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Cosmetic
Surgery
Questions and Answers About FACIAL COSMETIC SURGERY 1.
Who would be the best candidate?
Any person seeking an improvement in his/her facial appearance would
be a candidate for facial cosmetic surgery. However, good health and
realistic expectations are prerequisites for facial cosmetic
procedures. The patient should realize that improvement, not
perfection, is the goal of any given facial cosmetic procedure,
although obtaining a perfect outcome is not a rare situation. Each
facial cosmetic procedure has its own limitations as well as
superiorities and these should be discussed between the patient and
the surgeon during the initial consultation. Skin type, texture,
ethnic background, existing diseases and currently used medications
may all play a role in the final outcome of facial cosmetic surgery
and should be discussed in detail before surgery. Even in the presence
of some pre-existing diseases, you may still undergo cosmetic surgery
as long as the disease is under control. However, some health problems
that you had may exclude you from being a cosmetic surgical candidate.
You should notify your cosmetic surgeon about all diseases you have
and all current medications that you use, including over the counter
and herbal medications. 2.
Is there a specific age for cosmetic procedures?
Theoretically, cosmetic procedures can be performed at any age. For
instance, a 7 year-old boy/girl may undergo an otoplasty (aesthetic
ear surgery) in order to have correction of a severe prominent ear
deformity that may adversely affect his/her psychological or social
development, especially considering the school environment. On the
other hand, a rhinoplasty (aesthetic nose surgery) can be delayed
until 16-18 years of age, since the degree of maturation of bones and
cartilages of the nose may significantly affect the outcome. On the
other extreme, an otherwise healthy 80 year-old patient may easily
consider an aesthetic eyelid procedure. Age issue is something that
needs to be discussed on a patient-by-patient basis. 3.
Can I have more than one surgery at the same time?
Yes. However, this is something that you need to discuss with your
surgeon. Your surgeon may put the surgeries in a sequence and split
them into more than one session. For instance, if you are considering
cheek implants and aesthetic nose surgery at the same time, your
surgeon may suggest you undergo these two operations in different
times, since the swelling at the end of the first procedure may give
the surgeon false impressions in decision making on the other
procedure and adversely affect the final outcome. Sometimes your
surgeon may recommend that you consider additional procedure(s) while
you have just one in mind, in order to achieve a better cosmetic
outcome. Of course, you will decide whether you want additional
procedure(s) or not. 4.
Will I have scars on my face after aesthetic procedures?
Unfortunately, scars are usually a part of any given surgery. However,
facial plastic surgeons are trained for and capable of hiding or
camouflaging most of the incisions necessary for cosmetic procedures.
These incisions can be placed in natural skin creases or in invisible
locations. Some of the scars are so tiny that they do not attract any
attention, even if they are visible. If you have a history of
significant scarring, you should notify your doctor about this
condition. Despite all the best efforts by your surgeon, in rare
cases, scars become significant. Even in this instance, some of these
scars can be treated with surgical revision, lasers and injectable
medications. 5.
What is the longevity of the final outcome?
Final outcome longevity is different for each patient and type of
treatment, and therefore, it is practically unpredictable, but
generally measured by years. Facial cosmetic procedures cannot stop
aging and some patients may necessitate further surgeries sooner than
the others. Even in that case, the age you look will be younger than
your actual age. On the other hand, the outcome of some of the
cosmetic procedures may last much longer than the final outcome of the
others, since aging does not equally affect each part of the face. For
instance, the final outcome of aesthetic nose or ear surgery lasts
much longer (sometimes lifelong) than a facelift or eyelid procedure.
Some of the injectables such as collagen and Botox necessitate
periodic treatment, since their effects are transient and generally
measured by months. 6.
What are the risks and possible complications of cosmetic facial
surgeries?
This depends on the type of surgery you are considering. As any given
surgery carries some risks of complications, so do the cosmetic
surgeries. Fortunately, the chance of having a significant
complication is very low and even if it happens, your surgeon is
capable of and trained for dealing with most of these complications. 7.
What about pain?
You may experience some pain and discomfort after your cosmetic
surgery depending on your pain threshold. Fortunately, currently
available pain and sleep medications are good enough to provide a
comfortable immediate postoperative period. After the first few
postoperative days, you may not even need to take your pain
medications.
8.
I don't like the shape of my nose. What can be done?
Then, rhinoplasty (or aesthetic nose surgery) might be for you.
Theoretically, rhinoplasty can be performed at any age, however ages
of 15 to18 are generally accepted as the minimum ages for this
procedure, since the degree of maturation of bones and cartilages of
the nose may significantly affect the outcome. However, there are
exceptional cases where rhinoplasty was performed in earlier ages. You
can discuss what changes you want in your nose with your doctor and
see the possible outcome on a computer screen before surgery with the
aid of image processing. Rhinoplasty is usually performed under
general anesthesia on an outpatient (surgery in the morning, discharge
in the afternoon) basis. Depending on the technique that your doctor
chooses, you may have a very small and hidden incision between your
nostrils under your nose, or you may not carry any incisions at all.
If you have an incision, sutures are removed in 5-6 days. Your doctor
may place nasal packing in your nose depending on the type of the
surgery. If you have nasal packing, these are removed within 24-48
hours. Usually a splint is placed over your nose at the end of the
procedure and left in place for a week. Daily activities can be
resumed within a few days, however strenuous exercises should be
avoided. Bruises, if you have any, may take 2-3 weeks to fade away,
however you can hide these bruises by make-up after surgery. Most of
the swelling resolves within a few weeks. If you already had a
rhinoplasty and are seeking a revision, you should wait 6-12 months
before the second procedure. Your surgeon may recommend an aesthetic
chin surgery, which usually involves adding an implant to your chin,
in addition to rhinoplasty in order to achieve the best cosmetic
outcome.
9.
What can be done for my droopy and baggy upper and lower eyelids?
Droopy and/or baggy upper or lower eyelids may cause a tired,
unhealthy and aged look, and may also cause vision impairment.
Correction of these problems is possible with blepharoplasty
(aesthetic eyelid surgery), which involves excision of excess skin
from upper and/or lower eyelids, in addition to excision of excess fat
from upper and/or lower eyelids. The amount of skin to be excised can
be decided with simple maneuvers performed by your surgeon during your
initial consultation. You may also ask your surgeon if you will need
any fat excision from your eyelids, since fat excision is not
performed in every blepharoplasty procedure. You may also see the
possible outcome on a computer screen before surgery with the aid of
image processing during your initial consultation.
Blepharoplasty
can be performed under local or general anesthesia on an outpatient
basis. Your surgeon may send you to your eye doctor for an eye exam
before blepharoplasty in order to reveal any existing eye problems.
The result of your eye exam may play an important role in planning
your surgery. The incisions for blepharoplasty are tiny and are not
visible following surgery most of the time. The sutures are removed in
5 days, if your surgeon chose to use a non-absorbable suture material.
Absorbable suture materials do not necessitate removal.
If
you do not have any excess skin in your lower lid, but if you still
need fat excision for bagginess, lower lid surgery can be done from
inside of your lower eyelid to avoid an incision below your lash-line.
Your doctor will recommend that you place ice packs over your eyes
intermittently for the first 24-48 hours. Swelling and bruising
usually takes a few weeks to resolve completely, but in most cases,
you can return to your daily activities 5-6 days following your
surgery. Strenuous exercises should be avoided for a few weeks. In
order to achieve the best cosmetic outcome, your doctor may recommend
that you consider a brow lift procedure in addition to blepharoplasty.
10.
What can be done for my heavy-droopy eyebrows and/or forehead
wrinkles?
Droopy eyebrows (browptosis) may accentuate the tired appearance
caused by droopy upper eyelids. In that case, a browlift/forehead lift
can be performed in addition to blepharoplasty, since performing upper
eyelid blepharoplasty alone might not be sufficient to achieve the
best cosmetic outcome. Browlift/forehead lift can also correct
transverse forehead wrinkles and frown lines between the brows (these
conditions may also be treated with Botox, please see below). The
amount of browlift is decided during your initial consultation, and
you may even have an idea about the possible outcome of the surgery on
a computer screen with the aid of image processing. This procedure can
be performed under local anesthesia with sedation or general
anesthesia in an outpatient basis.
If
your forehead hairline is already high, raising the forehead more may
cause an unnatural appearance. Therefore, your surgeon may choose a
forehead hairline incision in order to raise your brows and correct
forehead wrinkling without raising your forehead hairline more. In
this case, the incision is very well camouflaged. If you have a narrow
forehead, or forehead wrinkling is minimal, the procedure can be
performed with the aid of an optical device through small incisions
placed in your hairy scalp (endoscopic brow/forehead lift). In this
case, the incisions are not even visible. Your doctor may choose to
place a drain to prevent any possible blood collection under your
forehead skin, and usually the drain is taken out in 24-48 hours.
Sutures are usually removed in 10 days. Swelling and bruising may take
1-2 weeks to resolve.
11.
What can be done for loosening, sagging and wrinkling in my face and
neck?
Aging is inevitable, and as the years go by, the skin of the face and
neck begins to loosen and starts wrinkling. Fat pads at the jawline,
beneath the chin and on your cheek become droopy. This aged appearance
can be improved by different procedures, such as lifting the face
and/or the neck, resurfacing the skin with laser and using injectables
such as Botox, collagen or others. Each of these procedures has its
own limitations and benefits and you should discuss all these options
with your surgeon who will help you to decide what would be the best
treatment for you. Your surgeon may also recommend that you consider
additional cosmetic procedures in order to achieve a better cosmetic
outcome during your initial consultation.
Facelift
and/or neck lift is usually performed to improve loose and sagging
facial and/or neck skin. The operation is usually performed under
general anesthesia on an outpatient basis. The incisions of this
procedure are well hidden in the hairlines and in natural creases just
in front of and behind your ear. Your surgeon may also choose to place
another short and invisible incision beneath your chin in order to
provide a better improvement in your neck. Rubber drains might be
placed under your lifted facial and neck skin to prevent blood
collection, and these drains are usually removed within the first
24-48 hours following your surgery. Sutures are usually removed by the
end of the first week. You may resume your daily activities in a week,
but strenuous exercises should be avoided for another month. Swelling
and bruising gradually start to resolve after the first week; however
complete resolution may take another 1-3 weeks.
Laser
skin resurfacing is usually performed to improve the texture of the
facial skin with acne scars or sun damage and to treat fine wrinkles
of the facial skin caused by aging and sun exposure. This may be
performed either in conjunction with the facelift or may be performed
as a separate procedure. Laser resurfacing is simply a controlled burn
of the facial skin, which provides immediate vaporization of the outer
layers of the skin and shrinks the loose collagen fibers causing fine
wrinkles. It is especially useful in the treatment of the wrinkles of
the lips and the wrinkles around the eyes. It is usually performed
under general anesthesia on an outpatient basis. Special wound care is
necessary following laser resurfacing. Swelling and redness gradually
resolve in a few weeks, but, following completion of the epithelial
healing which usually takes 7-10 days, redness can be covered with
make-up.
Botox
is a toxin obtained from certain microorganisms. When it is injected
into a muscle, it causes a transient paralysis in that muscle. Some of
the wrinkles in the face are the result of excessive activities of
certain facial expression muscles. These wrinkles are called "dynamic wrinkles" and can be corrected by injection of the
responsible facial muscle groups with Botox. Transverse forehead
lines, frown lines between brows, crow's feet (fine wrinkles around
the outer edge of the eyelids) and wrinkles of the lips are well known
dynamic wrinkles and can be corrected with Botox injections. The
effect may last up to 6 months, and can be repeated if the patient
desires.
Allergic
reaction to Botox is very rare and toxicity is usually not a problem
since it is used in very small amounts in order to obtain the desired
cosmetic outcome. The injection is performed with very fine needles
and is usually tolerated well by the patients. Disappearance or
improvement of the wrinkles in injected areas may take 7-10 days
following injection. Some patients may need additional "touch-up" injections, since the muscle activity is stronger
in some patients. It is a safe chemical and recently approved by FDA
for cosmetic use. However, you should notify your surgeon during your
initial consultation if you have any pre-existing nerve-muscle
diseases.
12.
What can be done for my (son's / daughter's) prominent ears?
You may consider otoplasty (aesthetic ear surgery). Large or prominent
ears may be a cause of mental stress and embarrassment, especially in
children. Otoplasty is a surgery to correct the shape and the size of
the ears, and it provides a better-balanced face-ear relationship.
Otoplasty can be performed under local or general anesthesia on an
outpatient basis. The incisions are usually hidden behind the ears;
however your surgeon may add other incisions depending on the degree
of the deformity. Sutures are usually self-absorbed and do not
necessitate removal. The ears may look swollen and bruised for a few
weeks. You (or your son/daughter) will need to wear a dressing to keep
the ears close to the head day and night for the first week. After the
first week, the dressing is worn only in bedtime for another week or
two. You may return to your daily activities in a few days.
13.
What are the facial implants?
Facial implants are synthetic or natural materials designed to augment
certain parts of the face. Facial implants may be used to augment your
chin, cheekbones and lips as well as deep furrows or depressed scars.
Chin implants are used to increase the projection of your chin and are
frequently used as an adjunct to aesthetic nose surgery. Chin implants
can be placed through a small hidden incision just beneath your chin
or through an incision placed inside of your lip. Cheek implants
provide a better-defined cheek prominence and are usually placed
through an incision made under your upper lip, inside your mouth.
Other
implants can be used to soften deep furrows of the face such as deep
grooves between your cheek and lips. Lips can also be augmented with
implants, and in contrast to collagen injections, the final result is
permanent. Implants come in different types, sizes and shapes, and
each of these has unique advantages and disadvantages specific to
each. You and your surgeon should decide which one is the best for
your needs. Some of the implants can also be sculpted depending on
your needs. Implant surgery is a reversible procedure, and implants
can be removed later, if you do not want to carry them anymore.
14.
What can be done for the hair growing all over my face?
Current laser technology permits permanent or long-term hair removal.
Laser hair removal is a safe and effective procedure to remove
unwanted hair; however, it consists of an average of 4-8 treatments.
Although you may start seeing significant improvement even after your
first treatment, generally it takes 2 to 3 treatments to see the
effectiveness of this particular treatment. There should be 5-6 weeks
between each treatment. The best results are obtained in the treatment
of coarse and black hair. A complete evaluation of your skin
(especially its color) by your doctor is mandatory before considering
this procedure. Laser hair removal may also be performed on other
parts of the body.
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