Depending on the procedure, your recovery period and related results may be relatively short (as in an eyelid surgery) or longer (as in a trunk liposuction). When you see yourself for the first time, postsurgically, remember that there may be swelling, stitches, or discoloration which will decrease over time. You will not see the person you last saw prior to surgery. You need to psychologically prepare yourself.

Patients who are in a personal crisis should postpone surgery until the crisis has ended. Changing your appearance to get "back at" a divorced spouse may not leave you with the desire results. If you have not dealt with the death of a spouse and feel getting a "facelift" will help you feel better, question yourself as to why you are really doing this?

Make sure you have a support person available to you postoperatively. This should be a close friend or relative that you can rely on to discuss any feelings of self-doubt you may have. There may be periods, especially during the post operative period, where you will question yourself. This is especially true of patients who tend to take longer to recover and for procedures where the end result is longer to visualize.

Post operative depression can be mild to severe for some patients. It is normal to feel some mild discontent several days after surgery. This can be attributed to any number of physical or metabolic changes to your system. Try to get "up and out". Do things that usually make you feel good. Talk with your surgeon if you feel you may not be improving after a week.

Keep in mind, this surgery was for you. This is to make you feel and look better.

RHINOPLASTY

Rhinoplasty, or cosmetic nasal surgery, is one of the most common cosmetic procedures performed today. The operation is usually carried out because a patient desires to improve his or her appearance. It is also frequently requested for repair of injuries, or correction of disfigurement from trauma. In addition, patients may also be influenced in their desire for surgery because of breathing obstruction, or other related functional problems. As this is a common procedure, and has been carried out for many years, technical refinements have allowed consistently good results, which are considerably better than they were 25 to 50 years ago. Nevertheless, patients must understand that the goal of this operation is improvement, and that perfection usually cannot be achieved. Patients who expect too much may be disappointed. Cosmetic nasal surgery is performed to bring the nose into harmony with the face, thereby improving overall appearance.

There is no standard operation for rhinoplasty. The plastic surgeon takes into account the patient's nasal features that need to be changed, carefully examining the nasal structure and the overlying skin covering. With this information, the surgeon and patient discuss the realistic modifications that can be made to obtain the desired result. Often there is an underlying deviation of the nasal septum, which causes difficulty in breathing. This can be corrected at the same time.

The surgery is usually performed through incisions inside the nose, and if any external incision is made, it is usually small and inconspicuous. The surgeon separates the skin of the nose from the underlying bone and cartilage, re-shapes the cartilage skeleton, then redrapes the framework with the skin. The skin, with its natural elasticity, usually re-shapes nicely over the new-formed framework. This surgery can be done under local anesthesia with intravenous sedation, or general anesthesia, usually in an outpatient surgical facility. The various procedures during the reshaping include removal of the hump on the bridge of the nose, narrowing the nose, refinement of the nasal tip, and correction of the deviated septum. Chin augmentation may or may not be suggested to further enhance the facial profile. The nose is usually splinted for support and to reduce swelling. A dressing may be placed inside the nose. This dressing is usually removed within the first day or two after the procedure.

Swelling and bruising around the nose and eyes is expected for two to four weeks. Although most of the swelling subsides by six weeks, some long-term swelling may take six months to one year to resolve. Complications related to this operation include bleeding, infection, diminished sense of smell, scarring and minor irregularities. These problems are rare and resolve in time. It is important to remember that healing after this operation continues for up to a year, as the skin shrinks and adjusts to the new framework. Occasionally, the final result may be different than what was anticipated by the patient and/or the surgeon. Minor irregularities can be corrected with a revision procedure after all healing is complete.

Following rhinoplasty, the nose has an improved esthetic appearance, in harmony with the other facial features. The improved appearance of the nose is long lasting. Most patients are highly satisfied with the results of their rhinoplasty.

AUGMENTATION MAMMOPLASTY

By most estimates almost 2 million women in this country have had an augmentation mammoplasty. Breast augmentation has been one of the most gratifying cosmetic operations from the standpoint of both the patient and the surgeon, and until recent controversies over the safety of silicone implants, it was the most common cosmetic surgical operation carried out in the United States. Although every operation involves some risks, breast augmentation is generally not considered to be high risk.

While breast augmentation will enlarge the breasts, it will not alter basic asymmetries in breast shape or form. Major variations may be improved, but will not be corrected. Slight differences in the size or shape of the two breasts are considered normal, and should not be a cause for concern. Long experience with this operation has demonstrated highly satisfactory results for the majority of patients who are considered suitable candidates for the surgery.

Modern silicone prostheses have been in use for thirty years. Both silicone gel and saline filled implants have been available. There have been innumerable media reports, and even some medical reports of patients with implants developing a neurological disease or connective tissue problems, suggesting that there might be a connection between the two; however, we know of no true scientific data to support this causal relationship. Extensive studies have been carried out, and there has, so far, been no evidence that the implants or silicone have any relationship to breast cancer, or systemic illnesses in patients. At the present time, in the United States, surgeons and patients are restricted to the use of saline filled implants for primary augmentations. Many recent studies have confirmed the safety of silicone breast implants. Specifically, patients with breast implants have no higher incidence of auto immune or connective tissue disease such as rheumatoid arthritis, scleraderma or lupus, in comparison with the general population.

Breast implants are available in a round or teardrop shape, with a smooth or textured surface. The procedure may be performed using intravenous sedation with local anesthesia, or with general anesthesia. The incision may be placed in one of three locations: Under the breast in the inframammary crease, under the areola (the pigmented skin around the nipple), or in the axilla (armpit). The implant is placed under the breast tissue and on top of or under the pectoralis muscle. You and your surgeon will make the final decision regarding which approach, or which placement to use.

After the procedure, you will be advised regarding wound care, bra selection, and follow-up. You may be asked to take it easy and remain quiet the night of surgery as bleeding around the implant can occasionally occur. It usually takes about 2-4 weeks for swelling and discoloration to subside, and for you to return to a normal activity level.

Postoperative bleeding is one possible complication. If this occurs, it will usually be within the first couple of days, and may require another operation to remove a collection of blood (hematoma). Infection is very uncommon, but should it occur adjacent to the implant, it might be necessary to remove the implant to resolve the infection. A fairly common problem that can occur with breast implants is related to the natural tissue capsule that forms around the implant within the body. Even though a capsule forms most of the time, only occasionally does it thicken or contract causing unnatural firmness and/or shape to the breast. In severe cases, it can also cause pain or discomfort and can lead to the formation of fine calcium deposits. In early cases, capsule formation can be corrected by gentle external massage, but in more severe cases, further surgery is required. This condition is called capsular contracture. In the past, surgeons often recommended firm compression to treat capsular contractures, a maneuver called closed capsulotomy. This is no longer recommended in most situations, because of the risk of breaking the outer shell of the implant. After augmentation mammoplastv, many patients have breast fed without difficulty, and occasionally, stretch marks can develop.

Breast implants have never been shown to cause any form of cancer in women. Implants do make mammography somewhat more difficult to interpret. This was true more pertinently with silicone gel filled implants. If you are having a mammogram, advise your radiographer about your implants so that the mammogram technique can be modified to include the extra views recommended.

Recently, some health insurance providers are excluding coverage for breast disease if a patient has had breast implants. There is no medical substantiation for this at the present time. In spite of the potential problems, most women who have had this surgery are very happy with the results. They report feeling better about themselves, and having improved self-esteem.

REDUCTION MAMMOPLASTY

Large breasts can be the source of problems in many aspects of a woman's life. Women with large, heavy breasts may have symptoms caused by the size, weight and position of the breasts. They may have back and neck pain, grooves in the shoulders from bra straps and rashes under the breasts due to moisture collection and heat. Some women with arthritic conditions of the back and shoulders may have more symptoms than usual because of the added weight and pull of the breasts. These symptoms may contribute to limited performance in certain occupations and in sports.

Some full-breasted women may appear heavier than they really are and may have difficulty obtaining stylish clothing. In some cases, it may even be difficult to find a properly fitting bra. Often, women with large breasts feel very self-conscious. Teenagers may not develop proper poise and posture as they try to hide the fullness of their breasts, a subject they may be unlikely to discuss freely with their parents.

Finally, large breasts may be difficult to assess for lumps or masses, thus making cancer detection much more difficult for the patient or for her physician. This may well be a source of further anxiety in a patient who is already embarrassed about her condi-tion. Breast reduction can eliminate or minimize these problems. Because of these medical problems, in many cases, medical insurance will cover the cost of breast reduction.

The goal of reduction mammoplasty is to reduce and recontour the breasts. The excess skin and tissue can be removed and the mounds reshaped into smaller, more attractive breasts. The procedure is performed in the ambulatory surgery unit or hospital under general anesthesia. The nipple areola complex is repositioned upward, and if indicated, reduced in size. Excess skin and breast tissue is removed from the lower and/or outside portion of the breast. A preoperative plan is made which allows both the surgeon and the patient to share in the decision as to the proposed size of the breast after surgery. The surgeon will attempt to make the breasts as identical as possible, but some asymmetry often remains. It is also not possible to pre-dict exactly how large the breasts will be after surgery, as there is some contraction, swelling and tissue reorganization after surgery. The incisions are designed so that the scars will not be visible with normal clothing. In time they fade and become less noticeable. Drains may be left in at the time of surgery and removed in a few days. The patient is usually up and about the day of or the day after surgery. With the advent of managed care, this surgery is performed more and more on an outpatient basis. Sutures are removed in approximately one week following surgery.

Potential complications include postoperative bleeding, infection and healing problems, which may result in heavy scars. When the nipple/areola complex is transferred to its new position, it may not 'take' or heal, and a portion or all of it may be lost. This is uncommon; smoking may contribute to this problem. As the nipple is repositioned with the breast tissue during the procedure, this can lead to disturbance of the superficial nerves to the nipple, and a decrease in sensation may occur. Ability to breast-feed will also be lost in most women undergoing this operation. Since these conditions are usually expected side effects of breast reduction surgery, a woman should consider these factors seriously before deciding to have the surgery. Although every attempt is made to obtain symmetry, there may be some irregularities in the size and shape of the breasts and in the position of the areola and nipple.

Most women report that their back and neck pain is reduced. They have fewer problems finding suitable clothes and are able to become more involved in sports. There is always a time of adjustment, and breast reduction usually results in the quickest body-image change. Therefore, most women need time to adjust to their new look. Most women are very pleased with the results.

ABDOMINOPLASTY (TUMMY TUCK)

Abdominoplasty is an operation designed to remove the excess fat and skin of the abdomen, and at the same time, tighten the muscles of the abdominal wall. Following pregnancy, or loss of weight, a patient may have residual excessive skin and/or fat on the abdomen, along with stretching of the abdominal muscles. When the only problem is excess fat in this area, and the skin and the muscles are not stretched, this can be corrected by liposuction alone. More commonly, the problem involves stretching of the skin and muscles, along with the excess of fat, and an abdominoplasty has to be performed to correct all three problems.

This operation is usually performed under general anesthesia in an outpatient surgical center. Though, some surgeons may have the patient spend one or more nights in a post surgical facility. The operation usually takes two to three hours to perform. It is usually necessary to restrict physical activities for a few weeks after surgery, and it may take four to six weeks before the patient returns to completely normal activities. Patients are usually given abdominal support in the form of an abdominal binder, for a few weeks after surgery.

The operation is performed through an incision along the lower abdomen, just above the pubic hairline, extending from one hip to the other. Another small incision is made around the belly button, which is left attached to the abdominal wall. The skin and fat are then elevated, and at this time, as needed, some fat may be removed from the flanks using liposuction. If needed, the abdominal muscles are tightened by stitching them together along the mid line. This will also tend to shorten them. The excess skin and fat is removed, and the residual skin and fat is pulled down and stitched into position. This usually requires the patient to be flexed at the hips at the time of the operation. The belly button is brought out through a small incision, and stitched to the new skin, in its normal position. Occasionally, drains are left beneath the skin for several days following the operation.

There can be some swelling and fluid collections following surgery, and it may be months before all of the swelling has subsided. There is numbness in the skin of the abdominal area, and occasionally in the upper thighs and flank areas, which can take a few months to improve. The scars around the belly button and the lower part of the abdomen gradually fade, and become less visible. Occasionally, the scars can become wide because of tension. Stretch marks and old scars in the lower part of the abdomen will be removed during the course of the surgery, but all of these may not be gone. Other complications, as in all operations, include bleeding, infection, and healing problems, leading to thicker scars. There may be some lack of symmetry, and because the skin has been undermined, there is a slight risk of inadequate circulation and loss of some skin. This risk is greater in patients who smoke, and these patients are usually advised to quit smoking a few weeks prior to surgery. Patients are also advised to refrain from taking aspirin or other medications that can cause bleeding. Another serious, though extremely rare complication of this operation may be blood clots in the legs.

Patients enjoy a more attractive figure with a firmer, flatter abdomen after abdominoplasty, and are usually delighted when trying on new clothes.

LIPOSUCTION

When we gain or lose weight, we are not adding or subtracting fat cells, but are changing the amount of fat within each cell. Fat cells lie beneath the skin throughout the body, but accumulate in greater amounts in certain areas. It is not surprising, therefore, that many people find in spite of weight loss; they are left with bulges or fat deposits in certain areas on the body. Liposuction is a surgical technique in which special probes, attached to a high suction pump, are passed through tiny punctures made in inconspicuous places around the body. Fat cells are then suctioned out, allowing the surgeon to shape and contour various parts of the body.

In 1982, removal of fat from the body by suction technique was brought to this country from France. Today, it has proven to be a safe and effective surgical technique that can result in a better body contours, with minimal scarring. This procedure gives the best results when used to remove localized areas of undesirable fat, after one has reached an appropriate weight with diet and exercise. It is a suitable operation for both men and women. Liposuction can be performed on virtually any area of the body, and is particularly useful in the neck, abdomen (tummy), waste, hips and thighs. In addition, it can be used on the arms, buttocks, calves, and ankles. In men, liposuction can be used to correct gynecomastia (enlarged breasts), and is frequently used to reduce excessive fat around the waist. Age is not a factor if the patient is in good general health. Liposuction is considered a contouring procedure, and is not specifically intended for the treatment of obesity. It can however, be an adjunct to diet and physical conditioning in the management of over-weight patients, where contour problems play a distinct role. If very large volumes of fat are to be removed, it may be necessary to carry out more than one operative procedure over time.

Except in instances where only a small amount of fat removal is desired, this procedure is generally performed under general anesthesia. However, it can be performed almost uniformly as an outpatient procedure. The length of the procedure varies depending upon how much fat is removed. The following technique is commonly used in performing liposuction, although individual surgeons may vary the sequence, extent, and technique of each operative step. A small one half-inch incision is made in the area of fat to be removed. A long fine needle is introduced, and a special liquid is infiltrated. The infiltration of liquid is called is called the "tumescent technique". Tumescence makes it easier to remove the fat, with less bleeding, postoperative bruising and pain. Patients recover quicker and are back to their usual activities sooner as compared to older techniques. After infiltration of the fluid, a thin, blunt tipped cannula is inserted under the skin, through the same incision, and carefully manipulated through the fat tissue. The probe is attached to a high vacuum hose, which suctions out the unwanted fat cells. After the desired amount of fat is removed, the incisions are closed and dressings applied. Intravenous fluid replacement is generally not needed for tumescent liposuction surgery. The patient is usually instructed to wear a pressure garment, to reduce swelling and aid in the healing process. In spite of this, there will be some swelling and discoloration, which will subside over a period of several weeks. The swelling may take many months to completely go away.

All surgical procedures carry certain risks. Fortunately, serious complications are very uncommon after liposuction. While there have been reported cases of perforation, skin loss, severe scarring and even death, these are extremely rare. Other complications such as infection, and blood clots in the lungs have also been reported, but again are rare. Minor problems, including serum filled pockets, or collections of blood under the skin, will resolve with time. The most common problem is a waviness or sagging in the skin, resulting from irregular fat removal or inadequate skin shrinkage over the newly contoured areas. Cellulite (dimpling) and other surface irregularities that were present before surgery will still be present after the procedure. Postoperative dimpling is more common in patients with poor skin elasticity. This problem can be minimized by faithful use of elastic garments for a few weeks following surgery, as per your plastic surgeon's recommendations. The area is frequently numb for sometime after surgery, but normal sensation usually returns after a period of time. Sometimes, minor secondary procedures are required to achieve the best results.

Ultrasonic liposuction

This technique is a useful innovation in cosmetic surgery. This procedure uses sound waves to break up fat cells before the fat is suctioned from under the skin. This technique utilizes ultrasound energy to break up the fat cells, and converts the fat to oil so that it can be removed more easily. The ultrasonic generator is attached to a special cannula. Tumescent fluid is introduced into the area from where the fat is to be removed. The ultrasound energy then breaks up the fat cells. The emulsified fat is then suctioned out through the hollow cannula. With ultrasonic liposuction, it is possible to remove fat from difficult areas such as the upper abdomen, flanks, hips and back. It is also possible to remove more fat in an area that is re-operated upon. Ultrasonic liposuction is not a replacement for traditional tumescent liposuction, but used in conjunction, allowing the surgeon to remove fat from more difficult areas. The results of ultrasonic liposuction are similar to traditional liposuction. There is, however, the possibility of more complications. If you're planning to have liposuction, make sure you discuss this in detail with your surgeon. Ultrasonic liposuction is a fairly new technique, and there are surgeons that may not be completely comfortable using it.

BLEPHAROPLASTY

Eyelid surgery is performed to give the eyes a more youthful, alert appearance. By removing excess fat, and possibly excess skin and muscle, from the upper and lower eyelids, eyelid surgery corrects eyelid drooping and under eye bags. Both of these make a person appear more tired and older.

Eyelid surgery may be performed in conjunction with a face lift, brow lift, or laser resurfacing, depending upon patient preference and/or need. It is not uncommon to perform only upper or lower eyelid surgery, again depending upon patient need and/or preference.

Eyelid surgery is usually performed around the age of 35 or older, but may be performed earlier in patients with a predisposition to bulging fat pads below the eyes.

The operation is performed through incisions made in the fold of the upper eyelid and just below the lash line in the lower eyelid. Once incisions are made, fat pads which cause bags are removed; if necessary, excess skin and/or muscles are excised in order to improve tone and appearance.

When the problem in the lower eyelid is primarily bulging fat, without excess skin, the operation may be carried out through an incision completely hidden inside the lower eyelid. This operation is called transconjunctival eyelid surgery. It is often performed in conjunction with laser resurfacing of the lower eyelid skin.

Most often eyelid surgery is performed under local anesthesia with oral or intravenous sedation. The procedure usually takes 1-3 hours. The patient is allowed to go home following a few hours of postoperative recovery. Most plastic surgeons will recommend that a patient keep their head elevated and apply ice packs for the first 24-48 hours. Recovery is usually quite rapid with most people returning to work in one week to 10 days. Possible complications of eyelid surgery include dryness of the eyes, which may be caused by an inability of the eyelids to completely close. In most cases, this will resolve with time, but may take several months. In some cases it may be permanent, and is treated with eye drops and ointment. People who have problems with dry eyes prior to the surgery have a greater risk of this occurring. Another potential complication is drooping of the lower lids which may require further operative repair if persistent. Temporary visual changes such as blurred vision may occur, and usually resolve as the healing process continues. A complete loss of vision may occur, but is extremely rare.

FACELIFT

The traditional facelift is most effective in improving the mid and lower face, as well as the neck. Additional procedures can be performed at the time of facelift, or as separate operations, to improve the forehead and brow, eyelids, and wrinkles around the mouth. The facelift procedure is performed to tighten the skin of the face and the neck, and give the patient a more youthful, rested and freshened appearance. This procedure includes, as necessary, tightening of the muscles of the neck, and removal of excess fat in the neck.

This procedure is generally performed under general anesthesia, but can be performed under local anesthesia with intravenous sedation. Though most commonly this operation is done as an outpatient procedure, minimal activity during the first 24 hours, with some form of skilled nursing observation is recommended by most surgeons, as problems such as postoperative bleeding can occur during this time.

The operation is performed through incisions that begin on the scalp, in the temple area, and extend in front of the ear. It then continues around and behind the ear, curving into the hair-bearing scalp. The skin of the face is lifted off of the facial muscles then pulled back in a tighter position. Some surgeons may tighten the facial muscles at the same time. Both sides of the face are addressed in a similar fashion. In some patients tightening the muscles of the neck, and removal of excess fat in the neck, is also done through a small incision made beneath the chin.

The surgery can last a few hours, and the stitches are usually removed in stages over the next five to ten days. Bruising and swelling can last up to 4 weeks, and it may be several months before all of the swelling is gone. The scars fade over several months, and in most cases is minimally noticeable. In some cases scars may heal thicker than normal and require some secondary procedures. Like any operation, the risks include blood accumulation under the skin, which can cause scarring, irregularity and discoloration of the skin. Occasionally, it may be necessary to reopen the incision to remove the blood. Other problems may include infection, hair loss, and poor skin healing with scarring. Skin loss is more common in individuals who are smoke, and quitting tobacco, at least a few weeks before surgery, is strongly suggested by most plastic surgeons. Numbness in areas near the incisions is normal for several months following surgery, and in a large number of cases it resolves over a period of time. In rare situations there can be loss of function of the muscles of animation and facial expression, because of injury to the nerves supplying these muscles. In most cases this is temporary, but in rare cases it can be permanent.

The goals of facelift surgery are to give a more youthful and rested appearance, and how long the results last vary from patient to patient. Makeup can be applied within a few days after surgery.
There is no upper or lower age limit for individuals desiring this operation. While correction is usually performed in the '60s or even early '70s, over stretched muscles with lack of tone may become more difficult to repair, and the results, while still excellent, may not last as long. When surgery is carried out at a younger age, the results tend to last longer, although the initial change may not be as striking. In general, patients are extremely pleased with this kind of surgery, and some may even repeat it after a few years.

CHEMICAL PEELING

Chemical peels are most commonly performed for cosmetic reasons, i.e. diminish acne scars, and in some cases, control acne, smoothing fine lines of the facial skin, and even out skin pigmentation discolorations. Peels remove the outer layer of skin allowing the collagen and dermis layers to rejuvenate. As we age, our skin sheds naturally. If the skin that is shed is not removed, it can affect the underlying areas, forming deep wrinkles and furrows in the epidermis.

Chemical peels consist of trichloroacetic acid (TCA), alphahydroxy acids (AHA) or phenol. The specific formula is adjusted to each patient's needs once you have discussed this with your plastic surgeon.

The mildest peels are the alphahydroxy acids. These are also called glycolic peels, lactic peels or fruit acid peels. Glycolic acid can be mixed with a cream as part of a daily regime for skin care. Persons with wrinkles, acne, sun damage, or pigmentation problems would benefit from glycolic peels. The AHA peel exfoliates the stratum corneum (outer most layer) of skin. The alphahydroxy acid peels can be done more frequently to get your skin to a maintenance level of every 4-6 weeks. The recovery time is minimal and often the patients can put on their makeup and resume normal activity within 24-48 hours. The peels may cause some redness and irritation to the skin. You may also experience some flaking and dryness.

Trichloroacetic acid (TCA) is the most intense peel used for superficial blemishes, fine surface wrinkles, and pigmentation problems. The recovery time is quicker than a phenol peel with new skin within 7-10 days. TCA is used the "blue peel" and your face may appear blue immediately after the treatment. TCA is preferred for darker skinned patients. The depth of the peel can be adjusted depending on the amount of damage your skin has. You may need more than one treatment to maintain results. Any discomfort should diminish within the first week.

Phenol is the deepest peel. It can cause changes in skin pigmentation and is not recommended for use on the neck and other body areas. It is used mainly for smoothing out very coarse wrinkles and pigmentation changes caused by overexposure to the sun or the aging process. After a phenol peel, the skin may lose its ability to tan and must be protected from the sun's rays at all times. Recovery time is longer than any other peel, usually several months. A phenol peel is not recommended for darker skinned and heart patients and you should inform your plastic surgeon if you have a heart condition.

Anesthesia is not required for the peels and they can be done in the plastic surgeon's office. Before considering any type of peel, consult your plastic surgeon to review all alternatives available to you.

EAR SURGERY

Surgery of the ear is most commonly performed for correction of ears that appear too large, or for protruding ears. The usual problems with protruding ears are a lack of development of the middle ear fold, which needs to be completed.

Surgery of the ear is commonly performed upon children and young adults ages 4-18. By the age of 4 the ears are fully developed, and having the operation performed early avoids teasing. Surgery of the ear should never by considered by parents unless the child is also aware of the problem and wishes to have it repaired.

Other indications for ear surgery include "lop ear", when the top of the ear folds forwards; or "shell ear", when all of the natural folds and creases in the ear are missing. Surgery can also improve stretched earlobes, lobes torn by earrings, or lobes with large creases and wrinkles.

Otoplasty is usually performed as an outpatient procedure, allowing the patient to go home the same day. It may be performed with local anesthesia and intravenous sedation, but in the case of very young children, it is usually performed under a general anesthesia. The patient is usually instructed to wear a head dressing for two days postoperatively, then a headband to protect the ears at night. Adults are usually returning to work, and children to school, within a week. Physical activity will usually be limited for approximately one month to protect the ears.

The operation is performed by a high or middle skin incision in back of the ears. Once the incision is made, cartilage is both remolded and held in position by using sutures, or cartilage and skin may be removed depending upon the problem. Reshaping of the cartilage is performed in order to form the natural folds of the ear. The procedure usually takes 2-3 hours depending upon what needs to be accomplished.

Possible complications of the ear surgery include bleeding, infection and asymmetry in the ears. Ears are not perfectly symmetrical, and slight differences may be seen. In most cases, the results of ear surgery are very pleasing.

BREAST RECONSTRUCTION

Many women opt to have their breasts reconstructed after surgery for breast cancer or any other disease. This gives the woman a better sense of self-esteem and self worth with an enhanced appearance. A patient may elect to have the reconstruction immediately post mastectomy or wait until the mastectomy has healed and the patient has had time to adjust to the trauma.

When to have the reconstruction is something you need to discuss with your plastic surgeon preferably prior to the mastectomy. If you are not comfortable with discussing this prior to your mastectomy, you cannot expect to have the reconstruction done at the time of surgery. Your physician will be able to give you pros and cons as to when to have the reconstruction. Some patients may have to wait, depending on the type of reconstruction flap that may be necessary. The emotional readjustment most women face after undergoing a mastectomy may also re-occur when the breast is reconstructed. Normal sensation to the breast will not be restored with reconstruction but some feeling may return.

You will want your breast surgeon and plastic surgeon to work together to form a plan of treatment that will be beneficial to you. You should have the final say in what will ultimately take place.

Reconstruction of the breast is usually done in stages. The first stage is reconstructing the breast mound. If your surgeon recommends using an implant, he will discuss the options with you. The FDA has approved silicone implants only for those patients participating in approved studies. Your physician would have to be an approved investigator in order to use silicone implants. There are also saline-filled implants available to patients. Review this completely with your physician.

Some patients will require tissue expanders prior to permanent implant insertion. Your physician will insert a balloon expander beneath the skin and muscle of the chest. The expander will be injected with a saline solution over a period of time to gently expand the skin. After the skin has been expanded enough, the expander will be removed and a permanent implant inserted.

If you do not need tissue expanders, your surgeon may be able to insert implants immediately if you wish.

Several tissue flap techniques can be used instead of implants. They are more intensive, require a longer healing period; however, with your own tissue being transferred, it may look more natural to you.

In one tissue transfer, the tissue is taken from the abdomen, back or buttocks. It remains attached with its own blood supply and is transferred beneath the skin to the chest. It consists of the skin, fat and muscle. This will create a pocket for an implant or make a complete breast mound without an implant.

Another tissue transfer, tissue is taken from the abdomen, back or buttocks but is cut from the area and transplanted to the chest. The blood vessels are then revascularized by the surgeon in the new area.

In either transfer, scars are left at the place of the donor skin and where the mound is reconstructed. Over time, they will fade but may never totally disappear.

The nipple and areolar area can also be reconstructed. The areolar area can actually be "tattooed" with a natural color to look just like your matching breast.

Recovery is more complex than most reconstructive surgeries. You may have drains to remove fluids from the surgical site. You will have stitches that will most often come out within the first 7-10 days. You will probably take up to six weeks to feel your old self again. Your surgeon will give you postoperative instructions on exercises and mobility.

Your reconstructed breast may not be identical to your natural breast. Some surgeons will recommend an operation to reduce, enlarge or lift your natural remaining breast.

MASTOPEXY

Breast lift is a procedure performed to raise and reshape sagging breasts. Breast sagging is a common problem following weight loss, pregnancy or aging. With aging, the breast skin is stretched, and there is a loss of breast volume. Due to the loss of volume, the location of the nipple to the areolar complex sag downward and there is a loss of cleavage.

If breast sagging is minimal, sagging and loss of volume may be corrected with the placement of breast implants alone. In many cases, this is advantageous, as the scarring is less.

Mastopexy involves making skin incisions around the areola, vertically downward then under the breast, at the inframammary crease. Once the skin incisions are made, the nipple and areola are moved to a more normal position and excess skin from beneath the breast is removed. Closing the skin incisions then recontours the breast to a higher position, with a more youthful appearance. If the breast tissue available is made adequate to fill the desired size, breast implants may be placed at the same time depending upon the patient's desired goal.

Breast lift usually takes one to two hours, and is usually performed with local anesthesia and intravenous sedation. General anesthesia may also be used. Most mastopexy's are performed as outpatient procedures, allowing the patient to go home the same day.

Most plastic surgeons recommend minimal activity for the first week following the procedure. Usual activities are allowed by four weeks postoperatively. Possible complications include bleeding, infection, and minor differences in position of the nipples and/or minor difference in the size of the breasts. The possible side effects may be decreased sensation to the nipple and areola and there may be an inability to breast-feed. In some patients, healing problems may lead to thickened or widened scars, and loss of tissue. Breast lift is enjoyed by many women, and in the proper patient, is a very gratifying procedure.

GYNECOMASTIA

Gynecomastia is a medical term describing enlarged male breast tissue. It affects approximately 40% of young men between the ages of 11-14, decreasing to 15% by the age of 16. In young men, breast enlargement is usually the result of hormonal changes during puberty. Gynecomastia, when occurring in older men, may be the result of hormonal changes, or medications; however, most often no cause is found. Breast enlargement may be seen in one or both breasts, and involves an increase in breast tissue immediately beneath the nipple-areolar area.

An evaluation by a physician will begin with a thorough history and physical exam to uncover any identifiable causes for the breast enlargement. If the male is uncomfortable or self-conscious about the breast enlargement, breast reduction surgery can help.

The operation is most often performed using intravenous sedation and local anesthetic. It is performed as an outpatient procedure allowing the patient to go home within a few hours. The operation is usually performed through an inconspicuous incision made around the lower ½ of the areola, which is the dark colored skin around the nipple; or through an incision under the arm. Through this incision, the plastic surgeon removes the excess fat and breast tissue, leaving a flatter, more contoured chest wall.

Liposuction may be used to remove excess fat, and aid with contouring, and may be the only method used if the tissue to be removed is primarily fat, rather than breast glandular tissue.

Depending upon the amount of tissue removed, a drain may or may not be left in place. The drain is usually removed in 1-3 days following the operation.

Possible complications of the surgery for gynecomastia include bleeding, infection and injury to the skin. Some people experience decreased sensation around the nipple - areola, and this may take up to a year to resolve. Following the operation you will probably be asked to wear an elastic pressure garment for 1-2 weeks, and most plastic surgeons will recommend minimal physical activity for about three week. This will decrease the risk of any injury to the chest wall.

Most patients are able to return to work within 2-4 days depending upon the type of work. Swelling will be present for approximately 4 weeks, but it may be 4-6 months until the final results will be obtained.

LASER SURGERY

The carbon dioxide laser is an alternative to chemical peels and dermabrasian for skin resurfacing. These lasers are now commonly used to treat surface damage to the skin caused by aging, acne scarring, uneven pigmentation and damage caused by the sun. Laser resurfacing may be the best tool to treat fine lines and wrinkles around the eyes and mouth, and may be performed in conjunction with facelifts, used to correct deep skin wrinkles or sagging.

The procedure is usually performed as an outpatient, and takes 30-60 minutes depending on the extent of treatment. It may be performed with local anesthesia and intravenous sedation, or general anesthetic, depending on the amount of area to be treated. Laser surgery removes the outer layers of skin, leaving the treated area moist and raw for approximately 7-10 days.

During the initial healing phase most patients are instructed to keep the skin moist with an antibacterial ointment. The initial redness will diminish often the first 1-2 weeks, after which time moisturizers and makeup may be used. Once the surface has healed the skin will remain pink for 3-6 months. During the healing phase, it is important to avoid sun exposure and wear sun block. Moist people are able to return to work in 2 weeks.

Risks of laser resurfacing are increased pigmentation, flare up of viral infections and burns caused by laser heat.

The results of laser resurfacing are long lasting, although the natural aging process continues. Following treatment, fine lines around the eyes and mouth will be diminished, if not eliminated, and the skin should be smoother, with more even pigmentation.

Other plastic surgical uses of lasers:

The laser is commonly used to remove tattoos, "age" spots, unwanted body hair and very small veins of the legs and face. For tattoo removal, local anesthetic may be used. It may take more than one treatment before maximum benefit is achieved and if the tattoo color is very deep in the skin all of the tattoo may not be removed with this method alone. "Spider" veins of the legs or very small veins of the face may be treated without anesthesia. More than one treatment may be necessary. The area treated area will show some discoloration, which will fade with time.

Many types of lasers are available for removal of unwanted body hair. Each laser has pros and cons, so the technique and type used should be discussed with your board certified plastic surgeon. During the removal of hair, a topical anesthetic may or may not be used, depending upon the area to be treated. More than one treatment may be necessary as the hair to be removed is in different cycles of growth. Hair removal by laser is not permanent, but multiple treatments can result in long term hair reduction.

SPIDER VEIN TREATMENT

Spider veins, or tenangietasis are small, thin veins that are near the surface of the skin. They become unsightly, and appear mainly on the legs, calves and ankles. They can be hereditary or associated with pregnancy, standing or sitting too long, weight gain or a sequela of certain medications. They can appear as a "spider", thus the name, with extensions from a central point. They can also appear a branches or simple thin lines.

Plastic surgeons use "sclerotherapy" to diminish the veins. Veins are injected with a sclerosing solution to make them collapse and fade. It may take more than one injection for them to totally face away. It will not prevent other veins from surfacing in the future.

There are few complications from the procedure itself. They may range from a blood clot forming in the vein, inflammation of the site of injection, allergic reaction to the sclerosing agent used, or a small scar left on the skin. You will have some bruising for several weeks after treatment. Always choose a qualified plastic surgeon who has done a number of the procedures prior to proceeding.

Usually the surgeon will check for signs of more serious deep vein conditions on your initial visit. Varicose veins are different than spider veins and usually need surgery to correct. Your physician will discuss your current health status, medications and treatments.

Prior to the treatment you will be asked to not use any oil or moisturizer based products on your skin where the spider vein will be treated. If the veins are on the legs, you will want to wear comfortable clothing. The procedure is usually done in the physician's office with no anesthesia necessary. It usually lasts 15-45 minutes depending on the number and type of veins being injected.

Your skin may have some mild bruising after the treatment. Usually within one month after the procedure all bruising will be diminished and you will be ready to show off your new legs. Millions of women are now seeking treatment for spider veins and treatment for men is on the rise.