Hair Implant

The process of losing hair is a natural occurrence. We normally lose about 40-200 hairs daily. Our hair starts to thin out when the lost hairs out number the re-growth of the follicles. There are multiple causes of hair loss, the most important is the hereditary (genetic). This means that every hair follicle has its life course predicted from the time we are in the womb. Other causes are hormonal, stress, scarring after scalp trauma, bad nutrition and medications.

Male pattern baldness starts at different ages and areas of our head, most commonly in the crown and/or temples and frontal hair line. A female's hair loss is more of a generalized thinning of the hair affecting the whole scalp. All persons are possible candidates for hair restoration. The one important factor is the donor area, Occipital (back) and temporal areas (sides) of each candidate. The reason why the hair is taken from the occipital or temporal areas of the scalp is that these hairs will not fall in our lifetime. If you see persons in their eighties or nineties, they usually have hair in the occipital and temporal areas. It is very rare to see complete baldness unless there is some type of medication or illness behind it. Transplanted hair is for life. We have been doing hair transplants for over 25 years and have gone through the evolution from large (3-3.5 millimeters) plugs (7-10 hairs per grafts) to the present mini (3-4 hairs) and micro-grafts (1-2 hairs), (1-1.75 millimeters). Presently we place several hundred to over a thousand grafts per session. Our vast experience and the usage of mini and micro-grafts provides each patient with a natural look, which is the most important aspect of this procedure.

The procedure

Hair transplants are done in our surgical suites as an out-patient procedure with local anesthesia. The session takes an average of 2-4 hours depending on the number of grafts used. The first consultation involves a complete history of the medical and hair condition of the patient. Each patient is evaluated in a unique way. All aspects of his/her hair are evaluated: donor area, recipient area, combing styles, how many grafts and/or sessions are needed to achieve each patient's goals. What is transplanted is the follicle, which is from where the hair grows; this is inside the skin of our scalp. It is the follicle that has the genetic information of not to fall. We could transplant this follicle to any place in the same patient's body and it will grow. The procedure involves harvesting the grafts from the donor area (strip of hair) and placing them where they are needed (frontal hairline, crown area).
The donor area is washed, outline and trimmed. Next the local anesthesia is applied and the grafts are harvested. After harvesting, the donor area is sutured. The donor area is invisible since it is covered by your hair; and the suture line is very thin.

The next step is the cleaning and preparing of the mini-micro grafts for insertion into the recipient sites. The recipient area is anesthetized and then the grafts are placed in the normal direction that hair grows.

After the grafts are inserted a bandage is placed over the scalp. This dressing is removed on the morning after the procedure. The dressing is to keep the area clean and all the grafts in place for a few hours.

Hair replacement candidates should have some noticeable hair loss with healthy hair growth at the back and sides of the head to serve as donor areas.

• A tube-like instrument punches round grafts from the donor site to be placed in the area where hair replacement is desired.
• A tissue expander causes the skin of hair-bearing scalp to gradually expand.
• When the skin beneath the hair has stretched enough, it is surgically placed over the bald area.
• During flap surgery, a section of bald scalp is cut out and a flap of hair-bearing skin is sewn into its place.
• The patterns used in scalp reduction vary widely, yet all meet the goal of bringing hair and scalp together to cover bald areas. 
• The results of hair replacement surgery can enhance your appearance and self-confidence.

Post-operation phase

The patient is seen in our center the day after the procedure to remove the dressing and have a shampoo. After combing their hair they are ready to go home or work.

The first 6-7 days after the procedure the patients are asked to restrain from strenuous physical activities (jogging, playing sports), they are not allowed to go to swimming pools or the ocean for 15 days. He/she can start to do all his/her desk work, or light activity the second day. On the 8th post-operative day the sutures are removed. A scab will form over each transplanted graft. All the scabs will fall off by themselves around the 10th postoperative day. Transplanted hair starts to grow around the second month after the procedure at 1 centimeter per month for the rest of the patient's life. Once the hair starts to grow it can be treated as your normal hair; cut, wash, and comb it. This is for life.

Eyelid Surgery (Blepharoplasty)

The eyes, commonly referred to as the windows of the soul, say a great deal about a person. We evaluate people's moods or attitudes by the light in their eyes or its absence. The loose skin over your eyes and the fat bags under them make you look more tired and older than you feel inside.

Contrary to the perception that you have to be a certain age before you need to have your eyes done, young adults may also benefit from removing bags under the eyes or lifting heavy lids. The average person as early as age 25 may have enough laxity in the upper eyelid that they can obtain significant improvement and at age approximately 25-30 for the lower eyelid.

Operations on the eyelids are not only among the most commonly performed plastic surgery procedures but also the ones that give you a high degree of improvement, and satisfac

tion. It may be performed alone or in conjunction with other facial surgery procedures such as a facelift or a brow lift.

The procedure

The goal of eyelid surgery is to rejuvenate the face by restoring the shape of the eye. Blepharoplasty is usually performed under local anesthesia and sedation. Fine incisions are placed in the crease above each eye to correct problems of the upper eyelids. Then a thin crescent of excess skin and muscle is removed.

Excess fatty tissue from the middle most portion of the eyelid is also removed. Sometimes there is also excess fatty tissue at the region over the eyebrow that can be removed in the same procedure. The incisions are closed with very fine sutures. The lower eyelid has two surgical approaches. The one we use the most is through a transconjuntival approach which is an incision where the scar is hidden inside the eyelid and is performed in patients that have only excess fatty tissue.

When excess skin and muscle needs to be removed, there is an incision placed in the natural simple crease below the lash line. Skin and muscle are repositioned and excess skin is removed. Neither incision requires any contact with the eyeball itself. When the surgery is finished a lubricating ointment is frequently placed on the eyeball. The whole procedure takes usually between one and a half to two hours.

• As people age, the eyelid skin stretches, muscles weaken, and fat accumulates around the eyes, causing "bags" above and below.
• The surgeon closes the incisions with fine sutures, which will leave nearly invisible scars.
• Before surgery, the surgeon marks the incision sites, following the natural lines and creases of the upper and lower eyelids.
• Underlying fat, along with excess skin and muscle, can be removed during the operation.
• In a transconjunctival blepharoplasty, a tiny incision is made inside the lower eyelid and fat is removed with fine forceps. No skin is removed, and the incision is closed with dissolving sutures.
• After surgery, the upper eyelids no longer droop and the skin under the eyes is smooth and firm.

Post-operation phase

During the first 24 hours, cold compresses are applied to the eyelids to reduce swelling and bruising. This surgery is done as an outpatient procedure, so if the operation is performed in the morning, you will be discharged in the afternoon after resting in your suite and feel comfortable to go.

This is as close to pain free plastic surgery as you can get. You may be given prescription pain medication, but it is unlikely that you would need to use it for more than a day, if at all. Sutures are removed usually at 48-72 hours. You will be allowed to return to work in three to four days, but most people would wait a week to allow bruising to resolve.

Ear Surgery (Otoplasty)

Ear surgery, or otoplasty, is usually done to set prominent ears back closer to the head or to reduce the size of large ears.

For the most part, the operation is done on children between the ages of four and 14. Ears are almost fully grown by age four, and the earlier the surgery, the less teasing and ridicule the child will have to endure. Ear surgery on adults is also possible, and there are generally no additional risks associated with ear surgery on an older patient.

Dermabrasion/Dermaplaning

Dermabrasion and dermaplaning help to "refinish" the skin's top layers through a method of controlled surgical scraping. The treatments soften the sharp edges of surface irregularities, giving the skin a smoother appearance.

Dermabrasion is most often used to improve the look of facial skin left scarred by accidents or previous surgery, or to smooth out fine facial wrinkles, such as those around the mouth. It's also sometimes used to remove the pre-cancerous growths called keratoses. Dermaplaning is commonly used to treat deep acne scars.

Both dermabrasion and dermaplaning can be performed on small areas of skin or on the entire face. They can be used alone, or in conjunction with other procedures such as facelift, scar removal or revision, or chemical peel.

If you're considering surgery to refinish the skin, this information will give you a basic understanding of the procedure-when it can help, how it's performed, and what results you can expect. It can't answer all of your questions, since a lot depends on your individual circumstances. Please ask your doctor about anything you don't understand.

Considering alternative procedures

If you're planning "surface repairs" on your face, you may also be considering chemical peel, an alternative method of surgically removing the top layer of skin. However, dermabrasion and dermaplaning use surgical instruments to remove the affected skin layers, while chemical peel uses a caustic solution.

Many plastic surgeons perform all three procedures, selecting one or a combination of procedures to suit the individual patient and the problem. Others prefer one technique for all surface repairs. In general, chemical peel is used more often to treat fine wrinkles, and dermabrasion and dermaplaning for deeper imperfections such as acne scars. A non-chemical approach may also be preferred for individuals with slightly darker skin, especially when treating limited areas of the face, since dermabrasion and dermaplaning are less likely to produce extreme changes and contrasts in skin color.

If you'd like more information on chemical peel, ask your plastic surgeon for the ASPS brochure on that topic.

The best candidates for dermabrasion

Dermabrasion and dermaplaning can enhance your appearance and your self-confidence, but neither treatment will remove all scars and flaws or prevent aging. Before you decide to have a skin-refinishing treatment, think carefully about your expectations and discuss them with your surgeon.

Men and women of all ages, from young people to older adults, can benefit from dermabrasion and dermaplaning. Although older people heal more slowly, more important factors are your skin type, coloring, and medical history. For example, black skin, Asian skin, and other dark complexions may become permanently discolored or blotchy after a skin-refinishing treatment. People who develop allergic rashes or other skin reactions, or who get frequent fever blisters or cold sores, may experience a flare-up. If you have freckles, they may disappear in the treated area.

In addition, most surgeons won't perform treatment during the active stages of acne because of a greater risk of infection. The same may be true if you've had radiation treatments, a bad skin burn, or a previous chemical peel.

The surgery

Dermabrasion and dermaplaning can be performed fairly quickly. The procedures usually take from a few minutes to an hour and a half, depending on how large an area of skin is involved. It's not uncommon for the procedure to be performed more than once, or in stages, especially when scarring is deep or a large area of skin is involved.

In dermabrasion, the surgeon scrapes away the outermost layer of skin with a rough wire brush, or a burr containing diamond particles, attached to a motorized handle. The scraping continues until the surgeon reaches the safest level that will make the scar or wrinkle less visible.

In dermaplaning, the surgeon uses a hand-held instrument called a dermatome. Resembling an electric razor, the dermatome has an oscillating blade that moves back and forth to evenly "skim" off the surface layers of skin that surround the craters or other facial defects. This skimming continues until the lowest point of the acne scar becomes more even with the surrounding skin.

The surgeon may then treat the skin in a number of ways, including ointment, a wet or waxy dressing, dry treatment, or some combination of these.

After your surgery

Right after the procedure, your skin will be quite red and swollen, and eating and talking may be difficult. You'll probably feel some tingling, burning, or aching; any pain you feel can be controlled with medications prescribed by your surgeon. The swelling will begin to subside in a few days to a week.

If you remember the scrapes you got when you fell down as a child, you'll have an idea of what to expect from this type of surgery. A scab or crust will form over the treated area as it begins to heal. This will fall off as a new layer of tight, pink skin forms underneath. Your face may itch as new skin starts to grow, and your surgeon may recommend an ointment to make you more comfortable. If ointment is applied immediately after surgery, little or no scab will form.

In any case, you surgeon will give you detailed instructions to care for your skin after surgery. For men, this will include delaying shaving for a while, then using an electric razor at first. It's very important that you understand your doctor's instructions and follow them exactly, to ensure the best possible healing.

If you notice the treated areas beginning to get worse instead of improving, for example, if it becomes increasingly red, raised, and itchy after it has started to heal-it may be a sign that abnormal scars are beginning to form. Call your surgeon as soon as possible, so that treatment can begin early.

Getting back to normal

Your new skin will be a bit swollen, sensitive, and bright pink for several weeks. During this time, you can begin gradually resuming your normal activities.

You can expect to be back at work in about two weeks. Your surgeon will probably advise you to avoid any activity that could cause a bump to your face for at least two weeks. More active sports-especially ball sports-should be avoided for four to six weeks. If you swim, stick to indoor pools to avoid sun and wind, and keep your face out of chlorinated water for at least four weeks. It will be at least three to four weeks before you can drink alcohol without experiencing a flush of redness.

Above all, it's important to protect your skin from the sun until the pigment has completely returned to your skin - as long as six to twelve months.

Facelift (Rhytidectomy)

As people age, the effects of gravity, exposure to the sun and the stresses of daily life can be seen in their faces. Deep creases form between the nose and mouth; the jaw line grows slack and jowly; folds and fat deposits appear around the neck.

A facelift (technically known as Rhytidectomy) can't stop this aging process. What it can do is "set back the clock," improving the most visible signs of aging by removing excess fat, tightening underlying muscles, and redraping the skin of your face and neck. A facelift can be done alone, or in conjunction with other procedures such as a forehead lift, eyelid surgery, or nose reshaping.

If you're considering a facelift, this brochure will give you a basic understanding of the procedure when it can help, how it's performed, and what results you can expect. It can't answer all of your questions, since a lot depends on the individual patient and the surgeon. Please ask your surgeon about anything you don't understand.

Nose Surgery (Rhinoplasty)

Rhinoplasty, or surgery to reshape the nose, is one of the most common of all plastic surgery procedures. Rhinoplasty can reduce or increase the size of your nose, change the shape of the tip or the bridge, narrow the span of the nostrils, or change the angle between your nose and your upper lip. It may also correct a birth defect or injury, or help relieve some breathing problems.

Cheek Implant

Cheek implant surgery is a procedure used to enhance the size of the cheeks and make them more prominent, giving the face a more harmonious look.

What does cheek implant surgery do?

• It compensates the lack of volume of women's and men's cheeks.
• In some cases, it is a good idea to perform it together with a face lift, since it accentuates the rejuvenating effect.
• It makes women's cheeks look more attractive by making them more prominent and well-defined, two features that are considered characteristic of female beauty.
• It balances the relationship of volume between the cheeks and the nose. This is why this surgery is usually performed together with a Rhinoplasty.

Chin Surgery (Mentoplasty)

Chin surgery, also known as Mentoplasty, is a surgical procedure to reshape the chin either by enhancement with an implant or reduction surgery on the bone. Many times a plastic surgeon may recommend chin surgery to a patient having nose surgery in order to achieve facial proportion, as the size of the chin may magnify or minimize the perceived size of the nose. Chin surgery helps provide a harmonious balance to your facial features so that you feel better about the way you look.

Insertion of a chin implant may take anywhere from 30 minutes to an hour. During the procedure, the surgeon selects the proper size and shape implant to enhance your appearance and inserts it into a pocket over the front of the jawbone. The small incision to create the pocket and insert the implant is placed inside the mouth (along the lower lip) or in the skin just under the chin area.

Usually, the chin is taped after surgery to minimize swelling and discomfort. Sutures in the skin will be removed in five to seven days. If an intra-oral incision is used, the sutures will dissolve.

Breast Augmentation

Breast augmentation, technically known as augmentation mammoplasty, is a surgical procedure to enhance the size and shape of a woman's breast for a number of reasons:

• To enhance the body contour of a woman who, for personal reasons, feels her breast size is too small.
• To restore breast volume lost due to weight loss or following pregnancy.
• To achieve better symmetry when breasts are moderately disproportionate in size and shape.
• To improve the shape of breasts that are sagging or have lost firmness, often used with a breast lift procedure.
• To provide the foundation of a breast contour when a breast has been removed or disfigured by surgery to treat breast cancer.
• To improve breast appearance or create the appearance of a breast that is missing or disfigured due to trauma, heredity, or congenital abnormalities.

By inserting an implant behind each breast, surgeons are able to increase a woman's bustline by one or more bra cup sizes.

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Breast Reduction

Women with very large, pendulous breasts may experience a variety of medical problems caused by the excessive weight-from back and neck pain and skin irritation to skeletal deformities and breathing problems. Bra straps may leave indentations in their shoulders. And unusually large breasts can make a woman-or a teenage girl-feel extremely self-conscious.

Breast reduction, technically known as reduction Mammaplasty, is designed for such women. The procedure removes fat, glandular tissue, and skin from the breasts, making them smaller, lighter, and firmer. It can also reduce the size of the areola, the darker skin surrounding the nipple. The goal is to give the woman smaller, better-shaped breasts in proportion with the rest of her body. 

The best candidates for breast reduction

Breast reduction is usually performed for physical relief rather than simply cosmetic improvement. Most women who have the surgery are troubled by very large, sagging breasts that restrict their activities and cause them physical discomfort.

In most cases, breast reduction isn't performed until a woman's breasts are fully developed; however, it can be done earlier if large breasts are causing serious physical discomfort. The best candidates are those who are mature enough to fully understand the procedure and have realistic expectations about the results. Breast reduction is not recommended for women who intend to breast-feed.

All surgery carries some uncertainty and risk

Breast reduction is not a simple operation, but it's normally safe when performed by a qualified plastic surgeon. Nevertheless, as with any surgery, there is always a possibility of complications, including bleeding, infection, or reaction to the anesthesia. Some patients develop small sores around their nipples after surgery; these can be treated with antibiotic creams. You can reduce your risks by closely following your physician's advice both before and after surgery.

The procedure does leave noticeable, permanent scars, although they'll be covered by your bra or bathing suit. (Poor healing and wider scars are more common in smokers). The procedure can also leave you with slightly mismatched breasts or unevenly positioned nipples. Future breast-feeding may not be possible, since the surgery removes many of the milk ducts leading to the nipples.

Some patients may experience a permanent loss of feeling in their nipples or breasts. Rarely, the nipple and areola may lose their blood supply and the tissue will die. (The nipple and areola can usually be rebuilt, however, using skin grafts from elsewhere on the body)

The surgery

Techniques for breast reduction vary, but the most common procedure involves an anchor-shaped incision that circles the areola, extends downward, and follows the natural curve of the crease beneath the breast. The surgeon removes excess glandular tissue, fat, and skin, and moves the nipple and areola into their new position. He or she then brings the skin from both sides of the breast down and around the areola, shaping the new contour of the breast. Liposuction may be used to remove excess fat from the armpit area.

In most cases, the nipples remain attached to their blood vessels and nerves. However, if the breasts are very large or pendulous, the nipples and areolas may have to be completely removed and grafted into a higher position. (This will result in a loss of sensation in the nipple and areolar tissue).

Stitches are usually located around the areola, in a vertical line extending downward, and along the lower crease of the breast. In some cases, techniques can be used that eliminate the vertical part of the scar. And occasionally, when only fat needs to be removed, liposuction alone can be used to reduce breast size, leaving minimal scars.

After your surgery

After surgery, you'll be wrapped in an elastic bandage or a surgical bra over gauze dressings. A small tube may be placed in each breast to drain off blood and fluids for the first day or two.
You may feel some pain for the first couple of days-especially when you move around or cough-and some discomfort for a week or more. Your surgeon will prescribe medication to lessen the pain.

The bandages will be removed a day or two after surgery, though you'll continue wearing the surgical bra around the clock for several weeks, until the swelling and bruising subside. Your stitches will be removed in one to three weeks.

If your breast skin is very dry following surgery, you can apply a moisturizer several times a day, but be sure to keep the suture area dry.

Your first menstruation following surgery may cause your breasts to swell and hurt. You may also experience random, shooting pains for a few months. You can expect some loss of feeling in your nipples and breast skin, caused by the swelling after surgery. This usually fades over the next six weeks or so. In some patients, however, it may last a year or more, and occasionally it may be permanent.

Getting back to normal

Although you may be up and about in a day or two, your breasts may still ache occasionally for a couple of weeks. You should avoid lifting or pushing anything heavy for three or four weeks.

Your surgeon will give you detailed instructions for resuming your normal activities. Most women can return to work (if it's not too strenuous) and social activities in about two weeks. But you'll have much less stamina for several weeks, and should limit your exercises to stretching, bending, and swimming until your energy level returns. You'll also need a good athletic bra for support.

You may be instructed to avoid sex for a week or more, since sexual arousal can cause your incisions to swell, and to avoid anything but gentle contact with your breasts for about six weeks.

A small amount of fluid draining from your surgical wound, or some crusting, is normal. If you have any unusual symptoms, such as bleeding or severe pain, don't hesitate to call your doctor.

Your new look

Although much of the swelling and bruising will disappear in the first few weeks, it may be six months to a year before your breasts settle into their new shape. Even then, their shape may fluctuate in response to your hormonal shifts, weight changes, and pregnancy.

Your surgeon will make every effort to make your scars as inconspicuous as possible. Still, it's important to remember that breast reduction scars are extensive and permanent. They often remain lumpy and red for months, and then gradually become less obvious, sometimes eventually fading to thin white lines. Fortunately, the scars can usually be placed so that you can wear even low-cut tops.

Of all plastic surgery procedures, breast reduction results in the quickest body-image changes. You'll be rid of the physical discomfort of large breasts, your body will look better proportioned, and clothes will fit you better.

However, as much as you may have desired these changes, you'll need time to adjust to your new image-as will your family and friends. Be patient with yourself, and with them. Keep in mind why you had this surgery, and chances are that, like most women, you'll be pleased with the results.

Breast Lift (Mastopexy)

Over the years, factors such as pregnancy, nursing, and the force of gravity take their toll on a woman's breasts. As the skin loses its elasticity, the breasts often lose their shape and firmness and begin to sag. Breastlift, or Mastopexy, is a surgical procedure to raise and reshape sagging breasts--at least, for a time. (No surgery can permanently delay the effects of gravity). Mastopexy can also reduce the size of the areola, the darker skin surrounding the nipple. If your breasts are small or have lost volume--for example, after pregnancy--breast implants inserted in conjunction with Mastopexy can increase both their firmness and their size. If you're considering a breast lift, this brochure will give you a basic understanding of the procedure--when it can help, how it's performed, and what results you can expect. It can't answer all of your questions, since a lot depends on your individual circumstances.

• Over time, a woman's breasts begin to sag and the areolas become larger. All surgery carries some uncertainty and risk.
• Incisions outline the area of skin to be removed and the new position for the nipple.
• Skin formerly located above the nipple is brought down and together to reshape the breast. Sutures close the incisions, giving the breast its new contour.
• After surgery, the breasts are higher and firmer, with sutures usually located around the areola, below it, and in the crease under the breast.
• If your expectations are realistic, chances are you'll be satisfied with your breast lift.

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Liposuction

Liposuction is a procedure that can help sculpt the body by removing unwanted fat from specific areas, including the abdomen, hips, buttocks, thighs, knees, upper arms, chin, cheeks and neck. During the past decade, liposuction, which is also known as "lipoplasty" or "suction lipectomy," has benefited from several new refinements. Today, a number of new techniques, including ultrasound-assisted lipoplasty (UAL), the tumescent technique, and the super-wet technique, are helping many plastic surgeons to provide selected patients with more precise results and quicker recovery times. Although no type of liposuction is a substitute for dieting and exercise, liposuction can remove stubborn areas of fat that don't respond to traditional weight-loss methods.

If you're considering liposuction, this brochure will give you a basic understanding of the procedure - when it can help, how it is performed and how you might look and feel after surgery. It won't answer all of your questions, since much depends on your individual circumstances. Please ask your doctor if there is anything about the procedure you don't understand.

The best candidates for liposuction

To be a good candidate for liposuction, you must have realistic expectations about what the procedure can do for you. It's important to understand that liposuction can enhance your appearance and self confidence, but it won't necessarily change your looks to match your ideal or cause other people to treat you differently. Before you decide to have surgery, think carefully about your expectations and discuss them with your surgeon.

The best candidates for liposuction are normal-weight people with firm, elastic skin who have pockets of excess fat in certain areas. You should be physically healthy, psychologically stable and realistic in your expectations. Your age is not a major consideration; however, older patients may have diminished skin elasticity and may not achieve the same results as a younger patient with tighter skin.

Liposuction carries greater risk for individuals with medical problems such as diabetes, significant heart or lung disease, poor blood circulation, or those who have recently had surgery near the area to be contoured.

Preparing for your surgery

Your surgeon will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding vitamins, iron tablets and certain medications. If you develop a cold or an infection of any kind, especially a skin infection, your surgery may have to be postponed.

Though it is rarely necessary, your doctor may recommend that you have blood drawn ahead of time in case it is needed during surgery.

Also, while you are making preparations, be sure to arrange for someone to drive you home after the procedure and, if needed, to help you at home for a day or two.

The surgery

The time required to perform liposuction may vary considerably, depending on the size of the area, the amount of fat being removed, the type of anesthesia and the technique used.

There are several liposuction techniques that can be used to improve the ease of the procedure and to enhance outcome.

Liposuction is a procedure in which localized deposits of fat are removed to recontour one or more areas of the body. Through a tiny incision, a narrow tube or cannula is inserted and used to vacuum the fat layer that lies deep beneath the skin. The cannula is pushed then pulled through the fat layer, breaking up the fat cells and suctioning them out. The suction action is provided by a vacuum pump or a large syringe, depending on the surgeon's preference. If many sites are being treated, your surgeon will then move on to the next area, working to keep the incisions as inconspicuous as possible.

Fluid is lost along with the fat, and it's crucial that this fluid be replaced during the procedure to prevent shock. For this reason, patients need to be carefully monitored and receive intravenous fluids during and immediately after surgery.

Technique variations

The basic technique of liposuction, as described above, is used in all patients undergoing this procedure. However, as the procedure has been developed and refined, several variations have been introduced.

Fluid Injection, a technique in which a medicated solution is injected into fatty areas before the fat is removed, is commonly used by plastic surgeons today. The fluid -- a mixture of intravenous salt solution, lidocaine (a local anesthetic) and epinephrine (a drug that contracts blood vessels) -- helps the fat be removed more easily, reduces blood loss and provides anesthesia during and after surgery. Fluid injection also helps to reduce the amount of bruising after surgery.

The amount of fluid that is injected varies depending on the preference of the surgeon.
Large volumes of fluid -- sometimes as much as three times the amount of fat to be removed -- are injected in the tumescent technique. Tumescent liposuction, typically performed on patients who need only a local anesthetic, usually takes significantly longer than traditional liposuction (sometimes as long as 4 to 5 hours). However, because the injected fluid contains an adequate amount of anesthetic, additional anesthesia may not be necessary. The name of this technique refers to the swollen and firm or "tumesced" state of the fatty tissues when they are filled with solution.

The super-wet technique is similar to the tumescent technique, except that lesser amounts of fluid are used. Usually the amount of fluid injected is equal to the amount of fat to be removed. This technique often requires IV sedation or general anesthesia and typically takes one to two hours of surgery time.

Ultrasound-Assisted Lipoplasty (UAL). This technique requires the use of a special cannula that produces ultrasonic energy. As it passes through the areas of fat, the energy explodes the walls of the fat cells, liquefying the fat. The fat is then removed with the traditional liposuction technique.

UAL has been shown to improve the ease and effectiveness of liposuction in fibrous areas of the body, such as the upper back or the enlarged male breast. It is also commonly used in secondary procedures, when enhanced precision is needed. In general, UAL takes longer to perform than traditional liposuction.

After your surgery

After surgery, you will likely experience some fluid drainage from the incisions. Occasionally, a small drainage tube may be inserted beneath the skin for a couple of days to prevent fluid build-up. To control swelling and to help your skin better fit its new contours, you may be fitted with a snug elastic garment to wear over the treated area for a few weeks. Your doctor may also prescribe antibiotics to prevent infection.

Don't expect to look or feel great right after surgery. Even though the newer techniques are believed to reduce some post-operative discomforts, you may still experience some pain, burning, swelling, bleeding and temporary numbness. Pain can be controlled with medications prescribed by your surgeon, though you may still feel stiff and sore for a few days.

It is normal to feel a bit anxious or depressed in the days or weeks following surgery. However, this feeling will subside as you begin to look and feel better.

Getting back to normal

Healing is a gradual process. Your surgeon will probably tell you to start walking around as soon as possible to reduce swelling and to help prevent blood clots from forming in your legs. You will begin to feel better after about a week or two and you should be back at work within a few days following your surgery. The stitches are removed or dissolve on their own within the first week to 10 days.

Activity that is more strenuous should be avoided for about a month as your body continues to heal. Although most of the bruising and swelling usually disappears within three weeks, some swelling may remain for six months or more.

Your surgeon will schedule follow-up visits to monitor your progress and to see if any additional procedures are needed.

If you have any unusual symptoms between visits - for example, heavy bleeding or a sudden increase in pain - or any questions about what you can and can't do, call your doctor.

Your new look

You will see a noticeable difference in the shape of your body quite soon after surgery. However, improvement will become even more apparent after about four to six weeks, when most of the swelling has subsided. After
about three months, any persistent mild swelling usually disappears and the final contour will be visible.

If your expectations are realistic, you will probably be very pleased with the results of your surgery. You may find that you are more comfortable in a wide variety of clothes and more at ease with your body. And, by eating a healthy diet and getting regular exercise, you can help to maintain your new shape.

Smartlipo

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What is Smartlipo?

Smartlipo is a liposuction surgery that uses a small laser fiber to melt away fat in areas of the body. The laser is inserted through a 1 to 2 mm. incision in the skin with a tube. The fat cells are broken down by the laser and liquefied, which allows the fat to exit the body through the incision or natural excretions that are usually completed by the next day.

What's the difference between traditional liposuction and Smartlipo?

Traditional liposuction surgery requires larger incisions to be made around the area that is being treated. Fat stays solid during this procedure and is sucked out using a vacuum. This is much more traumatic for tissues than Smartlipo, and bleeding, bruises, scarring, and stitches are common afterwards.

Smartlipo's laser stimulates collagen growth, which can tighten skin after the Smart Lipo surgery. This prevents the skin over the area from appearing loose, as it can after traditional liposuction.

How long does Smartlipo take?

Most Smartlipo surgeries usually take 45 minutes to an hour. Patients may have to wear an elastic bodysuit after the surgery in order to reduce swelling, but most people can return to work after only a few days.

Who is a good candidate for Smartlipo?

People who have a healthy diet and exercise regularly, but are unable to eliminate fat in certain areas are good candidates for Smartlipo. Some people will have areas on their body with more fat than they would like no matter how carefully they watch what they eat or how often they exercise. Smartlipo is not meant to drastically reduce anyone's weight. Instead, it is used to adjust the way areas like the thighs, face, and arms look. Therefore, people who are in shape or only slightly overweight are ideal Smartlipo patients.

Is a laser used in liposuction?

Yes, lasers are used sometimes to tighten the skin after fat is removed from underneath it. To some extent, especially in younger people, the skin will tighten itself. But a laser can be used to shrink the skin from its underside, through the incisions made for the liposuction cannula. This is often done on the neck or chin area.

How long does Smartlipo take?

Due to the minimally invasive nature of Smartlipo, there are few to no side affects after the surgery. Only local anesthesia is needed during Smartlipo, which makes the surgery much safer. General anesthesia is used in traditional liposuction, making complications more likely. Less than one percent of Smartlipo surgeries have complications, compared with ten percent of traditional liposuction procedures.

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Vibroliposuction

Vibroliposuction is themost recent liposuction technique, it is safe effective and easy.The emulsionprinciple allows the removal of the fat tissue without harming any other tissues, this result in a briefer post-operation period. It also allows mayor precision in difficult access areas or areas with great fibrosis (secondary liposuctions or male liposuctions).

It is exempt from risks inherent to other techniques due to the fact that the cannulas are not heated avoiding the danger of skin necrosis. It allows a larger skin retraction, optimum results in fibrotic areas difficult to liposuction because of their location or because of existence of previous liposuctions. 

The advantages for patientsare:

• Less edema
• No lumps (Bumpy Roads)
• Better and fast recovery
• Less pain
• Fast, smaller anesthetic time
• Less traumatic (less formation of hematomes, echymoses)
• Better aspect of the skin (specificity)
• Post-operative treatments are shorter

The vibration frequency is of 10 Hz. This vibration is the same used in the painkiller TENS apparatus, that increase the comfort of local anesthesia, which produces a release of endorphins of 20 to 30 minutes before the anesthetic effect is prolonged.

These principles were object of study of over 100 scientific official notices for 3 years around the world without ever having any objections.

Liposuction assisted by compressed or medicinal air:

Advantages for the surgeon

• Easier work and less tiring
• The access to treat difficult zones (back, fibrous areas…)
• Treatment of delicate zones (knees, calves, buttock) with great precision
• More homogenous infiltration with permanent control of the infiltrated quantities per zone (memory of 7)
• Possibility to work on zones already infiltrated and/or aspirated

Security-Quality

• The Lipomatic was conceived for a secure liposculpture respecting the non adipose structures (emuslsifying effect)
• Micropumping effect allowing the acceleration of fat evacuation without increasing the depression
• No thermal liberation
• Built in safety guard
• CE - 510 (FDA) - KFDA marking

Vibrolipo® system

Vibrolipo® system represents an undeniable innovation international patented.

The complete system permits to do a quantitative infiltration with vibration and also a Vibrolipo® sculpture with the same system

Its use is rather simple and practically does not require maintenance in addition it lacks technical risks for the patient.

Vibroliposuction has been conceived with the objective of facilitating medical performance, decreasing significantly the surgeons’ effort.

It works with a pneumatic engine triggered by compressed air that endows the cannula with a triple movement: fluctuation, rotation and vibration.

As a result of these three movements a helical trajectory is generated, which will emulsify the fat tissue. This tissue will at the same time be aspired by the cannula.

This all leads to a faster recovery and the equimosis and the edema of the treatment are less. In addition the vibration stimulates the collagen synthesis during the superficial liposuction, facilitating the posterior re-adaption of the skin.

Nutation

Wipping effect       

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Abdominoplasty (Tummy Tuck)

Tummy tuck or "abdominoplasty" is the surgical procedure to remove excess skin and fat from the middle and lower abdomen and to tighten the muscles of the abdominal wall. The procedure is designed to firm and smooth the abdomen, giving patients a tighter profile.

The best candidates for "tummy tuck" are women or men who are in relatively good shape who have large fat deposits or loose abdominal skin that did not respond to diet, exercise or both. Women who had multiple pregnancies and stretched their abdominal muscles and skin will specially benefit from such a procedure. Older patients who are obese and lost the elasticity of their skin can also benefit form this procedure. Tummy tuck can be used alone or in combination with liposuction in the sides (Flanks) to achieve better results.

The procedure involves an incision across the lower abdomen, a little above the pubic area, and beneath the bikini line. An incision is also made around the belly button to free it from the surrounding skin. The skin is separated from the abdominal wall and lifted up above the rib cage.

Then loose tissue from the left and right of the abdomen is pulled together, towards the center, and sutured. This tightens muscles, provides a stronger abdominal wall and makes the waist smaller.

The skin is then lowered and the excess is removed. A new opening is made for the belly button at the proper position. The incisions are closed with sutures and a firm elastic dressing is placed over the area. After the first couple of days, the elastic dressing will be replaced with an abdominal supporter.

Depending on the amount of skin to be removed, the scar can be anything from a small incision to a long line running from one hip bone across the pubic area, above the hairline, and up to the other hip bone.

After surgery, some people return to their jobs in two weeks, while some others take three or four weeks before going back. The results of tummy tuck are usually long lasting if weight and exercise are kept.

Dr. Christian Rivera’s patient

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Butt Implant Surgery

Who are the best candidates?

An area of the body not easily enlarged, shaped by weight training or diet is the buttocks region. Individuals that wish to enlarge, lift, and shape the buttock mounds, have a variety of different size and shape buttock implants from which to choose. The decision for the shape and size of the implants is made depending on each person’s individual desires and on their general body build. Buttock implants are very soft, SOLID SILICONE implants and are completely unlike breast implants, which are soft, FLUID-FILLED sacks.

Generally, anyone in average physical condition or good health can be a candidate for buttock implant (augmentation) surgery.

About the procedure and recovery time

Placed into each buttock area through a single incision overlying the tailbone, buttock implants are positioned to look as natural as possible for the optimal cosmetic effect.

Since this is an area of the body that is required for walking, sitting, and so many other movements, patients might experience greater pain during the recovery period than other common cosmetic surgery procedures and the recovery time is usually longer. Pain medications typically are prescribed to help with the discomfort, but after approximately 5-7 days the patient is able to be up and about; moving, walking, and sitting more comfortably.

There is generally very little swelling and bruising after buttock augmentation so the results may be seen very soon after surgery. Full physical activities are usually permitted within a month after surgery.

Surgical risks may include: infection, bleeding, nerve and/or muscle damage, slippage and asymmetry.

What to expect?

With the patient asleep (general anesthesia) a two to three inch incision is made between the buttocks in the midline. Through this incision the buttock muscle (gluteus maximus) is lifted up and a pocket is made just large enough for the implant. The implant is inserted into its pocket. The opposite side is then completed. Both sides are carefully examined in order to assure that the results look natural and symmetric. Dissolvable stitches placed in the skin incision. A bandage is placed that provides compression to the buttocks which in turn helps reduce discomfort and swelling. The person leaves the office surgical center within an hour or so after the two-hour procedure. The patient may be very uncomfortable the first several days. It is difficult to turn in any position to get comfortable and it is important that someone be with the person at least overnight and probably for the next several days just to help get out of bed, prepare meals, etc.

The taped dressing that is applied during surgery to provide compression and support is usually removed two to three days following surgery. At this time the patient can take showers and begin to move around more normally. The results can be seen immediately but the buttocks look more natural and become softer as the muscle stretches during the several months after surgery.

Full activities including gym work, bicycling, and running can usually be resumed about four weeks following surgery. It may take up to six or eight months until the results feel as if they're part of the body and the patient forgets about them even being there.