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James M. Clayton, M.D. Plastic Surgery
280 River Park Dr
Provo, UT 84604
Uber
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Breast Surgery
Facial Surgery
Body Surgery
Skin
Reconstructive Surgery
Non-Surgical
Breast Surgery
"For many women, the breasts are an important symbol of womanhood and self-image. In his Provo plastic surgery practice, Dr. James Clayton performs three types of cosmetic surgeries to help you achieve improved self-confidence and health, whether you feel your breasts are too small and out of proportion with your body, or if you struggle with sagging or overly large breasts that can cause pain and health-related issues. Additionally, Dr. Clayton offers breast reconstruction surgeries to women who have undergone a mastectomy.
Breast Augmentation
Breast Augmentation is a popular procedure that is performed if you feel your breasts are too small, or wish to improve their shape or projection. This procedure involves the insertion of either saline or silicone implants.
If You're Considering Breast Augmentation...
Breast augmentation, technically known as augmentation mammoplasty, is a surgical procedure to enhance the size and shape of a woman's breast for a number of reasons: To enhance the body contour of a woman who, for personal reasons, feels her breast size is too small; To restore breast volume lost due to weight loss or following pregnancy; To achieve better symmetry when breasts are moderately disproportionate in size and shape; To improve the shape of breasts that are sagging or have lost firmness, often used with a breast lift procedure; To provide the foundation of a breast contour when a breast has been removed or disfigured by surgery to treat breast cancer; To improve breast appearance or create the appearance of a breast that is missing or disfigured due to trauma, heredity, or congenital abnormalities. By inserting an implant behind each breast, surgeons are able to increase a woman's bust line by one or more bra cup sizes. If you're considering breast augmentation, this will give you a basic understanding of the procedure--when it can help, how it's performed, and what results you can expect. It can't answer all of your questions, since a lot depends on your individual circumstances. Please ask your surgeon if there is anything you don't understand about the procedure.
The Best Candidates for Breast Augmentation
Breast augmentation can enhance your appearance and your 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. The best candidates for breast augmentation are women who are looking for improvement, not perfection, in the way they look. If you're physically healthy and realistic in your expectations, you may be a good candidate.
Types of Breast Implants
The choice of implant filler, implant size, shape and other features will be determined based on your breast anatomy, body type and your desired increase in size. Your lifestyle, goals and personal preferences, as well your plastic surgeon's recommendations and sound surgical judgment are also determining factors. Implant manufacturers occasionally introduce new styles and types of implants, and therefore there may be additional options available to you. Breast implants are medical devices with a solid silicone, rubber shell. The implant shell may be filled with either saline solution (sterile salt water) or elastic silicone gel. Both saline and silicone gel breast implants are approved by the U.S. Food and Drug Administration (FDA). Approval means that an implant has been rigorously researched and tested, and reviewed by an independent panel of physicians for safety. The size of a breast implant is measured in cubic centimeters (ccs) based on the volume of the saline or silicone filler. Breast implants vary both by filler and in size, but there are additional features to consider: Texture: the implant shell may be smooth or textured Shape: the implant may have a round profile or one that is anatomic (teardrop or tapered shape); Profile: the implant may have a low, medium or high projection (the depth of the implant from the base to the highest point of the implant curve); Diameter: the width of the implant measured across it's base (the side of the implant that will be positioned over the chest wall). Adult women of any age can benefit greatly from the enhancement breast implants provide. It is usually recommended, however, that a woman's breasts are fully developed prior to placement of breast implants. Saline implants are FDA approved for augmentation in women 18 years of age and older. Silicone implants are FDA approved for augmentation in women age 22 and older. Saline or silicone implants may be recommended at a younger age if used for reconstruction purposes. You should be aware that breast implants are not guaranteed to last a lifetime and future surgery may be required to replace one or both implants. Regular examinations for breast health and to evaluate the condition of your implants are important whether you have chosen saline or silicone breast implants.
All Surgery Carries Some Uncertainty and Risk
Breast augmentation is relatively straightforward. But as with any operation, there are risks associated with surgery and specific complications associated with this procedure. The most common problem, capsular contracture, occurs if the scar or capsule around the implant begins to tighten. This squeezing of the soft implant can cause the breast to feel hard. Capsular contracture can be treated in several ways, and sometimes requires either removal or "scoring" of the scar tissue, or perhaps removal or replacement of the implant. As with any surgical procedure, excessive bleeding following the operation may cause some swelling and pain. If excessive bleeding continues, another operation may be needed to control the bleeding and remove the accumulated blood. A small percentage of women develop an infection around an implant. This may occur at any time, but is most often seen within a week after surgery. In some cases, the implant may need to be removed for several months until the infection clears. A new implant can then be inserted. Some women report that their nipples become oversensitive, under sensitive, or even numb. You may also notice small patches of numbness near your incisions. These symptoms usually disappear within time, but may be permanent in some patients. Breast implants do not generally interfere with a woman's ability to breast feed, or present a health hazard during pregnancy to a woman or her baby. However, pregnancy and the associated changes to a woman's body may alter the results of any breast surgery, including surgery to place breast implants. Therefore, it is important to discuss the options of breast implant surgery with your plastic surgeon if you are interested in becoming pregnant and breast feeding in the future. Occasionally, breast implants may break or leak. Rupture can occur as a result of injury or even from the normal compression and movement of your breast and implant, causing the man-made shell to leak. If a saline-filled implant breaks, the implant will deflate in a few hours and the salt water will be absorbed and naturally expelled by the body. If a silicone-gel filled implant leak or break, the elastic silicone gel may remain within the implant shell, or may escape into the breast implant pocket (a capsule of tissue that surrounds the implant). A leaking implant filled with silicone gel may not deflate and may not be noticeable except through imaging techniques such as an MRI. For this reason, a woman with silicone breast implants is advised to visit her plastic surgeon annually to assess that her implants are functioning well. An ultrasound exam or MRI screening can assess the condition of breast implants; after 3 years it is recommended that all silicone implants be properly screened. Following the placement of breast implants mammography is technically more difficult. Obtaining the best possible results requires specialized techniques and additional views. You must be candid about your implants when undergoing any diagnostic breast exam. In many cases, an ultrasound exam or MRI may be recommended in addition to mammography. While the majority of women do not experience these complications, you should discuss each of them with your physician to make sure you understand the risks and consequences of breast augmentation.
Planning Your Surgery
In your initial consultation, your surgeon will evaluate your health and explain which surgical techniques are most appropriate for you, based on the condition of your breasts and skin tone. If your breasts are sagging, your doctor may also recommend a breast lift. Be sure to discuss your expectations frankly with your surgeon. He or she should be equally frank with you, describing your alternatives and the risks and limitations of each. You may want to ask your surgeon for a copy of the manufacturer's insert that comes with the implant he or she will use -- just so you are fully informed about it. And, be sure to tell your surgeon if you smoke, and if you're taking any medications, vitamins, or other drugs. Your surgeon should also explain the type of anesthesia to be used, the type of facility where the surgery will be performed, and the costs involved. Because most insurance companies do not consider breast augmentation to be medically necessary, carriers generally do not cover the cost of this procedure.
Preparing For Your Surgery
Your surgeon will give you instructions to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications. A mammogram may be recommended prior to your procedure to ensure breast health and serve as a baseline for future comparison. In addition to explaining your surgical procedure, you plastic surgeon will discuss anesthesia, the recovery process and your obligations as a patient. You will also discuss where your procedure will be performed. You will be asked to sign consent forms to ensure that you fully understand the procedure you will undergo and any risks and potential complications of your surgery. There may be a waiting period of several days to weeks from the time of your consent to the day of surgery. While making preparations, be sure to arrange for someone to drive you home after your surgery and to help you out for a few days, if needed.
Where Your Surgery Will Be Performed
Your surgeon may prefer to perform the operation in an office facility, a freestanding surgery center, or a hospital outpatient facility. Occasionally, the surgery may be done as an inpatient in a hospital, in which case you can plan on staying for a day or two.
Types of Anesthesia
Breast augmentation can be performed with a general anesthesia, so you'll sleep through the entire operation. Some surgeons may use a local anesthesia, combined with a sedative to make you drowsy, so you'll be relaxed but awake, and may feel some discomfort.
The Surgery
The method of inserting and positioning your implant will depend on your anatomy and your surgeon's recommendation. The incision can be made either in the crease where the breast meets the chest, around the areola (the dark skin surrounding the nipple), or in the armpit. In addition, a saline implant may be placed through an incision at the navel. Every effort will be made to assure that the incision is placed so resulting scars will be as inconspicuous as possible. Working through the incision, the surgeon will lift your breast tissue and skin to create a pocket, either directly behind the breast tissue (submammary or subglandular placement) or may be placed beneath the pectoral muscle and on top of the chest wall (submuscular placement). Once the implant is positioned within this pocket, the incisions are closed with sutures, skin adhesive and/or surgical tape. A gauze bandage may be applied over your breasts to help with healing. The surgery usually takes one to two hours to complete. You'll want to discuss the pros and cons of these alternatives with your doctor before surgery to make sure you fully understand the implications of the procedure he or she recommends for you.
After Your Surgery
You're likely to feel tired and sore for a few days following your surgery, but you'll be up and around in 24 to 48 hours. Most of your discomfort can be controlled by medication prescribed by your doctor. Within several days, the gauze dressings, if you have them, will be removed, and you may be given a surgical bra. You should wear it as directed by your surgeon. You may also experience a burning sensation in your nipples for about two weeks, but this will subside as bruising fades. Your stitches will come out in a week to 10 days, but the swelling in your breasts may take three to five weeks to disappear.
Getting Back to Normal
You should be able to return to work within a few days, depending on the level of activity required for your job. Follow your surgeon's advice on when to begin exercises and normal activities. Your breasts will probably be sensitive to direct stimulation for two to three weeks, so you should avoid much physical contact. After that, breast contact is fine once your breasts are no longer sore, usually three to four weeks after surgery. Your scars will be firm and pink for at least six weeks. Then they may remain the same size for several months, or even appear to widen. After several months, your scars will begin to fade, although they will never disappear completely. Routine mammograms should be continued after breast augmentation for women who are in the appropriate age group, although the mammography technician should use a special technique to assure that you get a reliable reading, as discussed earlier.
Your New Look
For many women, the result of breast augmentation can be satisfying, even exhilarating, as they learn to appreciate their fuller appearance. Even if you believe your implants are functioning well, it is important that you follow-up as directed with your plastic surgeon to assess the condition of your breast implants. In addition, whether you choose to have breast implants or not, it is essential to your health that you practice a monthly breast self-exam and schedule regular diagnostic breast screenings. Your decision to have breast augmentation is a highly personal one that not everyone will understand. The important thing is how you feel about it. If you've met your goals, then your surgery is a success.
Breast Reduction
Breasts that are overly large for your frame and cause you pain can be helped with a breast reduction procedure, in which skin and tissue tightening techniques are used to decrease the size of the breasts.
If You're Considering Breast Reduction...
Women with very large, pendulous breasts may experience a variety of medical problems caused by the excessive weight-from back and neck pain and skin irritation to skeletal deformities and breathing problems. Bra straps may leave indentations in their shoulders. And unusually large breasts can make a woman-or a teenage girl-feel extremely self-conscious. Breast reduction, technically known as reduction mammaplasty, is designed for such women. The procedure removes fat, glandular tissue, and skin from the breasts, making them smaller, lighter, and firmer. It can also reduce the size of the areola, the darker skin surrounding the nipple. The goal is to give the woman smaller, better-shaped breasts in proportion with the rest of her body. If you're considering breast reduction, this will give you a basic understanding of the procedure- when it can help, how it's performed, and what results you can expect. It can't answer all of your questions, since a lot depends on your individual circumstances. Please be sure to ask your doctor if there is anything about the procedure you don't understand.
The Best Candidates for Breast Reduction
Breast reduction is usually performed for physical relief rather than simply cosmetic improvement. Most women who have the surgery are troubled by very large, sagging breasts that restrict their activities and cause them physical discomfort. In most cases, breast reduction isn't performed until a woman's breasts are fully developed; however, it can be done earlier if large breasts are causing serious physical discomfort. The best candidates are those who are mature enough to fully understand the procedure and have realistic expectations about the results. Breast reduction is not recommended for women who intend to breast-feed.
All Surgery Carries Some Uncertainty and Risk
Breast reduction is not a simple operation, but it's normally safe when performed by a qualified plastic surgeon. Nevertheless, as with any surgery, there is always a possibility of complications, including bleeding, infection, or reaction to the anesthesia. Some patients develop small sores around their nipples after surgery; these can be treated with antibiotic creams. You can reduce your risks by closely following your physician's advice both before and after surgery. The procedure does leave noticeable, permanent scars, although they'll be covered by your bra or bathing suit. (Poor healing and wider scars are more common in smokers.) The procedure can also leave you with slightly mismatched breasts or unevenly positioned nipples. Future breast-feeding may not be possible, since the surgery removes many of the milk ducts leading to the nipples. Some patients may experience a permanent loss of feeling in their nipples or breasts. Rarely, the nipple and areola may lose their blood supply and the tissue will die. (The nipple and areola can usually be rebuilt, however, using skin grafts from elsewhere on the body.)
Planning Your Surgery
In your initial consultation, it's important to discuss your expectations frankly with your surgeon, and to listen to his or her opinion. Every patient-and every physician, as well-has a different view of what is a desirable size and shape for breasts. The surgeon will examine and measure your breasts, and will probably photograph them for reference during surgery and afterwards. (The photographs may also be used in the processing of your insurance coverage.) He or she will discuss the variables that may affect the procedure-such as your age, the size and shape of your breasts, and the condition of your skin. You should also discuss where the nipple and areola will be positioned; they'll be moved higher during the procedure, and should be approximately even with the crease beneath your breasts. Your surgeon should describe the procedure in detail, explaining its risks and limitations and making sure you understand the scarring that will result. The surgeon should also explain the anesthesia he or she will use, the facility where the surgery will be performed, and the costs. (Some insurance companies will pay for breast reduction if it's medically necessary; however, they may require that a certain amount of breast tissue be removed. Check your policy, and have your surgeon write a predetermination letter if required.)
Preparing For Your Surgery
Your surgeon may require you to have a mammogram (breast x-ray) before surgery. You'll also get specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications. Some surgeons suggest that their patients diet before the operation. Breast reduction doesn't usually require a blood transfusion. However, if a large amount of breast tissue will be removed, your physician may advise you to have a unit of blood drawn ahead of time. That way, if a transfusion should be needed, your own blood can be used. While you're making preparations, be sure to arrange for someone to drive you home after your surgery and to help you out for a few days if needed.
Where Your Surgery Will Be Performed
Breast reduction surgery may be performed in a hospital, an outpatient surgery center or an office-based surgical suite. If you are admitted to the hospital, your stay will be a short one. The surgery itself usually takes two to four hours, but may take longer in some cases.
Type of Anesthesia
Breast reduction is nearly always performed under general anesthesia. You'll be asleep through the entire operation.
The Surgery
Techniques for breast reduction vary, but the most common procedure involves an anchor-shaped incision that circles the areola, extends downward, and follows the natural curve of the crease beneath the breast. The surgeon removes excess glandular tissue, fat, and skin, and moves the nipple and areola into their new position. He or she then brings the skin from both sides of the breast down and around the areola, shaping the new contour of the breast. Liposuction may be used to remove excess fat from the armpit area. In most cases, the nipples remain attached to their blood vessels and nerves. However, if the breasts are very large or pendulous, the nipples and areolas may have to be completely removed and grafted into a higher position. (This will result in a loss of sensation in the nipple and areolar tissue.) Stitches are usually located around the areola, in a vertical line extending downward, and along the lower crease of the breast. In some cases, techniques can be used that eliminate the vertical part of the scar. And occasionally, when only fat needs to be removed, liposuction alone can be used to reduce breast size, leaving minimal scars.
After Your Surgery
After surgery, you'll be wrapped in an elastic bandage or a surgical bra over gauze dressings. A small tube may be placed in each breast to drain off blood and fluids for the first day or two. You may feel some pain for the first couple of days-especially when you move around or cough-and some discomfort for a week or more. Your surgeon will prescribe medication to lessen the pain. The bandages will be removed a day or two after surgery, though you'll continue wearing the surgical bra around the clock for several weeks, until the swelling and bruising subside. Your stitches will be removed in one to three weeks. If your breast skin is very dry following surgery, you can apply a moisturizer several times a day, but be sure to keep the suture area dry. Your first menstruation following surgery may cause your breasts to swell and hurt. You may also experience random, shooting pains for a few months. You can expect some loss of feeling in your nipples and breast skin, caused by the swelling after surgery. This usually fades over the next six weeks or so. In some patients, however, it may last a year or more, and occasionally it may be permanent.
Getting Back to Normal
Although you may be up and about in a day or two, your breasts may still ache occasionally for a couple of weeks. You should avoid lifting or pushing anything heavy for three or four weeks. Your surgeon will give you detailed instructions for resuming your normal activities. Most women can return to work (if it's not too strenuous) and social activities in about two weeks. But you'll have much less stamina for several weeks, and should limit your exercises to stretching, bending, and swimming until your energy level returns. You'll also need a good athletic bra for support. You may be instructed to avoid sex for a week or more, since sexual arousal can cause your incisions to swell, and to avoid anything but gentle contact with your breasts for about six weeks. A small amount of fluid draining from your surgical wound, or some crusting, is normal. If you have any unusual symptoms, such as bleeding or severe pain, don't hesitate to call your doctor.
Your New Look
Although much of the swelling and bruising will disappear in the first few weeks, it may be six months to a year before your breasts settle into their new shape. Even then, their shape may fluctuate in response to your hormonal shifts, weight changes, and pregnancy. Your surgeon will make every effort to make your scars as inconspicuous as possible. Still, it's important to remember that breast reduction scars are extensive and permanent. They often remain lumpy and red for months, then gradually become less obvious, sometimes eventually fading to thin white lines. Fortunately, the scars can usually be placed so that you can wear even low-cut tops. Of all plastic surgery procedures, breast reduction results in the quickest body-image changes. You'll be rid of the physical discomfort of large breasts, your body will look better proportioned, and clothes will fit you better. However, as much as you may have desired these changes, you'll need time to adjust to your new image-as will your family and friends. Be patient with yourself, and with them. Keep in mind why you had this surgery, and chances are that, like most women, you'll be pleased with the results.
Breast Lift
If your breasts have begun to sag with age, you may choose to undergo a breast lift procedure in which skin and tissue tightening techniques are utilized to improve the projection and position of your breasts and nipple/areola.
If You're Considering a Breast Lift...
Over the years, factors such as pregnancy, nursing, and the force of gravity take their toll on a woman's breasts. As the skin loses its elasticity, the breasts often lose their shape and firmness and begin to sag. Breast lift, or mastopexy, is a surgical procedure to raise and reshape sagging breasts--at least, for a time. (No surgery can permanently delay the effects of gravity.) Mastopexy can also reduce the size of the areola, the darker skin surrounding the nipple. If your breasts are small or have lost volume--for example, after pregnancy--breast implants inserted in conjunction with mastopexy can increase both their firmness and their size. If you're considering a breast lift, this brochure will give you a basic understanding of the procedure--when it can help, how it's performed, and what results you can expect. It can't answer all of your questions, since a lot depends on your individual circumstances. Please be sure to ask your doctor if there is anything about the procedure you don't understand.
The Best Candidates for Breast Lift
A breast lift can enhance your appearance and your self-confidence, but it won't necessarily change your looks to match your ideal, or cause other people to treat you differently. Before you decide to have surgery, think carefully about your expectations and discuss them with your surgeon. The best candidates for mastopexy are healthy, emotionally-stable women who are realistic about what the surgery can accomplish. The best results are usually achieved in women with small, sagging breasts. Breasts of any size can be lifted, but the results may not last as long in heavy breasts. Many women seek mastopexy because pregnancy and nursing have left them with stretched skin and less volume in their breasts. However, if you're planning to have more children, it may be a good idea to postpone your breast lift. While there are no special risks that affect future pregnancies (for example, mastopexy usually doesn't interfere with breast-feeding), pregnancy is likely to stretch your breasts again and offset the results of the procedure. Breast lift surgery is a highly individualized procedure and you should do it for yourself, not to fulfill someone else's desires or to try to fit any sort of ideal image.
A Breast Lift May Be Right For You If:
You are physically healthy and maintain a stable weight; You do not smoke; You have realistic expectations; You are bothered by the feeling that your breasts sag, have lost shape and volume; Your breasts have a flatter, elongated shape or are pendulous; When unsupported, your nipples fall below the breast crease; Your nipples and areolas point downward; You have stretched skin and enlarged areolas; One breast is lower than the other.
All Surgery Carries Some Uncertainty and Risk
A breast lift is not a simple operation, but it's normally safe when performed by a qualified plastic surgeon. Nevertheless, as with any surgery, there is always a possibility of complications or a reaction to the anesthesia. Bleeding and infection following a breast lift are uncommon, but they can cause scars to widen. You can reduce your risks by closely following your physician's advice both before and after surgery. Mastopexy does leave noticeable, permanent scars, although they'll be covered by your bra or bathing suit. (Poor healing and wider scars are more common in smokers.) The procedure can also leave you with unevenly positioned nipples, or a permanent loss of feeling in your nipples or breasts.
Planning Your Surgery
In your initial consultation, it's important to discuss your expectations frankly with your surgeon, and to listen to his or her opinion. Every patient--and every physician, as well--has a different view of what is a desirable size and shape for breasts. The surgeon will examine your breasts and measure them while you're sitting or standing. He or she will discuss the variables that may affect the procedure--such as your age, the size and shape of your breasts, and the condition of your skin--and whether an implant is advisable. You should also discuss where the nipple and areola will be positioned; they'll be moved higher during the procedure, and should be approximately even with the crease beneath your breast. Your surgeon should describe the procedure in detail, explaining its risks and limitations and making sure you understand the scarring that will result. He or she should also explain the anesthesia to be used, the type of facility where the surgery will be performed, and the costs involved. Don't hesitate to ask your doctor any questions you may have, especially those regarding your expectations and concerns about the results.
Preparing For Your Surgery
Depending on your age and family history, your surgeon may require you to have a mammogram (breast x-ray) before surgery. You'll also get specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications. While you're making preparations, be sure to arrange for someone to drive you home after your surgery and to help you out for a few days if needed.
Where Your Surgery Will Be Performed
Your breast lift may be performed in a hospital, an outpatient surgery center, or a surgeon's office-based facility. It's usually done on an outpatient basis, for cost containment and convenience. If you're admitted to the hospital as an inpatient, you can expect to stay one or two days.
Types of Anesthesia
Breast lifts are usually performed under general anesthesia, which means you'll sleep through the operation. In selected patients--particularly when a smaller incision is being made--the surgeon may use local anesthesia, combined with a sedative to make you drowsy. You'll be awake but relaxed, and will feel minimal discomfort.
The Surgery
Mastopexy usually takes one and a half to three and a half hours. Techniques vary, but the most common procedure involves an anchor-shaped incision following the natural contour of the breast. The incision outlines the area from which breast skin will be removed and defines the new location for the nipple. When the excess skin has been removed, the nipple and areola are moved to the higher position. The skin surrounding the areola is then brought down and together to reshape the breast. Stitches are usually located around the areola, in a vertical line extending downwards from the nipple area, and along the lower crease of the breast. Some patients, especially those with relatively small breasts and minimal sagging, may be candidates for modified procedures requiring less extensive incisions. One such procedure is the doughnut (or concentric) mastopexy, in which circular incisions are made around the areola, and a doughnut-shaped area of skin is removed. If you're having an implant inserted along with your breast lift, it will be placed in a pocket directly under the breast tissue, or deeper, under the muscle of the chest wall.
After Your Surgery
After surgery, you'll wear an elastic bandage or a surgical bra over gauze dressings. Your breasts will be bruised, swollen, and uncomfortable for a day or two, but the pain shouldn't be severe. Any discomfort you do feel can be relieved with medications prescribed by your surgeon. Within a few days, the bandages or surgical bra will be replaced by a soft support bra. You'll need to wear this bra around the clock for three to four weeks, over a layer of gauze. The stitches will be removed after a week or two. If your breast skin is very dry following surgery, you can apply a moisturizer several times a day. Be careful not to tug at your skin in the process, and keep the moisturizer away from the suture areas. You can expect some loss of feeling in your nipples and breast skin, caused by the swelling after surgery. This numbness usually fades as the swelling subsides over the next six weeks or so. In some patients, however, it may last a year or more, and occasionally it may be permanent.
Getting Back to Normal
Healing is a gradual process. Although you may be up and about in a day or two, don't plan on returning to work for a week or more, depending on how you feel. And avoid lifting anything over your head for three to four weeks. If you have any unusual symptoms, don't hesitate to call your surgeon. Your surgeon will give you detailed instructions for resuming your normal activities. You may be instructed to avoid sex for a week or more, and to avoid strenuous sports for about a month. After that, you can resume these activities slowly. If you become pregnant, the operation should not affect your ability to breast-feed, since your milk ducts and nipples will be left intact.
Your New Look
Your surgeon will make every effort to make your scars as inconspicuous as possible. Still, it's important to remember that mastopexy scars are extensive and permanent. They often remain lumpy and red for months, then gradually become less obvious, sometimes eventually fading to thin white lines. Fortunately, the scars can usually be placed so that you can wear even low-cut tops. You should also keep in mind that a breast lift won't keep you firm forever--the effects of gravity, pregnancy, aging, and weight fluctuations will eventually take their toll again. Women who have implants along with their breast lift may find the results last longer. Your satisfaction with a breast lift is likely to be greater if you understand the procedure thoroughly and if your expectations are realistic.
Breast Reconstruction
If you have undergone a mastectomy and lost one or both breasts, you may be an ideal candidate for breast reconstruction. Techniques for this procedure vary so you should inquire about your options with Dr. Clayton during your consulation.
If You're Considering Breast Reconstruction...
Reconstruction of a breast that has been removed due to cancer or other disease is one of the most rewarding surgical procedures available today. New medical techniques and devices have made it possible for surgeons to create a breast that can come close in form and appearance to matching a natural breast. Frequently, reconstruction is possible immediately following breast removal (mastectomy), so the patient wakes up with a breast mound already in place, having been spared the experience of seeing herself with no breast at all. But bear in mind, post-mastectomy breast reconstruction is not a simple procedure. There are often many options to consider as you and your doctor explore what's best for you. This information will give you a basic understanding of the procedure – when it's appropriate, how it's done, and what results you can expect. It can't answer all of your questions, since a lot depends on your individual circumstances. Please be sure to ask your surgeon if there is anything you don't understand about the procedure.
The Best Candidates for Breast Reconstruction
Most mastectomy patients are medically appropriate for reconstruction, many at the same time that the breast is removed. The best candidates, however, are women whose cancer, as far as can be determined, seems to have been eliminated by mastectomy. Still, there are legitimate reasons to wait. Many women aren't comfortable weighing all the options while they're struggling to cope with a diagnosis of cancer. Others simply don't want to have any more surgery than is absolutely necessary. Some patients may be advised by their surgeons to wait, particularly if the breast is being rebuilt in a more complicated procedure using flaps of skin and underlying tissue. Women with other health conditions, such as obesity, high blood pressure, or smoking, may also be advised to wait. In any case, being informed of your reconstruction options before surgery can help you prepare for a mastectomy with a more positive outlook for the future.
All Surgery Carries Some Uncertainty and Risk
Virtually any woman who must lose her breast to cancer can have it rebuilt through reconstructive surgery. But there are risks associated with any surgery and specific complications associated with this procedure. In general, the usual problems of surgery, such as bleeding, fluid collection, excessive scar tissue, or difficulties with anesthesia, can occur although they're relatively uncommon. And, as with any surgery, smokers should be advised that nicotine can delay healing, resulting in conspicuous scars and prolonged recovery. Occasionally, these complications are severe enough to require a second operation. If an implant is used, there is a remote possibility that an infection will develop, usually within the first two weeks following surgery. In some of these cases, the implant may need to be removed for several months until the infection clears. A new implant can later be inserted. The most common problem, capsular contracture, occurs if the scar or capsule around the implant begins to tighten. This squeezing of the soft implant can cause the breast to feel hard. Capsular contracture can be treated in several ways, and sometimes requires either removal or scoring of the scar tissue, or perhaps removal or replacement of the implant. Reconstruction has no known effect on the recurrence of disease in the breast, nor does it generally interfere with chemotherapy or radiation treatment, should cancer recur. Your surgeon may recommend continuation of periodic mammograms on both the reconstructed and the re
Planning Your Surgery
You can begin talking about reconstruction as soon as you're diagnosed with cancer. Ideally, you'll want your breast surgeon and your plastic surgeon to work together to develop a strategy that will put you in the best possible condition for reconstruction. After evaluating your health, your surgeon will explain which reconstructive options are most appropriate for your age, health, anatomy, tissues, and goals. Be sure to discuss your expectations frankly with your surgeon. He or she should be equally frank with you, describing your options and the risks and limitations of each. Post-mastectomy reconstruction can improve your appearance and renew your self-confidence -- but keep in mind that the desired result is improvement, not perfection. Your surgeon should also explain the anesthesia he or she will use, the facility where the surgery will be performed, and the costs. In most cases, health insurance policies will cover most or all of the cost of post-mastectomy reconstruction. Check your policy to make sure you're covered and to see if there are any limitations on what types of reconstruction are covered.
Preparing For Your Surgery
Your oncologist and your plastic surgeon will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications. While making preparations, be sure to arrange for someone to drive you home after your surgery and to help you out for a few days, if needed. Breast reconstruction usually involves more than one operation. The first stage, whether done at the same time as the mastectomy or later on, is usually performed in a hospital. Follow-up procedures may also be done in the hospital. Or, depending on the extent of surgery required, your surgeon may prefer an outpatient facility.
Types of Anesthesia
The first stage of reconstruction, creation of the breast mound, is almost always performed using general anesthesia, so you'll sleep through the entire operation. Follow-up procedures may require only a local anesthesia, combined with a sedative to make you drowsy. You'll be awake but relaxed, and may feel some discomfort.
Types of Implants
If your surgeon recommends the use of an implant, you'll want to discuss what type of implant should be used. A breast implant is a silicone shell filled with either saline or elastic silicone gel. While there are many options available in post-mastectomy reconstruction, you and your surgeon should discuss the one that's best for you.
Skin expansion
The most common technique combines skin expansion and subsequent insertion of an implant. Following mastectomy, your surgeon will insert a balloon expander beneath your skin and chest muscle. Through a tiny valve mechanism buried beneath the skin, he or she will periodically inject a salt-water solution to gradually fill the expander over several weeks or months. After the skin over the breast area has stretched enough, the expander may be removed in a second operation and a more permanent implant will be inserted. Some expanders are designed to be left in place as the final implant. The nipple and the dark skin surrounding it, called the areola, are reconstructed in a subsequent procedure. Some patients do not require preliminary tissue expansion before receiving an implant. For these women, the surgeon will proceed with inserting an implant as the first step.
Flap reconstruction
An alternative approach to implant reconstruction involves creation of a skin flap using tissue taken from other parts of the body, such as the back, abdomen, or buttocks. In one type of flap surgery, the tissue remains attached to its original site, retaining its blood supply. The flap, consisting of the skin, fat, and muscle with its blood supply, are tunneled beneath the skin to the chest, creating a pocket for an implant or, in some cases, creating the breast mound itself, without need for an implant. Another flap technique uses tissue that is surgically removed from the abdomen, thighs, or buttocks and then transplanted to the chest by reconnecting the blood vessels to new ones in that region. This procedure requires the skills of a plastic surgeon who is experienced in microvascular surgery as well. Regardless of whether the tissue is tunneled beneath the skin on a pedicle or transplanted to the chest as a microvascular flap, this type of surgery is more complex than skin expansion. Scars will be left at both the tissue donor site and at the reconstructed breast, and recovery will take longer than with an implant. On the other hand, when the breast is reconstructed entirely with your own tissue, the results are generally more natural and there are no concerns about a silicone implant. In some cases, you may have the added benefit of an improved abdominal contour.
Follow-up Procedures
Most breast reconstruction involves a series of procedures that occur over time. Usually, the initial reconstructive operation is the most complex. Follow-up surgery may be required to replace a tissue expander with an implant or to reconstruct the nipple and the areola. Many surgeons recommend an additional operation to enlarge, reduce, or lift the natural breast to match the reconstructed breast. But keep in mind, this procedure may leave scars on an otherwise normal breast and may not be covered by insurance.
After Your Surgery
You are likely to feel tired and sore for a week or two after reconstruction. Most of your discomfort can be controlled by medication prescribed by your doctor. Depending on the extent of your surgery, you'll probably be released from the hospital in two to five days. Many reconstruction options require a surgical drain to remove excess fluids from surgical sites immediately following the operation, but these are removed within the first week or two after surgery. Most stitches are removed in a week to 10 days.
Getting Back to Normal
It may take you up to six weeks to recover from a combined mastectomy and reconstruction or from a flap reconstruction alone. If implants are used without flaps and reconstruction is done apart from the mastectomy, your recovery time may be less. Reconstruction cannot restore normal sensation to your breast, but in time, some feeling may return. Most scars will fade substantially over time, though it may take as long as one to two years, but they'll never disappear entirely. The better the quality of your overall reconstruction, the less distracting you'll find those scars. Follow your surgeon's advice on when to begin stretching exercises and normal activities. As a general rule, you'll want to refrain from any overhead lifting, strenuous sports, and sexual activity for three to six weeks following reconstruction.
Your New Look
Chances are your reconstructed breast may feel firmer and look rounder or flatter than your natural breast. It may not have the same contour as your breast before mastectomy, nor will it exactly match your opposite breast. But these differences will be apparent only to you. For most mastectomy patients, breast reconstruction dramatically improves their appearance and quality of life following surgery.
Brow Lift
To correct a brow that is asymmetrical or is drooping with age, you may undergo a brow lift, a surgical procedure that can restore youth to your mid and upper-face.
If You're Considering a Brow Lift...
A forehead lift or brow lift is a procedure that restores a more youthful, refreshed look to the area above the eyes. The procedure corrects drooping brows and improves the horizontal lines and furrows that can make a person appear angry, sad or tired. In a brow lift, the muscles and tissues that cause the furrowing or drooping are removed or altered to smooth the forehead, raise the eyebrows and minimize frown lines. Your surgeon may use the conventional surgical method, in which the incision is hidden just behind the hairline; or it may be performed with the use of an endoscope, a viewing instrument that allows the procedure to be performed with minimal incisions. Both techniques yield similar results -- smoother forehead skin and a more animated appearance. If you're considering a brow lift, this web page will provide a basic understanding of the procedure -- when it can help, how it's performed and what results you can expect. It won't answer all of your questions, since a lot depends on your individual circumstances. Be sure to ask your doctor if there is anything you don't understand about the procedure.
The Best Candidates for a Brow Lift
A brow lift is most commonly performed in the 40-60 age range to minimize the visible effects of aging. However, it can also help people of any age who have developed furrows or frown lines due to stress or muscle activity. Individuals with inherited conditions, such as a low, heavy brow or furrowed lines above the nose can achieve a more alert and refreshed look with this procedure. Brow lift surgery is often performed in conjunction with a facelift to provide a smoother overall look to the face. Eyelid surgery (blepharoplasty) may also be performed at the same time as a forehead lift, especially if a patient has significant skin overhang in the upper eyelids. Sometimes, patients who believe they need upper-eyelid surgery find that a forehead lift better meets their surgical goals. Patients who are bald, who have a receding hairline, or who have had previous upper-eyelid surgery may still be good candidates for forehead lift. The surgeon will simply alter the incision location or perform a more conservative operation. Remember, a forehead lift can enhance your appearance and your self-confidence, but it won't necessarily change your looks to match your ideal or cause other people to treat you differently. Before you decide to have surgery, think carefully about your expectations and discuss them in detail with your doctor.
All Surgery Carries Some Uncertainty and Risk
Complications are rare and usually minor when a forehead lift is performed by a qualified plastic surgeon. Yet, the possibility of complications must be considered. In rare cases, the nerves that control eyebrow movement may be injured on one or both sides, resulting in a loss of ability to raise the eyebrows or wrinkle the forehead. Additional surgery may be required to correct the problem. Formation of a broad scar is also a rare complication. This may be treated surgically by removing the wide scar tissue so a new, thinner scar may result. Also, in some patients, hair loss may occur along the scar edges. Loss of sensation along or just beyond the incision line is common, especially with the classic forehead lift procedure. It is usually temporary, but may be permanent in some patients. Infection and bleeding are very rare, but are possibilities. If a complication should occur during an endoscopic forehead lift, your surgeon may have to abandon the endoscopic approach and switch to the conventional, open procedure, which will result in a more extensive scar and a longer recovery period. To date, such complications are rare -- estimated at less than 1 percent of all endoscopy procedures. You can reduce your risk of complications by closely following your surgeon's instructions both before and after surgery.
Planning Your Surgery
For a better understanding of how a forehead lift might change your appearance, look into a mirror and place the palms of your hands at the outer edges of your eyes, above your eyebrows. Gently draw the skin up to raise the brow and the forehead area. That is approximately what a forehead lift would do for you. If you decide to consult a plastic surgeon, he or she will first evaluate your face, including the skin and underlying bone. During your consultation, the surgeon will discuss your goals for the surgery and ask you about certain medical conditions that could cause problems during or after the procedure, such as uncontrolled high blood pressure, blood-clotting problems, or the tendency to develop large scars. Be sure to tell the surgeon if you have had previous facial surgery, if you smoke, or if you take any drugs or medications -- including aspirin or other drugs that affect clotting. If you decide to proceed with a forehead lift, your surgeon will explain the surgical technique, the recommended type of anesthesia, the type of facility where the surgery will be performed, the risks and the costs involved. Don't hesitate to ask your doctor any questions you may have, especially those regarding your expectations and concerns about the results of surgery.
Preparing For Your Surgery
Your surgeon will give you specific instructions to prepare for the procedure, including guidelines on eating and drinking, smoking, and taking and avoiding certain vitamins and medications. Carefully following these instructions will help your surgery and your recovery proceed more smoothly. If your hair is very short, you may wish to let it grow out before surgery, so that it's long enough to hide the scars while they heal. Whether your forehead lift is done in an outpatient facility or in the hospital, you should arrange for someone to drive you home after your surgery, and to help you out for a day or two.
Where Your Surgery Will Be Performed
A forehead lift is usually done in a surgeon's office-based facility or an outpatient surgery center. However, it is occasionally done in the hospital.
Anesthesia Used for The Procedure
Most forehead lifts are performed under local anesthesia, combined with a sedative to make you drowsy. You'll be awake but relaxed, and although you may feel some tugging and mild discomfort, your forehead will be insensitive to pain. Some surgeons prefer to use general anesthesia, in which case you'll sleep through the entire operation.
The Surgery
Your surgeon will help you decide which surgical approach will best achieve your cosmetic goals: the classic or open method, or the endoscopic forehead lift. Make sure you understand the technique that your surgeon recommends and why he or she feels it is best for you. The classic forehead lift: Before the operation begins, your hair will be tied with rubber bands on either side of the incision line. Your head will not be shaved, but hair that is growing directly in front of the incision line may need to be trimmed. For most patients, a coronal incision will be used. It follows a headphone-like pattern, starting at about ear level and running across the top of the forehead and down the other side of the head. The incision is usually made well behind the hairline so that the scar won't be visible. If your hairline is high or receding, the incision may be placed just at the hairline, to avoid adding even more height to the forehead. In patients who are bald or losing hair, a mid-scalp incision that follows the natural pattern of the skull bones is sometimes recommended. By wearing your hair down on your forehead, most such scars become relatively inconspicuous. Special planning is sometimes necessary for concealing the scar in male patients, whose hairstyles often don't lend themselves as well to incision coverage. If you are bald or have thinning hair, your surgeon may recommend a mid-scalp incision so the resulting scar follows the natural junction of two bones in your skull and is less conspicuous. Working through the incision, the skin of the forehead is carefully lifted so that the underlying tissue can be removed and the muscles of the forehead can be altered or released. The eyebrows may also be elevated and excess skin at the incision point will be trimmed away to help create a smoother, more youthful appearance. The incision is then closed with stitches or clips. Your face and hair will be washed to prevent irritation and the rubber bands will be removed from your hair. Although some plastic surgeons do not use any dressings, your doctor may choose to cover the incision with gauze padding and wrap the head in an elastic bandage. The endoscopic forehead lift: Typically, an endoscopic forehead lift requires the same preparation steps as the traditional procedure: the hair is tied back and trimmed behind the hairline where the incisions will be made. However, rather than making one long coronal incision, your surgeon will make three, four or five short scalp incisions, each less than an inch in length. An endoscope, which is a pencil-like camera device connected to a television monitor, is inserted through one of the incisions, allowing the surgeon to have a clear view of the muscles and tissues beneath the skin. Using another instrument inserted through a different incision, the forehead skin is lifted and the muscles and underlying tissues are removed or altered to produce a smoother appearance. The eyebrows may also be lifted and secured into their higher position by sutures beneath the skin's surface or by temporary fixation screws placed behind the hairline. When the lift is complete, the scalp incisions will be closed with stitches or clips and the area will be washed. Gauze and an elastic bandage may also be used, depending on your surgeon's preference.
After Your Surgery
The immediate post-operative experience for a patient who has had a classic forehead lift may differ significantly from a patient who had the procedure performed endoscopically. Classic forehead lift patients may experience some numbness and temporary discomfort around the incision, which can be controlled with prescription medication. Patients who are prone to headaches may be treated with an additional longer-acting local anesthesia during surgery as a preventive measure. You may be told to keep your head elevated for two to three days following surgery to keep the swelling down. Swelling may also affect the cheeks and eyes-- however, this should begin to disappear in a week or so. As the nerves heal, numbness on the top of your scalp may be replaced by itching. These sensations may take as long as six months to fully disappear. If bandages were used, they will be removed a day or two after surgery. Most stitches or clips will be removed within two weeks, sometimes in two stages. Some of your hair around the incision may fall out and may temporarily be a bit thinner. Normal growth will usually resume within a few weeks or months. Permanent hair loss is rare. Endoscopic forehead lift patients may experience some numbness, incision discomfort and mild swelling. Incision site pain is usually minimal, but can be controlled with medication, if necessary. Endoscopic forehead lift patients usually experience less of the itching sensation felt by patients who have had the classic forehead lift. The stitches or staples used to close the incisions are usually removed within a week and the temporary fixation screws within two weeks.
Getting Back to Normal
Although you should be up and about in a day or two, plan on taking it easy for at least the first week after surgery. You should be able to shower and shampoo your hair within two days, or as soon as the bandage is removed. Most patients are back to work or school in a week to 10 days. Endoscopic patients may feel ready to return even sooner. Vigorous physical activity should limited for several weeks, including jogging, bending, heavy housework, sex, or any activity that increases your blood pressure. Prolonged exposure to heat or sun should be limited for several months. Most of the visible signs of surgery should fade completely within about three weeks. Minor swelling and bruising can be concealed with special camouflage makeup. You may feel a bit tired and let down at first, but your energy level will increase as you begin to look and feel better. Your New Look Most patients are pleased with the results of a forehead lift, no matter which surgical method was used. Often, patients don't realize how much their sagging forehead contributed to the signs of aging until they see how much younger and more rested they appear after the lift. Although a forehead lift does not stop the clock, it can minimize the appearance of aging for years. As time passes, you may want to repeat the procedure.
Chin Surgery
Chin surgery may increase or reduce the projection of your chin, may be performed to bring harmony to your appearance. Chin surgery (often called mentoplasty or genioplasty), is a surgical procedure to reshape the chin. This can be accomplished in several ways. Your plastic surgeon may recommend enhancement with a facial implant or surgical reshaping of the chin bone. The general goal of cosmetic chin surgery is to provide a harmonious balance to your chin and facial features so that you feel better about the way you look. Many times a plastic surgeon may recommend chin surgery to a patient having nose surgery in order to achieve facial proportion, as the size of the chin may magnify or minimize the perceived size of the nose.
What Happens During Chin Surgery?
Anesthesia administered for your comfort during the surgical procedures. The choices include intravenous sedation and general anesthesia. Your doctor will recommend the best choice for you. With a short incision under the chin or inside the mouth, your plastic surgeon can place a chin implant directly on the bone. For a chin implant, the incision may be inside your mouth, along the crease that joins your lower lip and gums. An incision just beneath the chin is another alternative that may be recommended. Surgery will usually require 30 minutes to one hour. Before the surgery, your plastic surgeon selects the proper size and shape implant to enhance your appearance. He or she then inserts it into a pocket over the front of the jawbone. The small incision to create the pocket and insert the implant is placed inside the mouth (along the lower lip) or in the skin just under the chin area.
Recovering from Chin Surgery
The chin is also taped to minimize swelling and discomfort. If an intra-oral incision is used, the sutures will dissolve on their own.Your incisions will be closed with absorbable sutures or stitches that will be removed within 1-2 weeks following your surgery. While the initial outcome of plastic surgery with facial implants is noticeable almost immediately, it may be obscured by visible swelling, which can take several months to fully dissipate.
Ear Pinning Surgery
Children and adults alike who struggle with the appearance of protruding ears, as well as the stress that may accompany them, can undergo ear pinning surgery to reshape and reduce the size of the ears.
If You're Considering Ear Surgery...
Ear surgery, or otoplasty, is usually done to set prominent ears back closer to the head or to reduce the size of large ears. This operation is typically done on children between the ages of four and 14. Ears are almost fully grown by age four, and the earlier the surgery is completed, the less teasing and ridicule the child will have to endure. Ear surgery on adults is also possible, and there are generally no additional risks associated with ear surgery on an older patient. If you're considering ear surgery for yourself or your child, this information will give you a basic understanding of the procedure-when it can help, how it's performed, and what results you can expect. It can't answer all of your questions, since a lot depends on your individual circumstances. Please be sure to ask your doctor if there is anything you don't understand about the procedure.
All Surgery Carries Some Uncertainty and Risk
When ear surgery is performed by a qualified, experienced surgeon, complications are infrequent and usually minor. Nevertheless, as with any operation, there are risks associated with surgery and specific complications associated with this procedure. A small percentage of patients may develop a blood clot on the ear. It may dissolve naturally or can be drawn out with a needle. Occasionally, patients develop an infection in the cartilage, which can cause scar tissue to form. Such infections are usually treated with antibiotics; rarely, surgery may be required to drain the infected area.
Planning For Surgery
Most surgeons recommend that parents stay alert to their child's feelings about protruding ears; don't insist on the surgery until your child wants the change. Children who feel uncomfortable about their ears and want the surgery are generally more cooperative during the process and happier with the outcome. In the initial meeting, your surgeon will evaluate your child's condition, or yours if you are considering surgery for yourself, and recommend the most effective technique. He or she will also give you specific instructions on how to prepare for surgery.
Where The Surgery Will Be Performed
Ear surgery is usually performed as an outpatient procedure in a hospital, a doctor's office-based surgical facility, or a freestanding surgery center. Occasionally, your doctor may recommend that the procedure be done as an inpatient procedure, in which case you can plan on staying overnight in the hospital.
Types of Anesthesia
If your child is young, your surgeon may recommend general anesthesia, so the child will sleep through the operation. For older children or adults, the surgeon may prefer to use local anesthesia, combined with a sedative, so you or your child will be awake but relaxed.
The Surgery
Ear surgery usually takes about two to three hours, although complicated procedures may take longer. The technique will depend on the problem. With one of the more common techniques, the surgeon makes a small incision in the back of the ear to expose the ear cartilage. He or she will then sculpt the cartilage and bend it back toward the head. Non-removable stitches may be used to help maintain the new shape. Occasionally, the surgeon will remove a larger piece of cartilage to provide a more natural-looking fold when the surgery is complete. Another technique involves a similar incision in the back of the ear. Skin is removed and stitches are used to fold the cartilage back on itself to reshape the ear without removing cartilage. In most cases, ear surgery will leave a faint scar in the back of the ear that will fade with time. Even when only one ear appears to protrude, surgery is usually performed on both ears for a better balance.
Getting Back to Normal
Adults and children are usually up and around within a few hours of surgery, although you may prefer to stay overnight in the hospital with a child until all the effects of general anesthesia wear off. The patient's head will be wrapped in a bulky bandage immediately following surgery to promote the best molding and healing. The ears may throb or ache a little for a few days, but this can be relieved by medication. Within a few days, the bulky bandages will be replaced by a lighter head dressing similar to a headband. Be sure to follow your surgeon's directions for wearing this dressing, especially at night. Stitches are usually removed, or will dissolve, in about a week. Any activity in which the ear might be bent should be avoided for a month or so. Most adults can go back to work about five days after surgery. Children can go back to school after seven days or so, if they're careful about playground activity. You may want to ask your child's teacher to keep an eye on the child for a few weeks.
Other Ear Problems
Besides protruding ears, there are a variety of other ear problems that can be helped with surgery. These include: lop ear, when the tip seems to fold down and forward; cupped ear, which is usually a very small ear; and shell ear, when the curve in the outer rim, as well as the natural folds and creases, are missing. Surgery can also improve large or stretched earlobes, or lobes with large creases and wrinkles. Surgeons can even build new ears for those who were born without them or who lost them through injury. Sometimes, however, the correction can leave a scar that's worse than the original problem. Ask your surgeon about the effectiveness of surgery for your specific case.
More Natural-Looking Ears
Most patients, young and old alike, are thrilled with the results of ear surgery. But keep in mind, the goal is improvement, not perfection. Don't expect both ears to match perfectly-perfect symmetry is both unlikely and unnatural in ears. If you've discussed the procedure and your expectations with the surgeon before the operation, chances are, you'll be quite pleased with the result.
Eyelid Surgery
You may elect to undergo an eyelid surgery to either reduce puffiness or remove excess skin around the eyes that may be making you appear older and more tired than you really are.
If You're Considering Eyelid Surgery...
Eyelid surgery (technically called blepharoplasty) is a procedure to remove fat--usually along with excess skin and muscle from the upper and lower eyelids. Eyelid surgery can correct drooping upper lids and puffy bags below your eyes - features that make you look older and more tired than you feel, and may even interfere with your vision. However, it won't remove crow's feet or other wrinkles, eliminate dark circles under your eyes, or lift sagging eyebrows. While it can add an upper eyelid crease to Asian eyes, it will not erase evidence of your ethnic or racial heritage. Blepharoplasty can be done alone, or in conjunction with other facial surgery procedures such as a facelift or brow lift. If you're considering eyelid surgery, this web page will give you a basic understanding of the procedure-when it can help, how it's performed, and what results you can expect. It can't answer all of your questions, since a lot depends on the individual patient and the surgeon. Please ask your surgeon about anything you don't understand.
The Best Candidates for Eyelid Surgery
Blepharoplasty can enhance your appearance and your self-confidence, but it won't necessarily change your looks to match your ideal, or cause other people to treat you differently. Before you decide to have surgery, think carefully about your expectations and discuss them with your surgeon. The best candidates for eyelid surgery are men and women who are physically healthy, psychologically stable, and realistic in their expectations. Most are 35 or older, but if droopy, baggy eyelids run in your family, you may decide to have eyelid surgery at a younger age. A few medical conditions make blepharoplasty more risky. They include thyroid problems such as hypothyroidism and Graves' disease, dry eye or lack of sufficient tears, high blood pressure or other circulatory disorders, cardiovascular disease, and diabetes. A detached retina or glaucoma is also reason for caution; check with your ophthalmologist before you have surgery.
All Surgery Carries Some Uncertainty and Risk
When eyelid surgery is performed by a qualified plastic surgeon, complications are infrequent and usually minor. Nevertheless, there is always a possibility of complications, including infection or a reaction to the anesthesia. You can reduce your risks by closely following your surgeon's instructions both before and after surgery. The minor complications that occasionally follow blepharoplasty include double or blurred vision for a few days; temporary swelling at the corner of the eyelids; and a slight asymmetry in healing or scarring. Tiny whiteheads may appear after your stitches are taken out; your surgeon can remove them easily with a very fine needle. Following surgery, some patients may have difficulty closing their eyes when they sleep; in rare cases this condition may be permanent. Another very rare complication is ectropion, a pulling down of the lower lids. In this case, further surgery may be required.
Planning Your Surgery
The initial consultation with your surgeon is very important. The surgeon will need your complete medical history, so check your own records ahead of time and be ready to provide this information. Be sure to inform your surgeon if you have any allergies; if you're taking any vitamins, medications (prescription or over-the-counter), or other drugs; and if you smoke. In this consultation, your surgeon or a nurse will test your vision and assess your tear production. You should also provide any relevant information from your ophthalmologist or the record of your most recent eye exam. If you wear glasses or contact lenses, be sure to bring them along. You and your surgeon should carefully discuss your goals and expectations for this surgery. You'll need to discuss whether to do all four eyelids or just the upper or lower ones, whether skin as well as fat will be removed, and whether any additional procedures are appropriate. Your surgeon will explain the techniques and anesthesia he or she will use, the type of facility where the surgery will be performed, and the risks and costs involved. (Note: Most insurance policies don't cover eyelid surgery, unless you can prove that drooping upper lids interfere with your vision. Check with your insurer.) Don't hesitate to ask your doctor any questions you may have, especially those regarding your expectations and concerns about the results.
Preparing For Your Surgery
Your surgeon will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications. Carefully following these instructions will help your surgery go more smoothly. While you're making preparations, be sure to arrange for someone to drive you home after your surgery, and to help you out for a few days if needed.
Where Your Surgery Will Be Performed
Eyelid surgery may be performed in a surgeon's office-based facility, an outpatient surgery center, or a hospital. It's usually done on an outpatient basis; rarely does it require an inpatient stay.
Types of Anesthesia
Eyelid surgery is usually performed under local anesthesia--which numbs the area around your eyes--along with oral or intravenous sedatives. You'll be awake during the surgery, but relaxed and insensitive to pain. (However, you may feel some tugging or occasional discomfort.) Some surgeons prefer to use general anesthesia; in that case, you'll sleep through the operation.
The Surgery
Blepharoplasty usually takes one to three hours, depending on the extent of the surgery. If you're having all four eyelids done, the surgeon will probably work on the upper lids first, then the lower ones. In a typical procedure, the surgeon makes incisions following the natural lines of your eyelids; in the creases of your upper lids, and just below the lashes in the lower lids. The incisions may extend into the crow's feet or laugh lines at the outer corners of your eyes. Working through these incisions, the surgeon separates the skin from underlying fatty tissue and muscle, removes excess fat, and often trims sagging skin and muscle. The incisions are then closed with very fine sutures. If you have a pocket of fat beneath your lower eyelids but don't need to have any skin removed, your surgeon may perform a transconjunctival blepharoplasty. In this procedure the incision is made inside your lower eyelid, leaving no visible scar. It is usually performed on younger patients with thicker, more elastic skin.
After Your Surgery
After surgery, the surgeon will probably lubricate your eyes with ointment and may apply a bandage. Your eyelids may feel tight and sore as the anesthesia wears off, but you can control any discomfort with the pain medication prescribed by your surgeon. If you feel any severe pain, call your surgeon immediately. Your surgeon will instruct you to keep your head elevated for several days, and to use cold compresses to reduce swelling and bruising. (Bruising varies from person to person: it reaches its peak during the first week, and generally lasts anywhere from two weeks to a month.) You'll be shown how to clean your eyes, which may be gummy for a week or so. Many doctors recommend eye drops, since your eyelids may feel dry at first and your eyes may burn or itch. For the first few weeks you may also experience excessive tearing, sensitivity to light, and temporary changes in your eyesight, such as blurring or double vision. Your surgeon will follow your progress very closely for the first week or two. The stitches will be removed two days to a week after surgery. Once they're out, the swelling and discoloration around your eyes will gradually subside, and you'll start to look and feel much better.
Getting Back to Normal
You should be able to read or watch television after two or three days. However, you won't be able to wear contact lenses for about two weeks, and even then they may feel uncomfortable for a while. Most people feel ready to go out in public (and back to work) in a week to 10 days. By then, depending on your rate of healing and your doctor's instructions, you'll probably be able to wear makeup to hide the bruising that remains. You may be sensitive to sunlight, wind, and other irritants for several weeks, so you should wear sunglasses and a special sunblock made for eyelids when you go out. Your surgeon will probably tell you to keep your activities to a minimum for three to five days, and to avoid more strenuous activities for about three weeks. It's especially important to avoid activities that raise your blood pressure, including bending, lifting, and rigorous sports. You may also be told to avoid alcohol, since it causes fluid retention.
Your New Look
Healing is a gradual process, and your scars may remain slightly pink for six months or more after surgery. Eventually, though, they'll fade to a thin, nearly invisible white line. On the other hand, the positive results of your eyelid surgery-the more alert and youthful look-will last for years. For many people, these results are permanent.
Facelift
If you experience sagging jowls on your lower face, a facelift surgery will combine skin and tissue tightening techniques to reveal a younger looking you.
If You're Considering a Facelift...
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 (technically known as rhytidectomy) can't stop this aging process. What it can do is set back the clock, improving the most visible signs of aging by removing excess fat, tightening underlying muscles, and redraping the skin of your face and neck. A facelift can be done alone, or in conjunction with other procedures such as a forehead lift, eyelid surgery, or nose reshaping.
The Best Candidates for a Facelift
The best candidate for a facelift is a man or woman whose face and neck have begun to sag, but whose skin still has some elasticity and whose bone structure is strong and well-defined. Most patients are in their forties to sixties, but facelifts can be done successfully on people in their seventies or eighties as well. A facelift can make you look younger and fresher, and it may enhance your self- confidence in the process. But it can't give you a totally different look, nor can it restore the health and vitality of your youth. Before you decide to have surgery, think carefully about your expectations and discuss them with your surgeon.
All Surgery Carries Some Uncertainty and Risk
When a facelift is performed by a qualified plastic surgeon, complications are infrequent and usually minor. Still, individuals vary greatly in their anatomy, their physical reactions, and their healing abilities, and the outcome is never completely predictable. Complications that can occur include hematoma (a collection of blood under the skin that must be removed by the surgeon), injury to the nerves that control facial muscles (usually temporary), infection, and reactions to the anesthesia. Poor healing of the skin is most likely to affect smokers. You can reduce your risks by closely following your surgeon's advice both before and after surgery.
Planning Your Surgery
Facelifts are very individualized procedures. In your initial consultation the surgeon will evaluate your face, including the skin and underlying bone, and discuss your goals for the surgery. Your surgeon should check for medical conditions that could cause problems during or after surgery, such as uncontrolled high blood pressure, blood clotting problems, or the tendency to form excessive scars. Be sure to tell your surgeon if you smoke or are taking any drugs or medications, especially aspirin or other drugs that affect clotting. If you decide to have a facelift, your surgeon will explain the techniques and anesthesia he or she will use, the type of facility where the surgery will be performed, and the risks and costs involved. Don't hesitate to ask your doctor any questions you may have, especially those regarding your expectations and concerns about the results.
Preparing For Your Surgery
Your surgeon will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications. Carefully following these instructions will help your surgery go more smoothly. If you smoke, it's especially important to stop at least a week or two before and after surgery; smoking inhibits blood flow to the skin, and can interfere with the healing of your incision areas. If your hair is very short, you might want to let it grow out before surgery, so that it's long enough to hide the scars while they heal. Whether your facelift is being done on an outpatient or inpatient basis, you should arrange for someone to drive you home after your surgery, and to help you out for a day or two if needed.
Where Your Surgery Will Be Performed
A facelift may be performed in a surgeon's office-based facility, an outpatient surgery center, or a hospital. It's usually done on an outpatient basis, but some surgeons may hospitalize patients for a day when using general anesthesia. Certain conditions such as diabetes or high blood pressure should be monitored after surgery, and may also require a short inpatient stay.
Types of Anesthesia
Most facelifts are performed under local anesthesia, combined with a sedative to make you drowsy. You'll be awake but relaxed, and your face will be insensitive to pain. (However, you may feel some tugging or occasional discomfort.) Some surgeons prefer a general anesthesia. In that case, you'll sleep through the operation.
The Surgery
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. Incisions usually begin above the hairline at the temples, extend in a natural line in front of the ear (or just inside the cartilage at the front of the ear), and continue behind the earlobe to the lower scalp. If the neck needs work, a small incision may also be made under the chin. In general, 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. Following surgery, a small, thin tube may be temporarily placed under the skin behind your ear to drain any blood that might collect there. The surgeon may also wrap your head loosely in bandages to minimize bruising and swelling.
After Your Surgery
There isn't usually significant discomfort after surgery; if there is, it can be lessened with the pain medication prescribed by your surgeon. (Severe or persistent pain or a sudden swelling of your face should be reported to your surgeon immediately.) Some numbness of the skin is quite normal; it will disappear in a few weeks or months. Your doctor may tell you to keep your head elevated and as still as possible for a couple of days after surgery, to keep the swelling down. If you've had a drainage tube inserted, it will be removed one or two days after surgery. Bandages, when used, are usually removed after one to five days. Don't be surprised at the pale, bruised, and puffy face you see. Just keep in mind that in a few weeks you'll be looking normal. Most of your stitches will be removed after about five days. Your scalp may take longer to heal, and the stitches or metal clips in your hairline could be left in a few days longer.
Getting Back to Normal
You should be up and about in a day or two, but plan on taking it easy for the first week after surgery. Be especially gentle with your face and hair, since your skin will be both tender and numb, and may not respond normally at first. Your surgeon will give more specific guidelines for gradually resuming your normal activities. They're likely to include these suggestions: Avoid strenuous activity, including sex and heavy housework, for at least two weeks (walking and mild stretching are fine); avoid alcohol, steam baths, and saunas for several months. Above all, get plenty of rest and allow your body to spend its energy on healing. At the beginning, your face may look and feel rather strange. Your features may be distorted from the swelling, your facial movements may be slightly stiff and you'll probably be self-conscious about your scars. Some bruising may persist for two or three weeks, and you may tire easily. It's not surprising that some patients are disappointed and depressed at first. By the third week, you'll look and feel much better. Most patients are back at work about ten days to two weeks after surgery. If you need it, special camouflage makeup can mask most bruising that remains.
Your New Look
The chances are excellent that you'll be happy with your facelift-especially if you realize that the results may not be immediately apparent. Even after the swelling and bruises are gone, the hair around your temples may be thin and your skin may feel dry and rough for several months. Men may find they have to shave in new places-behind the neck and ears-where areas of beard- growing skin have been repositioned. You'll have some scars from your facelift, but they're usually hidden by your hair or in the natural creases of your face and ears. In any case, they'll fade within time and should be scarcely visible. Having a facelift doesn't stop the clock. Your face will continue to age with time, and you may want to repeat the procedure one or more times-perhaps five or ten years down the line. But in another sense, the effects of even one facelift are lasting; years later, you'll continue to look better than if you'd never had a facelift at all.
Facial Implants
For a variety of facial features, facial implants can be used to increase projection and bring harmony and symmetry to the face.
If You're Considering Facial Implants
Plastic surgeons use facial implants to improve and enhance facial contours. These implants can bring the face into balance by building up the chin, the cheeks, or the jaw. There are many facial implants available, manufactured from a variety of materials. They can help strengthen a jawline or bring the chin or cheekbones into balance with the rest of the face. This web page describes some of the facial implants currently available as well as the techniques for their use. It will familiarize you with these procedures but cannot provide all the details which may be relevant to your particular needs. If you feel that one or more of the procedures described here may benefit you, be sure to ask your plastic surgeon for more information.
What to Expect From a Facial Implant
Facial implants can enhance your appearance and bolster your self esteem. If you are looking for improvement, not perfection, in your appearance and are realistic in your expectations, you may find that a facial implant is the right choice for you. Plastic surgeons will frequently use such implants to bring better balance to the features of a younger patient. For instance, a teenage girl may want her nose reshaped or her chin brought forward so that these traits are better proportioned. The more mature patient may choose to have an implant placed in conjunction with another cosmetic procedure. For example, during a facelift, a patient may wish to have implants placed over the cheekbones to help restore a more youthful appearance. Implants may also be selected to fill out a face that appears "sunken" or tired.
Cheek Surgery
To augment the cheek area, your plastic surgeon can insert cheek implants through an incision in the mouth, placing them directly on (or even below) the cheekbone. These facial implants can vary in size and shape, to achieve an individualized result. Cheek augmentation surgery usually requires about 30 to 45 minutes. When cheek implants are being placed in conjunction with another cosmetic procedure, such as a facelift, brow lift or eyelid surgery, the implants may be inserted through the incisions made for those procedures. Otherwise, an incision will be made either inside your upper lip or your lower eyelid. Your plastic surgeon forms a pocket for the implant, inserts it and secures it into place.
Recovering from Cheek Surgery
After the surgery, a dressing will be applied to minimize discomfort and swelling. The severity and duration of such side effects may vary, especially if another cosmetic procedure was performed at the same time. Your plastic surgeon will provide you with instructions about post-operative care. There will be dietary restrictions as well as limitations to your activities. Again, these instructions will vary, especially if another procedure was performed along with your implant surgery. However, you should be aware that your ability to move your mouth and lips may be diminished temporarily. Stitches used to close the incisions inside your mouth usually dissolve within about 10 days.
Chin Surgery
Chin surgery (often called mentoplasty or genioplasty), is a surgical procedure to reshape the chin. This can be accomplished in several ways. Your plastic surgeon may recommend enhancement with a facial implant or surgical reshaping of the chin bone. The general goal of cosmetic chin surgery is to provide a harmonious balance to your chin and facial features so that you feel better about the way you look. Many times a plastic surgeon may recommend chin surgery to a patient having nose surgery in order to achieve facial proportion, as the size of the chin may magnify or minimize the perceived size of the nose. With a short incision under the chin or inside the mouth, your plastic surgeon can place a chin implant directly on the bone. Insertion of a chin implant may take anywhere from 30 minutes to one hour. Before the surgery, your plastic surgeon selects the proper size and shape implant to enhance your appearance. He or she then inserts it into a pocket over the front of the jawbone. The small incision to create the pocket and insert the implant is placed inside the mouth (along the lower lip) or in the skin just under the chin area.
Recovering from Chin Surgery
After chin augmentation, the chin is taped to minimize swelling and discomfort. Sutures in the skin will be removed in five to seven days. If an intra-oral incision is used, the sutures will dissolve.
Lower-Jaw Surgery
Jaw implants increase the width of the lower third of your face. Much like the chin, a weak jaw can be thought of as one that is not well-defined and distinct from the neck, or one that slopes rather than angles from the ear to the chin. In some cases, both the chin and jaw can contribute to facial imbalance. Insertion of a jaw implant usually takes about one to two hours. Internal incisions are made on either side of the lower lip to provide access for creating a pocket into which the lower-jaw implant can be inserted. Dissolving sutures are used to close the incisions.
Recovering from Jaw Surgery
Swelling is sometimes significant immediately following surgery, usually peaking 24 to 48 hours afterward. Although most of the significant swelling will subside over a period of several days, prolonged mild swelling may prevent your final facial contour from becoming apparent for several months. During the healing phase, your activities and diet will be restricted. Your ability to smile, talk or move your mouth in any way may be limited for several days to weeks following surgery. Your plastic surgeon will instruct you about dental and oral hygiene during your recovery.
All Surgery Carries Some Uncertainty and Risk
Facial implants can produce some remarkable changes. Problems rarely occur, but you need to be informed about such possibilities. This brochure will touch upon a few, but is not intended to provide a detailed or complete inventory of potential risks. A facial implant can shift slightly out of alignment and a second operation my be necessary to replace it in its proper position. Infection can occur with any operation. If infection were to occur around a facial implant and did not clear up after treatment with antibiotics, the implant might have to be temporarily removed and replaced at a later time. Other, less-frequent risks may be associated with certain implants. Be sure to ask your plastic surgeon for a description of the risks associated with the procedure in which you are interested. Some of the implant materials are made of a solid silicone. Currently, there is no scientific evidence that this is a harmful substance. Your plastic surgeon will be happy to discuss any current scientific findings concerning the type of implant you're considering.
Planning Your Surgery
When you discuss your surgery with your plastic surgeon, be certain that you clearly express your expectations. Your plastic surgeon will help you determine what it is possible to achieve. It may be helpful to provide your surgeon with photos of people who have facial features similar to those you would like to have. Be sure you understand the details of the proposed surgery, including the cost and what to expect during your recovery. If the surgery will entail an incision inside your mouth, it is important that you inform your physician if you smoke or if you have any dental or gum problems. Your plastic surgeon will advise you on these matters. In preparing for your surgery, be sure to find out if you'll be able to drive home afterward or will require transportation. You should also ask if you'll need to refrain from eating or drinking the night before your surgery, and if you should stop taking any medications, including aspirin and similar drugs. You may be instructed to take oral antibiotics both before and after the procedure to help guard against infection. Your plastic surgeon will provide information about these important matters during your pre-operative consultation.
Where Your Surgery Will Be Performed
Your operation may take place in an office-based facility, a freestanding surgical center or a hospital outpatient facility. Sometimes, your plastic surgeon may require that you stay overnight. Your doctor will make such a recommendation based on your overall medical condition and whether another cosmetic procedure was performed simultaneously with the facial implant surgery.
Types of Anesthesia
In some cases, facial implant surgery may require only local anesthesia combined with a sedative. However, more frequently, a general anesthesia may be recommended.
Your New Look
Remember, with any facial surgery, you may feel and look better in a short period of time. However, it may not be advisable to participate in certain activities (especially activity that may result in the face being jarred or bumped) for several weeks. It's best to check with your plastic surgeon about such matters. You may not be able to accurately evaluate your appearance for weeks, or perhaps even months. Give yourself plenty of time to get used to your new look. You may be surprised to find that most people won't recognize that you've had facial implant surgery – only that you look better.
Fat Grafting
Fat grafting procedures involve utilizing fat from a donor site on your body and injecting it into a recipient site on your face to correct deep lines and wrinkles. Fat grafting is also known as autologous fat transplantation or micro-lipoinjection. During facial fat grafting, fat cells are extracted from your abdomen, thighs, buttocks or elsewhere and reinjected beneath the facial skin. Fat can fill in sunken cheeks or lines between the nose and mouth, correct skin depressions, minimize forehead wrinkles or enhance the lips. Allergic reaction is not a factor for fat because the filler is harvested from your own body. However, there is still a small risk of infection and other infrequent complications.
What to Expect During Your Procedure
Both the donor and recipient sites are numbed with local anesthesia. Sedation can be used as well. If you elect to use sedation, be sure to arrange for a ride home after your treatment. After cleansing and treatment with local anesthesia, fat is withdrawn using a syringe with a large-bore needle or a liposuction cannula. The fat is then prepared and injected into the recipient site with a needle. Sometimes an adhesive bandage is applied over the injection site. Slight overfilling may be necessary to allow for fat absorption that occurs. When fat is used to augment the cheeks, this overcorrection may cause the face to appear abnormally full.
After Fat Grafting
While some treatments require a brief recovery period, many patients resume normal activity right away. Expect some swelling, bruising or redness in both the donor and recipient sites. The severity of these symptoms depends upon the size and location of the treated area. Stay out of the sun until redness and bruising subsides - usually about 48 hours. In the meantime, you may use makeup with sunblock protection to help conceal your condition. In some cases, swelling and puffiness in the recipient site lasts several weeks, especially if a large area was filled.
How long do the results last?
While some patients report results lasting 1 year or more, the majority of patients find that at least half of the injected fullness disappears within 3-6 months. Therefore, repeated injections may be necessary. Your doctor will advise you on how to maintain your results with repeat treatments.
Nose Surgery
To correct a nose that is out of proportion with the face, Dr. Clayton can perform a nose surgery that will reshape your nose and may alter the bone, cartilage and skin to achieve a beautiful result.
If You're Considering Rhinoplasty...
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. If you're considering rhinoplasty, this information will give you a basic understanding of the procedure-when it can help, how it's performed, and what results you can expect. It can't answer all of your questions, since a lot depends on the individual patient and the surgeon. Please ask your surgeon about anything you don't understand.
The Best Candidates for Rhinoplasty
Rhinoplasty can enhance your appearance and your self-confidence, but it won't necessarily change your looks to match your ideal, or cause other people to treat you differently. Before you decide to have surgery, think carefully about your expectations and discuss them with your surgeon. The best candidates for rhinoplasty are people who are looking for improvement, not perfection, in the way they look. If you're physically healthy, psychologically stable, and realistic in your expectations, you may be a good candidate. Rhinoplasty can be performed to meet aesthetic goals or for reconstructive purposes-to correct birth defects or breathing problems. Age may also be a consideration. 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.
All Surgery Carries Some Uncertainty and Risk
When rhinoplasty is performed by a qualified plastic surgeon, complications are infrequent and usually minor. Nevertheless, there is always a possibility of complications, including infection, nosebleed, or a reaction to the anesthesia. You can reduce your risks by closely following your surgeon's instructions both before and after surgery. After surgery, small burst blood vessels may appear as tiny red spots on the skin's surface; these are usually minor but may be permanent. As for scarring, when rhinoplasty is performed from inside the nose, there is no visible scarring at all; when an open technique is used, or when the procedure calls for the narrowing of flared nostrils, the small scars on the base of the nose are usually not visible. In about one case out of ten, a second procedure may be required-for example, to correct a minor deformity. Such cases are unpredictable and happen even to patients of the most skilled surgeons. The corrective surgery is usually minor.
Planning Your Surgery
Good communication between you and your physician is essential. In your initial consultation, the surgeon will ask what you'd like your nose to look like, evaluate the structure of your nose and face, and discuss the possibilities with you. He or she will also explain the factors that can influence the procedure and the results. These factors include the structure of your nasal bones and cartilage, the shape of your face, the thickness of your skin, your age, and your expectations. Your surgeon will also explain the techniques and anesthesia he or she will use, the type of facility where the surgery will be performed, the risks and costs involved, and any options you may have. Most insurance policies don't cover purely cosmetic surgery; however, if the procedure is performed for reconstructive purposes, to correct a breathing problem or a marked deformity, the procedure may be covered. Check with your insurer, and obtain pre-authorization for your surgery. Be sure to tell your surgeon if you've had any previous nose surgery or an injury to your nose, even if it was many years ago. You should also inform your surgeon if you have any allergies or breathing difficulties; if you're taking any medications, vitamins, or recreational drugs; and if you smoke. Don't hesitate to ask your doctor any questions you may have, especially those regarding your expectations and concerns about the results.
Preparing For Your Surgery
Your surgeon will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, taking or avoiding certain vitamins and medications, and washing your face. Carefully following these instructions will help your surgery go more smoothly. While you're making preparations, be sure to arrange for someone to drive you home after your surgery and to help you out for a few days if needed.
Where Your Surgery Will Be Performed
Rhinoplasty may be performed in a surgeon's office-based facility, an outpatient surgery center, or a hospital. It's usually done on an outpatient basis, for cost containment and convenience. Complex procedures may require a short inpatient stay.
Types of Anesthesia
Rhinoplasty can be performed under local or general anesthesia, depending on the extent of the procedure and on what you and your surgeon prefer. With local anesthesia, you'll usually be lightly sedated, and your nose and the surrounding area will be numbed; you'll be awake during the surgery, but relaxed and insensitive to pain. With general anesthesia, you'll sleep through the operation.
The Surgery
Rhinoplasty usually takes an hour or two, though complicated procedures may take longer. During surgery the skin of the nose is separated from its supporting framework of bone and cartilage, which is then sculpted to the desired shape. The nature of the sculpting will depend on your problem and your surgeon's preferred technique. Finally, the skin is redraped over the new framework. 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. When the surgery is complete, a splint will be applied to help your nose maintain its new shape. Nasal packs or soft plastic splints also may be placed in your nostrils to stabilize the septum, the dividing wall between the air passages.
After Your Surgery
After surgery-particularly during the first twenty-four hours-your face will feel puffy, your nose may ache, and you may have a dull headache. You can control any discomfort with the pain medication prescribed by your surgeon. Plan on staying in bed with your head elevated (except for going to the bathroom) for the first day. You'll notice that the swelling and bruising around your eyes will increase at first, reaching a peak after two or three days. Applying cold compresses will reduce this swelling and make you feel a bit better. In any case, you'll feel a lot better than you look. Most of the swelling and bruising should disappear within two weeks or so. (Some subtle swelling-unnoticeable to anyone but you and your surgeon-will remain for several months.) A little bleeding is common during the first few days following surgery, and you may continue to feel some stuffiness for several weeks. Your surgeon will probably ask you not to blow your nose for a week or so, while the tissues heal. If you have nasal packing, it will be removed after a few days and you'll feel much more comfortable. By the end of one or, occasionally, two weeks, all dressings, splints, and stitches should be removed.
Getting Back to Normal
Most rhinoplasty patients are up and about within two days, and able to return to school or sedentary work a week or so following surgery. It will be several weeks, however, before you're entirely up to speed. Your surgeon will give you more specific guidelines for gradually resuming your normal activities. They're likely to include these suggestions: Avoid strenuous activity (jogging, swimming, bending, sexual relations-any activity that increases your blood pressure) for two to three weeks. Avoid hitting or rubbing your nose, or getting it sunburned, for eight weeks. Be gentle when washing your face and hair or using cosmetics. You can wear contact lenses as soon as you feel like it, but glasses are another story. Once the splint is off, they'll have to be taped to your forehead or propped on your cheeks for another six to seven weeks, until your nose is completely healed. Your surgeon will schedule frequent follow-up visits in the months after surgery, to check on the progress of your healing. If you have any unusual symptoms between visits, or any questions about what you can and can't do, don't hesitate to call your doctor.
Your New Look
In the days following surgery, when your face is bruised and swollen, it's easy to forget that you will be looking better. In fact, many patients feel depressed for a while after plastic surgery-it's quite normal and understandable. Rest assured that this stage will pass. Day by day, your nose will begin to look better and your spirits will improve. Within a week or two, you'll no longer look as if you've just had surgery. Still, healing is a slow and gradual process. Some subtle swelling may be present for months, especially in the tip. The final results of rhinoplasty may not be apparent for a year or more. In the meantime, you might experience some unexpected reactions from family and friends. They may say they don't see a major difference in your nose. Or they may act resentful, especially if you've changed something they view as a family or ethnic trait. If that happens, try to keep in mind why you decided to have this surgery in the first place. If you've met your goals, then your surgery is a success.
Liposuction
Liposuction is a commonly performed procedure in which a small vacuum-like instrument is inserted through small incisions in the skin. With this instrument, fat deposits you can not remove with diet and exercise are suctioned out.
If You're Considering Liposuction...
Liposuction is a procedure that can help sculpt the body by removing unwanted fat from specific areas, including the abdomen, hips, buttocks, thighs, knees, upper arms, chin, cheeks and neck. During the past decade, liposuction, which is also known as lipoplasty or suction lipectomy, has benefited from several new refinements. Today, a number of new techniques, including ultrasound-assisted lipoplasty (UAL), the tumescent technique, and the super-wet technique, are helping many plastic surgeons to provide selected patients with more precise results and quicker recovery times. Women may have liposuction performed under the chin, on their hips, thighs, and stomach, and in the under arm and breast area. For men, common sites include under the chin and around the waist. Liposuction may also be used in the reduction of enlarged male breasts, a condition known as gynecomastia. Healthy, normal-weight people with elastic skin and pockets of excess fat are good candidates for surgery. The best candidates for liposuction are of normal weight with localized areas of excess fat-- for example, in the buttocks, hips, and thighs. The surgeon inserts a cannula through small incisions in the skin. At the other end of the tube is a vacuum-pressure unit that suctions off the fat. A snug compression garment worn after surgery helps reduce swelling. Although no type of liposuction is a substitute for dieting and exercise, liposuction can remove stubborn areas of fat that don't respond to traditional weight-loss methods. If you're considering liposuction, this brochure will give you a basic understanding of the procedure -- when it can help, how it is performed and how you might look and feel after surgery. It won't answer all of your questions, since much depends on your individual circumstances. Please ask your doctor if there is anything about the procedure you don't understand.
The Best Candidates for Liposuction
To be a good candidate for liposuction, you must have realistic expectations about what the procedure can do for you. It's important to understand that liposuction can enhance your appearance and self confidence, but it won't necessarily change your looks to match your ideal or cause other people to treat you differently. Before you decide to have surgery, think carefully about your expectations and discuss them with your surgeon. The best candidates for liposuction are normal-weight people with firm, elastic skin who have pockets of excess fat in certain areas. You should be physically healthy, psychologically stable and realistic in your expectations. Your age is not a major consideration; however, older patients may have diminished skin elasticity and may not achieve the same results as a younger patient with tighter skin. Liposuction carries greater risk for individuals with medical problems such as diabetes, significant heart or lung disease, poor blood circulation, or those who have recently had surgery near the area to be contoured.
Planning Your Surgery
In your initial consultation, your surgeon will evaluate your health, determine where your fat deposits lie and assess the condition of your skin. Your surgeon will explain the body-contouring methods that may be most appropriate for you. For example, if you believe you want liposuction in the abdominal area, you may learn that an abdominoplasty or tummy tuck may more effectively meet your goals; or that a combination of traditional liposuction and UAL would be the best choice for you. Be frank in discussing your expectations with your surgeon. He or she should be equally frank with you, describing the procedure in detail and explaining its risks and limitations.
Getting the Answers You Need
Individuals considering liposuction often feel a bit overwhelmed by the number of options and techniques being promoted today. However, your plastic surgeon can help. In deciding which is the right treatment approach for you, your doctor will consider effectiveness, safety, cost and appropriateness for your needs. This is called surgical judgment, a skill that is developed through surgical training and experience. Your doctor also uses this judgment to prevent complications; to handle unexpected occurrences during surgery; and to treat complications when they occur. Your surgeon's education and training have helped to form his or her surgical judgement, so take the time to do some background checking. Patients are encouraged to consider a doctor certified by the American Board of Plastic Surgery (ABPS). By choosing a plastic surgeon who is certified by the ABPS, a patient can be assured that the doctor has graduated from an accredited medical school and completed at least five years of additional residency - usually three years of general surgery (or its equivalent) and two years of plastic surgery. To be certified by the ABPS, a doctor must also practice surgery for two years and pass comprehensive written and oral exams.
Preparing For Your Surgery
Your surgeon will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding vitamins, iron tablets and certain medications. If you develop a cold or an infection of any kind, especially a skin infection, your surgery may have to be postponed. Though it is rarely necessary, your doctor may recommend that you have blood drawn ahead of time in case it is needed during surgery. Also, while you are making preparations, be sure to arrange for someone to drive you home after the procedure and, if needed, to help you at home for a day or two.
Where Your Surgery Will Be Performed
Liposuction may be performed in a surgeon's office-based facility, in an outpatient surgery center, or in a hospital. Smaller-volume liposuction is usually done on an outpatient basis for reasons of cost and convenience. However, if a large volume of fat will be removed, or if the liposuction is being performed in conjunction with other procedures, a stay in a hospital or overnight nursing facility may be required.
Anesthesia for Liposuction
Various types of anesthesia can be used for liposuction procedures. Together, you and your surgeon will select the type of anesthesia that provides the most safe and effective level of comfort for your surgery. If only a small amount of fat and a limited number of body sites are involved, liposuction can be performed under local anesthesia, which numbs only the affected areas. However, if you prefer, the local is usually used along with intravenous sedation to keep you more relaxed during the procedure. Regional anesthesia can be a good choice for more extensive procedures. One type of regional anesthesia is the epidural block, the same type of anesthesia commonly used in childbirth. However, some patients prefer general anesthesia, particularly if a large volume of fat is being removed. If this is the case, a nurse anesthetist or anesthesiologist will be called in to make sure you are completely asleep during the procedure.
The Surgery
The time required to perform liposuction may vary considerably, depending on the size of the area, the amount of fat being removed, the type of anesthesia and the technique used. There are several liposuction techniques that can be used to improve the ease of the procedure and to enhance outcome. Liposuction is a procedure in which localized deposits of fat are removed to recontour one or more areas of the body. Through a tiny incision, a narrow tube or cannula is inserted and used to vacuum the fat layer that lies deep beneath the skin. The cannula is pushed then pulled through the fat layer, breaking up the fat cells and suctioning them out. The suction action is provided by a vacuum pump or a large syringe, depending on the surgeon's preference. If many sites are being treated, your surgeon will then move on to the next area, working to keep the incisions as inconspicuous as possible. Fluid is lost along with the fat, and it's crucial that this fluid be replaced during the procedure to prevent shock. For this reason, patients need to be carefully monitored and receive intravenous fluids during and immediately after surgery.
Technique Variations
The basic technique of liposuction, as described above, is used in all patients undergoing this procedure. However, as the procedure has been developed and refined, several variations have been introduced. Fluid Injection, a technique in which a medicated solution is injected into fatty areas before the fat is removed, is commonly used by plastic surgeons today. The fluid -- a mixture of intravenous salt solution, lidocaine (a local anesthetic) and epinephrine (a drug that contracts blood vessels) -- helps the fat be removed more easily, reduces blood loss and provides anesthesia during and after surgery. Fluid injection also helps to reduce the amount of bruising after surgery. The amount of fluid that is injected varies depending on the preference of the surgeon. Large volumes of fluid -- sometimes as much as three times the amount of fat to be removed -- are injected in the tumescent technique. Tumescent liposuction, typically performed on patients who need only a local anesthetic, usually takes significantly longer than traditional liposuction (sometimes as long as 4 to 5 hours). However, because the injected fluid contains an adequate amount of anesthetic, additional anesthesia may not be necessary. The name of this technique refers to the swollen and firm or tumesced state of the fatty tissues when they are filled with solution. The super-wet technique is similar to the tumescent technique, except that lesser amounts of fluid are used. Usually the amount of fluid injected is equal to the amount of fat to be removed. This technique often requires IV sedation or general anesthesia and typically takes one to two hours of surgery time. Ultrasound-Assisted Lipoplasty (UAL). This technique requires the use of a special cannula that produces ultrasonic energy. As it passes through the areas of fat, the energy explodes the walls of the fat cells, liquefying the fat. The fat is then removed with the traditional liposuction technique. UAL has been shown to improve the ease and effectiveness of liposuction in fibrous areas of the body, such as the upper back or the enlarged male breast. It is also commonly used in secondary procedures, when enhanced precision is needed. In general, UAL takes longer to perform than traditional liposuction.
All Surgery Carries Some Uncertainty and Risk
Liposuction is normally safe, as long as patients are carefully selected, the operating facility is properly equipped and the physician is adequately trained. As a minimum, your surgeon should have basic (core) accredited surgical training with special training in body contouring. Also, even though many body-contouring procedures are performed outside the hospital setting, be certain that your surgeon has been granted privileges to perform liposuction at an accredited hospital. Your doctor must have advanced surgical skills to perform procedures that involve the removal of a large amount of fat (more than 5 liters or 5,000 ccs); ask your doctor about his or her other patients who have had similar procedures and what their results were. Also, more extensive liposuction procedures require attentive after-care. Find out how your surgeon plans to monitor your condition closely after the procedure. However, it's important to keep in mind that even though a well-trained surgeon and a state-of-the art facility can improve your chance of having a good result, there are no guarantees. Though they are rare, complications can and do occur. Risks increase if a greater number of areas are treated at the same time, or if the operative sites are larger in size. Removal of a large amount of fat and fluid may require longer operating times than may be required for smaller operations. The combination of these factors can create greater hazards for infection; delays in healing; the formation of fat clots or blood clots, which may migrate to the lungs and cause death; excessive fluid loss, which can lead to shock or fluid accumulation that must be drained; friction burns or other damage to the skin or nerves or perforation injury to the vital organs; and unfavorable drug reactions. There are also points to consider with the newer techniques. For example, in UAL, the heat from the ultrasound device used to liquefy the fat cells may cause injury to the skin or deeper tissues. Also, you should be aware that even though UAL has been performed successfully on several thousand people worldwide, the long-term effects of ultrasound energy on the body are not yet known. In the tumescent and super-wet techniques, the anesthetic fluid that is injected may cause lidocaine toxicity (if the solution's lidocaine content is too high), or the collection of fluid in the lungs (if too much fluid is administered). The scars from liposuction are small and strategically placed to be hidden from view. However, imperfections in the final appearance are not uncommon after lipoplasty. The skin surface may be irregular, asymmetric or even baggy, especially in the older patient. Numbness and pigmentation changes may occur. Sometimes, additional surgery may be recommended.
After Your Surgery
After surgery, you will likely experience some fluid drainage from the incisions. Occasionally, a small drainage tube may be inserted beneath the skin for a couple of days to prevent fluid build-up. To control swelling and to help your skin better fit its new contours, you may be fitted with a snug elastic garment to wear over the treated area for a few weeks. Your doctor may also prescribe antibiotics to prevent infection. Don't expect to look or feel great right after surgery. Even though the newer techniques are believed to reduce some post-operative discomforts, you may still experience some pain, burning, swelling, bleeding and temporary numbness. Pain can be controlled with medications prescribed by your surgeon, though you may still feel stiff and sore for a few days. It is normal to feel a bit anxious or depressed in the days or weeks following surgery. However, this feeling will subside as you begin to look and feel better.
Getting Back to Normal
Healing is a gradual process. Your surgeon will probably tell you to start walking around as soon as possible to reduce swelling and to help prevent blood clots from forming in your legs. You will begin to feel better after about a week or two and you should be back at work within a few days following your surgery. The stitches are removed or dissolve on their own within the first week to 10 days. Activity that is more strenuous should be avoided for about a month as your body continues to heal. Although most of the bruising and swelling usually disappears within three weeks, some swelling may remain for six months or more. Your surgeon will schedule follow-up visits to monitor your progress and to see if any additional procedures are needed. If you have any unusual symptoms between visits -- for example, heavy bleeding or a sudden increase in pain -- or any questions about what you can and can't do, call your doctor.
Your New Look
You will see a noticeable difference in the shape of your body quite soon after surgery. However, improvement will become even more apparent after about four to six weeks, when most of the swelling has subsided. After about three months, any persistent mild swelling usually disappears and the final contour will be visible. If your expectations are realistic, you will probably be very pleased with the results of your surgery. You may find that you are more comfortable in a wide variety of clothes and more at ease with your body. And, by eating a healthy diet and getting regular exercise, you can help to maintain your new shape.
Tummy Tuck
A tummy tuck is commonly performed after you have lost a large amount of weight and have excess skin around your midsection. In this procedure, skin and tissue tightening techniques are used to remove the excess that may not respond to diet and exercise.
If You're Considering Abdominoplasty...
Also known as abdominoplasty, a tummy tuck removes excess fat and skin, and in most cases restores weakened or separated muscles creating an abdominal profile that is smoother and firmer. A flat and well-toned abdomen is something many of us strive for through exercise and weight control. Sometimes these methods cannot achieve our goals. Even individuals of otherwise normal body weight and proportion can develop an abdomen that protrudes or is loose and sagging. The most common causes of this include: Pregnancy, Aging, Significant fluctuations in weight, Heredity, Prior surgery. Tummy tuck surgery is a highly individualized procedure and you should do it for yourself, not to fulfill someone else's desires or to try to fit any sort of ideal image.
Abdominoplasty May Be Right For You If:
You are physically healthy and at a stable weight, You have realistic expectations, You do not smoke. Although the results of an abdominoplasty procedure are technically permanent, the positive outcome can be greatly diminished by significant fluctuations in your weight. For this reason, individuals who are planning substantial weight loss or women who may be considering future pregnancies may be advised to postpone abdominoplasty surgery. What a tummy tuck won't do: Tummy tucks are not a substitute for weight loss or an appropriate exercise program. Also, tummy tuck operations cannot correct stretch marks, although these may be removed or somewhat improved if they are located on the areas of excess skin that will be excised, generally the treated areas below the belly button.
All Surgery Carries Some Uncertainty and Risk
Thousands of abdominoplasties are performed successfully each year. When done by a qualified plastic surgeon who is trained in body contouring, the results are generally quite positive. Nevertheless, there are always risks associated with surgery and specific complications associated with this procedure. Post-operative complications such as infection and blood clots are rare, but can occur. Infection can be treated with drainage and antibiotics, but will prolong your hospital stay. You can minimize the risk of blood clots by moving around as soon after the surgery as possible. Poor healing, which results in conspicuous scars, may necessitate a second operation. Smokers should be advised to stop, as smoking may increase the risk of complications and delay healing. You can reduce your risk of complications by closely following your surgeon's instructions before and after the surgery, especially with regard to when and how you should resume physical activity.
Planning Your Surgery
In your initial consultation, your surgeon will evaluate your health, determine the extent of fat deposits in your abdominal region, and carefully assess your skin tone. Be sure to tell your surgeon if you smoke, and if you're taking any medications, vitamins, or other drugs. Be frank in discussing your expectations with your surgeon. He or she should be equally frank with you, describing your alternatives and the risks and limitations of each. If, for example, your fat deposits are limited to the area below the navel, you may require a less complex procedure called a partial abdominoplasty, also know as a mini-tummy tuck, which can often be performed on an outpatient basis. You may, on the other hand, benefit more from partial or complete abdominoplasty done in conjunction with liposuction to remove fat deposits from the hips, for a better body contour. Or maybe liposuction alone would create the best result. In any case, your surgeon should work with you to recommend the procedure that is right for you and will come closest to producing the desired body contour. During the consultation, your surgeon should also explain the anesthesia he or she will use, the type of facility where the surgery will be performed, and the costs involved. In most cases, health insurance policies do not cover the cost of abdominoplasty, but you should check your policy to be sure.
Preparing For Your Surgery
Your surgeon will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins, and medications. If you smoke, plan to quit at least one to two weeks before your surgery and not to resume for at least two weeks after your surgery. Avoid overexposure to the sun before surgery, especially to your abdomen, and do not go on a stringent diet, as both can inhibit your ability to heal. If you develop a cold or infection of any kind, your surgery will probably be postponed. Whether your surgery is done on an outpatient or inpatient basis, you should arrange for someone to drive you home after your surgery, and to help you out for a day or two after you leave the hospital, if needed.
Where Your Surgery Will Be Performed
Many surgeons perform both partial and complete abdominoplasties in an outpatient surgical center or an office-based facility. Others prefer the hospital, where their patients can stay for several days.
Types of Anesthesia
Your doctor may select general anesthesia, so you'll sleep through the operation. Other surgeons use local anesthesia, combined with a sedative to make you drowsy. You'll be awake but relaxed, and your abdominal region will be insensitive to pain. (However, you may feel some tugging or occasional discomfort.)
The Surgery
Complete abdominoplasty usually takes two to five hours, depending on the extent of work required. Partial abdominoplasty may take an hour or two. Most commonly, the surgeon will make a long incision from hipbone to hipbone, ,just above the pubic area. A second incision is made to free the navel from surrounding tissue. With partial abdominoplasty, the incision is much shorter and the navel may not be moved, although it may be pulled into an unnatural shape as the skin is tightened and stitched. Next, the surgeon separates the skin from the abdominal wall all the way up to your ribs and lifts a large skin flap to reveal the vertical muscles in your abdomen. These muscles are tightened by pulling them close together and stitching them into their new position. This provides a firmer abdominal wall and narrows the waistline. The skin flap is then stretched down and the extra skin is removed. A new hole is cut for your navel, which is then stitched in place. Finally, the incisions will be stitched, dressings will be applied, and a temporary tube may be inserted to drain excess fluid from the surgical site. In partial abdominoplasty, the skin is separated only between the incision line and the navel. This skin flap is stretched down, the excess is removed, and the flap is stitched back into place.
After Your Surgery
For the first few days, your abdomen will probably be swollen and you're likely to feel some pain and discomfort which can be controlled by medication. Depending on the extent of the surgery, you may be released within a few hours or you may have to remain hospitalized for two to three days. Your doctor will give you instructions for showering and changing your dressings. And though you may not be able to stand straight at first, you should start walking as soon as possible. Surface stitches will be removed in five to seven days, and deeper sutures, with ends that protrude through the skin, will come out in two to three weeks. The dressing on your incision may be replaced by a support garment.
Getting Back to Normal
It may take you weeks or months to feel like your old self again. If you start out in top physical condition with strong abdominal muscles, recovery from abdominoplasty will be much faster. Some people return to work after two weeks, while others take three or four weeks to rest and recuperate. Exercise will help you heal better. Even people who have never exercised before should begin an exercise program to reduce swelling, lower the chance of blood clots, and tone muscles. Vigorous exercise, however, should be avoided until you can do it comfortably. Your scars may actually appear to worsen during the first three to six months as they heal, but this is normal. Expect it to take nine months to a year before your scars flatten out and lighten in color. While they'll never disappear completely, abdominal scars will not show under most clothing, even under bathing suits.
Your New Look
Abdominoplasty, whether partial or complete, produces excellent results for patients with weakened abdominal muscles or excess skin. And in most cases, the results are long lasting, if you follow a balanced diet and exercise regularly. If you're realistic in your expectations and prepared for the consequences of a permanent scar and a lengthy recovery period, abdominoplasty may be just the answer for you.
Upper Arm Lift
If you struggle with excess skin hanging from your upper arms, you may choose to undergo an upper arm lift in which skin and tissue tightening techniques are used to remove the excess skin. Fluctuations in weight, aging and even heredity can cause changes in appearance that you might not expect. One such change that can occur in the upper arm results in a droopy, sagging, batwing-like appearance. Fitness may strengthen and improve underlying muscle tone of the upper arm, but it cannot address excess skin that has lost elasticity or underlying weakened tissues and localized fat deposits. If the underside of your upper arms has developed sagging, droopy skin, or appears loose and full due to excess skin and fat, an arm lift may be right for you. In general, an arm lift reduces excess skin and underlying fat that occurs between underarm region in the elbow, reshaping the arm to result in smoother skin and more normal contours. An arm lift results in a more toned and proportionate appearance, enhancing your self-confidence and expanding your fashion choices. The trade-off to your improved image is a resulting scar on the inside of your upper arm. Inner Arm Incision Back of Arm Incision Minimal Arm Lift Incision This webpage presents an overview of arm lift, technically called brachioplasty. The best way to learn how an arm lift can help fulfill your personal goals is a consultation with a plastic surgeon certified by the American Board of plastic surgery.
What is an arm lift?
An arm lift is a surgical procedure that reshapes the under portion of the upper arm, and the underarm region to the elbow. This procedure is performed to: Reduce excess sagging skin that droops downward when arms are extended away from the body; Tighten and smooth the underlying supportive tissue that defines the shape of the upper arm. In addition, any localized pockets of fat in the upper arm region may be reduced through brachioplasty, most commonly in conjunction with liposuction techniques. The conditions treated with an arm lift may develop in both men and women, most often due to a loss of elasticity in the skin and underlying tissue of the upper arm. This may be the result of significant weight loss and skin that has been so stretched it loses the ability to retract. Conditions may also result from the natural changes that occur with aging, heredity or a combination of these conditions. An arm lift cannot correct weakened muscles of the upper arm; in fact many individuals who seek surgery are relatively fit individuals who are bothered by a condition that cannot be corrected through exercise. In general, good candidates for an arm lift are: Adults of any age whose weight is relatively stable and who are not significantly overweight; Healthy individuals who do not have medical conditions that can impair healing or increase risk of surgery; Non-smokers; Individuals with a positive outlook and realistic goals for what an arm lift can accomplish; Individuals committed to leading a healthy lifestyle of proper nutrition and fitness.
Where do I begin?
A consultation with your plastic surgeon is the first step to learn how and on what can help you achieve a smoother and more normal contour of the arm. A consultation is designed to fully educate you about brachioplasty in a non-pressured environment, and will include: A discussion of your goals and an evaluation of the individual case; The options available for an arm left; The likely outcomes of brachioplasty and any associated risks or potential complications; The course of treatment recommended by your plastic surgeon.
Evaluation
Overall health and personal outlook can greatly impact the outcome of arm lift surgery. These will be carefully evaluated in a consultation with your plastic surgeon. The success of your procedure, safety and overall satisfaction require that you: Honestly share your expectations; Fully disclose health history, current medications, the use of vitamins, herbal supplements, alcohol, tobacco and drugs; Commit to precisely following all of your plastic surgeon's instructions.
Your Arm Lift
An arm lift is a safe and satisfying procedure that can greatly improve the appearance of your upper arm. The procedure begins with an incision placed in the inside of the upper arm. The incision may extend from the underarm to the elbow, or be more limited in length. Incision length and pattern depend on the amount and location of excess skin to be removed, as well as the preferences and surgical judgment of your plastic surgeon. If fat will be reduced during your arm lift, it will be excised or treated with liposuction techniques. The underlying supportive tissues are tightened and reshaped with internal sutures. Overlying skin is then smoothed over the new contour of your arm, with excess skin reduced. Your incisions will be closed with absorbable sutures, or stitches that will be removed within one to two weeks following your arm lift. The trade off to an improved body contour and image through an arm lift is a resulting scar on the inside portion of your upper arm. In addition, uneven contours can develop in the arm after surgery. In some cases, skin elasticity is so poor that relapse of the skin is possible.
Preparing for Surgery
Your plastic surgeon will carefully explain the technique for your arm lift. Prior to any surgery, you will be given specific instructions that may include: Pre-surgical considerations, diagnostic testing and medications; Day of surgery instructions and medications; Specific information related to the use of anesthesia; Postoperative care and follow up. In addition, you will be asked to sign consent forms to assure your plastic surgeon that you full understand the procedure or procedures you will undergo and any associated risks and potential complications. Possible risks of an arm lift include bleeding, infection, fluid accumulation, delayed or poor healing, skin loss, blood clots, excessive or widened scars, numbness and other changes in skin sensation and irregular or asymmetric contour or scars. Any surgery carries risks associated with anesthesia. These risks and others will be fully disclosed prior to your consent. It is important that you address all your questions directly with your plastic surgeon. It is natural to feel some anxiety, whether excitement for the anticipated outcomes or preoperative stress. Discuss these feelings with your plastic surgeon.
What to Expect
Brachioplasty may be performed in your surgeon’s accredited office-based surgical facility, an ambulatory surgical facility or a hospital, possibly with an overnight hospital stay. Procedures are most commonly performed under general anesthesia, although local anesthesia with sedation may be used. These decisions will be based on the requirements of your specific procedure and considerations of patient and surgeon preference.
Following surgery
Once your arm lift is completed, dressing or bandages will be applied to your incisions, and your arms may be wrapped in an elastic bandage to minimize swelling and to support your new contours as you heal. Small, thin tubes may be temporarily placed under the skin to drain excess fluid or blood that may collect. Before you are released following surgery, you and an accompanying responsible family member, friend or caregiver will be given specific instructions that may include: How to care for the surgical site and drains; Medications to apply or take orally to aid healing and reduce the potential for infection; Specific concerns to look for at the surgical site or in overall health; When to follow-up with your plastic surgeon.
Progress and healing
Following your arm lift, your arms will be swollen and bruised, and you will experience some discomfort. Discomfort is common and can be controlled with medication. You will be instructed to keep your arms elevated for several days following surgery and return to light walking as soon as possible to minimize the potential for blood clots and other complications. You will also be instructed to avoid lifting or bearing any weight on your arms for several days to weeks. Your surgeon may also advise you to limit your range of motion until internal healing is complete. You will be ready to return to work and light, normal activities within a few days, as long as you do not engage in any lifting or vigorous exercise. Follow all instructions carefully - this is essential to the success of your outcome. Your incisions will heal within 7 to 14 days, after which time sutures will be removed if necessary. Additional healing will continue for many weeks as swelling resolves and incision lines continue to improve. Numbness and a firm feeling over the skin's surface will resolve over time. You must practice diligent sun protection until the healing process is fully completed or skin in the treated area may develop irregular pigmentation and scars may become raised, red or dark. It may take a year or more following a given procedure for incision lines to refine and fade to some degree. Continue to follow your plastic surgeon's instructions and attend follow-up visits as scheduled.
Results and Outlook
The dramatic improvement in arm contour following arm lift surgery can greatly enhance your body image. A smooth, toned arm that matches your body image and personal goals does, however, come with visible scars. This is a fair trade-off to achieving a body contour that matches your body weight and proportion. The results of arm lift will be long-lasting, provided that you maintain a stable weight and general fitness. As your body ages, it is natural to lose some firmness. However, most of your improvement should be relatively permanent.
Body Contouring After Weight Loss
Following a bariatric procedure, you may exhibit excess skin and tissue on your body. Using a combination of "lift" procedures and liposuction, Dr. Clayton will help you further slenderize your body with body contouring. Dramatic weight loss, whether achieved by proper nutrition and exercise, as the result of bariatric surgery, or from other forms of medical treatment, has many benefits. However, once you reach your weight loss goals, you may find that you still don’t have the fit and healthy body image you desire. Skin may be loose, sagging and in many cases, your body contours may appear irregular and disharmonious. If you have undergone dramatic weight loss that has resulted in excess sagging skin, surgical body contouring may be right for you. In general, body contouring following major weight loss reduces excess fat and skin that has developed in multiple body areas. The result of surgery is a smoother, more attractive body contour. Body contouring after major weight loss is an important and rewarding phase of your challenge to have a healthier, more proportionate body, and can help you further enhance your body image and self-confidence.
What is Body Contouring Surgery?
The condition of being significantly overweight can cause stress on your health in many ways. If your physical activity has been limited due to your overweight condition, you may have weak muscle and poor skin tone, and your skin may be severely stretched. Bariatric surgery, in its various forms, is one method of major weight loss for individuals clinically defined as obese. Following weight reduction surgery, or any substantial weight loss, the skin and tissues often lack elasticity and cannot conform to the reduced body size. As a result, skin that has been severely stretched now is unsupported, and begins to sag in pockets that most commonly develop around these areas: Face, neck and jowls, resulting in a droopy, sad appearance; Upper arms, resulting in a “bat-wing” appearance; Breasts, causing them to flatten and hang with nipples pointing down; Abdominal area, extending around the sides and into the lower back, resulting in an apron-like overhang; Buttocks, groin and thighs, causing hanging pockets of skin; Weak and sagging skin that becomes macerated (wet or infected) is not only unattractive, it is also a serious threat to your health that should be treated. Surgical body contouring after major weight loss improves the shape and tone of the underlying tissue that supports fat and skin, and removes excess sagging fat and skin. The result is a more normal body appearance with smoother contours. This is, in essence, the final phase of your total weight loss experience. However, before you decide to undergo body-contouring surgery, it is important to understand that your weight loss must have stabilized. If you continue to lose weight, sagging pockets will redevelop. If you rapidly regain the weight you have lost, you will traumatically stress your already weakened and thin skin, causing further stress to the skin, visible stretch marks and wide scars. If you have weight reduction surgery, your plastic surgeon will work closely with your physician to determine when it is appropriate for you to begin body contouring. In general, good candidates for body contouring are: Adults of any age whose weight loss has stabilized; Healthy individuals who do not have medical conditions that can impair healing or increase surgery risks; Non-smokers; Individuals with positive outlook and realistic goals; Individuals committed to leading a healthy lifestyle.
Where do I begin?
A consultation with your plastic surgeon is the first step to learn how body contouring can help you achieve better health and an improved appearance. A consultation is designed to fully educate you about surgery in a non-pressured environment, and will include: A discussion of your goals and an evaluation of your individual case; The options available in body contouring; The likely outcomes of body contouring and any associated risks; The course of treatment recommended by your plastic surgeon.
Evaluation
Overall health and personal outlook can greatly impact the outcome of your surgery. These will be carefully evaluated in your consultation with your plastic surgeon. The success of your procedure, safety and overall satisfaction require that you honestly share your expectations, fully disclose your medical history and commit to following your surgeons instructions.
Preparing for Surgery
Your plastic surgeon will carefully explain your body-contouring plan. Prior to any surgery, you will be given specific instructions that may include information about diagnostic testing, medications, day of surgery instructions, anesthesia and post-operative care. In addition, you will be asked to sign consent forms to assure your plastic surgeon that you fully understand the procedure(s) and any associated risks or potential complications. Possible risks of body contouring include bleeding, infection, fluid accumulation, delayed or poor healing, skin loss, blood clots, excessive or widened scars, numbness and other changes in skin sensation, and irregular or asymmetric scars. Any surgery carries risks associated with anesthesia. These risks and others will be fully discussed prior to your consent. It is important that you address all your questions directly with your plastic surgeon. It is natural to feel some anxiety, whether excitement for the anticipated outcomes or preoperative stress. Discuss these feelings with your plastic surgeon.
Where is Surgery Performed?
Body contouring procedures may be performed in your surgeon’s accredited office-based surgical facility, an ambulatory surgical facility or hospital, possibly with an overnight hospital stay. Procedures are most commonly performed under general anesthesia, although local anesthesia with sedation may also be used. These decisions will be based on the requirements of your specific procedure and considerations of patient and surgeon preference. Your surgeon and the assisting staff will fully attend to your comfort and safety.
Procedural Steps: What happens during body contouring surgery?
The procedures necessary to achieve your goals will be defined along with a plan for the timing of these procedures. Plastic surgery procedures that may be recommended by your physician include: Lower body lift: to correct sagging of the abdomen, buttocks, groin and outer thighs; Breast lift: to correct sagging, flattened breasts; Arm lift: to correct sagging of the upper arms; Thigh lift: to correct sagging of the inner, outer and mid thigh.
Step 1 - Anesthesia
Medications are administered for your comfort during the surgical procedures. The choices include intravenous sedation and general anesthesia. Your doctor will recommend the best choice for you.
Step 2 - The incisions
All body contouring procedures require incisions to remove excess skin. In many cases, these incisions may be extensive. Incision length and pattern depend on the amount and location of excess skin to be removed, as well as personal preference and your doctor's surgical judgment. Advanced techniques usually allow incisions to be placed in strategic locations where they can be hidden by most types of clothing, but this is not always the case. Body contouring is often performed in stages. Your particular condition and goals, as well as your plastic surgeon's best judgment, will all influence how your doctor defines a surgical plan. While it may have taken you two years or more to lose all the excess weight, it may take equally as long for the results of your body contouring to be complete.
Body Lift
A complete lower body lift treats sagging buttocks, abdomen, waist, hips and outer thighs in one procedure or in staged procedures. Incision patterns vary, and may include a circumferential incision around the body to remove the "belt" of excess skin and fat.
Breast Lift
The incision patterns for lifting a woman's sagging breasts will be determined based on the amount of excess skin to be removed. These may include one or a combination of incisions in a circular pattern around the areola, in a line extending from the areola to the breast crease, and horizontally along the breast crease. A breast implant also may be recommended to enhance breast shape and size.
Arm Lift
Sagging skin in the upper arms is treated with an incision from the underarm area extending along the inside or back of the upper arm. Additional incisions on the arms may be necessary anywhere excess skin has formed sagging pockets. The smoother, tighter contours that result from upper arm contouring are apparent almost immediately, although initially obscured by swelling and bruising. In addition, skin quality is dramatically improved in both appearance and texture.
Thigh Lift
Reshaping of the thighs is achieved through incisions in the groin that can extend downward to the knee along the inner portion of the thigh. Improving contours of the outer thigh may require an incision extending from the groin around the hip. Through these incisions your plastic surgeon will tighten tissues for a smoother, better toned thigh.
Following Surgery
Once your procedures are completed, dressing or bandages may be applied to your incisions. Areas of the body that have been treated may be wrapped in an elastic bandage to minimize swelling and support your new contours as you heal. Small, thin tubes may be temporarily placed under the skin to drain excess fluid or blood that may collect. Before you are released, you and your accompanying caregiver will be given specific instructions that may include: How to care for the surgical site and drains; Medications to apply or take orally to aid healing and reduce infection risk; Specific concerns to look for at the surgical site or in your general health; When to follow up with your plastic surgeon.
Progress and Healing
Initial healing will include swelling at the incision sites. Discomfort is common and can be controlled with medication. You will be instructed to return to light walking as soon as possible to minimize the potential for blood clots and other complications. You may be instructed to avoid bending, straining or lifting for several days to weeks. Where tightening of the abdomen or thighs is involved, your plastic surgeon may also instruct you to avoid standing fully upright and stressing any internal sutures as they heal, and to sleep with pillows elevating your knees. Follow all instructions carefully – this is essential to the success of your outcome. Initial wound healing may take 7 to 14 days, after which time sutures will be removed if necessary. You will be ready to return to work and normal activity in a few weeks, so long as you do not engage in any heavy lifting or vigorous exercise. Healing will continue for many weeks as swelling resolves and incision lines continue to improve. Numbness and a firm feeling over the skin’s surface will improve over time. Once you have completely recovered from one series of procedures, it may be time to begin preparation for additional procedures in other body areas.
Your Results and Outlook
The results of a body contouring following major weight loss are visible almost immediately; however, it may take as long as one to two years or more for the final results of all the recommended procedures to be fully appreciated. Visible scars are something you must accept in your goals to achieving a body contour that matches your new body weight and proportion. The results are long lasting, provided that you maintain a stable weight and general fitness. As your body ages, it is natural to lose some firmness, but most of your initial improvement should be relatively permanent.
Breast Reduction for Men
Men who exhibit excess breast tissue can often undergo a male breast reduction, which may combine skin and tissue tightening techniques with liposuction.
A Word About Breast Reduction in Men...
Gynecomastia is a medical term that comes from the Greek words for women-like breasts. Though this oddly named condition is rarely talked about, it's actually quite common. Gynecomastia affects an estimated 40 to 60 percent of men. It may affect only one breast or both. Though certain drugs and medical problems have been linked with male breast overdevelopment, there is no known cause in the vast majority of cases. In cases where gynecomastia is primarily the result of excess fatty tissue, liposuction techniques alone may be used. After liposuction, the patient has a flatter chest contour. Excision techniques are recommended when glandular breast tissue or excess skin must be removed. Incision patterns vary depending on the specific conditions and the surgeon's preference. Sometimes a combined approach with both excision and liposuction is necessary. The areola can be reduced, or the nipple repositioned for a more natural chest contour. For men who feel self-conscious about their appearance, breast-reduction surgery can help. The procedure removes fat and or glandular tissue from the breasts, and in extreme cases removes excess skin, resulting in a chest that is flatter, firmer, and better contoured.
The Best Candidates for Male Breast Reduction
Gynecomastia surgery is a highly individualized procedure and you should do it for yourself, not to fulfill someone else’s desires or to try to fit any sort of ideal image. This procedure is a good option for you if: You are physically healthy and of relatively normal weight; You have realistic expectations; Your breast development has stabilized; You are bothered by the feeling that your breasts are too large. Surgical correction of gynecomastia is best performed on: Men whose condition cannot be corrected through alternative medical treatments; Healthy individuals who do not have a life-threatening illness or medical conditions that can impair healing; Non-smokers and non-drug users; Men with a positive outlook and specific goals in mind for improving the physical symptoms of gynecomastia.
All Surgery Carries Some Uncertainty and Risk
When male breast-reduction surgery is performed by a qualified plastic surgeon, complications are infrequent and usually minor. Nevertheless, as with any surgery, there are risks. These include infection, skin injury, excessive bleeding, adverse reaction to anesthesia, and excessive fluid loss or accumulation. The procedure may also result in noticeable scars, permanent pigment changes in the breast area, or slightly mismatched breasts or nipples. If asymmetry is significant, a second procedure may be performed to remove additional tissue. The temporary side effects of male breast reduction include loss of breast sensation or numbness, which may last up to a year.
Planning Your Surgery
The initial consultation with your surgeon is very important. Your surgeon will need a complete medical history, so check your own records ahead of time and be ready to provide this information. First, your surgeon will examine your breasts and check for causes of the gynecomastia, such as impaired liver function, use of estrogen-containing medications, or anabolic steroids. If a medical problem is the suspected cause, you'll be referred to an appropriate specialist. Your plastic surgeon may, in extreme cases, also recommend a mammogram, or breast x-ray. This will not only rule out the very small possibility of breast cancer, but will reveal the breast's composition. Once your surgeon knows how much fat and glandular tissue is contained within the breasts, he or she can choose a surgical approach to best suit your needs. Don't hesitate to ask your surgeon any questions you may have during the initial consultation- including your concerns about the recommended treatment or the costs involved. Treatment of gynecomastia may be covered by medical insurance, but policies vary. Check with your health insurance provider to be sure. If you are covered, make certain you get written pre-authorization for the treatment recommended by your plastic surgeon. Your surgeon will give you specific instructions on how to prepare for surgery, including guidelines on eating, drinking, and taking certain vitamins and medications. Smokers should plan to stop smoking for a minimum of one or two weeks before surgery and during recovery. Smoking decreases circulation and interferes with proper healing. Therefore, it is essential to follow all your surgeon's instructions.
Procedural Steps
Plastic surgery to correct gynecomastia is technically called reduction mammaplasty, and reduces breast size, flattening and enhancing the chest contours. In severe cases of gynecomastia, the weight of excess breast tissue may cause the breasts to sag and stretch the areola (the dark skin surrounding the nipple). In these cases the position and size of the areola can be surgically improved and excess skin may be reduced.
Anesthesia
Medications are administered for your comfort during the surgical procedure. The choices include intravenous sedation and general anesthesia. Your doctor will recommend the best choice for you.
Liposuction
In cases where gynecomastia is primarily the result of excess fatty tissue, liposuction techniques alone may be used. This requires insertion of a cannula, a thin hollow tube, through several small incisions. The cannula is moved back and forth in a controlled motion to loosen the excess fat, which is then removed from the body by vacuum suction. There are various liposuction techniques that may be used; the technique most appropriate in your case will be defined prior to your procedure.
Excision
Excision techniques are recommended where glandular breast tissue or excess skin must be removed to correct gynecomastia. Excision also is necessary if the areola will be reduced, or the nipple repositioned to a more natural male contour. Incision patterns vary depending on the specific conditions and surgical preference.
Will there be scars?
Any surgical treatment to correct gynecomastia will require incisions. While most incision lines are concealed within natural contours, some may be visible and are a necessary result of breast reduction surgery.
After Your Surgery
Whether you've had excision with a scalpel or liposuction, you will feel some discomfort for a few days after surgery. However, discomfort can be controlled with medications prescribed by your surgeon. In any case, you should arrange to have someone drive you home after surgery and to help you out for a day or two if needed. You'll be swollen and bruised for awhile--in fact, you may wonder if there's been any improvement at all. To help reduce swelling, you'll probably be instructed to wear an elastic pressure garment continuously for a week or two, and for a few weeks longer at night. Although the worst of your swelling will dissipate in the first few weeks, it may be three months or more before the final results of your surgery are apparent. In the meantime, it is important to begin getting back to normal. You'll be encouraged to begin walking around on the day of surgery, and can return to work when you feel well enough--which could be as early as a day or two after surgery. Any stitches will generally be removed about 1 to 2 weeks following the procedure. Your surgeon may advise you to avoid sexual activity for a week or two, and heavy exercise for about three weeks. You'll be told to stay away from any sport or job that risks a blow to the chest area for at least four weeks. In general, it will take about a month before you're back to all of your normal activities. You should also avoid exposing the resulting scars to the sun for at least six months. Sunlight can permanently affect the skin's pigmentation, causing the scar to turn dark. If sun exposure is unavoidable, use a strong sunblock.
Your New Look
Gynecomastia surgery can enhance your appearance and self-confidence, but it won't necessarily change your looks to match your ideal. Before you decide to have surgery, think carefully about your expectations and discuss them frankly with your plastic surgeon. The results of the procedure are significant and permanent. If your expectations are realistic, chances are good that you'll be very satisfied with your new look.
Body Lift
Similar to other lift procedures, a body lift can be performed after you have lost a considerable amount of weight and now struggle with excess skin on various areas of your body. A well-toned body with smooth contours often is a sign of fitness achieved by healthy diet and exercise. But exercise cannot always achieve results for individuals who have loose, sagging skin and uneven contours. Aging, sun damage, pregnancy and fluctuations in body weight as well as genetic factors contribute to poor tissue elasticity and may result in sagging of the abdomen, buttocks, thighs, and upper arms. If you desire a firmer, more youthful looking body contour, then a surgical body lift may help achieve your goals. In general, a body lift reduces excess fat and skin resulting in smoother skin and contours. These physical changes to the body can improve your body image and enhance your self-confidence. This web page presents an overview of body lift procedures. The best way to learn how body contouring through body lifts can help fulfill your personal goals is a consultation with a plastic surgeon.
What are body lifts?
A body lift is surgery performed to correct excess loose and sagging skin and irregular contours of the: Abdominal area, locally or extending around the sides and into the lower back area; Buttocks, that may be low, flat or shaped unevenly; Groin that may sag into the inner thigh; Thigh, including the inner, outer, or posterior thigh, or circumferentially. Upper arms, including the armpit region Surgical body lifting improves the shape and tone of the underlying tissue that supports fat and skin. Excess sagging fat and skin is removed to treat conditions caused in part by poor tissue elasticity. In addition, a body lift can improve a dimpled, irregular skin surface, commonly known as cellulite. Body lifts are not intended strictly for the removal of excess fat. Liposuction alone can remove excess fat deposits where skin has good elasticity and is able to naturally conform to new body contours. In cases where skin elasticity is poor, a combination of liposuction and body lift techniques may be recommended. Body lifting procedures may be appropriate for individuals who are of stable weight that is reasonably proportionate to their height and body frame. In addition, it is recommended that women considering future pregnancies postpone and abdominal body lift since pregnancy may diminish results. Body lift procedures may be performed on adults of any age who have realistic goals in mind for improvement of their body contour. Good candidates are: Individuals with significant soft tissue looseness in one or multiple body areas; Healthy individuals who do not have medical conditions that can impair healing or increase risk of surgery; Non-smokers; Individuals with a positive outlook and specific goals in mind for body contouring.
Where do I begin?
A consultation with your plastic surgeon is the first step to learn how body lifting procedures can improve your body contours. A consultation is designed to fully educate you about your body lift in a non-pressured environment, and will include: A discussion of your goals and an evaluation of your individual case; The options available in body lift surgery; The likely outcomes of body lifting procedures and any risks or potential complications; The course of treatment recommended by your plastic surgeon.
Evaluation
Overall health and personal outlook can greatly impact the outcome of body contouring surgery, including body lifts. These will be carefully evaluated in your consultation. The success of your procedure, safety and overall satisfaction require that you: Honestly share your expectations; Fully disclose health history, current medications, use of vitamins, herbal supplements, alcohol, tobacco and drugs; Commit to precisely following all of your plastic surgeon’s instructions.
Your Body Lift
Your body lift will be individualized to your specific conditions and the regions to be treated. Conditions that may be improved by a body lift include: Dimpled or uneven soft tissue; Lax, loose skin; Excess fat and tissue; Sagging body contours. Many conditions can contribute to tissue that is weak and lacking in tone and firmness, and to uneven or sagging body contours. These most commonly include: Weight changes, especially substantial weight loss, such as occurs following gastric bypass surgery; Stress on the skin and underlying tissue that may result from pregnancy; The natural aging process causing skin and tissue to lose elasticity and tone over time; Sun damage and other environmental factors that cause premature skin aging; Heredity or the genetic make-up that determines one’s body type and skin qualities including cellulite; Childhood and teenage obesity resulting in premature loss of youthful skin tone. There is no other method of body contouring that can restore body shape, skin appearance, and skin tone as effectively as a body lift. Body lifts are surgical procedures and they require incisions; in some cases, incisions may be extensive. Incision length and pattern depend on the amount and location of skin to be removed, as well as personal preference and surgical judgment. Advanced techniques usually allow incisions to be placed in locations where they can be hidden by most types of clothing and swimsuits. Other body contouring procedures may be performed separately or in the same surgical session as a body lift, including liposuction and tummy tuck, breast lift or male or female breast reduction. However, not all patients are good candidates for combined procedures. Your case will be evaluated on an individual basis.
Preparing for Surgery
Your plastic surgeon will carefully explain your body lift procedure. Prior to surgery, you will be given specific instructions that may include: Pre-surgical considerations, diagnostic testing and medications; Day of surgery instructions and medications; Specific information related to the use of anesthesia; Postoperative care and follow up. In addition, you will be asked to sign consent forms to assure your plastic surgeon that you full understand the procedure or procedures you will undergo and any associated risks and potential complications. Possible risks of a body lift include bleeding, infection, fluid accumulation, delayed or poor healing, skin loss, blood clots, excessive or widened scars, numbness and other changes in skin sensation and irregular or asymmetric contour or scars. Any surgery carries risks associated with anesthesia. These risks and others will be fully disclosed prior to your consent. It is important that you address all your questions directly with your plastic surgeon. It is natural to feel some anxiety, whether excitement for the anticipated outcomes or preoperative stress. Discuss these feelings with your plastic surgeon.
Where Your Surgery Will be Performed
A body lift may be performed in your plastic surgeon’s accredited office-based surgical facility, an ambulatory surgical facility or a hospital, possibly with an overnight hospital stay. Procedures are most commonly performed under general anesthesia, although local anesthesia with sedation may be used. These decisions will be based on the requirements of your specific procedure and considerations of patient and surgeon preference. Your plastic surgeon and the assisting staff will fully attend to your comfort and safety.
Following Surgery
Once your procedure is completed, dressings or bandages may be applied to your incisions, and you may be wrapped in an elastic bandage to minimize swelling and support your new contours as you heal. One or more small, thin tubes may be temporarily placed under the skin to drain excess fluid or blood that may collect. Before you are released following surgery, you and an accompanying family member, friend or caregiver will be given specific instructions that may include: How to care for the surgical site and drains; Medications to apply or take orally to aid healing and reduce potential for infection; Specific concerns to look for at the surgical site or in the overall health; When to follow-up with your plastic surgeon.
Progress and Healing
Initial healing will include swelling at the incision sites. Discomfort is common and can be controlled with medication. You will be instructed to return to light walking as soon as possible to minimize the potential for blood clots and other complications. You must avoid bending, straining or lifting for several days. Where tightening of the abdomen or thighs is involved, your plastic surgeon may also instruct you to avoid standing fully upright and stressing any internal sutures as they heal, and to sleep with pillows elevating your knees. Follow all instructions carefully – this is essential to the success of your outcome. A return to light, normal activity is possible as soon as you feel ready, usually within 2-3 weeks following surgery. Initial wound healing may take 7 to 14 days, after which time sutures will be removed if necessary. You will be ready to return to work and normal activity in a few weeks, so long as you do not engage in any heavy lifting or vigorous exercise. Healing will continue for several weeks as swelling dissipates and incision lines continue to improve. You must practice diligent sun protection until the healing process is fully complete. Continue to follow your plastic surgeons instructions and attend follow-up visits as scheduled.
Results and Outlook
The results of a body lift are visible almost immediately, however it may take several months for your final results to fully develop. Numbness and a firm feeling over the skin’s surface will resolve over time. It may take a year or more for incisions lines to refine and fade to some degree. Although permanent, these lines can usually be hidden by most clothing and swimsuits. Your new uplifted body contours should be long lasting provided that you maintain your weight and general fitness. As your body ages, it is natural to lose some firmness. However, most of your improvement should be relatively permanent.
Thigh Lift
If you have lost a great deal of weight in your lower body and struggle with excess tissue around your thighs, a thigh lift, in which skin and tissue tightening techniques are utilized to correct the issue, may be ideal for you. A thigh lift reshapes the thighs by reducing excess skin, and in some cases fat, resulting in smoother skin and better-proportioned contours of the thighs and lower body. If fitness and weight loss efforts have not achieved your goals for a body that is firmer, more youthful-looking and more proportionate to your overall body image, a surgical thigh lift may be right for you.
Is a Thigh Lift Right For Me?
Candidates for Thigh Lift Surgery Have: Body weight that is relatively stable; Excess tissue along the inner (medial) thigh and/or the outer thigh; No medical conditions that can impair healing or increase risk of surgery; Positive outlook and realistic goals for thigh lift surgery. Commitment healthy lifestyle with good nutrition and fitness What it won’t do: Thigh lifts are not intended strictly for the removal of excess fat. Liposuction alone can remove excess fat deposits where skin has good elasticity and is able to naturally conform to new body contours. In cases where skin elasticity is poor, a combination of liposuction and thigh lift techniques may be recommended.
Anesthesia
Medications are administered for your comfort during the surgical procedures. The choices include intravenous sedation and general anesthesia. Your doctor will recommend the best choice for you.
The incision
Incision patterns vary based on the area or areas to be treated, degree of correction and patient and surgeon preference. One common technique used for a thigh lift places incisions in the groin, extending downward wrapping around the back of the thigh. The underlying tissue matrix will be reshaped and tightened, and skin will be reduced and redraped resulting in more proportionate and smoother body contours. You may qualify for a minimal incision medial thigh lift which involves an incision only in the groin area. Your surgeon will determine what’s appropriate. Improving the contours of the outer thigh may require an incision extending from the groin around the hip. Through these incisions your plastic surgeon will tighten tissues for a smoother, better-toned lower body contour. Advanced techniques usually allow incisions to be placed in strategic locations where they can be hidden by most types of clothing and swimsuits. However, incisions may be extensive. Deep support sutures within underlying tissues help to form the newly shaped contours. Sutures close the skin incisions.
Results of Thigh Lift Surgery
The smoother tighter contouring that result from a thigh lift are apparent almost immediately, although initially obscured by some swelling and bruising. You may be required to wear a compression garment for several weeks following your procedure to minimize swelling and support the tissues as they heal. Following a thigh lift, skin quality is dramatically improved both in appearance and feel. The decision to have thigh lift surgery is extremely personal and you’ll have to decide if the benefits will achieve your goals and if the risks and potential complications are acceptable. Your plastic surgeon and/or staff will explain in detail the risks associated with surgery. You will be asked to sign consent forms to ensure that you fully understand the procedure you will undergo and any risks and potential complications.
When You Go Home
When your procedure is completed, dressing or bandages may be applied to your incisions, and you may be wrapped in an elastic bandage or a compression garment to minimize swelling and to support your new contours as you heal. One or more small, thin tubes may be temporarily placed under the skin to drain excess fluid or blood that may collect. If you experience shortness of breath, chest pains, or unusual heart beats, seek medical attention immediately. Should any of these complications occur, you may require hospitalization and additional treatment. The practice of medicine and surgery is not an exact science. Although good results are expected, there is no guarantee. In some situations, it may not be possible to achieve optimal results with a single surgical procedure and another surgery may be necessary. Following your plastic surgeon's instructions is key to the success of your surgery. It is important that the surgical incisions are not subjected to excessive force, swelling, abrasion, or motion during the time of healing. Your doctor will give you specific instructions on how to care for yourself.
Tumescent Technique
A specific form of liposuction, the tumescent technique involves a solution which infiltrates fat deposits, liquifying them and making them easier to remove.
If Your Surgeon Recommends the Tumescent Technique...
The tumescent technique is a relatively new liposuction method that can reduce post operative bruising, swelling and pain. Because blood loss is minimized during tumescent liposuction, use of the technique reduces the chance that a blood transfusion will be needed. In the tumescent technique, areas of excess fat are injected with a large amount of anesthetic liquid before liposuction is per-formed. The liquid causes the compartments of fat to become swollen and firm or "tumesced." The expanded fat compartments allow the liposuction cannula to travel smoothly beneath the skin as the fat is removed.
Candidates for Tumescent Liposuction
Any person who is a candidate for traditional liposuction is also a good candidate for the tumescent technique. Although the technique can be used on any area of the body, it is commonly used on areas that require enhanced precision, such as the face, neck, arms, calves and ankles. Individuals who have large areas of excess fat may also be good candidates for tumescent liposuction.
Understanding the Risk
Although the anesthesia requirements are lessened and blood loss is minimized with tumescent liposuction, patients undergoing the procedure still face the same risks and cosmetic complications associated with tradi-tional liposuction surgery. There are also risks specifically associated with the tumescent technique. These rare complications include pulmonary edema (the collection of fluid in the lungs), which may occur if too much fluid is administered; and lidocaine toxicity, which occurs if the solution's lidocaine content is too high. You can reduce your risks by choosing a board-certified plastic surgeon who has adequate experience with the technique.
Anesthesia
For many patients, general anesthesia is the best option. For others, the anesthetic contained in the solution combined with sedation may provide sufficient comfort during the procedure. Or, if your doctor feels it's appropriate, the tumescent solution itself may serve as the sole means of anesthesia.
The Surgery
In tumescent liposuction, the warmed tumescent liquid -- a dilute solution containing lidocaine, epinephrine and intravenous fluid -- is injected into the area to be treated. As the liquid enters the fat, it becomes swollen, firm and blanched. Liposuction is then performed on the tumesced areas.
After Surgery
The long-acting effects of the anesthetic solution help to provide pain relief after the procedure and decrease the need for additional pain medication. For the first day or two after surgery, most patients experience swelling in the treated areas, as well as some fluid drainage from the incision sites. Light activity is usually resumed within the first few days after tumescent liposuction; normal activity can be resumed within a few weeks.
Your New Look
Patients are usually able to see a noticeable difference almost immediately after surgery. However, more improvement can be seen after three weeks, when most of the swelling has subsided. After about three months, any persistent mild swelling will disappear and the final contour will be visible. Patients are usually very pleased with the results of the procedure. By eating a healthy diet and getting regular exercise, you can help to maintain your slimmer figure or leaner physique.
Skin
For some individuals, surgical interventions may be several years down the road and skin care options may be a good stopgap to diminish signs of aging. In his Provo practice, plastic surgeon Dr. James Clayton offers skin treatments to pamper your skin, removing many signs of aging, as well as Latisse, which can greatly improve the appearance of your lashes.
Galvanic Spa II
The Galvanic Spa II system offered by Dr. Clayton works to revitalize your skin by penetrating your skin's surface to work with its underlying layers to reduce surface impurities as well as wrinkles and signs of aging. This system, made by NuSkin, can show marked improvements in the appearance and condition of the skin on your body, face and scalp.
Kinerase
Kinerase is a plant-based antioxidant skin care regimen that fights early signs of aging like wrinkles and sun damage. The Kinerase line of products includes cleansers and toners, moisturizers, products for sun protection, eye care as well as products that promote cleaner, more clear skin. While some Kinerase products are commercially available, the professional grade products are only available through Dr. Clayton's practice.
Latisse
Latisse is a medical-grade product that is clinically proven to add fullness and length to your existing lashes. By prolonging the growth phase of your lashes, this at-home topical product allows existing lashes to grow longer and for an extended period of time.
Breast Reconstruction
Dr. Clayton offers multiple breast reconstruction surgery techniques, ranging from implant-based to flap-based, to rebuild your breasts.
If You're Considering Breast Reconstruction
Reconstruction of a breast that has been removed due to cancer or other disease is one of the most rewarding surgical procedures available today. New medical techniques and devices have made it possible for surgeons to create a breast that can come close in form and appearance to matching a natural breast. Frequently, reconstruction is possible immediately following breast removal (mastectomy), so the patient wakes up with a breast mound already in place, having been spared the experience of seeing herself with no breast at all. But bear in mind, post-mastectomy breast reconstruction is not a simple procedure. There are often many options to consider as you and your doctor explore what's best for you. This information will give you a basic understanding of the procedure – when it's appropriate, how it's done, and what results you can expect. It can't answer all of your questions, since a lot depends on your individual circumstances. Please be sure to ask your surgeon if there is anything you don't understand about the procedure.
The Best Candidates for Breast Reconstruction
Most mastectomy patients are medically appropriate for reconstruction, many at the same time that the breast is removed. The best candidates, however, are women whose cancer, as far as can be determined, seems to have been eliminated by mastectomy. Still, there are legitimate reasons to wait. Many women aren't comfortable weighing all the options while they're struggling to cope with a diagnosis of cancer. Others simply don't want to have any more surgery than is absolutely necessary. Some patients may be advised by their surgeons to wait, particularly if the breast is being rebuilt in a more complicated procedure using flaps of skin and underlying tissue. Women with other health conditions, such as obesity, high blood pressure, or smoking, may also be advised to wait. In any case, being informed of your reconstruction options before surgery can help you prepare for a mastectomy with a more positive outlook for the future.
Follow-up Procedures
Most breast reconstruction involves a series of procedures that occur over time. Usually, the initial reconstructive operation is the most complex. Follow-up surgery may be required to replace a tissue expander with an implant or to reconstruct the nipple and the areola. Many surgeons recommend an additional operation to enlarge, reduce, or lift the natural breast to match the reconstructed breast. But keep in mind, this procedure may leave scars on an otherwise normal breast and may not be covered by insurance.
After Your Surgery
You are likely to feel tired and sore for a week or two after reconstruction. Most of your discomfort can be controlled by medication prescribed by your doctor. Depending on the extent of your surgery, you'll probably be released from the hospital in two to five days. Many reconstruction options require a surgical drain to remove excess fluids from surgical sites immediately following the operation, but these are removed within the first week or two after surgery. Most stitches are removed in a week to 10 days.
Your New Look
Chances are your reconstructed breast may feel firmer and look rounder or flatter than your natural breast. It may not have the same contour as your breast before mastectomy, nor will it exactly match your opposite breast. But these differences will be apparent only to you. For most mastectomy patients, breast reconstruction dramatically improves their appearance and quality of life following surgery.
All Surgery Carries Some Uncertainty and Risk
Virtually any woman who must lose her breast to cancer can have it rebuilt through reconstructive surgery.
But there are risks associated with any surgery and specific complications associated with this procedure.
In general, the usual problems of surgery, such as bleeding, fluid collection, excessive scar tissue, or difficulties with anesthesia, can occur although they're relatively uncommon.
And, as with any surgery, smokers should be advised that nicotine can delay healing, resulting in conspicuous scars and prolonged recovery. Occasionally, these complications are severe enough to require a second operation.
If an implant is used, there is a remote possibility that an infection will develop, usually within the first two weeks following surgery.
In some of these cases, the implant may need to be removed for several months until the infection clears. A new implant can later be inserted.
The most common problem, capsular contracture, occurs if the scar or capsule around the implant begins to tighten.
This squeezing of the soft implant can cause the breast to feel hard. Capsular contracture can be treated in several ways, and sometimes requires either removal or scoring of the scar tissue, or perhaps removal or replacement of the implant.
Reconstruction has no known effect on the recurrence of disease in the breast, nor does it generally interfere with chemotherapy or radiation treatment, should cancer recur.
Your surgeon may recommend continuation of periodic mammograms on both the reconstructed and the remaining normal breast. If your reconstruction involves an implant, be sure to go to a radiology center where technicians are experienced in the special techniques required to get a reliable x-ray of a breast reconstructed with an implant.
Women who postpone reconstruction may go through a period of emotional readjustment.
Just as it took time to get used to the loss of a breast, a woman may feel anxious and confused as she begins to think of the reconstructed breast as her own.
Planning Your Surgery
You can begin talking about reconstruction as soon as you're diagnosed with cancer.
Ideally, you'll want your breast surgeon and your plastic surgeon to work together to develop a strategy that will put you in the best possible condition for reconstruction.
After evaluating your health, your surgeon will explain which reconstructive options are most appropriate for your age
health, anatomy, tissues, and goals. Be sure to discuss your expectations frankly with your surgeon. He or she should be equally frank with you, describing your options and the risks and limitations of each. Post-mastectomy reconstruction can improve your appearance and renew your self-confidence -- but keep in mind that the desired result is improvement, not perfection
Your surgeon should also explain the anesthesia he or she will use
the facility where the surgery will be performed, and the costs. In most cases, health insurance policies will cover most or all of the cost of post-mastectomy reconstruction. Check your policy to make sure you're covered and to see if there are any limitations on what types of reconstruction are covered.
Preparing For Your Surgery
Your oncologist and your plastic surgeon will give you specific instructions on how to prepare for surgery
including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications.
While making preparations, be sure to arrange for someone to drive you home after your surgery and to help you out for a few days, if needed.
Breast reconstruction usually involves more than one operation. The first stage, whether done at the same time as the mastectomy or later on, is usually performed in a hospital.
Follow-up procedures may also be done in the hospital. Or, depending on the extent of surgery required, your surgeon may prefer an outpatient facility.
Types of Anesthesia
The first stage of reconstruction, creation of the breast mound, is almost always performed using general anesthesia, so you'll sleep through the entire operation.
Follow-up procedures may require only a local anesthesia, combined with a sedative to make you drowsy. You'll be awake but relaxed, and may feel some discomfort.
Types of Implants
If your surgeon recommends the use of an implant, you'll want to discuss what type of implant should be used.
A breast implant is a silicone shell filled with either saline or elastic silicone gel.
While there are many options available in post-mastectomy reconstruction, you and your surgeon should discuss the one that's best for you.
Skin expansion
The most common technique combines skin expansion and subsequent insertion of an implant.
Following mastectomy, your surgeon will insert a balloon expander beneath your skin and chest muscle.
Through a tiny valve mechanism buried beneath the skin, he or she will periodically inject a salt-water solution to gradually fill the expander over several weeks or months. After the skin over the breast area has stretched enough, the expander may be removed in a second operation and a more permanent implant will be inserted. Some expanders are designed to be left in place as the final implant. The nipple and the dark skin surrounding it, called the areola, are reconstructed in a subsequent procedure.
Some patients do not require preliminary tissue expansion before receiving an implant.
For these women, the surgeon will proceed with inserting an implant as the first step.
Flap reconstruction
An alternative approach to implant reconstruction involves creation of a skin flap using tissue taken from other parts of the body, such as the back, abdomen, or buttocks.
In one type of flap surgery, the tissue remains attached to its original site, retaining its blood supply.
The flap, consisting of the skin, fat, and muscle with its blood supply, are tunneled beneath the skin to the chest, creating a pocket for an implant or, in some cases, creating the breast mound itself, without need for an implant.
Another flap technique uses tissue that is surgically removed from the abdomen, thighs, or buttocks and then transplanted to the chest by reconnecting the blood vessels to new ones in that region.
This procedure requires the skills of a plastic surgeon who is experienced in microvascular surgery as well.
Regardless of whether the tissue is tunneled beneath the skin on a pedicle or transplanted to the chest as a microvascular flap, this type of surgery is more complex than skin expansion.
Scars will be left at both the tissue donor site and at the reconstructed breast, and recovery will take longer than with an implant. On the other hand, when the breast is reconstructed entirely with your own tissue, the results are generally more natural and there are no concerns about a silicone implant. In some cases, you may have the added benefit of an improved abdominal contour.
Getting Back to Normal
It may take you up to six weeks to recover from a combined mastectomy and reconstruction or from a flap reconstruction alone.
If implants are used without flaps and reconstruction is done apart from the mastectomy, your recovery time may be less.
Reconstruction cannot restore normal sensation to your breast, but in time, some feeling may return.
Most scars will fade substantially over time, though it may take as long as one to two years, but they'll never disappear entirely. The better the quality of your overall reconstruction, the less distracting you'll find those scars.
Follow your surgeon's advice on when to begin stretching exercises and normal activities.
As a general rule, you'll want to refrain from any overhead lifting, strenuous sports, and sexual activity for three to six weeks following reconstruction.
Hand Surgery
Dr. Clayton performs hand surgery procedures to restore mobility and an aesthetically pleasing appearance to your hands.
Dramatic advances have been made in recent years in treating patients with hand injuries, degenerative disorders, and birth defects of the hand.
At the forefront of these advances have been plastic surgeons-specialists whose major interest is improving both function and appearance. Plastic surgeons undergo intensive training in hand surgery, and they (along with orthopedic surgeons and general surgeons) treat patients with a wide range of hand problems.
This information is designed to give you a basic understanding of the most common hand problems-what they are, what plastic surgeons can do for them, and the results you can expect.
It can't answer all of your questions, since each problem is unique and a great deal depends on your individual circumstances. Please be sure to ask your doctor if there is anything about the procedure you don't understand.
If You're Considering Hand Surgery
If you're considering hand surgery, a consultation with a plastic surgeon is a good place to start.
The surgeon will examine you, discuss the possible methods of treatment for your problem, and let you know if surgery is warranted. If it is, the surgeon will discuss the procedure in detail, including where the surgery will be performed (in the surgeon's office, an outpatient surgery center, or a hospital), the anesthesia and surgical techniques that will be used, possible risks and complications, the recovery and rehabilitation period, and the probable outcome in terms of function and appearance.
Don't hesitate to ask your surgeon any questions you may have during the initial consultation-including any concerns you have about the recommended treatment and the costs involved.
Since hand surgery is performed primarily to correct physical abnormalities, it usually is covered by insurance. Check your policy or call your carrier to be sure.
All Surgery Carries Some Uncertainty and Risk
Thousands of successful hand operations are performed each year.
While the procedures are generally safe when performed by a qualified and experienced plastic surgeon, complications can arise.
In all types of hand surgery, the possible complications include infection, poor healing, loss of feeling or motion, blood clots, and adverse reactions to the anesthesia.
These complications are infrequent, however, and they can generally be treated. You can reduce your risks by choosing a qualified surgeon and by closely following his or her advice.
Hand Injuries
The most common procedures in hand surgery are those done to repair injured hands, including injuries to the tendons, nerves, blood vessels, and joints; fractured bones; and burns, cuts, and other injuries to the skin. Modern techniques have greatly improved the surgeon's ability to restore function and appearance, even in severe injuries. In many cases, surgery can restore a significant degree of feeling and function to injured hands. However, recovery may take months, and a period of hand therapy will most often be needed (see Recovery and rehabilitation below.) Among the techniques now used by plastic surgeons:
Grafting
the transfer of skin, bone, nerves, or other tissue from a healthy part of the body to repair the injured part;
Flap surgery
moving the skin along with its underlying fat, blood vessels, and muscle from a healthy part of the body to the injured site;
Replantation or transplantation
restoring accidentally amputated fingers or hands using microsurgery, an extremely precise and delicate surgery performed under magnification. Some injuries may require several operations over an extended period of time.
Carpal Tunnel Syndrome
The carpal tunnel is a passageway through the wrist carrying tendons and one of the hand's major nerves.
Pressure may build up within the tunnel because of disease (such as rheumatoid arthritis), injury, fluid retention during pregnancy, overuse, or repetitive motions. The resulting pressure on the nerve within the tunnel causes a tingling sensation in the hand, often accompanied by numbness, aching, and impaired hand function. This is known as carpal tunnel syndrome.
In some cases, splinting of the hand and anti-inflammatory medications will relieve the problem. If this doesn't work, however, surgery may be required.
In the operation, the surgeon makes an incision from the middle of the palm to the wrist.
He or she will then cut the tissue that's pressing on the nerve, in order to release the pressure. A large dressing and splint are used after surgery to restrict motion and promote healing. The scar will gradually fade and become barely visible.
The results of the surgery will depend in part on how long the condition has existed and how much damage has been done to the nerve.
For that reason, it's a good idea to see a doctor early if you think you may have carpal tunnel syndrome.
Rheumatoid Arthritis
Rheumatoid arthritis, an inflammation of the joints, is a disabling disease that can affect the appearance and the function of the hands and other parts of the body.
It often deforms finger joints and forces the fingers into a bent position that hampers movement.
Disabilities caused by rheumatoid arthritis can often be managed without surgery-for example, by wearing special splints or using physical therapy to strengthen weakened areas.
For some patients, however, surgery offers the best solution. Whether or not to have surgery is a decision you should make in consultation with your surgeon and your rheumatologist.
Surgeons can repair or reconstruct almost any area of the hand or wrist by removing tissue from inflamed joints, repositioning tendons, or implanting artificial joints.
While your hand may not regain its full use, you can generally expect a significant improvement in function and appearance. Still, it's important to remember that surgical repair doesn't eliminate the underlying disease. Rheumatoid arthritis can continue to cause damage to your hand, sometimes requiring further surgery, and you'll still need to see your rheumatologist for continuing care.
Dupuytren's Contracture
Dupuytren's contracture is a disorder of the skin and underlying tissue on the palm side of the hand.
Thick, scar-like tissue forms under the skin of the palm and may extend into the fingers, pulling them toward the palm and restricting motion. The condition usually develops in mid-life and has no known cause (though it has a tendency to run in families).
Surgery is the only treatment for Dupuytren's contracture.
The surgeon will cut and separate the bands of thickened tissue, freeing the tendons and allowing better finger movement. The operation must be done very precisely, since the nerves that supply the hand and fingers are often tightly bound up in the abnormal tissue. In some cases, skin grafts are also needed to replace tightened and puckered skin.
The results of the surgery will depend on the severity of the condition.
You can usually expect significant improvement in function, particularly after physical therapy (see Recovery and rehabilitation.), and a thin, fairly inconspicuous scar.
Congenital Deformities
Congenital deformities of the hand-that is, deformities a child is born with-can interfere with proper hand growth and cause significant problems in the use of the hand.
Fortunately, with modern surgical techniques most defects can be corrected at a very early age-in some cases during infancy, in others at two or three years-allowing normal development and functioning of the hand.
One of the most common congenital defects is syndactyly, in which two or more fingers are fused together.
Surgical correction involves cutting the tissue that connects the fingers, then grafting skin from another part of the body. (The procedure is more complicated if bones are also fused.) Surgery can usually provide a full range of motion and a fairly normal appearance, although the color of the grafted skin may be slightly different from the rest of the hand.
Other common congenital defects include short, missing, or deformed fingers, immobile tendons, and abnormal nerves or blood vessels.
In most cases, these defects can be treated surgically and significant improvement can be expected.
Recovery and Rehabilitation
Since the hand is a very sensitive part of the body, you may have mild to severe pain following surgery.
Your surgeon can prescribe injections or oral medication to make you more comfortable. How long your hand must remain immobilized and how quickly you resume your normal activities depends on the type and extent of surgery and on how fast you heal.
To enhance your recovery and give you the fullest possible use of your hand
your surgeon may recommend a course of rehabilitation (physical and occupational therapy) under the direction of a trained hand therapist. Your therapy may include hand exercises, heat and massage therapy, electrical nerve stimulation, splinting, traction, and special wrappings to control swelling. Keep in mind that surgery is just the foundation for recovery. It's crucial that you follow the therapist's instructions and complete the entire course of therapy if you want to regain the maximum use of your hand.
Tissue Expansion
Before continuing with some forms of reconstructive surgery, you may undergo tissue expansion, a process in which your skin is gradually stretched in order to produce the excess skin necessary for your surgery.
If Your Doctor Recommends Tissue Expansion.
Tissue expansion is a relatively straightforward procedure that enables the body to "grow" extra skin for use in reconstructing almost any part of the body.
A silicone balloon expander is inserted under the skin near the area to be repaired and then gradually filled with salt water over time, causing the skin to stretch and grow. Although tissue expansion is most commonly used for breast reconstruction, it also may be used to repair skin damaged by birth defects, accidents or surgery, and in certain cosmetic procedures.
If your doctor is recommending tissue expansion, this web page will give you a basic understanding of the procedure.
It can't answer all of your questions, since a lot depends on your individual circumstances. Please be sure to ask your surgeon if there is anything you don't understand about the procedure. A silicone balloon expander is inserted beneath the skin. Once in place, the expander is gradually filled with salt water through a tiny valve. When the tissue has grown to the desired amount, the expander is removed. In breast reconstruction, a permanent implant is then inserted. Tissue Expansion is ideal for scalp repair because the stretched skin on the scalp retains normal hair growth. Most other body tissue does not grow hair to the same degree. Following tissue expansion, the repaired scalp restores a more natural appearance. Expansion is also used to repair skin on the head and neck, hands, arms, and legs.
The Best Candidates for Tissue Expansion
Almost anyone in need of additional skin can benefit from tissue expansion, from infants to elderly men and women.
The procedure is used widely in breast reconstruction when there is not enough skin to accommodate a permanent implant to restore a woman's natural appearance.
It is also an option for repairing or replacing areas of the scalp, where hair growth makes it difficult to replace lost tissue with skin from other areas of the body. Tissue expansion generally produces excellent results when reconstructing some areas of the face and neck, the hands, arms, and legs.
Expansion may be more difficult on the back, torso, or other areas where skin is thick.
If the affected area is severely damaged or scarred, expansion is probably not an option, since healthy skin is the first requirement.
Advantages and Disadvantages
Until recently, surgeons were limited to skin flaps and skin grafts to reconstruct damaged tissue.
Tissue expansion, however, provides an added technique with several advantages.
First, expansion offers a near-perfect match of color, texture, and hair-bearing qualities.
Second, because the skin remains connected to the donor area's blood and nerve supply, there is a smaller risk that it will die. In addition, because the skin doesn't have to be moved from one area to another, scars are often less apparent.
On the other hand, skin expansion has one significant drawback
the length of time required to grow additional skin. Depending on the area to be reconstructed, tissue expansion can take as long as 3 - 4 months. During this time, the expander creates what can be an unsightly bulge, which is desirable in breast reconstruction, but can be quite noticeable for someone requiring repair of the scalp or other areas of the body. Furthermore, the procedure requires repeated visits to the surgeon for injection of the salt water that inflates the balloon. For some people, the inconvenience and obvious appearance of an expander are enough for them to consider other options.
All Surgery Carries Some Uncertainty and Risk
Skin expansion can produce some remarkable results.
But as with any operation, there are risks associated with surgery and specific complications associated with this procedure.
The most common concern is that the silicone expander used in the procedure will break or leak while it is in the body.
While expanders are rigorously tested and placed with care, leaks do occur. If the expander should leak, the salt-water solution, also known as saline, used to fill the expander is harmlessly absorbed by your system and the expander is replaced in a relatively minor surgical procedure.
A small percentage of patients develop an infection around the expander.
While this may occur at any time, it's most often seen within a few weeks after the expander is inserted. In some cases, the expander may need to be removed for several months until the infection clears. A new expander can then be inserted.
You may have concerns about the use of a silicone tissue expander in this procedure because of the Food & Drug Administration's (FDA) limitations on silicone breast implants.
At this time, the FDA ruling does not affect tissue expanders because they are filled with salt water, not silicone gel, and are left in place for only six to 10 weeks, not permanently. Be sure to ask your doctor if you want to know more about the FDA recommendations.
Planning Your Surgery
During your initial consultation, your surgeon will evaluate your condition.
Your age, skin condition, medical history and other factors will help your surgeon determine if you'll benefit from tissue expansion. Your flexibility and tolerance for the inconvenience associated with this procedure will help you determine if you want to pursue it. Before proceeding with tissue expansion, discuss your expectations and your understanding of it with your surgeon.
Preparing For Your Surgery
Your surgeon will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain medications.
If you smoke, your surgeon will probably ask you to quit for at least two weeks before and after your surgery, since smoking may have an effect on how well you heal.
Whether your surgery is done on an outpatient or inpatient basis, you should arrange for someone to drive you home after your surgery, and to help you out for a day or two, if needed.
Where Your Surgery Will Be Performed
While most tissue expansion is done in an outpatient surgical facility
the size and location of the expansion, as well as the preference of the patient and surgeon, will dictate where the surgery takes place.
Your surgeon may begin tissue expansion immediately at the time of breast removal.
If you've had an injury, on the other hand, your surgeon will probably recommend that tissue expansion be performed in an outpatient surgical facility after the wound has healed.
More and more frequently, surgeons are performing tissue expansions on an out patient basis for cost savings and convenience.
Types of Anesthesia
Types of Anesthesia
Your surgeon may use local anesthesia, combined with a sedative to make you drowsy. You'll be awake but relaxed, and should feel little discomfort. Or, your surgeon may recommend the use of a general anesthesia, in which case you'll sleep through the entire operation.
The Surgery
In most cases, the initial operation will take one to two hours, depending on the size and area of skin to be expanded.
Your surgeon will begin by making a small incision next to the area of skin to be repaired, and will do everything possible to make the incision as inconspicuous as possible.
He or she will then insert the silicone balloon expander in a pocket created beneath the skin.
The expander includes a tiny tube and a self-sealing valve that allows the surgeon to gradually fill the expander with saline solution. The valve is usually left just beneath the surface of the skin.
Once the incision has healed, you'll be asked to return to your surgeon's office periodically so that the expander can be injected with additional saline.
As the expander enlarges, your skin will stretch. In some people, this procedure causes some minor discomfort.
When the skin has stretched enough to cover the affected area, you'll have a second operation to remove the expander and reposition the new tissue.
In breast reconstruction, the surgery required to remove the expander and insert the permanent implant is relatively brief. More complex surgery to repair skin on the face or scalp will take longer, and may require more than one expansion sequence to complete.
After Your Surgery
How you feel after surgery depends on the extent and complexity of the procedure.
The initial surgery to insert the expander causes most patients only temporary discomfort which can be controlled with medication prescribed by your physician.
You may feel some minor discomfort each time saline is injected into the expander, but this usually lasts only an hour or two.
The follow-up procedure to remove the expander and put the new tissue in place may create some temporary discomfort, but this, too, can be controlled with medication.
Getting Back to Normal
Again, how soon you resume your normal routine depends on the length, complexity and type of surgery you've had.
For breast reconstruction patients, if tissue expansion is separate from breast removal, normal activity can resume in two to four days.
Most tissue expansion patients find they can keep up with their normal routine while the expander is in place.
Following the second surgery, most patients are up and about within a week.
Your New Look
Generally, the results of tissue expansion are superior to other methods used to reconstruct or repair damaged skin.
But keep in mind, the goal is improvement, not perfection. For most tissue expansion patients, the procedure dramatically improves their appearance and quality of life following surgery.
If you're physically healthy, psychologically stable, and realistic in your expectations, you'll probably be quite pleased with your results.
Wound Care
Dr. Clayton employs advanced reconstructive techniques to treat and care for wounds and similar traumas to the skin. As you and your plastic surgeon form your surgical plan, it's important to have a clear understanding of what will happen during the procedure. Asking questions is key to making an informed decision. Direct closure is usually performed on skin-surface wounds that have straight edges, such as a simple cut. Maximum attention is given to the aesthetic result, taking extra care to minimize noticeable stitch marks. In deciding how to treat a wound, a plastic surgeon must carefully assess its size, severity, and features:
Is skin missing?
Have nerves or muscles been damaged?
Has skeletal support been affected?
Skin Grafts
A wound that is wide and difficult or impossible to close directly may be treated with a skin graft. A skin graft is basically a patch of healthy skin that is taken from one area of the body, called the "donor site," and used to cover another area where skin is missing or damaged. There are three basic types of skin grafts.
A split-thickness skin graft
commonly used to treat burn wounds, uses only the layers of skin closest to the surface. When possible, your plastic surgeon will choose a less conspicuous donor site. Location will be determined in part by the size and color of the skin patch needed. The skin will grow back at the donor site, however, it may be a bit lighter in color.
A full-thickness skin graft
might be used to treat a burn wound that is deep and large, or to cover jointed areas where maximum skin elasticity and movement are needed. As its name implies, the surgeon lifts a full-thickness (all layers) section of skin from the donor site. A thin line scar usually results from a direct wound closure at the donor site.
A composite graft
used when the wound to be covered needs more underlying support, as with skin cancer on the nose. A composite graft requires lifting all the layers of skin, fat, and sometimes the underlying cartilage from the donor site. A straight-line scar will remain at the site where the graft was taken. It will fade with time.
Tissue Expansion
Tissue expansion is a procedure that enables the body to "grow" extra skin by stretching adjacent tissue.
A balloon-like device called an expander is inserted under the skin near the area to be repaired and then gradually filled with salt water over time, causing the skin to stretch and grow. The time involved in tissue expansion depends on the individual case and the size of the area to be repaired.
The advantages of tissue expansion are many
it offers a near-perfect match of skin color, sensation, and texture; the risk of tissue loss is decreased because the skin remains connected to its original blood and nerve supply; and scars are less apparent than those in flaps or grafts. The expander temporarily creates what can be an unsightly bulge, making this option undesirable for some patients.
Advanced Wound Care: Flap Surgery/MicroSurgery
Though success will largely depend on the extent of a patient's injury, flap surgery and microsurgery have vastly improved a plastic surgeon's ability to help a severely injured or disfigured patient.
Using advanced techniques that often take many hours and may require the use of an operating microscope, plastic surgeons can now replant amputated fingers or transplant large sections of tissue, muscle or bone from one area of the body to another with the original blood supply in tact.
A flap is a section of living tissue that carries its own blood supply and is moved from one area of the body to another.
Flap surgery can restore form and function to areas of the body that have lost skin, fat, muscle movement, and/or skeletal support.
A local flap uses a piece of skin and underlying tissue that lie adjacent to the wound.
The flap remains attached at one end so that it continues to be nourished by its original blood supply, and is repositioned over the wounded area. A regional flap uses a section of tissue that is attached by a specific blood vessel. When the flap is lifted, it needs only a very narrow attachment to the original site to receive its nourishing blood supply from the tethered artery and vein.
A musculocutaneous flap, also called a muscle and skin flap, is used when the area to be covered needs more bulk and a more robust blood supply.
Musculocutaneous flaps are often used in breast reconstruction to rebuild a breast after mastectomy. This type of flap remains "tethered" to its original blood supply.
In a bone/soft tissue flap, bone, along with the overlying skin, is transferred to the wounded area, carrying its own blood supply.
A microvascular free flap is a section of tissue and skin that is completely detached from its original site and reattached to its new site by hooking up all the tiny blood vessels.
Cleft Lip and Palate
Children who suffer from a cleft lip and palate and may struggle with related communication problems, can undergo cleft lip and palate repair surgery to correct the issue.
If You're Considering Surgery to Correct Cleft Lip or Palate
In the early weeks of development, long before a child is born, the right and left sides of the lip and the roof of the mouth normally grow together.
Occasionally, however, in about one of every 800 babies, those sections don't quite meet. A child born with a separation in the upper lip is said to have a cleft lip. A similar birth defect in the roof of the mouth, or palate, is called a cleft palate. Since the lip and the palate develop separately, it is possible for a child to have a cleft lip, a cleft palate, or variations of both.
If your child was born with either or both of these conditions, your doctor will probably recommend surgery to repair it.
Medical professionals have made great advances in treating children with clefts and can do a lot to help your child lead a normal, healthy, happy life.
This information will give you a basic understanding of the operation
when it can help, how it's performed, and what results you can expect. It can't answer all of your questions, since a lot depends on you individual circumstances. Please be sure to ask your surgeon if there is anything you don't understand about the procedure.
The Importance of a Team Approach
Children born with a cleft lip or palate may need the skills of several medical professionals to correct the problems associated with the cleft.
In addition to needing plastic surgery to repair the opening, these children may have problems with their feeding and their teeth, their hearing, their speech, and their psychological development as they grow up.
For that reason, parents should seek the help of a Cleft Lip and Palate Team as early as possible.
Medical professionals with special experience in the problems of cleft lip and palate have formed such teams all over the country to help parents plan for their child's care from birth, or even before. Typically, a Cleft Team might include a plastic surgeon, a pediatrician, a dentist, a speech and language specialist, a social worker, a hearing specialist, an ear-nose-throat specialist, a psychologist, a nurse, and a genetic counselor.
Ask your doctor for a referral to a Cleft Team in your area. Or, for more information, contact The Cleft Palate Foundation, 104 S.
All Surgery Carries Some Uncertainty and Risk
When surgery is done by a qualified plastic surgeon with experience in repairing cleft lip or palate, the results can be quite positive.
Nevertheless, as with any operation, there are risks associated with surgery and specific complications associated with this procedure.
In cleft lip surgery, the most common problem is asymmetry, when one side of the mouth and nose does not match the other side.
The goal of cleft lip surgery is to close the separation in the first operation. Occasionally, a second operation may be needed.
In cleft palate surgery, the goal is to close the opening in the roof of the mouth so the child can eat and learn to speak properly.
Occasionally, poor healing in the palate or poor speech may require a second operation.
Planning For Surgery
At your initial consultation, your doctor will discuss the details of the procedure he or she will use, including where the surgery will be performed
the type of anesthesia to be used, possible risks and complications, recovery, costs, and the results you can expect. Your surgeon will also answer any questions you may have about feeding your baby, by breast or by bottle, both before and after the surgery.
In most cases, health insurance policies will cover most or all of the cost of cleft lip or cleft palate surgery.
Check your policy to make sure your child is covered and to see if there are any limitations on what types of treatment are covered.
Cleft Lip Surgery
A cleft lip can range in severity from a slight notch in the red part of the upper lip to a complete separation of the lip extending into the nose.
Clefts can occur on one or both sides of the upper lip. Surgery is generally done when the child is about 10 weeks old.
To repair a cleft lip, the surgeon will make an incision on either side of the cleft from the mouth into the nostril.
He or she will then turn the dark pink outer portion of the cleft down and pull the muscle and the skin of the lip together to close the separation. Muscle function and the normal "cupid's bow" shape of the mouth are restored. The nostril deformity often associated with cleft lip may also be improved at the time of lip repair or in a later surgery.
Recovering From Cleft Lip Surgery
Your child may be restless for awhile after surgery, but your doctor can prescribe medication to relieve any discomfort.
Elbow restraints may be necessary for a few weeks to prevent your baby from rubbing the stitched area.
If dressings have been used, they'll be removed within a day or two, and the stitches will either dissolve or be removed within five days.
Your doctor will advise you on how to feed your child during the first few weeks after surgery.
It's normal for the surgical scar to appear to get bigger and redder for a few weeks after surgery.
This will gradually fade, although the scar will never totally disappear. In many children, however, it's barely noticeable because of the shadows formed by the nose and upper lip.
Cleft Palate Surgery
In some children, a cleft palate may involve only a tiny portion at the back of the roof of the mouth; for others, it can mean a complete separation that extends from front to back.
Just as in cleft lip, cleft palate may appear on one or both sides of the upper mouth. However, repairing a cleft palate involves more extensive surgery and is usually done when the child is nine to 18 months old, so the baby is bigger and better able to tolerate surgery.
To repair a cleft palate, the surgeon will make an incision on both sides of the separation, moving tissue from each side of the cleft to the center or midline of the roof of the mouth.
This rebuilds the palate, joining muscle together and providing enough length in the palate so the child can eat and learn to speak properly.
Recovering From Cleft Palate Surgery
For a day or two, your child will probably feel some soreness and pain, which is easily controlled by medication.
During this period, you child will not eat or drink as much as usual -- so an intravenous line will be used to maintain fluid levels. Elbow restraints may be used to prevent your baby from rubbing the repaired area. Your doctor will advise you on how to feed your child during the first few weeks after surgery. It's crucial that you follow your doctor's advice on feeding to allow the palate to heal properly.
The Repaired Lip or Palate
Children with a cleft palate are particularly prone to ear infections because the cleft can interfere with the function of the middle ear.
To permit proper drainage and air circulation, the ear-nose-and-throat surgeon on the Cleft Palate Team may recommend that a small plastic ventilation tube be inserted in the eardrum. This relatively minor operation may be done later or at the time of the cleft repair. In addition, surgery may be recommended by your plastic surgeon when your child is older to refine the shape and function of the lip, nose, gums, and palate. You'll want to discuss further needs with the members of the Cleft Team seeing your child.
Perhaps most important, keep in mind that surgery to repair a cleft lip or palate is only the beginning of the process.
Family support is critical for your child. Love and understanding will help him or her grow up with a sense of self-esteem that extends beyond the physical defect.
Skin Cancer
Several forms of skin cancer can be treated and removed by Dr. Clayton utilizing advanced reconstructive techniques.
Skin cancer is the most common form of cancer in the United States.
More than 500,000 new cases are reported each year and the incidence is rising faster than any other type of cancer. While skin cancers can be found on any part of the body, about 80 percent appear on the face, head, or neck, where they can be disfiguring as well as dangerous.
The purpose of this web page is to educate you about the different types of skin cancer, their causes, and preventive measures you can take;
to help you know when to consult a doctor; and to explain the role of the plastic surgeon in the diagnosis and treatment of skin cancer and other skin growths. Basal cell carcinoma may come in many forms. It often begins as a small, pearly nodule. Squamous cell carcinoma may begin as a red, scaly patch, a group of crusted nodules, or a sore that doesn't heal. Malignant melanoma is often asymmetrical, with blurred or ragged edges and mottled colors. Small skin cancers can often be excised quickly and easily in the physician's office. Simple excision usually leaves a thin barely visible scar. A bone/soft tissue flap is used to reconstruct the nose following skin cancer excision. The incision lines of the flap are hidden within the natural creases of the nose and face.
Who Gets Skin Cancer and Why
The primary cause of skin cancer is ultraviolet radiation, most often from the sun, but also from artificial sources like sunlamps and tanning booths. In fact, researchers believe that our quest for the perfect tan, an increase in outdoor activities, and perhaps the thinning of the earth's protective ozone layer are behind the alarming rise we're now seeing in skin cancers. Anyone can get skin cancer, no matter what your skin type, race or age, no matter where you live or what you do. But your risk is greater if.
Your skin is fair and freckles easily.
You have light-colored hair and eyes.
You have a large number of moles, or moles of unusual size or shape.
You have a family history of skin cancer or a personal history of blistering sunburn.
You spend a lot of time working or playing outdoors.
You live closer to the equator, at a higher altitude, or in any place that gets intense, year-round sunshine.
You received therapeutic radiation treatments for adolescent acne.
Types of Skin Cancer
By far the most common type of skin cancer is basal cell carcinoma.
Fortunately, it's also the least dangerous kind; it tends to grow slowly and rarely spreads beyond its original site. Though basal cell carcinoma is seldom life-threatening, if left untreated it can grow deep beneath the skin and into the underlying tissue and bone, causing serious damage (particularly if it's located near the eye).
Squamous cell carcinoma is the next most common kind of skin cancer, frequently appearing on the lips, face, or ears.
It sometimes spreads to distant sites, including lymph nodes and internal organs. Squamous cell carcinoma can become life threatening if it's not treated.
A third form of skin cancer, malignant melanoma, is the least common, but its incidence is increasing rapidly, especially in the Sunbelt states.
Malignant melanoma is the most dangerous type of skin cancer. If discovered early enough, it can be completely cured. If it's not treated quickly, however, malignant melanoma may spread throughout the body and is often deadly.
Other Skin Growths You Should Know About
Two other common types of skin growths are moles and keratoses.
Moles are clusters of heavily pigmented skin cells, either flat or raised above the skin surface.
While most pose no danger, some-particularly large moles present at birth, or those with mottled colors and poorly defined borders-may develop into malignant melanoma. Moles are frequently removed for cosmetic reasons, or because they're constantly irritated by clothing or jewelry (which can sometimes cause pre-cancerous changes).
Solar or actinic keratoses are rough, red or brown, scaly patches on the skin.
They are usually found on areas exposed to the sun, and sometimes develop into squamous cell cancer.
Recognizing Skin Cancer
Basal and squamous cell carcinomas can vary widely in appearance.
The cancer may begin as small, white or pink nodule or bumps; it can be smooth and shiny, waxy, or pitted on the surface. Or it might appear as a red spot that's rough, dry, or scaly...a firm, red lump that may form a crust...a crusted group of nodules...a sore that bleeds or doesn't heal after two to four weeks...or a white patch that looks like scar tissue.
Malignant melanoma is usually signaled by a change in the size, shape, or color of an existing mole, or as a new growth on normal skin.
Watch for the "ABCD" warning signs of melanoma: Asymmetry-a growth with unmatched halves; Border irregularity-ragged or blurred edges; Color-a mottled appearance, with shades of tan, brown, and black, sometimes mixed with red, white, or blue; and Diameter- a growth more than 6 millimeters across (about the size of a pencil eraser), or any unusual increase in size.
If all these variables sound confusing, the most important thing to remember is this
Get to know your skin and examine it regularly, from the top of your head to the soles of your feet. (Don't forget your back.) If you notice any unusual changes on any part of your body, have a doctor check it out.
Choosing a Doctor
If you're concerned about skin cancer, your family physician is a good place to start.
He or she should examine your skin at your annual physical, and can refer you to a specialist if necessary.
If you notice an unusual growth yourself, consult a plastic surgeon or a dermatologist.
Both are skilled at diagnosing and treating skin cancer and other skin growths. A plastic surgeon can surgically remove the growth in a manner that maintains function and offers the most pleasing final appearance, a consideration that may be especially important if the cancer is in a highly visible area. If a treatment other than surgical excision is called for, the plastic surgeon can refer you to the appropriate specialist.
Diagnosis and Treatment
Skin cancer is diagnosed by removing all or part of the growth and examining its cells under a microscope.
It can be treated by a number of methods, depending on the type of cancer, its stage of growth, and its location on your body.
Most skin cancers are removed surgically, by a plastic surgeon or a dermatologist.
If the cancer is small, the procedure can be done quickly and easily, in an outpatient facility or the physician's office, using local anesthesia. The procedure may be a simple excision, which usually leaves a thin, barely visible scar. Or curettage and desiccation may be performed. In this procedure the cancer is scraped out with an electric current to control bleeding and kill any remaining cancer cells. This leaves a slightly larger, white scar. In either case, the risks of the surgery are low.
If the cancer is large, however, or if it has spread to the lymph glands or elsewhere in the body, major surgery may be required.
Other possible treatments for skin cancer include cryosurgery (freezing the cancer cells), radiation therapy (using x-rays), topical chemotherapy (anti-cancer drugs applied to the skin), and Mohs surgery, a special procedure in which the cancer is shaved off one layer at a time. (Mohs surgery is performed only by specially trained physicians and often requires a reconstructive procedure as follow-up.)
Discussing Your Options and Concerns
All of the treatments mentioned above
when chosen carefully and appropriately, have good cure rates for most basal cell and squamous cell cancers, and even for malignant melanoma if it's caught early enough.
You should discuss these choices thoroughly with your doctor before beginning treatment.
Find out which options are available to you, how effective they're likely to be for your particular cancer, the possible risks and side effects, who can best perform them, and the cosmetic and functional results you can expect. If you have any doubts about the outcome, get a second opinion from a plastic surgeon before you begin treatment.
A Word About Reconstruction
The different techniques used in treating skin cancers can be life saving, but they may leave a patient with less than pleasing cosmetic or functional results.
Depending on the location and severity of the cancer, the consequences may range from a small but unsightly scar to permanent changes in facial structures such as your nose, ear, or lip.
In such cases, no matter who performs the initial treatment, the plastic surgeon can be an important part of the treatment team.
Reconstructive techniques, ranging from a simple scar revision to a complex transfer of tissue flaps from elsewhere on the body, can often repair damaged tissue, rebuild body parts, and restore most patients to acceptable appearance and function.
Preventing a Recurrence
After you've been treated for skin cancer, your doctor should schedule regular follow-up visits to make sure the cancer hasn't recurred. Your physician, however, can't prevent a recurrence. It's up to you to reduce your risks by changing old habits and developing new ones. (These preventive measures apply to people who have not had skin cancer as well.)
Avoid prolonged exposure to the sun, especially between 10 a.m. And 2 p.m. and during the summer months. Remember, ultraviolet rays pass right through water and clouds, and reflect off sand and snow.
When you do go out for an extended period of time, wear protective clothing such as wide brimmed hats and long sleeves.
On any exposed skin, use a sunscreen with an SPF (sun protection factor) of at least 15. Reapply it frequently, especially after you've been swimming or sweating.
Finally, examine your skin regularly. If you find anything suspicious, consult a plastic surgeon or a dermatologist as soon as possible.
Scar Revision
If you have a scar from a previous trauma, scar revision procedures performed by Dr. Clayton will greatly reduce the appearance of them as well as likely improve mobility-related issues for some scars.
If You're Considering Scar Revision
Scars, whether they're caused by accidents or by surgery, are unpredictable.
The way a scar develops depends as much on how your body heals as it does on the original injury or on the surgeon's skills.
Many variables can affect the severity of scarring, including the size and depth of the wound, the blood supply to the area, the thickness and color of your skin, and the direction of the scar.
How much the appearance of a scar bothers you is, of course, a personal matter.
While no scar can be removed completely
plastic surgeons can often improve the appearance of a scar, making it less obvious through the injection or application of certain steroid medications or through surgical procedures known as scar revisions.
If you're considering scar revision, this will give you a basic understanding of the most common types of scars, the procedures that treat them, and the results you can expect.
It can't answer all of your questions, since a lot depends on your individual circumstances. Please be sure to ask your doctor if there is anything about the procedure you don't understand.
Making the Decision
Many scars that appear large and unattractive at first may become less noticeable with time.
Some can be treated with steroids to relieve symptoms such as tenderness and itching. For these reasons, many plastic surgeons recommend waiting as long as a year or more after an injury or surgery before you decide to have scar revision.
If you're bothered by a scar, your first step should be to consult a board-certified plastic surgeon.
The surgeon will examine you and discuss the possible methods of treating your scar, the risks and benefits involved, and the possible outcomes. Be frank in discussing your expectations with the surgeon, and make sure they're realistic. Don't hesitate to ask any questions or express any concerns you may have.
Insurance usually doesn't cover cosmetic procedures.
However, if scar revision is performed to minimize scarring from an injury or to improve your ability to function, it may be at least partially covered. Check your policy or call your carrier to be sure.
All Surgery Carries Some Uncertainty and Risk
While scar revision is normally safe, there is always the possibility of complications.
These may include infection, bleeding, a reaction to the anesthesia, or the recurrence of an unsightly scar.
You can reduce your risks by choosing a qualified plastic surgeon and closely following his or her advice, both before surgery and in follow-up care.
Keloid Scars
Keloids are thick, puckered, itchy clusters of scar tissue that grow beyond the edges of the wound or incision.
They are often red or darker in color than the surrounding skin. Keloids occur when the body continues to produce the tough, fibrous protein known as collagen after a wound has healed.
Keloids can appear anywhere on the body, but they're most common over the breastbone, on the earlobes, and on the shoulders.
They occur more often in dark-skinned people than in those who are fair. The tendency to develop keloids lessens with age.
Keloids are often treated by injecting a steroid medication directly into the scar tissue to reduce redness, itching, and burning. In some cases, this will also shrink the scar.
If steroid treatment is inadequate, the scar tissue can be cut out and the wound closed with one or more layers of stitches.
This is generally an outpatient procedure, performed under local anesthesia. You should be back at work in a day or two, and the stitches will be removed in a few days. A skin graft is occasionally used, although the site from which the graft was taken may then develop a keloid.
No matter what approach is taken, keloids have a stubborn tendency to recur, sometimes even larger than before.
To discourage this, your surgeon may combine the scar removal with steroid injections, direct application of steroids during surgery, or radiation therapy. Or you may be asked to wear a pressure garment over the area for as long as a year. Even so, the keloid may return, requiring repeated procedures every few years.
Hypertrophic Scars
Hypertrophic scars are often confused with keloids, since both tend to be thick, red, and raised.
Hypertrophic scars, however, remain within the boundaries of the original incision or wound. They often improve on their own (though it may take a year or more) or with the help of steroid applications or injections.
If a conservative approach doesn't appear to be effective, hypertrophic scars can often be improved surgically.
Your plastic surgeon will remove excess scar tissue, and may reposition the incision so that it heals in a less visible pattern. This surgery may be done under local or general anesthesia, depending on the scar's location and what you and your surgeon decide. You may receive steroid injections during surgery and at intervals for up to two years afterward to prevent the thick scar from reforming.
Contractures
Burns or other injuries resulting in the loss of a large area of skin may form a scar that pulls the edges of the skin together, a process called contraction.
The resulting contracture may affect the adjacent muscles and tendons, restricting normal movement.
Correcting a contracture usually involves cutting out the scar and replacing it with a skin graft or a flap.
In some cases a procedure known as Z-plasty may be used. And new techniques, such as tissue expansion, are playing an increasingly important role. If the contracture has existed for some time, you may need physical therapy after surgery to restore full function.
Facial Scars
Because of its location, a facial scar is frequently considered a cosmetic problem, whether or not it is hypertrophic.
There are several ways to make a facial scar less noticeable. Often it is simply cut out and closed with tiny stitches, leaving a thinner, less noticeable scar.
If the scar lies across the natural skin creases (or "lines of relaxation") the surgeon may be able to reposition it to run parallel to these lines, where it will be less conspicuous.
Some facial scars can be softened using a technique called dermabrasion, a controlled scraping of the top layers of the skin using a hand-held, high-speed rotary wheel.
Dermabrasion leaves a smoother surface to the skin, but it won't completely erase the scar.
Z-Plasty
Z-plasty is a surgical technique used to reposition a scar so that it more closely conforms to the natural lines and creases of the skin, where it will be less noticeable.
It can also relieve the tension caused by contracture. Not all scars lend themselves to Z-plasty, however, and it requires an experienced plastic surgeon to make such judgments.
In this procedure, the old scar is removed and new incisions are made on each side, creating small triangular flaps of skin.
These flaps are then rearranged to cover the wound at a different angle, giving the scar a "Z" pattern. The wound is closed with fine stitches, which are removed a few days later. Z-plasty is usually performed as an outpatient procedure under local anesthesia.
While Z-plasty can make some scars less obvious, it won't make them disappear. A portion of the scar will still remain outside the lines of relaxation.
Skin Grafting and Flap Surgery
Skin grafts and flaps are more serious than other forms of scar surgery.
They're more likely to be performed in a hospital as inpatient procedures, using general anesthesia. The treated area may take several weeks or months to heal, and a support garment or bandage may be necessary for up to a year.
Grafting involves the transfer of skin from a healthy part of the body (the donor site) to cover the injured area.
The graft is said to "take" when new blood vessels and scar tissue form in the injured area. While most grafts from a person's own skin are successful, sometimes the graft doesn't take. In addition, all grafts leave some scarring at the donor and recipient sites.
Flap surgery is a complex procedure in which skin, along with the underlying fat, blood vessels, and sometimes the muscle, is moved from a healthy part of the body to the injured site.
In some flaps, the blood supply remains attached at one end to the donor site; in others, the blood vessels in the flap are reattached to vessels at the new site using microvascular surgery.
Skin grafting and flap surgery can greatly improve the function of a scarred area.
The cosmetic results may be less satisfactory, since the transferred skin may not precisely match the color and texture of the surrounding skin. In general, flap surgery produces better cosmetic results than skin grafts.
After Scar Revision
With any kind or scar revision, it's very important to follow your surgeon's instructions after surgery to make sure the wound heals properly.
Although you may be up and about very quickly, your surgeon will advise you on gradually resuming your normal activities.
As you heal, keep in mind that no scar can be removed completely
the degree of improvement depends on the size and direction of your scar, the nature and quality of your skin, and how well you care for the wound after the operation. If your scar looks worse at first, don't panic; the final results of your surgery may not be apparent for a year or more.
General Reconstruction
In addition to the procedures above, Dr. Clayton offers other reconstructive surgeries to correct trauma or deformities in an effort to improve your quality of life and self-image.
Reconstructive Surgery: Procedures at a Glance
Gaspare Tagliacozzi, 1597
We bring back, refashion and restore to wholeness the features that nature gave but chance destroyed, not that they may be an advantage to the living soul, not as a mean artifice but as an alleviation of illness, not as becomes charlatans but as becomes good physicians and followers of the great Hippocrates. For though the original beauty is indeed restored . . . the end for which the physician is working is that the features should fulfill their offices according to nature's decree.
What is Reconstructive Surgery?
It's estimated that more than 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.
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 that were thought to be impossible 10 years ago.
Who has Reconstructive Surgery?
Patients may be divided into two basic categories
those who have congenital deformities, otherwise known as birth defects, and those with developmental deformities, acquired as a result of accident, infection, disease, or 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.
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.
All Surgery Carries Some Uncertainty and Risk
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.
Planning Your Surgery
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 microsurgery 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.
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.
Options in Wound Treatment
In deciding how to treat a wound, a plastic surgeon must carefully assess its size, severity, and features: Is skin missing?
Have nerves or muscles been damaged? Has skeletal support been affected?
As you and your plastic surgeon form your surgical plan, it's important to have a clear understanding of what will happen during the procedure.
Asking questions is key to making an informed decision.
Direct closure is usually performed on skin-surface wounds that have straight edges, such as a simple cut.
Maximum attention is given to the aesthetic result, taking extra care to minimize noticeable stitch marks.
Skin Grafts
A wound that is wide and difficult or impossible to close directly may be treated with a skin graft. A skin graft is basically a patch of healthy skin that is taken from one area of the body, called the "donor site," and used to cover another area where skin is missing or damaged. There are three basic types of skin grafts.
A split-thickness skin graft
commonly used to treat burn wounds, uses only the layers of skin closest to the surface. When possible, your plastic surgeon will choose a less conspicuous donor site. Location will be determined in part by the size and color of the skin patch needed. The skin will grow back at the donor site, however, it may be a bit lighter in color.
A full-thickness skin graft
might be used to treat a burn wound that is deep and large, or to cover jointed areas where maximum skin elasticity and movement are needed. As its name implies, the surgeon lifts a full-thickness (all layers) section of skin from the donor site. A thin line scar usually results from a direct wound closure at the donor site.
A composite graft
used when the wound to be covered needs more underlying support, as with skin cancer on the nose. A composite graft requires lifting all the layers of skin, fat, and sometimes the underlying cartilage from the donor site. A straight-line scar will remain at the site where the graft was taken. It will fade with time.
Tissue Expansion
issue expansion is a procedure that enables the body to "grow" extra skin by stretching adjacent tissue.
A balloon-like device called an expander is inserted under the skin near the area to be repaired and then gradually filled with salt water over time, causing the skin to stretch and grow. The time involved in tissue expansion depends on the individual case and the size of the area to be repaired.
The advantages of tissue expansion are many
it offers a near-perfect match of skin color, sensation, and texture; the risk of tissue loss is decreased because the skin remains connected to its original blood and nerve supply; and scars are less apparent than those in flaps or grafts. The expander temporarily creates what can be an unsightly bulge, making this option undesirable for some patients.
Advanced Wound Care: Flap Surgery & Microsurgery
Though success will largely depend on the extent of a patient's injury, flap surgery and microsurgery have vastly improved a plastic surgeon's ability to help a severely injured or disfigured patient. Using advanced techniques that often take many hours and may require the use of an operating microscope, plastic surgeons can now replant amputated fingers or transplant large sections of tissue, muscle or bone from one area of the body to another with the original blood supply in tact. A flap is a section of living tissue that carries its own blood supply and is moved from one area of the body to another. Flap surgery can restore form and function to areas of the body that have lost skin, fat, muscle movement, and/or skeletal support.
A local flap
uses a piece of skin and underlying tissue that lie adjacent to the wound. The flap remains attached at one end so that it continues to be nourished by its original blood supply, and is repositioned over the wounded area.
A regional flap
uses a section of tissue that is attached by a specific blood vessel. When the flap is lifted, it needs only a very narrow attachment to the original site to receive its nourishing blood supply from the tethered artery and vein.
A musculocutaneous flap
also called a muscle and skin flap, is used when the area to be covered needs more bulk and a more robust blood supply. Musculocutaneous flaps are often used in breast reconstruction to rebuild a breast after mastectomy. This type of flap remains "tethered" to its original blood supply.
In a bone/soft tissue flap
bone, along with the overlying skin, is transferred to the wounded area, carrying its own blood supply.
A microvascular free flap
a section of tissue and skin that is completely detached from its original site and reattached to its new site by hooking up all the tiny blood vessels.
Other Reconstructive Procedures
In addition to correcting cuts and other surface wounds
plastic surgeons also regularly treat both cancerous and non-cancerous growths and problems with the supporting structures beneath the skin.
Tumors, both cancerous and benign, vary widely in type, severity and recurrence.
The removal method chosen will depend largely on the type of growth, what stage it's in, and its location on the body.
Skin cancers and growths are usually removed by excision and closure, in which the growth is simply removed completely with a scalpel, leaving a small thin scar.
If the cancer is large or spreading, major surgery may be necessary, using flaps to reconstruct the affected area.
Hand Surgery
Whether the defect is congenital or acquired, plastic surgeons can usually restore comfort, mobility, and normal appearance to patients with hand problems.
Acquired defects include carpal tunnel and other painful conditions caused by pressure on the nerves (usually at the wrist or elbow); trigger fingers, a condition caused by swelling of a flexor tendon in the hand; ganglion cysts, a benign cystic growth and scar contracture which occurs when a wound or burn on the hand heals poorly and forms scar tissue that curls the fingers or restricts mobility. Dupuytren's disease causes a similar problem of hand contracture.
Children born with syndactyly (webbed fingers) can benefit from finger separation
where a zig-zag-type incision separates the fingers and rearranges the tissue between them, preventing growth deformities. If a child had polydactyly (extra fingers), correction is often more than simply removing the extra digits. The surgeon may also need to balance the tendons of the hand and stabilize the remaining finger joints so that the hand functions as normally as possible. Plastic surgeons also reconstruct missing digits, including the thumb, which supplies half of the hand's function.
Laser Surgery
In the past decade, laser technology has revolutionized many areas of plastic surgery.
The laser's allure comes from its ability to "blast" away or diminish imperfections or growths with minimum bleeding, bruising, and scarring. Currently, there are many types of lasers available, with many more under development. Therefore, it's important to understand that not all lasers are alike. If you're planning to have laser surgery, it's best to find a doctor who is well experienced with, and has access to, a variety of lasers.
The yellow pulsed-dye laser uses a type of dye as its active medium.
It has a pulsing beam that is heavily absorbed by hemoglobin, which gives blood its red color. This laser is often used for performing surgery on children who have pinkish birthmarks called port-wine stains. The laser destroys the abnormal blood vessels, lightening the birthmark to the point of being barely noticeable. Scarring, which was a problem with earlier laser models, is minimal with the yellow pulsed-dye laser.
The "pigment-blasting" laser family
the Q-switch ruby, the Q-switch YAG, and the alexandrite is a group of lasers that are effective in eliminating the black and blue pigments of tattoos, pigmented lesions and the brown patches and spots that often occur with aging. Though the removal of decorative tattoos is considered a cosmetic procedure, the removal of "traumatic tattoos" is a reconstructive process. Traumatic tattoos occur when material particles are forced under the skin through an accident such as an explosion or collision.
The carbon dioxide laser, sometimes called the "workhorse" of lasers, is an invisible light absorbed by water, the primary component of human skin.
When the beam is focused, it can cut tissue and seal blood vessels simultaneously. When defocused, it vaporizes. These characteristics make it the treatment of choice for removing warts and many types of skin growths.
The YAG laser has been shown to be effective in the surgery of various types of hemangiomas, which are skin growths with heavy concentrations of blood vessels.
It delivers highly-focused energy and-unlike other lasers-its tip can be placed directly on the skin, mimicking a scalpel.
The argon laser is similar to the yellow pulsed-dye laser.
The argon laser emits a blue-green light that is absorbed heavily by the color red. It is particularly effective in treating abnormalities that have a proliferation of blood vessels, such as blood blisters, "spider" blood vessels on the face, "strawberry" birthmarks, hemangiomas, and bulky vascular tumors.
The copper vapor laser is a newer type of laser that emits a yellowish light. Its uses include treating brown or red pigmented areas.
The number of laser treatments you'll need depends largely upon the size and severity of the defect.
A child with a large birthmark may need six to ten laser treatments to achieve satisfactory results. Only one treatment may be needed to remove some small spider veins on the face.
Lasers have a number of valuable uses, but a laser should not be viewed as a "magic wand" that improves the results of any type of surgery.
For traditional kinds of surgery and most plastic surgery, the scalpel is still the proven instrument of choice.
Bioidentical Hormone Replacement Therapy
If you’re feeling moody or not your best self, bioidentical hormone replacement therapy (BHRT) maybe an alternative to traditional hormone replacement. BHRT is customized to your body chemistry. Every body is different. Which is why a prescribing BHRT plan by Dr. Clayton may restore your vitality. As we age, women and men have decreasing levels of hormones, which affect our health and the way we feel. In women this is called menopause, whereas in men it is called andropause. Hormone deficiency symptoms for men and women are very similar and are listed below:
Bio-identical hormones are identical in structure and function to the hormones in our body.
To boost your hormone levels, bioidentical hormone replacement therapy (BHRT) can usually relieve symptoms of menopause and andropause. Both men and women need testosterone and estrogen for proper health and function. Scientific investigation has found that testosterone is converted to estrogen at the cellular level in our bodies, according to the specific needs of each organ. Women convert more testosterone to estrogen and men convert less. Because of this, testosterone alone as bio-identical hormone replacement therapy can relieve the symptoms of aging due to low testosterone and low estrogen in men and women. It is also important to note that many scientific studies show the positive effects hormone replacement therapy can have on our cardiovascular and bone health and other body functions.
We offer testosterone pellets, which are implanted in the deep subcutaneous tissue, as an easy, painless treatment for hormone replacement therapy.
The pellets release a small, constant amount of testosterone according to each person's individual need. The pellets last approximately 3 months in women and 4 months in men. They avoid the daily application of hormone cream or the repeated injections of testosterone shots.
Menopause Symptoms
Change in memory/thinking
Fatigue
Night sweats
Hot flashes
Trouble Sleeping
Weight gain
Irritability
Decreased libido
Andropause Symptoms
Memory disturbances
Decreased endurance
Night sweats
Decreased strength
Sleep disturbances
Central abdominal fat gain
Anxiety
Decreased erections
What to Expect
You will meet with Dr. Clayton then proceed with your lab work.
Dr. Clayton will review your lab results during your second visit and determine the appropriate course of therapy. If pellets are required, a third visit will be scheduled. You may need to return after 3-6 months depending on how you respond to the initial course of therapy.
If you are feeling less than your usual self or seeking a boost in your vitality, call us today at (801) 375-4646 to schedule your appointment.
Chemical Peel
A chemical peel is a topical application that can correct many skin impurities like uneven skin tone and texture.
If You're Considering Chemical Peel
A chemical peel uses a chemical solution to improve and smooth the texture of the facial skin by removing its damaged outer layers.
It is helpful for those individuals with facial blemishes, wrinkles and uneven skin pigmentation. Phenol, trichloroacetic acid (TCA) and alpha hydroxy acids (AHAs) are used for this purpose.
The precise formula used may be adjusted to meet each patient's needs.
Although chemical peel may be performed in conjunction with a facelift, it is not a substitute for such surgery, nor will it prevent or slow the aging process. This brochure provides basic information about certain types of chemical peel treatments and the results you might expect. It won't answer all your questions, since a lot depends on your individual circumstances. Once you and your plastic surgeon have decided on a specific peel program, be sure to ask about any details that you do not understand.
Deciding if chemical peel is right for you
A chemical peel is typically performed for cosmetic reasons -- to enhance your appearance and your self confidence.
The procedure may also remove pre-cancerous skin growths soften acne facial scars and help control acne.
In certain cases, health insurance may cover the peel procedure.
Be sure to check your policy and contact your insurance company before the procedure is performed.
Alpha hydroxy acids (AHAs)
such as glycolic, lactic, or fruit acids are the mildest of the peel formulas and produce light peels. These types of peels can provide smoother, brighter-looking skin for people who can't spare the time to recover from a phenol or TCA peel. AHA peels may be used to treat fine wrinkling, areas of dryness, uneven pigmentation and acne. Various concentrations of an AHA may be applied weekly or at longer intervals to obtain the best result. Your doctor will make this decision during your consultation and as the treatment proceeds. An alpha hydroxy acid, such as glycolic acid, can also be mixed with a facial wash or cream in lesser concentrations as part of a daily skin-care regimen to improve the skin's texture.
Trichloroacetic acid (TCA)
can be used in many concentrations, but it is most commonly used for medium-depth peeling. Fine surface wrinkles, superficial blemishes and pigment problems are commonly treated with TCA. The results of TCA peel are usually less dramatic than and not as long-lasting as those of a phenol peel. In fact, more than one TCA peel may be needed to achieve the desired result. The recovery from a TCA peel is usually shorter than with a phenol peel.
Phenol
the strongest of the chemical solutions and produces a deep peel. It is used mainly to treat patients with coarse facial wrinkles, areas of blotchy or damaged skin caused by sun exposure, or pre-cancerous growths. Since phenol sometimes lightens the treated areas, your skin pigmentation may be a determining factor as to whether or not this is an appropriate treatment for you. Phenol is primarily used on the face; scarring may result if it's applied to the neck or other body areas.
All chemical peels carry some uncertainty and risk
A chemical peel is normally a safe procedure when it is performed by a qualified, experienced plastic surgeon.
However, some unpredictability and risks such as infection and scarring, while infrequent, are possible.
AHA peels may cause stinging, redness, irritation and crusting.
However, as the skin adjusts to the treatment regimen, these problems will subside.
With a TCA peel, your healed skin will be able to produce pigment as always; the peel will not bleach the skin.
However, TCA-peel patients are advised to avoid sun exposure for several months after treatment to protect the newly formed layers of skin. Even though TCA is milder than phenol, it may also produce some unintended color changes in the skin.
With a phenol peel, the new skin frequently loses its ability to make pigment (that is, tan).
This means that not only will the skin be lighter in color, but you'll always have to protect it from the sun. Phenol may pose a special risk for patients with a history of heart disease. It's important that you make your surgeon aware of any heart problems when your medical history is taken.
It is also possible that phenol will cause some undesired cosmetic results, such as uneven pigment changes.
Certain modified phenol peels are gentler and may be preferred in some circumstances.
Uses
Smooths rough, dry skin
Improves texture of sun-damaged skin
Aids in control of acne
Can be mixed with bleaching agent to correct pigment problems
Can be used as TCA pre-treatment
Considerations
A series of peels may be needed
As with most peel treatments, sunblock use is recommended
Considerations
Can be used on neck or other body areas
May require pre-treatment with Retin-A or AHA creams
Treatment takes only 10-15 minutes
Preferred for darker-skinned patients
Peel depth can be adjusted
Repeat treatment may be needed to maintain results
Sunblock must be used for several months
Healing is usually quick, much quicker than with a phenol peel
Uses
Corrects blotches caused by: sun exposure, birth-control pills, aging
Smooths out coarse wrinkles
Removes pre-cancerous growths
Considerations
Used on the face only
Not recommended for dark-skinned individuals
Procedure may pose risk for patients with heart problems
Full-face treatment may take one hour or more
Recovery may be slow - Complete healing may take several months
May permanently remove facial freckles
Sun protection, including sunblock, must always be used
Results are dramatic and long-lasting
Permanent skin lightening and lines of demarcation may occur
Planning for a Chemical Peel
In some states, no medical degree is required to perform a chemical peel - even the strongest phenol peels.
Many states have laws that permit non-physicians to administer certain peel solutions, but regulate the strengths which they are permitted to apply. You should be warned that phenol and TCA peels have been offered by inadequately trained practitioners claiming "miracle techniques" to rejuvenate the skin.
It is very important that you find a physician who has adequate training and experience in skin resurfacing.
Your plastic surgeon may offer you a choice of peel techniques or suggest a combination of peels to obtain the best result for you.
During your initial consultation, it is important that you discuss your expectations with your plastic surgeon.
Don't hesitate to ask any questions or express any concerns that you may have. Expect your plastic surgeon to explain the planned procedure in detail, including its risks and benefits, the recovery period and the costs. If you have a history of herpes, you should inform your physician prior to the procedure. Remember, chemical peel treatments are usually not covered by medical insurance unless they are performed for medically related problems.
Preparing For Your Chemical Peel
Your plastic surgeon will instruct you on how to prepare for your peel treatment.
Sometimes Retin-A, a prescription medication derived from Vitamin A, is used to pre-treat the skin.
This thins out the skin's surface layer, allowing the TCA solution to penetrate more deeply and evenly. If your skin won't tolerate Retin-A pre-treatment, an AHA cream may be used instead. Hydroquinone, a bleaching agent, is sometimes used in conjunction with Retin-A or AHA pre-treatment, especially if you have blotchy skin areas or pigmentation problems. You may have to spend a month or more in the pre-treatment phase before the doctor will schedule your actual peel.
You will need to arrange for someone to drive you home and help you out for a day or two if you are having a phenol or deeper TCA peel.
You probably won't need any extra assistance if you're having an AHA peel or superficial TCA peel.
Where Your Peel Will Be Performed
Where Your Peel Will Be Performed
Most chemical peels may be safely performed in a plastic surgeon's office, office-based surgical facility or outpatient surgical center. Your plastic surgeon may want you to stay overnight in a facility or hospital if other cosmetic procedures are performed simultaneously.
Types of Anesthesia
Anesthesia isn't required for phenol or TCA peels because the chemical solution acts as an anesthetic.
However, sedation may be used before and during the procedure to relax you and keep you comfortable.
No anesthesia is needed for AHA peels since they cause only a slight stinging sensation during application.
How the Peel Works
AHA peels/treatments
Your doctor will apply the AHA solution to your cleansed facial skin, a process that usually takes no more than 10 minutes. No "after-peel" ointment or covering is required. Depending on the strength of the peel, periodic treatments may be necessary until the desired effects are achieved. For some patients, the application of an AHA-based face wash or cream once or twice a day at home will be sufficient to accomplish the desired goal. Your plastic surgeon may add Retin-A or a bleaching agent to your at-home treatment schedule. After several weeks of at-home use, your doctor will examine your skin to determine if your regimen needs adjustment.
Phenol and TCA peels
Typically, the skin is first thoroughly cleansed. Then, the surgeon will carefully apply the phenol or TCA solution. You may feel a stinging sensation as the peel solution is applied, but this feeling will quickly pass. A full-face TCA peel usually takes no more than 15 minutes. Two or more TCA peels may be needed to obtain the desired result, and those may be spaced out over several months. Mild TCA peels may be repeated as often as every month. If phenol solution has been used, your plastic surgeon may coat the treated area with petroleum jelly or a waterproof adhesive tape. With lighter peels, no covering is necessary. A full-face phenol peel generally takes one or two hours to perform, while a phenol peel to a smaller facial region (perhaps the skin above the upper lip) may take only 10 or 15 minutes. A single treatment usually suffices.
After Your Treatment
After an AHA peel, it is common to experience some temporary flaking or scaling, redness and dryness of the skin.
However, these conditions will disappear as the skin adjusts to treatment.
After a phenol or TCA peel, your doctor may prescribe a mild pain medication to relieve any tingling or throbbing you may feel.
If tape was used to cover your face, it will be removed after a day or two. A crust or scab will form on the treated area. To help your face heal properly, it is essential that you follow your doctor's specific post-operative instructions.
A TCA peel may also cause significant swelling, depending on the strength of the peel used.
If you've had a phenol peel, your face may become quite swollen.
Your eyes may even be swollen shut temporarily. You will need someone to help care for you for a day or two. You may also be limited to a liquid diet and advised not to talk very much during the first few days of recovery.
Getting Back to Normal
With an AHA peel, the temporary redness, flaking and dryness that you experience will not prevent you from working or engaging in your normal activities.
A fresher and improved skin texture will result with continued AHA treatments. Remember, protecting your skin from the sun is also important following these mild acid peels. Ask your doctor to recommend a sunblock with adequate UVA and UVB protection and use it every day.
With a TCA peel, the moderate discomfort and mild swelling you may experience will subside within the first week.
In about a week to ten days, your new skin will be apparent and you should be healed sufficiently to return to your normal activities. It is best to avoid sun exposure unless you are adequately protected.
With a phenol peel, new skin will begin to form in about seven to ten days.
Your face will be very red at first, gradually fading to a pinkish color over the following weeks to months. During this time, it is especially important that you use a sunblock or blotchy, irregular skin coloring may result.
About two weeks after treatment, you may return to work and resume some of your normal activities.
Your skin will be healed enough for you to wear makeup. (For makeup tips, ask your plastic surgeon for the ASPS brochure on camouflage cosmetics.)
Your New Look
Improvements from AHA peels may be very subtle at first.
You may detect a healthier glow to your skin. With continued treatments, you will notice a general improvement in the texture of your skin.
The results of a TCA peel are usually not as long-lasting as those of phenol peel.
However, your skin will be noticeably smoother and fresher-looking.
If you're planning a phenol peel, you can expect dramatic improvement in the surface of your skin - fewer fine wrinkles, fewer blemishes and more even-toned skin.
Your results will be long-lasting, although not immune to the effects of aging and sun exposure.
Injectable Fillers
Injectable fillers have many cosmetic uses and can be utilized to fill deep creases on the face and even as a treatment for some depressed scars. As we age, our faces begin to show the effects of gravity, sun exposure and years of facial muscle movement, such as smiling, chewing and squinting. The underlying tissues that keep our skin looking youthful and plumped up begin to break down, often leaving laugh lines, smile lines, crow's feet or facial creases over the areas where this muscle movement occurs. Soft-tissue fillers, most commonly injectable collagen, hyaluronic acid, or fat, can help fill in these lines and creases, temporarily restoring a smoother, more youthful-looking appearance.
If You're Considering Injectables
If You're Considering Injectables
When injected beneath the skin, these fillers plump up creased and sunken areas of the face. They can also add fullness to the lips and cheeks. Injectable fillers may be used alone or in conjunction with a resurfacing procedure, such as a laser treatment, or a recontouring procedure, such as a facelift.
What are the different types of fillers?
Collagen
a natural protein that supports the skin. Injectable collagen formulas derived from human dermis include Cosmoderm® or Cosmoplast®. Zyderm® and Zyplast® are forms of bovine collagen that, unlike human derived collagen, require prior allergy testing. The results may last 2 to 4 months.
Hyaluronic Acid
a natural substance found in our bodies. It is well suited to plump thin lips and fill facial creases such as nasolabial folds. It may also be appropriate for some surface wrinkles and concave scars. The results may last 6 months or longer.
Hydroxylapatite
a mineral-like compound found naturally in human bones, suspended in a gel-like formulation. It is the heaviest of facial fillers and is recommended to fill deeper creases such as nasolabial folds, marionette lines and frown lines, as well as to enhance fullness of the cheeks and other facial contours.
Human fat
harvested from your own body, can be reinjected to enhance facial fullness, fill deep creases and to build up shallow contours. Fat injection requires a more extensive procedure than other injectable fillers because it uses liposuction techniques to extract the fat prior to injection.
PMMA
(polymethylmethacrylate) fillers contain 20% tiny PMMA microspheres suspended in 80% purified collagen gel. An FDA-approved PMMA filler is recommended for the correction of facial wrinkles known as smile lines.
What to Expect from Treatment
The most important fact to remember about injectable fillers is that the results are not permanent.
Injected material is eventually metabolized by the body. You should not expect the same long-lasting results that may be gained from cosmetic surgery.
In some individuals, the results may last only a few weeks; in others, the results may be maintained indefinitely.
Researchers believe that age, genetic background, skin quality and lifestyle as well as the injected body site may all play a role in the injected material's "staying power." However, the precise reason for the variation of results among patients has yet to be identified.
If you've had short-lived results from fat injections, you shouldn't necessarily assume that collagen injections will work better for you.
And, conversely, if you've had disappointing results from collagen, don't assume that injected fat is the answer. Although it's true that some individuals' bodies are more receptive to one substance than the other, others may find that neither substance produces long-lasting results. Sometimes one substance may work better than the other for a specific problem.
Risks Related to Injectables
When injectables are administered by a qualified plastic surgeon, complications are infrequent and usually minor in nature.
Still, individuals vary greatly in their anatomy, their physical reactions and their healing abilities. The outcome of treatment with injectables is never completely predictable.
Hyaluronic Acid
side effects are typically mild or moderate in nature and last for less than 7 days. Adverse events inclde redness, pain, firmness, swelling, lumps/bumps, bruising, itching, and discoloration.
Collagen
Allergic reaction is the primary risk of collagen. To help determine if you are allergic to the substance, your surgeon will perform an allergy skin test about a month before the procedure. After the test is performed, the test site should be watched carefully for three or four weeks, or as long as your surgeon advises. Any sign of redness, itching, swelling or other occurrences at the test site should be reported to your surgeon. Risks not necessarily related to allergies include infection, abscesses, open sores, skin peeling, scarring and lumpiness, which may persist over the treated area. Reports of these problems are very rare.
Fat
Allergic reaction is not a factor for fat because it's harvested from a patient's own body. However, there is still a small risk of infection and other infrequent complications.
Planning for Treatment
Facial rejuvenation is very individualized.
That's why it's important to discuss your hopes and expectations with a board-certified plastic surgeon who has experience with many different types of surgical and non-surgical facial procedures.
In your initial consultation, your plastic surgeon will evaluate your face - the skin, the muscles and the underlying bone - and discuss your goals for the surgery.
Your doctor will help you select a treatment option based on your goals and concerns, your anatomy and your lifestyle.
Your surgeon will ask you about your medical history, drug allergies, and check for conditions that could cause problems
such as active skin infections or non-healed sores from injuries. Collagen injections are generally off limits for pregnant women, individuals who are allergic to beef or bovine products, patients who suffer from autoimmune diseases, and those who are allergic to lidocaine (the anesthetic agent contained in the syringe with the collagen material). For more specific information about the contraindications and risks of collagen use, ask your doctor for the manufacturer's brochure for patients.
Insurance usually doesn't cover cosmetic procedures.
However, if your injectable treatment is being performed to treat a scar or indentation from an accident or injury, you may be reimbursed for a portion of the cost. Check with your insurance carrier to be sure.
Where Your Treatment Will Be Performed
Where Your Treatment Will Be Performed
Injectables are usually administered in a surgeon's office-based facility. If, however, you are being hospitalized for a facelift, neck lift, brow lift, or any other procedure, your injections may be administered in the hospital as well.
Types of Anesthesia
Collagen
Because the anesthetic agent lidocaine is mixed in with collagen, additional anesthetic is usually not used. However, if you are especially sensitive to pain, your doctor may use a topical cream anesthetic or a Freon spray to numb the injected area. Or, you may elect to have an injected local anesthetic or sedative drugs.
Fat
Both the donor and recipient sites are numbed with local anesthesia. Sedation can be used as well. If you elect to use sedation, be sure to arrange for a ride home after your treatment.
Collagen Injection
Collagen is a naturally occurring protein that supports tissue of the skin, joints, bones and ligaments.
Injectable collagen can be derived from purified bovine collagen, porcine collagen or human sources. The purification process ensures the product is similar to human collagen. Injectable collagen is produced in varying concentrations to meet individual patient needs.
Collagen is used primarily to fill wrinkles, lines and scars on the face and sometimes the neck, back and chest.
First, a skin test determines if you are allergic to the substance. If you are not allergic, the collagen is injected at several points along the edge of the targeted area. Local anesthesia can be used to control discomfort as the injections are administered. Because part of collagen is salt water that will be absorbed within a few days, your doctor may slightly overfill the area. You may be asked to hold a hand mirror during the procedure to help your doctor decide when you've had enough.
After treatment, you may notice some minor discomfort, stinging or throbbing in the injected area.
Occasionally some bruising or swelling will occur, but it is usually minor. Redness that appears in the injected site usually disappears within 24 hours. However, in some individuals, particularly fair-skinned patients, this redness may persist for a week or more. Tiny scabs may also form over the needle-stick areas; these generally heal quickly.
No bandaging is needed and you are free to eat, drink, and wear makeup with sunblock protection shortly thereafter.
There may be some temporary swelling and redness in the treated area which should dissipate within a few days. If these symptoms persist, contact your surgeon.
The duration of your results will vary.
In general, the injected material is likely to disappear faster in areas that are more affected by muscle movement. Your doctor can help you determine how long you can go between treatments to best maintain your results.
Fat Injection
Fat-injection procedure is also known as autologous fat transplantation or micro-lipoinjection.
Fat cells are extracted from the patient's abdomen, thighs, buttocks or elsewhere and reinjected beneath the facial skin. Fat can fill in sunken cheeks or lines between the nose and mouth, correct skin depressions, minimize forehead wrinkles or enhance the lips.
After cleansing and treatment with local anesthesia, fat is withdrawn using a syringe with a large-bore needle or a liposuction cannula.
The fat is then prepared and injected into the recipient site with a needle. Sometimes an adhesive bandage is applied over the injection site. Slight overfilling may be necessary to allow for fat absorption that occurs. When fat is used to augment the cheeks, this overcorrection may cause the face to appear abnormally full.
While some treatments require a brief recovery period, many patients resume normal activity right away.
Expect some swelling, bruising or redness in both the donor and recipient sites. The severity of these symptoms depends upon the size and location of the treated area. Stay out of the sun until redness and bruising subsides - usually about 48 hours. In the meantime, you may use makeup with sunblock protection to help conceal your condition. In some cases, swelling and puffiness in the recipient site lasts several weeks, especially if a large area was filled.
While some patients report results lasting 1 year or more, the majority of patients find that at least half of the injected fullness disappears within 3-6 months.
Therefore, repeated injections may be necessary. Your doctor will advise you on how to maintain your results with repeat treatments.
Your New Look
Your New Look
If you're like most patients, you'll be very satisfied with the results of your injectable treatments. You may be surprised at the pleasing results that can be gained from this procedure.
Port Wine Stain
Dr. Clayton offers treatments to reduce the appearance of port wine stains, or birthmarks, on various places of your body.
Skin Management
Skin Management treatments, like Retin-A, can help to reduce many skin impurities and issues like surface wrinkles
Managing Healthy Skin
From early on, we learn that having a smooth, clear complexion is an attribute of physical attractiveness.
However, as we age, maintaining that healthy glow becomes more difficult.
The face is the most exposed part of the body, vulnerable to the harsh rays of the sun and subject to acne, rashes, allergic reactions, and injuries that may leave permanent scars.
A number of non-surgical refinishing treatments are available for individuals who want to eliminate or soften imperfections on their facial skin and achieve a clearer, fresher look.
These treatments include glycolic acids (sometimes called "fruity acids"), which are natural fruit substances blended into facial preparations and are used to eliminate rough or dried surface skin, and Retin-A®, a vitamin A-enriched cream that changes the cellular metabolism of the skin's surface to treat fine facial wrinkles and blotches caused by sun damage.
Each of these treatments can be used alone, or may be prescribed in conjunction with an aesthetic surgery procedure, such as a facelift or a chemical peel.
What to Expect from Skin-Surface Treatments
Surface-repair treatments can enhance your appearance and give your skin a smoother, fresher look, but they won't remove deep scars and flaws or prevent aging.
These treatments should not be thought of as mini-facelifts. Generally speaking, Retin-A® and glycolic acid treatments offer less dramatic results than surgical approaches like dermaplaning, dermabrasion, or chemical peel.
Before you decide to have a skin-rejuvenating treatment of any type, think carefully about your expectations and discuss them with your plastic surgeon.
Planning for Treatment
Whether you're planning a surgical or nonsurgical skin treatment, it's important that you find a doctor who has training and experience with a variety of skin-management techniques.
You'll want a doctor who can give you the best possible single treatment or treatment combination. Look elsewhere if your doctor tells you that he or she has perfected a single technique that promises unbelievable results. The choice is yours, but be certain your doctor is qualified to prescribe such treatments. After all, these treatments involve your face - the most visible part of your body.
n your initial consultation, be open in discussing your treatment goals with your doctor and don't hesitate to ask any questions or express any concerns you may have.
Your surgeon should be equally open with you and explain the factors that could influence your choice of treatment options such as age, skin condition, and previous plastic surgeries.
The surgeon will ask about your medical history and conduct a routine examination.
If you're having a surgical procedure in conjunction with your skin treatment, your doctor should explain the process in detail, including the risks and benefits, the recovery period, and the costs. Insurance usually doesn't cover aesthetic procedures.
Where Your Treatment Will Be Performed
Where Your Treatment Will Be Performed
It is unlikely that you'll have to spend time in the hospital for your skin treatment unless the treatment is performed in conjunction with a facelift or some other more complex procedure. Your initial application of Retin-A® or glycolic acid will probably be performed in a doctor's office or an outpatient facility.
The Treatments Retin-A®
Best candidates
In general, Retin-A® is most effective in older patients who have some fine facial wrinkles, or blotchy pigmented areas caused by sun damage. However, Retin-A® is often prescribed to younger, active individuals who want to combat the aging effects of sun exposure. Patients who are planning to have a chemical peel treatment are often instructed by their doctors to use Retin-A® as a preparation treatment; Retin-A® thins the skin's outer layer, allowing the acid solution used in a peel treatment to penetrate more deeply and evenly. Retin-A® is not recommended for pregnant women or nursing mothers, because its effects on the fetus and nursing infant are still being studied.
Reactions/side-effects
Although no serious medical problems have been associated with Retin-A®, it's possible that its use could result in temporary skin irritation and redness. If this happens, your doctor may recommend a milder formulation. As late as 1993, Retin-A® had not received approval for use as an anti-aging treatment from the Food and Drug Administration (FDA). It has received FDA approval as an acne treatment, and doctors have been safely using it for this purpose for more than two decades. However, the full scope of Retin-A®'s effects and potential benefits continues to investigated.
Beginning treatment
Your initial application of Retin-A® will include a lesson on how to continue your skin-care routine at home. After your face has been washed thoroughly, a small amount of Retin-A®, in either cream or gel form, is rubbed over your face and nose. It's likely that a very gentle formula will be used at the beginning - especially if you are younger or have a fair complexion. You may be switched to a stronger formula after your skin becomes accustomed to treatment. Only a very small amount of Retin-A® - a pea-sized dab - is needed to cover the entire face. You will be instructed to apply Retin-A® every night before you go to bed. Because Retin-A® is drying to the skin, your doctor may also recommend that you apply a moisturizer once or twice a day. This routine is usually continued for about eight months to a year, after which you'll be switched to a less-frequent schedule of maintenance, with Retin-A® applications only two or three times per week. At periodic follow-up visits, your doctor may adjust the strength of your prescription or its frequency of use. To maintain the benefits of Retin-A®, its use must be continued for a lifetime.
After treatment
It's normal to experience some redness, irritation, itching, stinging, or skin dryness once you begin to use Retin-A®. However, you can expect these symptoms to gradually disappear as the skin becomes acclimated to the treatment. Caring for your new skin. Because Retin-A® thins out the skin's outer layer, you will need to consistently use a sun-block to protect yourself from ultraviolet light, and you may have to discontinue using certain products or cosmetics on your face. Though the degree of change varies from person to person, with continued use of Retin-A®, you will begin to see subtle improvements in the texture and tone of your skin. Retin-A® users notice a rosy glow during the beginning months of use, followed by the disappearance of fine lines and the shrinking of large pores. After about six months, many Retin-A® users report that wrinkles are barely visible and that age spots have faded.
Glycolic Acid Treatments
Best candidates
Glycolic or "fruity acid" treatments can offer smoother skin to people of all ages. This type of treatment seems to work best on patients who have rough, sun-damaged skin. Glycolic acids are sometimes formulated with bleaching chemicals to correct areas of uneven pigmentation.
Reactions/side-effects
It's important to remember that side-effects may occur even with non-surgical treatments. No serious medical problems have been associated with glycolic acids, but their use may cause temporary skin irritation and redness. Switching to a milder formula may remedy the problem.
Beginning treatment
Your initial application of glycolic acid cream will include a lesson on how to continue your skin-care routine at home. The way in which glycolic acid is applied to the face depends upon what form it's in. Two common forms are cream or facial wash. Both forms contain about 12 percent glycolic acid, which helps slough away dry, sun-damaged skin on the face's surface. Each also contains a special moisturizer and, if needed, a bleaching agent. In most cases, the acid is applied to the face twice daily, either by smoothing on the cream or using the facial wash. Your doctor may adjust the strength of the acid formulation or the frequency of its use after evaluating your skin's condition in follow-up visits.
After treatment
It's normal to experience some redness, irritation, itching, stinging, or skin dryness once you begin to use glycolic acid. However, you can expect these symptoms to gradually disappear as the skin adjusts to the treatment.
Caring for your new skin
Because glycolic acid thins the skin's outer layer, you will need to consistently use a sun-block to protect yourself from ultraviolet light, and you may have to discontinue using certain products or cosmetics on you face. Though the degree of change varies from person to person, with continued use of glycolic acid preparations, you will begin to see subtle improvements in the texture and tone of your skin. In most cases, glycolic acid users notice an overall freshness and smoothness. After a while, pigmented blotches fade or disappear as the bleaching effect begins to work. The time necessary for visible results depends on the degree of pigmentation and individual circumstances. Some patients see results in as little as six weeks.
Your New Routine
Your New Routine
Most people find that maintaining their new look is easier than expected. Using the cream or facial wash will become a natural part of your morning or evening routine - and the difference you'll see will be worth the extra effort.
Botox
Botox Cosmetic is one of the most popular injectable treatments to correct lines and wrinkles on the face. Ask Dr. Clayton about the additional therapeutic uses Botox may have, as well.
Botox® Injections
The cosmetic form of botulinum toxin, often referred to by its product name Botox®, is a popular injectable treatment.
This purified toxin blocks the nerve impulses, temporarily paralyzing the muscles that cause wrinkles to give the skin a smoother, more refreshed appearance. Studies have also suggested that Botox is effective in relieving migraine headaches, excessive sweating and muscle spasms in the neck and eyes.
Botulinum toxin can be used as a wrinkle treatment to smooth:
Frown lines; Crows feet; Forehead furrows; Skin bands on the neck.
Smiling, frowning, squinting and even chewing
basically any facial movement can eventually lead to one of the most common signs of aging: wrinkles. They can make you appear tired or even angry when you are not. One of the quickest and safest remedies to remove wrinkles is an injection of botulinum toxin.
Botulinum toxin can be combined with other cosmetic skin procedures such as chemical peels
dermal fillers or microdermabrasion to further improve your results. This combination of therapies can even help to prevent the formation of new lines and wrinkles.
Who Should Consider Botox?
Botox Cosmetic is indicated for
the temporary correction of moderate to severe glabellar lines (frown lines) associated with corrugator and/or procerus muscle activity in patients 18 to 65 years of age. If you exhibit lines on the smooth part of your forehead above and between the brows (the glabella), you should consider treatment with Botox Cosmetic.
Botox Cosmetic
contraindicated if the patient exhibits an infection at the proposed injection site(s) and or has a known hypersensitivity to any botulinum toxin preparation or to any of the components in the formulation. Do not undergo Botox treatment if you are allergic to any of the ingredients or if you have experienced an allergic reaction to another product containing botulinum toxin. Ask your plastic surgeon about the possible side effects of Botox.
Botulinum toxins won't fix all types of skin problems.
For example, while it can diminish under-eye wrinkles, it can't repair the damage caused by the sun. Your skin thickness, type, and the degree of wrinkling all play a role in determining the effectiveness of botulinum toxin. A qualified plastic surgeon is the best person to evaluate the appropriateness of this treatment for you personally.
Special Considerations, Risks and Recovery
You may resume normal activities immediately. One note of caution: Don't rub or massage the treated areas after the wrinkle treatment because it can cause the botulinum toxin to migrate to another area of your face. If this happens, you could have temporary facial weakness or drooping. Although generally safe, botulinum toxin side effects and complications can include:
Bruising and pain at the injection site
Redness
Headache
Flu-like symptoms
Nausea
Temporary facial weakness or drooping
Very rarely
the toxin can spread beyond the treatment area, which can cause botulism-like signs and symptoms such as breathing problems, trouble swallowing, muscle weakness and slurred speech.
Coolsculpting
CoolSculpting® is a revolutionary non-surgical contouring treatment that freezes stubborn fat, which then is naturally eliminated from your body. No needles, no special diets, no supplements, no surgery. And most importantly, no downtime.
What will the results be?
Many patients are satisfied after one treatment. However, during your consultation, we can discuss a treatment plan that will meet your specific treatment needs.
What happens during the treatment?
To initiate the treatment we will position the device on your body. The device will then draw the bulge up between two cooling panels. The sensation is a firm pull and pressure – enough of a pull to ensure the selected tissue will be cooled most efficiently. An hour or so later, depending on your needs, you’re done.
Can I return to normal activities after the procedure?
CoolSculpting is completely non-surgical, so typically you can return to normal activities immediately. Some patients experience redness, minor bruising, tingling, numbness or discomfort in the treated area, but this is temporary and will resolve completely. Often times, patients return to work after the session is over.
When will I see results?
You may start to see changes as quickly as three weeks after your treatment, and will experience the most dramatic results after one to three months. Your body is still flushing fat cells and will continue doing so for up to four to six months after treatment.
Are the results permanent?
During CoolSculpting, the treated fat cells are eliminated. As long as you maintain a healthy lifestyle, long-term results should remain stable.
Laser Skin Resurfacing
Laser Skin Resurfacing may be an option for you if you struggle with superficial skin issues like uneven texture or tone as well as many skin discoloration issues.
If You're Considering Laser Resurfacing
In laser resurfacing, sometimes called "laser peel," a carbon dioxide (CO2) laser is used to remove areas of damaged or wrinkled skin, layer by layer.
The procedure is most commonly used to minimize the appearance of fine lines, especially around the mouth and the eyes. However, it is also effective in treating facial scars or areas of uneven pigmentation. Laser resurfacing may be performed on the whole face or in specific regions. Often, the procedure is done in conjunction with another cosmetic operation, such as a facelift or eyelid surgery.
Laser resurfacing is still a very new procedure.
However, it has been shown that in some cases, this surgical method produces less bleeding, bruising and post-operative discomfort than is typically seen with other resurfacing methods.
This brochure will give you a basic understanding of the laser resurfacing procedure - when it can help, how it's performed and what results you can expect.
It cannot, however, provide all the details which may be relevant to your particular needs. Please ask your plastic surgeon if there is anything about the procedure you don't understand.
A Word About The Laser
Laser resurfacing is performed using a beam of laser energy which vaporizes the upper layers of damaged skin at specific and controlled levels of penetration.
It's clear that laser resurfacing may offer a number of advantages over other resurfacing methods
precision, little (if any) bleeding and less post-operative discomfort. However, laser resurfacing isn't for everyone. In some cases, an alternative skin resurfacing treatment, such as dermabrasion or chemical peel, may still be a better choice.
All resurfacing treatments work essentially the same way.
First, the outer layers of damaged skin are stripped away. Then, as new cells form during the healing process, a smoother, tighter, younger-looking skin surface appears. Laser resurfacing is a new method being used by plastic surgeons to remove damaged skin. Because it is new, there are no long-term data on this technique. However, a number of studies using microscopic examination have shown that the physical changes that occur to laser-treated skin are essentially identical to those that occur with either dermabrasion or chemical peel. Ask your plastic surgeon about the latest facts concerning long-term follow-up.
For superficial or medium resurfacing, the laser can be limited to the epidermis and papillary dermis.
For deeper resurfacing, the upper levels of the reticulas dermis can also be removed. Varied penetration allows treatment of specific spots or wrinkles.
It's also important to consider the length of recovery when choosing among the skin-resurfacing alternatives.
In general, the more aggressive the resurfacing procedure is, the more prolonged the recovery is likely to be. "Light" resurfacing procedures, such as superficial chemical peels or superficial laser resurfacing, offer shorter recovery times. However, these lighter procedures may need to be repeated multiple times to achieve results comparable to those achieved with more aggressive techniques.
The Best Candidates for Laser Resurfacing
In many cases, facial wrinkles form in localized areas, such as near the eyes or around the mouth.
The laser can be precisely controlled so that only these specific areas are targeted.
Patients with olive skin, brown skin or black skin may be at increased risk for pigmentation changes no matter what type of resurfacing method is recommended.
Your plastic surgeon will evaluate your skin characteristics and make recommendations accordingly.
Also, individuals who have taken accutane in the past 12-18 months
or are prone to abnormal (keloid-like) scarring or those with active skin infections on the treatment area may not be appropriate candidates for this procedure.
Remember, having laser resurfacing can help enhance your appearance and your self-confidence, but it won't completely remove all facial flaws or prevent you from aging.
Lines that occur as a result of natural movements of the face - smiling, squinting, blinking, talking, chewing - will inevitably recur. Your plastic surgeon can suggest ways to help you preserve your results by protecting yourself from sun exposure or using maintenance treatments, such as light chemical peels or medicated facial creams. Before you decide to have laser resurfacing, think carefully about your expectations and discuss them with your surgeon.
All Surgery Carries Some Uncertainty and Risk
When laser resurfacing is performed by a qualified, experienced surgeon, complications are infrequent and usually minor.
However, because individuals vary greatly in their anatomy, their physical reactions and their healing abilities, the outcome is never completely predictable.
Risks associated with laser resurfacing include: burns or other injuries from the heat of the laser energy, scarring, and obvious lightening or darkening of the treated skin.
Also, laser resurfacing can activate herpes virus infections ("cold sores") and, rarely, other types of infection.
Additional corrective measures and treatment may be required if healing seems abnormal or delayed or if there is any evidence of abnormal pigmentation or scarring.
You can reduce your risks by choosing a qualified plastic surgeon who has received special training in laser surgery.
Planning Your Surgery
Not every practitioner who offers laser surgery has the same level of experience and skill with laser use.
That is why it is especially important that you find a plastic surgeon who is adequately trained in the procedure.
One safety measure is to find out whether your surgeon has privileges to perform laser resurfacing with a CO2 laser at an accredited hospital.
Even if the operation is to be conducted in your doctor's private facility, the fact that he or she has privileges to use that same laser in a hospital ensures that the doctor has been reviewed by the institution's experts.
In your initial consultation, be frank in discussing your expectations with the surgeon and don't hesitate to ask any questions you may have.
Your surgeon should be equally frank with you, explaining the factors that could influence the procedure and the results - such as any abnormal skin condition which has been diagnosed or previously treated, medications you are taking or have taken in the past, previous skin injuries or previous operations.
Your surgeon will discuss your medical history, perform a routine examination and photograph the area to be treated.
He or she should explain the procedure in detail, along with its risks and benefits, the recovery period and the costs.
Remember, cosmetic laser treatments can be expensive and are usually not covered by medical insurance.
On rare occasions, the procedure can be used for modification of scars or the removal of pre-cancerous skin growths. These conditions could meet the criteria for "medical necessity," usually required by insurance companies before coverage will be provided. Your plastic surgeon can advise you how to contact your insurance carrier to determine whether benefits will be allowed in such instances.
Preparing for the Laser Procedure
Depending on your individual needs, your surgeon may recommend that you begin a pre-treatment plan to prepare the skin for resurfacing.
At the time of the procedure, you will be given specific instructions on how to care for your skin immediately following your laser treatment.
Your surgeon may also instruct you to follow a specific maintenance regimen for long-term care of the skin to maximize the benefits of the procedure.
While you are making plans, be sure to make arrangements for someone to drive you home if you will be given tranquilizers or sedation for your laser treatment.
Where your Laser Treatment Will be Performed
Where your Laser Treatment Will be Performed
Laser resurfacing may be performed in a hospital, an outpatient surgery center or a surgeon's office-based facility. For cost containment and convenience, laser resurfacing is usually done on an outpatient basis. For the more extensive resurfacing procedures or for resurfacing combined with other surgical procedures, you may be admitted to a hospital or a recovery center.
Types of Anesthesia
Types of Anesthesia
Laser resurfacing is most commonly performed under local anesthesia with sedation, especially when it's used to treat localized areas of the face. You'll be awake but relaxed, and will feel minimal discomfort. For more extensive resurfacing, your surgeon may prefer to use general anesthesia, in which case you'll sleep through the procedure.
The Procedure
Laser resurfacing is a relatively quick procedure. It usually takes anywhere from a few minutes to 1 1/2 hours, depending on how large of an area is involved.
When the imperfections are especially deep, your surgeon may recommend that the resurfacing be performed in two or more stages.
During the procedure
the activated laser is carefully passed back and forth over the skin until the surgeon reaches the level that will make the wrinkle or scar less visible.
When the procedure is over, your surgeon may choose to treat the resurfaced skin with applications of protective creams or ointments until healing is complete.
Some surgeons choose to apply a bandage over the treated areas which will cover and protect the healing skin for the first five to ten days.
After Your Treatment
You are likely to experience some mild swelling and discomfort after laser resurfacing.
However, this can be controlled with ice packs and medications prescribed by your surgeon.
If a bandage was applied after your procedure, it may be replaced with a fresh one after a day or two.
After about a week or so, your bandage will be removed and a thin layer of ointment may be applied to the skin. Once this stage is reached, your surgeon will provide instructions on how to gently wash and care for your healing skin.
During this phase of healing, it is very important that you not pick the crusts off the treated area or scarring may result.
Most patients are free of crusts by about 10 days post-operatively. Redness may persist for several weeks.
Getting Back to Normal
Your new skin will usually remain bright pink to red in the weeks following the procedure.
Your surgeon may prescribe medications to make this color subside more rapidly. After about two weeks or so, most patients can safely apply makeup to conceal this temporary color change. However, some pinkness may remain for up to six months.
It is rare, some patients may find that their healing skin is unusually sensitive to the makeup that was regularly used prior to treatment.
In such instances, makeup should be avoided until a substitute can be found or until the healing progresses to a point at which the makeup no longer causes a reaction.
Above all, in the months following treatment, it's important to protect the treated area from the sun until all the color has returned to normal.
Using sun protection regularly will help to maintain your results and reduce the chance of any new sun damage to your skin.
If you must be in the sun, apply a strong sun block with an SPF of 15 or higher and shade your face with a hat or visor.
If resurfacing was performed around the eyes, it's best to also wear good quality sunglasses with UVA and UVB 100 percent filters.
Your New Look
The final result from laser resurfacing may take several months to fully appear.
However, once the pinkness fades, patients usually notice a significant improvement in the quality of their skin and a fresher, smoother appearance.
It's important to understand that your results will be long-lasting, but not permanent.
Remember, your new skin is not immune to the effects of aging. In the months and years following your laser treatment, your natural facial movements will eventually cause any "expression" lines to recur.
As with other methods of skin rejuvenation, laser treatments can usually be repeated.
However, by protecting yourself from the sun and following a skin-care regimen recommended by your plastic surgeon, you can help maintain your rejuvenated look.
Products
In his office, Dr. Clayton offers many popular, professional-grade products to be used as a part of a non-surgical treatment. In his Provo practice, plastic surgeon Dr. James Clayton offers medical-grade cosmetic products to rejuvenate and maintain healthy skin as well as grow and maintain fuller, longer eyelashes.
Galvanic Spa II
The Galvanic Spa II system offered by Dr. Clayton works to revitalize your skin by penetrating your skin's surface to work with its underlying layers to reduce surface impurities as well as wrinkles and signs of aging. This system, made by NuSkin, can show marked improvements in the appearance and condition of the skin on your body, face and scalp.
Kinerase
Kinerase is a plant-based antioxidant skin care regimen that fights early signs of aging like wrinkles and sun damage. The Kinerase line of products includes cleansers and toners, moisturizers, products for sun protection, eye care as well as products that promote cleaner, more clear skin. While some Kinerase products are commercially available, the professional grade products are only available through Dr. Clayton's practice.
Latisse
Latisse is a medical-grade product that is clinically proven to add fullness and length to your existing lashes. By prolonging the growth phase of your lashes, this at-home topical product allows existing lashes to grow longer and for an extended period of time.
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About Us
At James M. Clayton Cosmetic Plastic Surgery, we understand that true beauty comes from within. That's why our goal is to perform each cosmetic surgery procedure with artistry and natural results. Dr. Clayton insists on taking the time to get to know each of his patients personally. Prior to performing any procedure, Dr. Clayton will take the time to discuss your expectations as well as any concerns you may have. When you meet with Dr. Clayton during your consultation, his caring demeanor and dedication to personal attention will be immediately evident. Dr. Clayton is very well trained and is know for being a meticulous surgeon and perfectionist. During his years of private practice, Dr. Clayton's philosophy of beauty has helped thousands of men and women improve their appearance and restore their self- confidence.