Surgical Procedures

Breast Augmentation

Breast augmentation is a cosmetic surgery procedure to increase breast size and enhance breast shape, typically through the placement of silicone or saline breast implants. From a cosmetic surgeon’s perspective, the ultimate goal of breast augmentation is to enhance a patient’s natural proportions and create a more symmetrical, aesthetically pleasing breast profile. The exact procedure is tailored to meet a woman’s individual need.

There is no “typical” breast augmentation patient, and women choose to have the procedure for many different reasons- having larger breasts is just one of them. Breast augmentation is one of the most effective procedures to correct noticeable breast asymmetry,and breast implants can be used to help correct tuberous breast deformities.

Procedure

To insert the breast implant, depending on patient’s anatomy and desired outcome, one of the following type of incision is made:

• Inframammary: This involves a short incision made in the crease underneath the breast, called the inframammary fold. This leaves a thin, 1 to 2 inch scar that is easily concealed within the crease. Advantages of this incision type include a wider access point, allowing a cosmetic surgeon to place larger silicone implants or gummy bear implants with precision.
• Peri-areolar: The incision is made around the outer edge of the areola, so the resulting scar is located within this natural transition in pigmentation. Cosmetic surgeons will often use this incision type if they are also performing a mild to moderate breast lift at the same time
• Trans-axillary: This involves a small incision made within the armpit, through which your cosmetic surgeon will place the breast implant using a specialized camera and instruments to ensure optimal placement. This leaves a small scar within the armpit but achieves a breast augmentation with no scar on the breast itself.
• Trans-umbilical: This technique involves an incision just above the belly button. Each breast implant is inserted through this incision and then brought up to the breast. Advantages of the trans-umbilical technique include a single scar with no scarring on the breast itself.

After making an incision, the surgeon will position the implant in the breast. The implants can be positioned in different ways. The plastic surgeon may opt to position the implant completely over the pectoral muscle, completely under the pectoral muscle, or half under the pectoral muscle. The last option is known as dual plane. During your consultation with the plastic surgeon, you will discuss which position will have the best result for you. The most important criteria in deciding whether to place the implant under the pectoral muscle are thickness of skin and volume of fatty tissue. If the skin is not thick enough, the implant may be visible if the implant is positioned above the pectoral muscle. This creates an unnatural result. Once the breast implant has been positioned, the pocket is closed and then the skin is stitched together with absorbable stitches.The wound is then taped with steri-strips, over which a transparent watertight plaster is placed.

Duration

Breast Augmentation is an outpatient procedure, typically performed using general anesthesia. Patient is expected to walk around within few hours after surgery.

After the procedure

Soreness and swelling are likely for a few weeks after surgery. Bruising is possible, too. Expect scars to fade over time but not disappear completely.

While you’re healing, it might help to wear a compression bandage or sports bra for extra support and positioning of the breast implants. Your surgeon might prescribe pain medication as well.

Follow your surgeon’s instructions about returning to regular activities. If you don’t have a physically demanding job, you might be able to return to work within a few weeks. Avoid strenuous activities — anything that could raise your pulse or blood pressure — for at least two weeks. While you’re healing, remember that your breasts will be sensitive to physical contact or jarring movements.

If your surgeon used sutures that don’t absorb on their own or placed drainage tubes near your breasts, you’ll need a follow-up appointment for removal.

If you notice warmth and redness in your breast or you run a fever, you might have an infection. Contact your surgeon as soon as possible. Also contact your surgeon if you have shortness of breath or chest pain.

What are the risks of this procedure?

As with any surgery, there are potential risks to be aware of, including:

• Infection
• Implant leaks
• Pain and tenderness
• Excessive scar tissue
• Cosmetic dissatisfaction
• Asymmetry

Life after breast augmentation

The results of a breast implant procedure are typically long-lasting. Breast implants often “last” as long as 10 years (this number is variable and can be larger or smaller) but can vary depending on the patient, type, size and shape, among other factors. Patients often elect to undergo second or even third breast augmentation procedure as they naturally age to maintain their aesthetic profile.

Patients cite this procedure as a great confidence booster, especially when patients are good candidates and maintain reasonable expectations for what breast augmentations can achieve. Asking the right questions and performing your due diligence before your procedure can go a long way to help provide a wonderful experience and ultimately reach your aesthetic goals.

Facelift Surgery (Rhytidectomy)

Face lift or rhytidectomy is a surgical procedure that is designed to repair sagging, drooping and wrinkled facial and neck skin. These problems all occur naturally with age. However, diet, smoking, heredity and obesity can all lead to accelerated aging of the skin.

Face lift surgery can help fix some of the damage caused by age. Often restores a person’s appearance to a more youthful look.

It reshapes the lower half of the face by removing excess facial skin.

Rhytidectomy can tighten loose, hanging skin around the jaw line, also known as “jowls.” It can also remove deep creases around the mouth and nose, and excess, hanging skin and fat under the chin and in the neck.

The procedure can also tighten the underlying tissues, and it may be combined with surgery to enhance the forehead, cheeks, brows, and eyelids.

It can be done alone or in conjunction with other cosmetic procedures such as an eye lift or forehead lift.

Procedure Details

The length of the procedure is 1 to 2 hours. Surgery is done by administering general anesthesia.

Incisions are made right above the hairline near temples, behind earlobe and at lower scalp. The incisions are strategically located, so they can be concealed easily after you have healed from surgery. The surgeon will use these incisions to remove excess fat tissue and loose skin. Once they have removed the excess skin and fat tissue they will close the incisions with sutures.

After the Procedure

After the procedure patient is taken to recovery. Vitals shall be monitored carefully during this time. After patient is conscious and vitals are stable he/she is moved to a regular hospital room or released from care.

After the surgery head will be wrapped in gauze in order to minimize bruising and swelling. A surgical drainage tube will be in place. The drainage tube will be removed within 1 to 2 days of the procedure.

It is important to keep the head raised for the first few days after the procedure to minimize swelling. This can be done by sleeping on two pillows rather than one.

Within 5 days of your procedure the surgeon will remove any stitches or clips. They will also remove any bandages at this time. Initially your face will be puffy and bruised, but this should subside within 4 to 6 weeks of the procedure.

Hospital Stay

Most patents are released form care within 1 day their procedure.

Recovery before traveling home

Patients seeking face lift through medical tourism can return home within 7 to 10 days of their procedure.

Travel Tip

It is best to plan an extended stay beyond your face lift procedure to allow for post-operative care. Most surgeons require several follow-ups in the days immediately following the procedure. Find a hotel near the clinic where you have the procedure for easy access to medical care. It is best to find a hotel room that is handicap accessible so you are properly accommodated during your recovery.

Self care and Life after face lift:

• No exercise for 3 to 4 weeks
• Return to work within 2 to 3 weeks
• Wear SPF 15 sun block for the first 6 months
• No smoking

Results

Generally, most patients are pain free about 2 weeks after they have a face lift. In most cases the surgical scars from a face lift are completely hidden and some will fade completely over time. Most patients are satisfied with the results of this procedure.

Risks and Complications

As is with any surgery there are risks associated with face lift surgery. The following is a list of the most common risks and complications:

• Reaction to anesthesia or medication
• Breathing problems
• Bleeding problems
• Infection
• Heart problems
• Abnormal facial contour
• Attached earlobe
• Skin blistering
• Ear nerve damage
• Facial weakness or paralysis
• Facial nerve injury
• Heavy scarring
• Loss of sideburns
• Numbness
• Skin irregularity
• Tightness

Physician is to be immediately consulted if any of the following occur:

• Face begins to swell
• Large bruises develop
• Face or lip becomes paralyzed or begins to sag on one side
• Incision is red, swollen or warm to the touch
• Stitches pull apart
• Fever above 100.5 degrees
• Chills
• Bandage is soaked with blood
• Breathing difficulty
• Chest pain
• Rash or signs of allergic reaction

Rhinoplasty (Nose Surgery)

Rhinoplasty (RIE-no-plas-tee) is surgery that changes the shape of the nose. The motivation for rhinoplasty may be to change the appearance of the nose, improve breathing or both.

The upper portion of the structure of the nose is bone, and the lower portion is cartilage. Rhinoplasty can modify bone, cartilage, skin or all three. Talk with your surgeon about whether rhinoplasty is appropriate for you and what it can achieve.

When planning rhinoplasty, your surgeon will consider your other facial features, the skin on your nose and what you would like to change.

Why it’s done

Rhinoplasty can change the size, shape or proportions of your nose. It may be done to repair deformities from an injury, correct a birth defect or improve some breathing difficulties.

Risks

As with any major surgery, rhinoplasty carries risks such as bleeding, infection and an adverse reaction to the anesthesia. Other possible risks specific to rhinoplasty include:

• Recurring nosebleeds
• Difficulty breathing through your nose
• Permanent numbness in and around your nose
• Possibility of an uneven-looking nose
• Pain, discoloration or swelling that may persist
• Scarring
• Hole in the septum (septal perforation)

Talk to your doctor about how these risks apply to you.

How you prepare

Before scheduling rhinoplasty, you must meet with your surgeon to discuss important factors that determine whether the surgery is likely to work well for you. This meeting generally includes:

• Your medical history. The most important question your doctor will ask you is about your motivation for surgery and your goals. Your doctor will also ask questions about your medical history — including a history of nasal obstruction, surgeries and any medications you take. If you have a bleeding disorder, such as hemophilia, you may not be a candidate for rhinoplasty.
• A physical exam. Your doctor will conduct a complete physical examination, including any laboratory tests, such as blood tests. He or she also will inspect your skin and the inside and outside of your nose. The physical exam helps your doctor determine what changes need to be made and how your physical features — for example, the thickness of your skin or the strength of the cartilage at the end of your nose — may affect your results. The physical exam is also critical for determining the impact of rhinoplasty on your breathing.
• Photographs. Someone from your doctor’s office may take photographs of your nose from different angles. Your surgeon may use computer software to manipulate the photos to show you what kinds of results are possible. Your doctor will use these photos for before-and-after assessments, reference during surgery and long-term reviews. Most importantly, the photos permit a specific discussion about the goals of surgery.
• A discussion of your expectations. You and your doctor should talk about your motivations and expectations. He or she will explain what rhinoplasty can and can’t do for you and what your results might be. It’s normal for people to feel a little self-conscious discussing their appearance, but it’s very important that you’re open with your surgeon about your desires and goals for surgery. Sometimes your surgeon may speak with you about performing a surgery to augment your chin. This is because a small chin will create the illusion of a larger nose. It’s not required to have chin surgery in those circumstances, but it may better balance the facial profile.

Once the surgery is scheduled, you’ll need to arrange for someone to drive you home if you’re having an outpatient procedure.

For the first few days after anesthesia, you may have lapses of memory, slowed reaction time and impaired judgment. So arrange for a family member or friend to stay with you a night or two to help with personal care tasks as you recover from surgery.

Food and medications

Avoid medications containing aspirin or ibuprofen (Advil, Motrin IB, others) for two weeks before and after surgery. These medications may increase bleeding. Take only those medications approved or prescribed by your surgeon.

If you smoke, stop smoking. Smoking slows the healing process after surgery and may make you more likely to get an infection.

What you can expect

Rhinoplasty is not a procedure with a set series of steps. Each operation is unique and is customized for the specific anatomy and goals of the person undergoing the procedure.

Rhinoplasty may be done inside your nose or through a small external incision at the base of your nose, between your nostrils. Your surgeon will likely readjust the bone and cartilage underneath your skin.

Your surgeon can augment your nasal bone or cartilage in several ways, depending on how much needs to be added, the structure of your nose and available materials. For small changes, the surgeon may use cartilage harvested from deeper inside your nose or from your ear. For larger requirements, the surgeon can use cartilage from your rib, implants or bone from other parts of your body.

During the surgery

Rhinoplasty requires local anesthesia with sedation or general anesthesia, depending on the complexity of the surgery and your surgeon’s preferences. Discuss with your doctor beforehand which kind of anesthesia is best in your case.

• Local anesthesia with sedation. This type of anesthesia is usually used in an outpatient setting and is limited to a specific area of your body. Your doctor injects a pain-numbing medication into your nasal tissues and sedates you with medication injected through an intravenous (IV) line. This makes you groggy but not fully asleep.
• General anesthesia. You receive the drug (anesthetic) by inhaling it or through an IV line — a small tube placed in a vein in your hand, neck or chest. General anesthesia affects your entire body and induces a temporary state of unconsciousness. General anesthesia requires a breathing tube.

After the surgery, you’ll be in a recovery room, where the staff monitors your return to wakefulness. You might leave later that day or, if you have other health issues, you might stay overnight.

After the surgery

After the surgery you need to rest in bed with your head raised higher than your chest, to reduce bleeding and swelling. Your nose may be congested because of swelling or from the splints placed inside your nose during surgery.

In most cases, the internal dressings remain in place for one to seven days after surgery. Your doctor also tapes a splint to your nose for protection and support. It’s usually in place for about one week.

Slight bleeding and drainage of mucus and old blood are common for a few days after the surgery or after removing the dressing. Your doctor may place a “drip pad” — a small piece of gauze held in place with tape — under your nose to absorb drainage. Change the gauze as directed by your doctor. Don’t place the drip pad tight against your nose.

To further decrease the chances of bleeding and swelling, your doctor may ask that you follow these precautions for several weeks after surgery:

• Avoid strenuous activities such as aerobics and jogging.
• Take baths instead of showers while you have bandages on your nose.
• Don’t blow your nose.
• Eat high-fiber foods, such as fruits and vegetables, to avoid constipation. Constipation can cause you to strain, putting pressure on the surgery site.
• Avoid extreme facial expressions, such as smiling or laughing.
• Brush your teeth gently to limit movement of your upper lip.
• Wear clothes that fasten in the front; don’t pull clothing, such as shirts or sweaters, over your head.

In addition, don’t rest eyeglasses or sunglasses on your nose for at least four weeks after the surgery, to prevent pressure on your nose. You can use cheek rests, or tape the glasses to your forehead until your nose has healed.

Use SPF 30 sunscreen when you’re outside, especially on your nose. Too much sun may cause permanent irregular discoloration in the skin of your nose.

Some temporary swelling or black-and-blue discoloration of your eyelids can occur for two to three weeks after nasal surgery. Swelling of the nose takes longer to resolve. Limiting your dietary sodium will help the swelling go away faster. Don’t put anything such as ice or cold packs on your nose after surgery.

Your nose changes throughout your life whether you have surgery or not. For this reason, it’s difficult to say when you have obtained your “final result.” However, most of the swelling is gone at a year.

Results

Very slight changes to the structure of your nose — often measured in millimeters — can make a large difference in how your nose looks. Most of the time, an experienced surgeon can get results both of you are satisfied with. But in some cases, the slight changes aren’t enough, and you and your surgeon might opt for a second surgery for further refinements. If this is the case, you must wait at least a year for the follow-up surgery, because your nose can undergo changes during this time.

Frequently Asked Questions

How is rhinoplasty different from septoplasty?

Rhinoplasty is a surgery to change the shape of the nose. Because both breathing and the shape of the nose are interrelated, sometimes a rhinoplasty is performed not only to change the way the nose looks but typically it’s also performed to improve nasal breathing too.

A septoplasty is a surgery to improve breathing by straightening the wall inside the nose that divides the nasal passages into a right and a left side (nasal septum). When the septum is crooked, it can make it harder to breathe through the nose. A septoplasty is often combined with a rhinoplasty.

Is rhinoplasty a simple operation?

No. Rhinoplasty is one of the most challenging operations there is. This is due to several factors. First, the nose is a complicated three-dimensional shape that is in the middle of the face. Changes made during rhinoplasty are often very small but, when added together, can make a significant difference in the way the nose looks and functions. Because these changes are small, so is the margin for error.

Swelling and the placement of local anesthetic in the skin distort the nose during surgery, camouflaging many of the subtle changes made. Rhinoplasty is also not a procedure. In other words, there is no standard plan or set order of steps. Each operation is tailored to the needs of the patient.

Will I need to stay in the hospital?

Nearly everyone who has rhinoplasty is able to safely leave the hospital after surgery. In very rare cases, you may stay in the hospital for one night if you are having a hard time with nausea or have other health problems that need to be monitored.

How long is the recovery period?

Plan to take a week off from all obligations. By the one week appointment, people usually feel like they are themselves again.

After surgery, there will be some swelling. The swelling can take many months to resolve although most people stop noticing it after a couple of months. People are typically back to performing most activities after a week and resuming all activities after two to four weeks.

Hair Transplant Surgery

A hair transplant is a surgical procedure in which a dermatological surgeon moves hair to a bald area of the head. The surgeon usually moves hair from the back or side of the head to the front or top of the head. Hair transplants typically occur in a medical office under local anesthesia. Pattern baldness is responsible for the majority of hair loss. This comes down to genetics. Theremaining cases are due to a variety of factors, including:

• Diet
• Stress
• Illness
• Hormonal imbalance
• Medications

Different types of hair transplants

There are two types of transplant procedures: slit grafts and micrografts.

Slit grafts contain 4 to 10 hairs per graft. Micrografts contain one or two hairs per graft,depending on the amount of coverage needed.

Good Candidates for Hair Transplant

Receiving a hair transplant can improve your appearance and self-confidence.

Good candidates for a hair transplant include:

• Men with male pattern baldness
• Women with thinning hair
• Anyone who has lost some hair from a burn or scalp injury

Hair replacement isn’t a good option for:

• Women with a widespread pattern of hair loss throughout the scalp
• People who don’t have enough “donor” hair sites from which to remove hair for transplant
• People who form keloid scars (thick, fibrous scars) after injury or surgery
• People whose hair loss is due to medication such as chemotherapy

Procedure Overview

After thoroughly cleaning your scalp, a surgeon uses a small needle to numb an area of your head with local anesthesia. Next, they use a scalpel to remove a round section of your scalp covered with hair. Then they sew the scalp closed.

The surgeon next separates the removed portion of scalp into small sections using a magnifying lens and sharp surgical knife. When implanted, these sections will help achieve natural-looking hair growth.

The surgeon makes tiny holes with a blade or needle in the area of your scalp that is receiving the hair transplant. They gently place hairs in these holes. During one treatment session, a surgeon may transplant hundreds or even thousands of hairs.

After the graft, gauze or bandages will cover your scalp for a few days. A hair transplant session can take four hours or more.

Your stitches will be removed about 10 days after surgery.

You may require up to three or four sessions to achieve the full head of hair you desire. Sessions occur several months apart to allow each transplant to fully heal.

After the surgery

Your scalp may be sore, and you may need to take medications following hair transplant surgery, such as:

• Pain medication
• Antibiotics to reduce your risk of infection
• Anti-inflammatory medications to keep swelling down

Most people can return to work several days after surgery.

It’s normal for the transplanted hair to fall out two to three weeks after the procedure. This makes way for new hair growth. Most people will see some amount of new hair growth eight to 12 months after surgery.

Many doctors prescribe minoxidil (Rogaine) or the hair growth medication finasteride (Propecia) to improve hair regrowth. These medications also help slow or stop future hair loss.

Complications associated with a hair transplant

Side effects from a hair transplant are usually minor and clear up within a few weeks. They can include:

• Bleeding
• Infection
• Swelling of the scalp
• Bruising around the eyes
• A crust that forms on the areas of the scalp where hair was removed or implanted
• Numbness or lack of sensation on the treated areas of the scalp
• Itching
• Inflammation or infection of the hair follicles, which is known as folliculitis
• Shock loss, or sudden but typically temporary loss of the transplanted hair
• Unnatural-looking tufts of hair

Results

Typically, people who’ve had a hair transplant will continue to grow hair in the transplanted areas of the scalp. The new hair may appear more or less dense depending on:

• Scalp laxity, or how loose your scalp skin is
• Density of follicles in the transplanted zone
• Hair caliber or quality

• Hair curl

  If you don’t take medication (such as minoxidil or finasteride) or undergo a low level of laser therapy, you may continue to experience hair loss in non-treated areas of your scalp.

  It’s important to discuss the expected outcome with your surgeon and develop realistic expectations.

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