationary areas (such as the cheeks).

HAIR TRANSPLANTATION

What is it?

Micro-hair transplantation is a state-of-the-art hair transplantation technique that has replaced "plugs" or larger grafts of hair. It fills in balding areas with the patient' own hair using a variety of techniques, including scalp reduction, tissue expansion, strip grafts, scalp flaps or clusters of punch grafts (plugs, miniplugs and microplugs). The method restores a natural, more youthful, and vigorous look, with potentially positive psychological effects, such as a boost in confidence. It's less expensive than other hair-loss treatments when factored over time.

Who has it done?

By age 50, about 50% of American men—and a substantial number of women—are affected by hair loss, much of which is hereditary. Although it works best on men with male pattern baldness after hair loss has stopped, both men and women seek hair transplantation.

Will it work for me?

Patients must have an availability of healthy hair in donor areas of adequate density. Hair transplantation may be combined with other surgical procedures in patients with larger areas of baldness.
Patients should not have unrealistic expectations about the nature and extent of transplanted hair growth. Individual hair characteristics, such as coarseness and curl, can affect the possible density of transplanted hair. Survival of transplanted hair is not always predictable.

How does it work?

Transplantation is a progressive process requiring hundreds of micro-grafts, each of which will generally contain from one to three hairs mini-grafted from a donor site on the side or back of the head. They are randomly implanted in the bald (or thinning) area so that they will grow in a natural pattern and produce an undetectable result.

Where does it happen and how long does it take?

Most micro-hair transplant procedures (individual hair micrograft restorations) use local anesthesia and are performed on an outpatient basis. Other procedures such as flap surgery, require general anesthesia and are performed in a surgical setting. After approximately six weeks, the transplanted hair will fall out and be replaced about three months later when the new hair grows in. To achieve sufficient density, several sessions lasting one to three hours each may be required.

What is the recovery process?

The procedure involves some degree of minor discomfort, bruising and swelling. There may be numbness around the donor or recipient site, which generally disappears within two to three months. Several days are required before normal activities can be resumed. Patients can usually return to work in two to five days. Strenuous activities should be avoided for ten days to three weeks.

How long will the results last?

The procedure is permanent. Once the transplant procedures are complete, there is no further necessity for surgery.

LIP AUGMENTATION

What is it?

Lip augmentation creates fuller, plumper lips and reduces fine wrinkles around the mouth. Lips may be injected with collagen or with fat transferred from another site in the patient's body. Both liquid collagen and fat are absorbed and repeat treatments are necessary to maintain results. Newer, longer-lasting options include implantable materials like AlloDerm and SoftForm.
Temporary procedures, like collagen or fat injection, can be appealing to patients who want to experiment with a fuller-lipped look, but not necessarily commit to it.
Patients with a reaction to the pre-treatment collagen skin test, who have a serious allergy history, or are allergic to lidocaine (a local anesthetic) should not consider lip augmentation. Treatment is sometimes postponed for patients with active inflammatory skin conditions or with infections.

How does it work?

A natural or synthetic biocompatible material, or the patient's own fat, is injected or implanted in the lips. One injection is usually sufficient to produce the desired result, which may be temporary, depending on the material used. Injections may need to be repeated periodically. Proper placement of the injected material is important. AlloDerm, a natural collagen sheet made from donated skin, is inserted through tiny incisions inside the corners of the mouth. Once the AlloDerm implant is in place, it eventually becomes integrated with the natural tissues. Gore-Tex, SoftForm and soft ePTFE are other synthetic implant options.

Further options include:

Autologen—injectable dermal implant material made from the patient's own skin. Dermalogen—injectable Human Tissue Matrix (HTM) procured from donor tissue.

MICRODERMABRASION

What is it?

Microdermabrasion is effective in reducing fine lines, "crow's feet," age spots and acne scars Proven to be a very popular non-surgical cosmetic procedure, it stimulates the production of skin cells and collagen.

Who has it done?

People of any age seeking to improve their skin's appearance. Excellent for skin sensitive to chemical procedures, it is effective on all skin colors and types, giving the skin an overall fresh, healthy-looking glow. Patients with good skin tone will show best results.

How does it work?

The hand piece emits crystals onto the surface of the skin, resulting in a gentle abrasion or "polishing" process. Microdermabrasion may be combined with a light chemical peel to increase the effect.

Where does it happen and how long does it take?

Performed on an outpatient basis, usually in a physician's office, each treatment takes from 30 minutes to an hour. No anesthetic is required. The number of treatments recommended for maximum results can range between five and twelve, spaced from two to three weeks apart. Maintenance of results requires periodic repeat treatments after the initial regimen is completed.

What is the recovery process?

As a non-surgical, safe, effective "lunch hour" procedure, normal activities can be resumed immediately. Virtually no side effects are incurred.

How long will the results last?

Effects are permanent, although new wrinkles may form as skin ages. An individualized skin care program may be recommended to maximize results.

NOSE RESHAPING

(Rhinoplasty)

What is it?

Rhinoplasty, or surgery to reshape the nose, is one of the most common of all plastic surgery procedures. Rhinoplasty can reduce or increase the size of your nose, change the shape of the tip or the bridge, narrow the span of the nostrils, or change the angle between your nose and your upper lip. It may also correct a birth defect or injury, or help relieve some breathing problems.

How does it work?

Rhinoplasty is designed to reduce excess cartilage and bone in the nose, removing irregularities and bumps to give a straightened, smooth and, usually, smaller appearance. Adding tissue to enhance certain features of the nose can also occur. The overall trend in modern rhinoplasty is away from over-reduction of tissue, which can reduce the ability to breath through the nose, and towards individualized treatment of each segment of the nose to give a balanced and refined look without compromising function. 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.
Many plastic surgeons perform rhinoplasty from within the nose, making their incision inside the nostrils. Others prefer an "open" procedure, especially in more complicated cases; they make a small incision across the columella, the vertical strip of tissue separating the nostrils. 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.

Who has it done?

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 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 your surgeon.

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. Many surgeons 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.

How long does it take and where is it performed?

Usually, Rhinoplasty takes from one to three hours depending on the complexity of the condition of the nose. Nearly all rhinoplasty operations are done as outpatient surgeries in Dr. Nassour's office-based surgical facility.

How long is recovery?

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.

SKIN RESURFACING

What is it?

Aging, sun exposure, heredity and lifestyle factors including nutrition, alcohol consumption and smoking all may contribute to facial wrinkling. Pigmentary changes of the skin, such as blotchiness or brown spots, may also occur with age or as a result of birth control pills, pregnancy or genetic factors. Prior acne may have made the surface of your skin uneven. These problems, as well as certain other skin conditions, may be improved by skin resurfacing.
Chemical peels, dermabrasion and laser skin resurfacing all achieve results in basically the same way. Layers of your skin are removed and, as the healing process progresses, a new, healthier-looking skin emerges. What differentiates the various resurfacing methods is the way in which the skin's layers are removed. Chemical peels involve the application of a caustic solution, dermabrasion utilizes high-speed rotary wheel, and laser resurfacing uses a laser beam.

How does laser resurfacing work?

Skin resurfacing using a carbon dioxide (CO2)laser is the most recently developed of the techniques described in this brochure. Its effects are similar to those of chemical peels and dermabrasion, except that the laser removes skin layers by vaporization rather than with chemicals or a sanding device. Your plastic surgeon is trained in the safe use of laser equipment. He or she is able to specify the amount of energy transmitted to the skin's surface by the laser beam and control the depth of penetration.
Like the other resurfacing methods, the laser is effective in treating wrinkles, blotchiness or age spots, and scars from acne or other causes. It can be used on the entire face or specific areas. Patients with a variety complexions, including some darker-skinned individuals, may be treated with the laser. Certain other characteristics of your skin, such as its thickness and texture, may influence whether you are a good candidate for laser resurfacing. Some patients may benefit from the laser's mild "tightening" effect on the skin, particularly in the lower eyelid area where the skin often becomes somewhat loose as a result of aging.

Will it work for me?

Are there any age requirements?

Patients may have their skin resurfaced at almost any age. You may be a good candidate for skin resurfacing if you have one or more of the following conditions: Wrinkled or sun-damaged facial skin Vertical wrinkles around your mouth, such as those that cause lipstick "bleed" "Crow's feet" lines around your eyes and perhaps some skin laxity in your lower eyelid area Fine wrinkling of your upper eyelids Brown spots or blotchy skin coloring Certain precancerous skin growths Acne or chicken pox scars Superficial facial scars from a past injury

Will insurance coverage pay for skin resurfacing?

Skin resurfacing procedures usually are not covered by insurance. Occasionally, however, if the resurfacing is being performed to treat precancerous skin conditions or improve certain types of scars, insurance coverage may be available. Your plastic surgeon or a member of the staff will explain how you can find out from your insurance company if a particular procedure will be covered.

What is the consultation like?

You may have certain characteristics that make you a better candidate for one technique rather than another, or your surgeon may have a preference based on his or her personal experience with the different methods. During the consultation, you may be asked to look in a mirror and point out the specific areas of your face that you would like to see improved. This will help your surgeon to understand your expectations and determine whether they realistically can be achieved.

Your plastic surgeon will carefully examine your skin to determine which resurfacing technique, or combination of treatments, will provide you with the best results. Your skin type, the severity of any sun damage, the extent of uneven pigmentation and the depth of skin imperfections will be evaluated. Fine lines, coarse wrinkling or deep acne scarring each may require a different approach to treatment.
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, and medications that you currently take. Be sure to tell your plastic surgeon if you have ever had x-ray treatments of your facial skin such as those used in the treatment of acne or if you have had a prior chemical peeling procedure. Current or past use of Accutane[TM], as well as Retin-A[TM] and other topical skin preparations, must be reported to your surgeon. For your safety, it is important that you provide complete information.

Where does it happen and how long does it take?

Your skin resurfacing treatment may be performed in your plastic surgeon's office, a free-standing ambulatory facility or a hospital. Procedure length varies depending on your surgeon's chosen techniques. You should arrange for someone to drive you home after the procedure and probably assist you for a day or two.

What is the recovery process?

The amount of time you can allow for recovery also may be an important factor in selecting a particular resurfacing method or determining the extent of treatment. All resurfacing techniques can be performed to varying depths.
A more superficial treatment will require less healing time, but you may need to have the procedure repeated more than once to achieve the same results as a deeper treatment. If you are having aesthetic (cosmetic) surgery, such as a facelift or eyelid surgery, you may be able to have a skin resurfacing procedure performed at the same time.
Following all resurfacing treatments, it is important that you avoid direct or indirect exposure to the sun until all the redness or pinkness of your skin has subsided. Even after that, it is advisable for you to protect your skin by regular use of a sunblock and, whenever possible, a wide-brimmed hat. This is particularly important if you have had a phenol peel which eliminates your skin's ability to tan. If the area around your eyes has been treated, you should wear good quality sunglasses when outdoors. After some types of skin resurfacing treatments, you may need to be careful about exposing your skin to chlorinated water. You can minimize certain risks and help to maintain the results of your skin resurfacing treatment by following the instructions of your plastic surgeon.

What about chemical peels and microdermabrasion?

The different types of chemical peels vary according to their specific ingredients and their strength. The depth of their peeling action may also be determined by factors such as how long they remain on the skin and whether they are applied lightly or rubbed more vigorously onto the skin. A chemical peel solution may be applied to your entire face or just to certain regions, such as the crow's feet area around your eyes or the vertical wrinkles around your mouth. Your plastic surgeon will apply the solution using a sponge, a cotton pad or sometimes, for smaller areas, a cotton swab or brush. Your surgeon decides how long to leave the solution on your face by carefully observing any changes in the appearance of your skin. With certain types of chemical peels, the solution may be "neutralized" after an appropriate amount of time has elapsed. For more information, please see "Chemical Peel."
Dermabrasion uses a small, rapidly spinning wheel with a roughened surface similar to fine-grained sandpaper to abrade the skin, removing its upper layers. This resurfacing procedure sometimes is selected for the treatment of facial scars such as those caused by acne and often is performed on the cheeks or the entire face. Dermabrasion, like the deeper chemical peels, is very effective in reducing the appearance of vertical wrinkles around the mouth that often cause lipstick "bleed." It can be used on a small area of skin and on patients with somewhat darker complexions. The treated area usually will blend with the surrounding skin so that there is little if any noticeable difference in the pigmentation. For more information, please see "Microdermabrasion."

How do I prepare for laser resurfacing?

Prior to a deeper chemical peel, laser resurfacing, or less often, dermabrasion, your plastic surgeon will place you on a pretreatment program during which you will apply special creams, lotions or gels to your skin for a few weeks or longer. You may also be given certain oral medications that you should begin taking prior to your treatment. Your surgeon will provide you with additional instructions.

What happens after laser resurfacing?

Medications will be administered for your comfort prior to the treatment. Frequently, local anesthesia alone or combined with intravenous sedation is used for patients undergoing skin resurfacing procedures. Sometimes, general anesthesia may be desired. When the treatment is completed, your resurfaced skin may be covered with petroleum jelly or other protective ointment. In some cases, dressings, tape or a bandage may be applied.
Deeper chemical peels, dermabrasion or laser skin resurfacing will produce redness and swelling to varying degrees. Depending on the post-treatment regimen selected by your plastic surgeon, a scab may or may not form over the treated area. You will be advised about cleansing your skin, as well as if and when you should apply any ointments. In the case of men who have undergone resurfacing procedures, shaving must be delayed for a while.
It is essential that you follow your plastic surgeon's instructions and avoid doing anything that might interrupt the healing process. About seven to ten days after your skin resurfacing procedure, a new skin will have begun to form. After the initial redness subsides, your skin may be pink for several weeks to months. Camouflage makeup usually can be used within a couple of weeks, but your plastic surgeon will advise you.
Straining, bending and lifting should be avoided during the early period following your skin resurfacing procedure. Generally, you should be able to return to work within a week or two. Exercise or other strenuous activities may need to be delayed a few weeks longer.

How long will the results last?

Because of the persistence of skin pinkness following many types of resurfacing procedures, it may take months before you can fully appreciate your new look. Most patients feel that the results are definitely worth waiting for and, in the case of deeper treatments, the benefits are relatively long-lasting. Superficial resurfacing procedures, such as light chemical peels, will need to be repeated periodically in order to maintain their benefits.<
Your skin will, of course, continue to age. Also the type of wrinkles caused by movement of your facial muscles will eventually reappear. Some wrinkles may recur sooner than others, depending on their location as well as the type and extent of your resurfacing treatment. Despite this, you can expect that improvements in skin quality and texture achieved by resurfacing will make your complexion appear younger and fresher for many years to come.

NON-ELECTIVE

Reconstructive Surgery

What is it?

Reconstructive surgery is performed on abnormal structures of the body, caused by congenital defects, developmental abnormalities, trauma (accidents, injuries, burns), infection, tumors or disease. It is generally performed to improve functions, but may also be done to approximate a normal appearance.
It's estimated that more that one million reconstructive procedures are performed by plastic surgeons every year. Reconstructive surgery helps patients of all ages and types - whether it's a child with a birth defect, a young adult injured in an accident, or an older adult with a problem caused by aging.

Some reconstructive procedures are:

• Advanced wound care
• Hand surgery
• Laser surgery
• Skin grafts
• Scar revision
• Skin cancer
• Tissue expansion (growing extra skin by stretching adjacent tissue)
• Breast reconstruction (single or double mastectomies from breast cancer)
• Cleft lip and palate
• Gynecomastia (male breast reduction)

Who has reconstructive surgery?

There are two basic categories of patients: those who have congenital deformities, otherwise known as birth defects, and those with developmental deformities, acquired as a result of accident, infection, disease, or in some cases, aging.
Some common examples of congenital abnormalities are birthmarks; cleft-lip and palate deformities; hand deformities such as syndactyly (webbed fingers), or extra or absent fingers; and abnormal breast development.
Burn wounds, lacerations, growths, and aging problems are considered acquired deformities. In some cases, patients may find that a procedure commonly thought to be aesthetic in nature may be performed to achieve a reconstructive goal. For example, some older adults with redundant or drooping eyelid skin blocking their field of vision might have eyelid surgery. Or an adult whose face has an asymmetrical look because of paralysis might have a balancing facelift. Although appearance is enhanced, the main goal of the surgery is to restore function.
Large, sagging breasts are one example of a deformity that develops as a result of genetics, hormonal changes, or disease. Breast reduction, or reduction mammaplasty, is the reconstructive procedure designed to give a woman smaller, more comfortable breasts in proportion with the rest of her body. In another case, a young child might have reconstructive otoplasty (outer-ear surgery) to correct overly-large or deformed ears.

Will insurance coverage pay for reconstructive surgery?

Reconstructive surgery is generally covered by most health insurance policies, although coverage for specific procedures and levels of coverage may vary greatly. There are a number of "gray areas" in coverage for plastic surgery that sometimes require special consideration by an insurance carrier. These areas usually involve surgical operations which may be reconstructive or cosmetic, depending on each patient's situation. For example, eyelid surgery (blepharoplasty) - a procedure normally performed to achieve cosmetic improvement - may be covered if the eyelids are drooping severely and obscuring a patient's vision.
Usually, health insurance policies will consider the cost of reconstructive surgery a covered expense. Check with your carrier to make sure you're covered and to see if there are any limitations on the type of surgery you're planning. Work with your doctor to get pre-authorization from the insurer for the procedure.
How does reconstructive surgery differ from cosmetic, or elective, procedures? The goals of reconstructive surgery differ from those of cosmetic surgery. Reconstructive surgery is performed on abnormal structures of the body, caused by birth defects, developmental abnormalities, trauma or injury, infection, tumors, or disease. It is generally performed to improve function, but may also be done to approximate a normal appearance.
Cosmetic surgery is performed to reshape normal structures of the body to improve the patient's appearance and self-esteem. Although no amount of surgery can achieve "perfection," modern treatment options allow plastic surgeons to achieve improvements in form and function thought to be impossible 10 years ago. Please be sure to ask your plastic surgeon to explain anything you don't understand. Also, ask for information that specifically details the procedure you are considering for yourself or your child.

How risky is reconstructive surgery?

When reconstructive surgery is performed by a qualified plastic surgeon, complications are infrequent and usually minor. However, individuals vary greatly in their anatomy and healing ability and the outcome is never completely predictable.
As with any surgery, complications can occur. These may include infection; excessive bleeding, such as hematomas (pooling of blood beneath the skin); significant bruising and wound-healing difficulties; and problems related to anesthesia and surgery.<
There are a number of factors that may increase the risk of complications in healing. In general, a patient is considered to be a higher risk if he or she is a smoker; has a connective-tissue disease; has areas of damaged skin from radiation therapy; has decreased circulation to the surgical area; has HIV or an impaired immune system; or has poor nutrition. If you regularly take aspirin or some other medication that affects blood clotting, it's likely that you'll be asked to stop a week or two before surgery.

What is the consultation like?

In evaluating your condition, a plastic surgeon will be guided by a set of rules known as the reconstructive ladder. The least-complex types of treatments-such as simple wound closure-are at the lower part of the ladder. Any highly complex procedure-like micro-surgery to reattach severed limbs-would occupy one of the ladder's highest rungs. A plastic surgeon will almost always begin at the bottom of the reconstructive ladder in deciding how to approach a patient's treatment, favoring the most direct, least-complex way of achieving the desired result.

What are treatment options healing rates?

The size, nature and extent of the injury or deformity will determine what treatment option is chosen and how quickly the surgery will be performed. Reconstructive surgery frequently demands complex planning and may require a number of procedures done in stages.

Because it's not always possible to predict how growth will affect outcome, a growing child may have to plan for regular follow-up visits on a long-term basis to allow additional surgery as the child matures.

Everyone heals at a different rate-and plastic surgeons cannot pinpoint an exact "back-to-normal" date following surgery. They can, however, give you a general idea of when you can expect to notice improvement.