COSMETIC SURGERY

Forehead Surgery

With time most eyebrows fall, crowding the upper eyelids. The forehead can also develop deep furrows. Between the eyebrows frown lines can impart an angry or worried appearance.

These changes are the result of aging and the action of muscles beneath the skin. With time, the muscles that hold the eyebrow in proper position relax allowing the eyebrow to move downward. Although this occurs most commonly along the outer portion of the brow a droop of the inner brow can also be seen. When the brows are low there is a natural tendency to use the forehead muscles to hold the eyebrow upward. This causes the gradual formation of deep furrows across the forehead. Frowning causes lines that gradually form between the eyebrows and in some people become quite noticeable.

Endoscopic forehead surgery can help turn back the effects of time and muscle action on the forehead. It can even make you feel better about yourself. I can not however make you younger or completely change your appearance.

Most forehead lift patients are between thirty and sixty years old. Very successful surgery can also be performed on patients that are younger or older.

The endoscopic forehead lift is used to elevate the eyebrows, smooth the forehead and decrease the effect of muscle contraction on the area between the eyebrows. It can be combined with other facial plastic surgery operations such as eyelid surgery, facelift surgery and laser skin resurfacing.

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Each patient has very individual and specific concerns. During your consultation these concerns will be discussed. An evaluation of your face, neck and forehead will be made in order to determine if forehead lift surgery is appropriate. Photographs will be taken as a part of your permanent record. These help to plan the surgery and to evaluate the post-operative result. A medical history will be obtained that includes general medical problems as well as smoking, the use of medications that can promote bleeding and any healing difficulties that you may have.

Having realistic expectations about the results of surgery is very important. These should be discussed during the consultation. Your overall emotional state is also important as it can effect both your satisfaction with surgery and your post-operative course.

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It is important to follow any instructions given to you prior to surgery. These will include information on eating, smoking and medication usage. It is very important to stop smoking prior to surgery. Smoking causes decreased blood flow to the skin and can impair healing. Carefully following your instructions will make the surgery and post-operative recovery easier.

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The goal of the endoscopic forehead lift procedure is to elevate the eyebrows, smooth the forehead and remove frown lines between the eyebrows.

Several small incisions are made in the hairline. An endoscope is then employed to see below the scalp. The forehead is freed and the eyebrows elevated. This also smoothes the forehead. When appropriate, muscles between the eyebrows are removed to decrease frown lines in this area. Several surgical staples are used to close the incisions. Even though small incisions are utilized it is possible to constantly visualize the progress of surgery through the endoscope. The entire procedure takes between one and two hours. A small dressing is often applied.

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At the beginning of surgery medications are given to relieve anxiety and pain. A general or local anesthesia is employed to maximize your comfort.

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Some bruising and swelling are normal after surgery. These can last several weeks and subside gradually. Mild pain, easily controlled with medication, is common for several days after surgery. Significant pain is very rare and should be brought to our attention. Bandages when employed are removed within several days. Staples are removed in about one week.

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The risks of endoscopic forehead lift surgery are infrequent and typically minor. There is however a great variability in an individuals healing ability, underlying anatomy and reaction to surgery. The results of surgery are therefore never completely predictable.

The most common complications of surgery include a collection of blood under the skin and temporary numbness in the forehead area. Suspected problems should be brought to our attention promptly. To minimize the likelihood of complications be certain to carefully follow your pre-operative instructions.

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The costs of cosmetic surgery vary depending on the complexity and length of the surgery required as well as the facility where the surgery is performed. There is both a surgical and a facility fee. Anesthesia and facility fees are incurred when general anesthesia is necessary. Your fees will be fully discussed with you after your initial consultation. Payment of fees for cosmetic surgery is expected prior to surgery since these types of surgery are not covered by insurance.

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Eyelid Surgery

With time the skin of the upper eyelid stretches and hangs downward covering more and more of the upper eyelid. Eventually the eyelashes disappear under the drooping skin. A bulge of fatty tissue can also appear in the inner portion of the eyelid. In the lower eyelids prominent bags of fatty tissue are seen as well as some degree of wrinkly skin.

These changes are the result of aging and the action of muscles beneath the skin. There are elastic fibers in the skin. These fibers eventually lose their snap back ability allowing the skin to become wrinkly and to hang downward. Additionally, there is what can be thought of as a door in both the upper and lower eyelid. This door holds the normal fatty tissue back so it is not seen. Eventually, this door weakens allowing the fatty tissue to move forward. This is seen as a bulge or "bag" in the eyelids.

Cosmetic eyelid surgery can help turn back the effects of time and muscle action on the eyelids. It can even make you feel better about yourself. It can not, however, make you younger or completely change your appearance.

Most cosmetic eyelid surgery patients are between thirty and sixty years old. Very successful surgery can also be performed on patients that are younger or older.

The cosmetic eyelid surgery is used to tighten the eyelid skin and to remove the bags caused by bulging fat deposits. It can be combined with other facial plastic surgery operations such as endoscopic forehead elevation, facelift surgery and laser skin resurfacing.

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Each patient has very individual and specific concerns. During your consultation these concerns will be discussed. A complete evaluation of your eyelids and the area around them will be made in order to determine if cosmetic eyelid surgery is appropriate. Photographs will be taken as a part of your permanent record. These help to plan the surgery and to evaluate the post-operative result. A medical history will be obtained that includes general medical problems as well as smoking, the use of medications that can promote bleeding and any healing difficulties that you may have.

Having realistic expectations about the results of surgery is very important. These should be discussed during the consultation. Your overall emotional state is also important as it can effect both your satisfaction with surgery and your post-operative course.

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It is important to follow any instructions given to you prior to surgery. These will include information on eating, smoking and medication usage. It is advisable to stop smoking prior to surgery. Smoking causes decreased blood flow to the skin and can impair healing. Carefully following your instructions will make the surgery and post-operative recovery easier.

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The goal of cosmetic eyelid surgery is to tighten and smooth the skin of the eyelid. In the upper eyelid this should pull the skin upward, away from the eyelashes thereby allowing more of the upper eyelid to be seen. Fatty tissue is typically removed as well.

The incision for upper eyelid surgery is hidden in the natural crease of the eyelid. A measured amount of skin is removed. Care is taken to be certain that enough skin remains to allow the eyelids to close properly. Any fatty tissue is now removed. A concealed suture closes the skin.

Lower eyelid surgery can be performed in several ways. When appropriate, an incision can be made on the inside of the eyelid completely hiding the surgery. At other times a skin incision is camouflaged by placing it just beneath the eyelashes. Through either incision the fatty tissue is removed from the lower eyelid helping to flatten it. At times, the skin is further tightened and smoothed by skin removal or the application of a skin resurfacing laser. When sutures are utilized these will dissolve on their own.

The entire procedure takes between one and two hours. At the end of surgery ice is applied to the area to reduce swelling and black and blue. No bandages are used allowing you to see immediately after surgery.

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At the beginning of surgery, medications are given to relieve anxiety and pain. A local anesthetic is administered to the operative area. You will typically be sleepy enough not to perceive what is going on. Keeping you comfortable is very important.

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Some bruising and swelling are normal after surgery. These can last several weeks and subside gradually. Mild pain, easily controlled with medication, is common for several days after surgery. Significant pain is very rare and should be brought to our attention. Ice is applied intermittently for 48 hours after surgery while awake.

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The risks of cosmetic eyelid surgery are infrequent and typically minor. There is however a great variability in an individuals healing ability, underlying anatomy and reaction to surgery. The results of surgery are therefore never completely predictable.

The rare complications of surgery include bleeding, infection and retraction of the eyelid. Suspected problems should be brought to our attention promptly. To minimize the likelihood of complications be certain to carefully follow your pre-operative instructions.

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The costs of cosmetic surgery vary depending on the complexity and length of the surgery required as well as the facility where the surgery is performed. There is both a surgical and a facility fee. Your fees will be fully discussed with you after your initial consultation. Payment of fees for cosmetic surgery is expected prior to surgery since these types of surgery are not covered by insurance.

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Laser Skin Resurfacing

With time most people's skin will form deep or superficial wrinkles. The skin under the eyelids can become loose and crinkled. Additionally, it can take on a weather beaten appearance. These changes are due to the constant action of muscles on the overlying skin. This can all be attributed to aging.

The wrinkle lines are commonly seen under the eyes and along the outer portion of the eyes where they are known as "crow's feet". They are frequently seen as vertical lines on the upper lip typically in smokers. To varying degrees, they also occur on the forehead, cheeks and lower portion of the mouth.

Cosmetic laser skin resurfacing can help turn back the effects of time and muscle action on the face. It can even make you feel better about yourself. It can not, however, make you younger or completely change your appearance.

Most skin resurfacing patients are between thirty and sixty years old. Very successful surgery can also be performed on patients that are younger or older.

Cosmetic laser skin resurfacing is used to smooth wrinkles of the face and to rejuvenate the texture of the skin. It can be combined with other facial plastic surgery operations such as eyelid surgery, facelift surgery and endoscopic forehead lift surgery.

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Each patient has very individual and specific concerns. During your consultation these concerns will be discussed. An evaluation of your face, neck and forehead will be made in order to determine if cosmetic laser skin resurfacing is appropriate for you. Photographs will be taken as a part of our permanent record. These help to plan the surgery and to evaluate the post-operative result. A medical history will be obtained that includes general medical problems as well as smoking, the use of medications that can promote abnormal recovery and any healing difficulties that you may have.Having realistic expectations about the results of surgery is very important. These should be discussed during the consultation. Your overall emotional state is also important as it can effect both your satisfaction with surgery and your post-operative course.

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It is important to follow any instructions given to you prior to surgery. These will include information eating, smoking and medication usage. In general, your skin should not be tanned prior to laser skin resurfacing. An anti-viral medication will usually be prescribed prior to treatment. Carefully following your instructions will make the treatment and post-operative period easier.

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After surgery the treated area will be red and tend to weep for several days. Redness persists for a longer period of time. The exact length of time depends on the area treated and the type of laser used. Mild discomfort, easily controlled with medication, is common for several days after treatment. Significant pain is very rare and should be brought to our attention.

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The risks of laser skin resurfacing are infrequent and the side effects are typically minor. There is however great variability in an individual's healing ability, underlying anatomy and reaction to treatment. The results of treatment are therefore never completely predictable.

The most common complications of surgery include prolonged redness and superficial infections. suspected problems should be brought to our attention promptly. To minimize the likelihood of complications be certain to carefully follow your pre-operative instructions.

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The costs of cosmetic surgery vary depending on the complexity and length of the treatment required as well as the facility where the treatment is performed. Anesthesia and facility fees are incurred when general anesthesia is necessary. Your fees will be fully discussed with you after your initial consultation. Payment of fees for cosmetic surgery is expected prior to surgery since these types of surgery are not covered by insurance.

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Alloderm Lip Augmentation

Alloderm is an acellular dermal graft from donor tissue. The patient's body incorporates this material producing an essentially permanent enhancement. Other material such as collagen only produces a temporary enhancement. The body will not reject Alloderm since it is biologically inert. It has been used for many cosmetic procedures including lip rejuvenation procedures.

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Patients who are concerned about the thinness of their lips, who want fuller more voluptuous lips will benefit from this procedure. It is also used effectively in patients who have sustained trauma and need reconstruction of their lips.

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Measurements are taken of the lips to determine the amount of fullness to be achieved. Expectations are discussed in detail between the physician and patient. Since the material is permanent, it is better to do less than more. Each procedure is individually tailored to the patient's needs.

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Tiny incisions are made at both corners of the lip. An elevator instrument is passed from one incision to the other to make a tunnel for the alloderm material. The alloderm is sized according to the patient's preoperative evaluation. It is then passed from one end of the incision towards the other end. The corners of the lip are then sutured with absorbable suture material that will dissolve in 1-2 weeks.

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The procedure is done under local anesthesia with sedation. The patient is comfortable and does not experience pain.

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The postoperative effects are dramatic. Depending on what the patient desires, the fullness can be achieved at the corners, in the middle or along the length of the lip. Both upper and lower lips can be done at the same time. You will not be able to whistle for approximately 3-6 months. There will be some swelling during the first week before the alloderm starts to shrink to an appropriate size. When kissing, the sensation will be minimal for the first few months. The lips will feel hard initially but soften over time. The total healing process takes 6 -12 months. Smokers will heal much slower than nonsmokers.

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The major complication is over correction. The risk of this is minimized by the physician fully understanding the patient's expectations. Infection is rare and is minimized by using antibiotics postoperatively. As with any surgery there is always the risk of needing further surgery. The amount of scarring is minimal because the incisions are carefully placed at the corners of the lip.

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Insurance companies do not cover this procedure. The price, which includes surgical fees as well as the facility and anesthesia fees, is discussed with the patient preoperatively.

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BOTOX® Treatment

When we frown for any reason, we gather the tissue between our eyebrows into a fold. In some of us, this causes a chronic furrow. This produces a frustrated, discouraged, angry look on our face. This can be distractin to others, and a bother to ourselves.

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BOTOX® is the trade name of Botulinum Toxin Type A, a purified substance produced by the bacterium Clostridium botulinum. In large amounts, this substance blocks the nerve impulses to muscles, causing a form of paralysis called botulism. By using extremely small doses of BOTOX®, injected directly into a specific muscle, only the action of that muscle will be paralyzed. Therefore, the problem that muscle causes, like a twitch, spasm or frown line will be stopped.

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The frown lines between the eyebrows are caused by the action of a muscle called the corrugator. You can feel this as a thickening just below the inside of your eyebrows, when you purposefully make yourself frown. Injection BOTOX® directly into the corrugator muscle stops your ability to draw your eyebrows together when you frown. Once the muscle is paralyzed, it cannot contract, and the fown line gradually fade away.

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The actual treatment takes only a few minutes and the BOTOX® takes effect in three to four days. Gradually, over three to five months, the BOTOX® will fade and the muscle action will return. When the frown line starts to reappear, a simple repeat treatment is all that is necessary to maintain the desired result.

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BOTOX® is also effective in the treatment of crow's feet and forehead wrinkles. Additionally, it is useful in treating wrinkles around the mouth and neck folds.

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This therapy should be done only by a physician trained in the use of BOTOX®.

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BOTOX® has been used since 1980 for the treatment of strabismus (lazy eye), blepharospasm (uncontrolled eye blinking), and facial spasm. BOTOX® was first used for cosmetic conditions such as forehead wrinkles in 1989.

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The side effects of BOTOX® are related to the local injection of the solution. There will be a slight discomfort from the needle entering the skin, and a small chance of a bruise at the site of the injection. There are no reports of damage to the eye. There have bee no permanent side effects from the use of BOTOX®. Approximately 1% of patients will develop a slight lowering of ptosis of one eyelid. This is temporary, and may not even be noticeable.

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Certainly, the physician most qualified to work around your eyes is your ophthalmic and facial plastic surgeon whom you have known and trusted to do other surgeries and procedures. We are completely familiar with the delicate tissue and anatomy surrounding the eyes and face. We will be more than happy to answer any of your questions about your special needs, and about this remarkable procedure.

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Collagen Replacement Therapy

Collagen is a natural protein found in bone, tendon, muscle and skin. It is this network of collagen fibers in the skin that is responsible for our texture, resiliency, and shape. Over time this collagen weakens and results in loss of skin tone. Human collagen is very similar to collagen found in certain animals, especially bovine (cow) collagen.

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Collagen replacement therapy is a very useful treatment option for those patients interested in facial rejuvenation. In particular, lip augmentation, reducing crows feet around the eyes, and acne scars, are amenable to this treatment. This procedure is for the patient who is not interested in a permanent surgical result and is willing to settle for a temporary measure. Repeated injections of Collagen are given every 3-4 months initially. Maintenance injections are needed several times a year depending on the area treated. This is to maintain full correction. Collagen can also be utilized as an adjunct to other non-surgical and surgical procedures.

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Because bovine collagen is used, a skin test must be administered to the patient to see if a reaction occurs. Approximately 3% of the general population has an allergic response to bovine collagen. The test is administered in the forearm skin. The area is monitored for 4 weeks. If a reaction occurs, Collagen therapy should not be administered. If you have a history of multiple severe allergies, hypersensitivity to bovine products, desensitization to meat products or known lidocaine hypersensitivity, you should not have Collagen.It is important to point out to the physician the areas that you want enhanced with Collagen. This allows us to fully understand what your expectations are.

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Depending on the area injected, either zyplast or zyderm is used. This is a simple office procedure. A very small amount is injected in each area of concern. An immediate improvement is seen. There maybe minimal bleeding which is stopped with gentle pressure. The whole procedure can take 5-15 minutes depending on the area.

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Because this procedure is done in the office, sedation is not required. The Collagen syringe comes with a mixture of lidocaine, so anesthetic is simultaneously injected with the Collagen. In some areas such as the lips, which are more sensitive, ice cubes can be placed before injection. Also, an anesthetic cream is sometimes applied prior to injection.

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The effects can be dramatic. Most results are immediate. There can be some redness and swelling after the injection, but they usually subside within 3-5 days. Since this is a temporary material, repeated office visits every 3-4 months are necessary to maintain full enhancement in the first year. Subsequently, injections several times a year will be necessary.

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The fee depends on the type of collagen used and the location it is used. There is a "test" fee during the initial visit. The costs will be discussed with you during your initial consultation. Payment of fees for cosmetic surgery is expected prior to surgery since these types of procedures are not covered by insurance.

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