What is Plastic Surgery?
Plastic surgery is a surgical sub-specialty that deals with the healing and restoration of patients with injury, disfigurement or scarring resulting from trauma, disease or congenital defects. It includes aesthetic, or cosmetic surgery to correct or rejuvenate facial and bodily features not pleasing to the patient. Derived from Greek, the word plastic means molding or giving form and does not refer to the use of plastic materials.

What is aesthetic (cosmetic) surgery?
Aesthetic surgery, also known as cosmetic surgery, seeks to improve an individual’s appearance. These types of operations most often involve the nose, ears, face, forehead, eyelids, breasts, abdomen, hips and thighs.

What questions should I ask before choosing a plastic surgeon to make sure he/she is qualified to operate on me?
Bringing a checklist of questions can help ensure the safety and quality of your procedure.

Questions to ask are:

• What are your credentials?
  Verify the doctor’s medical licensure, education, training and board certification. Doctors level of experience, expertise and training vary, in order to make the best choice for yourself, it is vital that you review with the doctor that you chose. If US experience or training is important to you, be sure to ask.
• Are you certified as a Plastic Surgeon?
  There are many who claim to specialize in Plastic Surgery. Again, it is vital that you verify the doctor’s credentials. When the doctor claims to be board-certified, ask by which board.
• Do you have hospital privileges to perform this surgery?
  Some surgical procedures can be performed in the doctor’s office or other outpatient facility but it is important to find out if the doctor has operating privileges in an accredited hospital for the same procedure you are having. Before granting operating privileges, many hospitals have review committees that evaluate a surgeons training and competency for specific procedures.
• Where will you perform my surgery?
  If it’s in an office-based facility, ask if it’s accredited. If it is at a hospital, find out which facility and verify its credentials.
• How many procedures of this type have you performed?
  Also ask what training has been completed, especially in new techniques. Ask to see certificates of training.
• What are the risks involved with the procedure?
  There are risks with any surgical procedure. Find out what they are, how often they occur, and how they will be handled if they do occur.
• What is the expected recovery time?
  Be sure to discuss postoperative restrictions on activity and typical time periods for resuming work.
• What is your policy on surgical revisions?
  Some cases may require revisions to achieve the desired results. Find out about any costs for which you may be responsible.

What procedures do plastic surgeons perform?
They include Aesthetic (also called cosmetic) issues with the face, neck and trunk, including forehead, eyes, nose, ears, lips, chin, neck, breasts, abdomen, hips, buttocks, thighs, calves, arms, and skin.

Is a plastic surgeon a skin specialist?
Dermatologists specialize in skin, but the plastic surgeon has an equally important in treatments involving the skin. The skills of a plastic surgeon are especially needed when large areas of the skin must be removed and replaced especially where disfigurement may result or when these areas are in conspicuous areas such as the face. Plastic surgeons also perform skin-resurfacing techniques, for cosmetic purposes, in order to achieve healthier looking skin by reducing facial wrinkling and pigmentary changes of the skin.

Will I have a scar after plastic surgery?
Scarring is inevitable of healing, however a very fine lined scar placed in the correct orientation may be virtually invisible. A plastic surgeon spends years trying to master techniques to place scars in the most desirable location. Plastic surgeons will try to make incisions in areas that will not show, like under undergarments or along natural creases. Scars will normally fade over time, but certain areas of the body such as the back and chest, produce more severe scarring regardless of the technique used for reconstruction and closure. The severity of the scarring varies from person to person.

Please contact us so that we may discuss your specific questions and needs.

A breast lift, or Mastoplexy, is a surgical procedure to raise and reshape breasts that have sagged as a result of pregnancy, nursing, and the natural force of gravity. Mastopexy is not permanent – since no surgery can permanently delay the effects of gravity but it can reduce the size of the areola, the darker skin surrounding the nipple.

The Procedure Breast lift surgery can be performed under local anesthesia, along with intravenous sedation, or general anesthesia depending on your health, the extent of the procedure and whether you are having other procedures at the same time. Techniques vary, but the most common procedure involves an anchor-shaped incision following the natural contour of the breast. The incision outlines the area from which breast skin will be removed and defines the new location for the nipple. When the excess skin has been removed, the nipple and areola are moved to the higher position. The skin surrounding the areola is then brought down and together to reshape the breast. Stitches are usually located around the areola, in a vertical line extending downwards from the nipple area, and along the lower crease of the breast.

Breast reduction, or Reduction Mammaplasty, is the removal of excess skin and breast tissue with re-positioning of the nipple to a higher situation.  It is most frequently performed for heavy breasts that results in physical problems, rather than for cosmetic appearance.

The Procedure The surgery is performed under general anesthesia.  There are different techniques depending on how big the breasts are and how much tissue needs to be removed.  The surgery is performed with pre-operative marks as guidelines.  In moderate size breasts the nipple is left attached to underlying breast tissue, excess skin and breast tissue is removed and then the nipple is placed in a new higher position.  The remaining skin and breast tissue is sutured together.  The types of scars that commonly arise are, a scar that goes around the nipple at its new position and a scar that extends from the new nipple position downward underneath the breast.  In bigger breasts, there is often a scar that goes underneath the breast from the midline to the side.  Drains are usually required and a supportive dressing is placed after surgery.

Buttock implants are placed into each buttock area through a single incision overlying the tailbone, buttock implants are used to for augmentation or general reshaping of the buttocks.

The Procedure Procedure is carried out under general anesthesia, a two to three inch incision is made between the buttocks in the midline. Through this incision, the buttock muscle (gluteus maximums) 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. Dissolvable stitches placed in the skin incision. A bandage is placed that provides compression to the buttocks, which in turn helps reduce, the discomfort and swelling. Procedure lasts approximately two hours. The taped dressing that is applied is usually removed two to three days following surgery.

A chemical peel can revitalize and resurface skin. It can treat wrinkles and fine lines around the eyes and mouth, sun spots, age spots, freckles, blotchy skin, mild scarring, certain types of acne, pre-cancerous keratoses and scaling patches. Chemical peels cannot, however, remove loose or sagging skin, halt the aging process, change pore size, remove deep scars or broken blood vessels. The different types of peels penetrate to different levels and, consequently, produce different results, but all are similar in that they involve applying a chemical solution to remove the damaged outer layers of skin and allow newer layers to replace the old ones. The deeper a peel penetrates, the more profound the results but the more lengthy the recovery period. Chemical peels can also prove to be an excellent additional treatment following more extensive procedures like a facelift, brow lift or eyelid lift.

Most peels can be performed on the face, neck, chest, hands, arms and legs. Peels vary in intensity and depth depending upon the type and strength of chemical used. Your physician may choose to use a combination of chemicals for your procedure, in effect, tailoring the treatment specifically to your skin type and its needs.

The Procedure The treatment begins with cleansing the skin and removing all traces of grease with rubbing alcohol or acetone. The face is then rinsed with water and blown-dry with a small fan. The physician applies the chemical peeling agent so that all areas of the skin to be treated are covered evenly. A grey-white film, referred to as “frost”, develops on the skin by the end of the application. The peeling solution is left in place for a few minutes and then thoroughly removed with water.

Chin surgery, or Mentoplasty, involves the augmentation, reduction, or general reshaping of the chin. The two most common methods are: chin augmentation, which reshapes the chin by inserting a silicone implant under the skin, and chin reductions, which involve bone reduction with power bone instruments. In chin augmentation surgery, implants are used to change the underlying structure, which affects the overall balance of facial features. Often chin implants are used together with other facial implants, particularly cheek implants, however, they can be used alone. This operation is often performed in conjunction with nose surgery as well as a facelift and/or liposuction of the face and neck. Chin implants are made in various shapes and sizes. They are made out of both solid and semi-solid materials.

The Procedure

Chin augmentation is usually performed in an outpatient surgical center, either operated by your surgeon or a hospital facility. It takes between 30 and 60 minutes but depending on the extent of the procedure, it can take longer. If you are having more than one procedure, overnight hospitalization may be required.

Chin surgery can be performed under local anesthesia, along with intravenous sedation, or general anesthesia depending on your health, the extent of the procedure and whether you are having other procedures at the same time. Before your surgery, routine laboratory tests may be requested including blood counts and blood chemistries. A small incision is made, usually inside the lower lip, to create the pocket and then the implant is inserted inside the mouth, along the lower lip, directly over the jawbone or in the skin just under the chin area. The implants are made in a variety shapes and sizes. Incisions inside the mouth (intra-oral incision) are closed with sutures (stitches) that dissolve. Removable sutures are used for incisions under the chin and are taken out after five to seven days. To minimize swelling and discomfort, the chin is usually taped for about a week.

Dermabrasion is like laser skin resurfacing in that it can treat deeper wrinkles and improve the appearance of acne scars or skin discolorations and remove pre-cancerous keratoses. In addition, this treatment is useful in treating unwanted tattoos and scarring caused by chicken pox or injuries. Dermaplaning is a similar treatment but involves deeper planing of skin, which is used for crater-like scars. Dermabrasion penetrates much deeper than chemical peels and the skimming of the outer layers of skin to the dermis layer causes the skin to produce collagen. Dermabrasion is also performed in conjunction with more extensive procedures like a facelift, brow lift, or eyelift.

The Procedure

Dermabrasion is usually performed in a physician’s office or in an outpatient surgical center, either operated by your physician or a hospital facility. If you are having another procedure, such as a facelift or eyelid lift at the same time, then overnight hospitalization may be required. Dermabrasion and dermaplaning are fairly quick procedures, but depending on the extent of the treatment it can take a few minutes to an hour or more. It is not unusual for your physician to recommend that the procedure be repeated or done in stages, especially when treating deep scars or a large area of skin.

A full face-lift, or Rhytidectomy, is an operation to improve the loose skin of the neck, the jaw line, the deeper wrinkle lines, and the corners of the mouth.  It may be combined with other procedures to improve the fine wrinkles on the face.

The Procedure There are a number of different techniques used to tighten the skin on the face.  The surgery is usually performed under general anesthesia and may be aided by using endoscopic surgical techniques. The surgery is performed through an incision that starts in the temporal hair area, downwards  in front of the ears, curving underneath the ear lobe, and then extends up behind the ear sometimes into the hairline.  Depending on the extent of surgery performed you can be in hospital from one to three days.  After you wake up it is likely that you will have soft padding around your face and you may have drains. It is also likely that there will be an intravenous drip to provide fluid.  The nurses will check your blood pressure, pulse and temperature on a regular basis and observe the color of the skin of your face.

Facial Implants, or Malarplasty, is the medical term used to describe the augmentation or general reshaping of the cheeks and jaw. In cheek and jaw augmentation surgery, implants are used to change the underlying structure, which affects the overall balance of facial features. Often cheek implants are used together with other facial implants, particularly chin implants, however, they can be used alone. These procedures are often performed in conjunction with other cosmetic procedures such as facelift, nose surgery, eyelid surgery, and chin surgery. Cheek and jaw implants are made in various shapes and sizes and are made out of both solid and semi-solid materials. The Procedure

The procedure is usually performed in an outpatient surgical center, either operated by your surgeon or a hospital facility, and takes between 30 and 60 minutes, but depending on the extent of the procedure, it can take longer. If you are having more than one procedure, overnight hospitalization may be required.

Cheek and jaw augmentation can be performed under local anesthesia, along with intravenous sedation. General anesthesia may be advised depending on your health, the extent of the procedure and whether you are having other procedures at the same time. Before your surgery, routine laboratory tests may be requested including blood counts and blood chemistries. Cheek augmentation involves placing the implant over the cheekbone through an incision made inside the mouth or through an opening just beneath the lower eyelash. The incision blends with the lash line and is nearly unnoticeable. The surgeon creates a pocket in the tissue and then inserts the implant. The implant is placed directly on or below the cheekbone. Incisions are closed with sutures (stitches) that dissolve in a week or two. In some cases a small titanium screw may be used to attach the implant to the bone. After surgery, a dressing will be applied to minimize discomfort and swelling. Insertion of a jaw implant usually takes about one to two hours. Incisions are made inside the mouth on either side of the lower lip. The surgeon creates a pocket into which the lower-jaw implant can be inserted. The incisions are closed with dissolving stitches.

As the skin ages, it begins to lose its elasticity resulting in frown lines, wrinkling across the forehead, and an increasing heaviness in the eyebrows. Forehead lifts are an option if you have a sagging brow or deep furrows between the eyes. This procedure is usually done between age forty and sixty-five but can be performed at an earlier age. A forehead or brow lift tightens loose skin and removes the excess, forehead wrinkling and drooping brows are modified. When necessary, part of the muscle that causes vertical frown lines between the brows is also removed. Although a brow lift may make you look younger, it cannot curb the ageing process. This procedure is often performed in conjunction with a facelift, which eliminates sagging in the jowls and neck. Eyelid surgery may also be performed at the same time but, sometimes, patients who believe they need upper-eyelid surgery find that a forehead lift can achieve the desired results.

It is important to note that the texture of the skin is not changed by a forehead lift. Although the skin may be tightened, scars, age spots, fine lines and creases will soon return to their original texture. In such cases, skin treatments like laser skin resurfacing, dermabrasion and chemical peels improve the texture of the skin and are frequently used in combination with a forehead lift. Finally, injectable fillers such as collagen can plump forehead lines and Botox injections can retard the formation of wrinkles.

The Procedure Most forehead lifts are performed under local anesthesia, combined with a sedative to make you drowsy. This keeps you in a twilight state, you'll be awake but relaxed, and although you may feel some tugging and mild discomfort, your forehead will be insensitive to pain. Some surgeons, however, prefer to use general anesthesia. To begin with, your hair is tied back with rubber bands on either side of your head where the incision will be made. The head does not need to be shaved, but hair growing directly in front of the incision line may need to be trimmed. There are two techniques used for forehead lifts, the coronal brow lift and the endoscopic forehead lift, both of which take about an hour or two.

For a coronal brow lift, the incision is made slightly behind the natural hairline, running from ear to ear across the top of the head, in the same place that a hair band or headset would sit. The incision is usually made well behind the hairline so that the scar is visible.

After the incision is made, the skin of the forehead is lifted away from the underlying tissue so that it can be removed and the muscles of the forehead can be reduced or released. The eyebrows may also be elevated and excess skin at the incision point is trimmed away. The incision is then closed with stitches or clips. Your face and hair is to be washed to prevent irritation and the rubber bands holding the hair are removed.

Some surgeons do not use any dressings, while others choose to cover the incision with gauze padding and wrap the head in an elastic bandage.

The endoscopic forehead lift typically requires the same preparation steps as the coronal brow lift procedure. This technique leaves minimal scars and has a shorter recovery period. Rather than making one long coronal incision, however, your surgeon will make between three to five scalp incisions of less than an inch in length. An endoscope, a small wand with a camera on the end connected to a monitor, is inserted through one of the incisions. The endoscope allows the surgeon to have a clear view of the muscles and tissues beneath the skin. Another instrument is then inserted through a different incision, the forehead skin is lifted and the muscles and underlying tissues are removed or released. The eyebrows may also be lifted and secured into their higher position by sutures beneath the surface of the skin or by temporary fixation screws placed behind the hairline. Finally, the incisions are closed with stitches or clips and the hair and forehead are washed. Again, depending on your surgeon’s individual preference, gauze and an elastic bandage may also be used.

Hair transplantation refers to the surgical movement of permanent hair with its roots to an area of bald or balding skin. Hair transplantation is an effective and permanent solution for hair loss. In almost all cases of so-called "male-pattern baldness", there is a permanent fringe of hair along the side and back of the scalp. This hair demonstrates "donor dominance". This means it will grow permanently even if it is moved to an area which is bald or balding.

The Procedure In a hair transplant, hair is taken from donor sites and placed in the affected area. Hair is usually taken from the side and the back of the head, which is usually not affected by male-pattern baldness. The extracted hair is usually called a graft. Grafts include not only the hair follicles, but also the surrounding tissue and skin. The hair is then placed into small slits created by the doctor in the balding areas of the scalp. Hair transplantation is done under local anesthesia as an outpatient procedure. Hair and follicles are removed from the "donor area" of permanent hair along the back and sides of the head. The surrounding hair immediately camouflages this area.

The removed hair follicles are then divided into individual grafts of varying sizes. The smallest grafts contain 1-2 hairs and are often referred to as "follicular units" or "micro grafts". Larger minigrafts may contain up to 6 hairs and can provide more density per graft. Choice of number and type of graft is made taking into account the patient's hair type, quality, color and the area to be transplanted. Once prepared the grafts (hair and its roots) are then inserted into the thin area. Hair transplantation is an office procedure that takes approximately four to eight hours depending on the extent of the planned procedure.

Liposuction, or Lipoplasty, is the removal of fatty tissue from underneath the skin using small incisions and metal cannulas.  It can also be called 'body contouring, lipoplasty or liposculpture'.  It tends to work best for treating localized areas of fat that have not responded to diet.  In some situations ultrasound treatment may also be used in order to assist dissolving the fat prior to removing it by suction.

The Procedure Small areas of liposuction can be carried out under local anesthesia.   For bigger areas the procedure is performed under a general anesthetic.  The area of the body which has the excess fat is usually marked out prior to surgery to identify those areas that are most prominent.  During surgery, small incisions are made. Some fluid is then introduced into and around the fat in order to assist removal of the fat.  The fat is then sucked out. Extreme care is taken not to damage the overlying skin or underlying important structures like nerves and blood vessels. The small incisions are closed with dissolving stitches.  The surgery is usually performed as a Day Case. After the operation, it is likely that the patient will need to wear an elasticized garment in order to help control the swelling and improve the overall shape. Liposuction may also be used in conjunction with other procedures such as a face-lift, in order to provide better definition of certain areas (e.g. under the chin).

A neck lift, or Platysmaplasty, often referred to as a “mini-facelift” or a “minimal or partial facelift”, corrects for a minimal amount of loose skin around the neck. This procedure concentrates solely on the neck area and, although it can yield dramatic effects to the neckline without undergoing a full facelift, it is not for individuals who have a considerable amount of loose skin under the jaw or in front of the neck. It is, however, a good option for younger patients who do not require as much correction. It is not only faster but less invasive which means reduced swelling, scarring, bruising and risk. While a neck lift may make you look younger, it cannot curb the ageing process. The Procedure

Procedures are usually performed in an outpatient surgical center, either operated by your surgeon or a hospital facility, and take about an hour.

Neck Lift surgery can be performed under local anesthesia mild sedation, under “twilight anesthesia” (which is local anesthesia with heavy sedation) or under general anesthesia. Usually long or multiple procedures are performed under general anesthesia.

In a Neck Lift, the surgeon can remove some of the saggy and redundant neck skin through incisions behind the ear and under the chin area. Sometimes the incisions extend in front of the ear as well. The muscle under the chin is tightened and elevated by placing a suture across the neck crease. Loose skin is tightened by pulling the skin upward and backward and removing the excess skin from behind the ear. The incisions are closed with sutures that will be removed after one to two weeks, self-dissolving sutures or, in the scalp area, removable surgical staples.

Spider veins, Sclerotherapy, are noticeable small veins that are close to the skin's surface in a branch-like or linear formation.

Spider veins should not be confused with Varicose veins, which are caused by faulty valves in the venous system, creating twisted and swollen veins. Varicose veins are larger, darker and tend to bulge with a rope-like texture on the skin's surface. Varicose veins are also more likely to cause pain and be related to more serious vein disorders. Treatment of varicose veins is generally considered outside the realm of cosmetic surgery and patients are often referred to a vascular surgeon. The Procedure Spider veins can be treated by sclerotherapy or laser surgery. Spider veins on the face can be treated with lasers. Leg spider veins are treated with sclerotherapy

Thigh lifts are surgical techniques to eliminate loose and sagging skin. The Procedure The procedure is usually performed in an outpatient surgical center, either operated by your surgeon or a hospital facility, and takes 2-3 hours, but depending on the extent of the procedure, it can take longer. If you are having more than one procedure, overnight hospitalization may be required. Lift surgery can be performed under local anesthesia, along with intravenous sedation, or general anesthesia depending on your health, the extent of the procedure and whether you are having other procedures at the same time.

For thigh lifts, excess skin is lifted and removed through incisions made in the inner thigh and/or high upper outer thigh. The incisions are extensive but are usually not visible when clothing is worn. Simultaneous lifting of the thighs and buttocks is done using incisions that follow a French-cut bathing suit line only a bit higher up on the hip. The surgeon lifts and removes the excess skin down to the muscle and removes the thick layer of fat beneath the skin. Drain tubes may be placed at the incision to draw out fluids.

Tummy Tuck, or Abdominoplasty, means removal of excess skin and fatty tissue from the anterior abdominal walls.  It is also called an apronectomy.  Excess fat on the anterior abdominal wall may be caused by being generally overweight or having been pregnant with the skin stretching over the abdominal wall which has lost its elasticity and does not return to its pre-pregnancy state. Weakness of the anterior abdominal wall muscles can be related to excess weight gain, pregnancy, or general abdominal wall weakness. If the skin has lost its elasticity, removal of the fat can result in the overlying skin becoming wrinkly and indented.  The exact type of operation that would be performed, the amount of skin that would be removed and the potential use of liposuction during the surgery would be discussed with each individual, prior to the operation. The surgery is likely to be of most benefit and last longer if you have finished having your family.  It is probably unwise to go through this major surgical operation if you have any chance of having children in the future.  Pregnancy is likely to undo all the work that has been done, and would therefore be something that most surgeons would be reluctant to undertake this procedure unless there were very firm assurances that you did not wish to become pregnant in the future.

The end result is to improve the shape of the anterior abdominal wall and to decrease the bulging that can occur between the umbilicus and the pubic bone area. 

The Procedure You will be given a general anesthetic and be completely asleep during the surgery.  The operation takes from about one hour to an hour and a half to perform. If it has been necessary to tighten up your stomach, you will find that on return to the ward you will be nursed with your knees and hips bent.  This may be with you lying on the left or right side or if lying on your back, with some pillows underneath your knees.  This is to take the pressure off the muscle to help with post-operative pain and discomfort.  It is also likely that there will be drains and you will be required to wear anti-embolism stockings.  The nurses will make regular post-operative checks of temperature, blood pressure and pulse rate. It is likely that there will be an intravenous drip in place, in order to provide fluids until you feel like eating and drinking again.  It is likely there will be a firm bandage around your stomach, which may have Velcro fastenings that can be loosened if it becomes too uncomfortable. This supports the surgery that has been done and decreases swelling.

Arm lifts, or Brachioplasty, are surgical techniques to eliminate loose and sagging skin. The Procedure The procedure is usually performed in an outpatient surgical center, either operated by your surgeon or a hospital facility, and takes 2-3 hours, but depending on the extent of the procedure, it can take longer. If you are having more than one procedure, overnight hospitalization may be required. Lift surgery can be performed under local anesthesia, along with intravenous sedation, or general anesthesia depending on your health, the extent of the procedure and whether you are having other procedures at the same time.

For an arm lift, incisions are made on the inner and under surface of the arm, often in a zigzag pattern. The surgical opening may run from the armpit to as low as the elbow. As the excess skin and fat is removed, the remaining skin is stretched and sutured into place and the incisions are bandaged. An arm lift usually takes about two hours. After a monitored time in the recovery room, patients can usually go home the same day.