Botox has revolutionized the way we look at many cosmetic surgery procedures. It is quick and safe with few side effects. There is little down time and is reversible if the patient does not enjoy the result. It is also affordable making it a great place to start your experience with cosmetic surgery.
Botox works by actually paralyzing the muscle that it is injected into. The effect take 3-5 days to be seen and results often improve with repeated treatment. The results last between 3 to 6 months depending on the size of the muscle and the amount of BotoxR injected.
Botox can be combined with other procedures such as brow lifting or eyelid surgery to give an improved cosmetic result.
Risks and complications of Botox.
The most common complication is bruising at the injection site that takes time to resolve. If the BotoxR affects certain eye muscles then drooping of the eyelid may occur and require drops or ointment until the BotoxR wears off. We take great care as plastic surgeons to understand the anatomy of the face and inject the correct muscles. There are some patients who do not respond to BotoxR or become less responsive overtime due to the formation of antibodies.
How your Botox is diluted?
This is an important question to ask and understand as you may be paying for very dilute Botox form one doctor and not getting the results you desire. Botox comes in a bottle with 100 units. We add 4 to 6 cc of sterile saline to the bottle and you are charged per treatment area with larger muscles requiring more Botox units injected. All businesses need to make a profit but we feel that patients should get value for their dollar and we hope you become a satisfied patient of Richmond Surgical Arts.
This operation can be done to correct a number of different eyelid problems. The most common request is to remove the hanging or drooping skin from the upper eyelids or the bulges/bags and or wrinkles from below the lower eyelids.
One can also correct a lid that hangs too low and covers too much of the eye. You can also change the shape of the eyelid opening should it be desired to create a more almond shape to the eye rather then a round shape which occurs as we age.
The age at when this procedure is performed varies since some patients have a genetic predisposition to heavy eyelids or bulging lower lids.
There are certain medical conditions that cause eyelid problems and evaluation by an ophthalmologist may be needed prior to surgery.
Technical aspects of the operation
The procedure is may be performed under local anesthesia, sedation or with the patient asleep. Incisions are made in the region of you natural upper eyelid crease to hide the scar so it is almost imperceptible. Excess skin and fat are removed. Sutures are used to elevate the eyelid or eyebrow. The sutures used in the skin are very fine and dissolve in 7-10 days.
Lower eyelid surgery varies more in technique depending on what the patient desires to be corrected. Small bulges may be removed from inside the eye using a so called “transconjunctival approach”. This type of procedure was developed by Paul Tessier the founding father of craniofacial surgery. There are no visible incisions on the skin with this technique. Often a laser or chemical peel of the lower eyelid skin is combined with this procedure to tighten and eliminate fine skin wrinkles. If needed a small “pinch of skin” may be removed externally to improve the cosmetic result.
Traditional lower eyelid blepharoplasty procedures to remove fat and muscle are less often performed. Modern techniques that preserve tissue and reposition the muscle and fat to restore youthful look are often performed.
If the lateral aspect of the eye has drooped or the white of the eye is showing above the lower eyelid a canthoplasty is needed to return the lid to a more youthful shape and position.
Risks of eyelid surgery
The most common complication from eyelid surgery is asymmetry of the eyelid creases. Many times these is unavoidable since the eyelids start out with creases at different levels and have different amounts of bulging and drooping. The inability to completely close the eyelids may occur after surgery. It usually resolves with time and stretching exercises.
A short period of using extra eye lubrication may be needed.
Ectropion or drooping of the lower lid after surgery may occur. Careful preoperative planning and use of conservative skin resection with use of canthoplasty help limit this problem.
Dry eyes, bleeding, poor scaring, infection and permanent visual loss are all complications that have resulted from blepharoplasty.
Ears that stand out are often a social concern for both children and adults. The correction of this deformity can be performed as outpatient surgery with minimal recovery.
Children usually undergo the operation at 5-7 years old. Adults may undergo the procedure at any time.
The goal of the procedure is to modify the skin and cartilage to allow the ear to be in a more normal position closer to the head. It is often difficult to achieve perfect symmetry of both ears after surgery. The procedure is performed under sedation or anesthesia. The incisions are hidden behind the ear or in the shadows of the front of the ear. A bulky dressing is applied after surgery and worn for 48 hours. A headband is worn for several more days and at night for several weeks. The skin sutures used dissolve and do not require removal.
This operation is performed to lift and elevate the skin and soft tissue of the neck and cheek. Patients who desire to remove the so-called “turkey neck” are often an ideal candidate for a facelift.
The goal of surgery is to elevate and restore upper facial volume by transferring the tissue that gravity and time have pulled down into the cheek, neck and jowl region.
The results of a facelift can last 7-10 or years or longer depending on a patient’s lifestyle and things like sun exposure. A “Tuck” or mini face-lift is what we recommend for our prior face-lift patients when they desire further improvement after 5-7 years from their original procedure.
This local anesthesia or light sedation procedure is a short procedure and the recovery is fast with minimal bruising and uses sutures that dissolve.
Dr. Lynam has trained and performs a variety of facelift techniques including the short scar facelift, the weekend type facelift, the midface lift as well as a traditional facelift surgery. The types of facelift you choose depends on what you desire to correct and how much recovery time you have available.
Technical aspects of the operation
This procedure is performed under deep sedation or general anesthesia in the surgery center. It is a 3-4 hours procedure and may take longer if other procedures are added such as eyelid surgery or forehead surgery.
We use tumescent anesthesia and fine cannula liposuction to remove unwanted fat in areas of the neck and jowl. The skin incisions are hidden within and around the ear and often go below the sideburn hair so not to give an unnatural or “windblown” look from lifting the sideburn hair too high.
The goal is to make you look refreshed and younger but retain your identity and sense of self. An incision behind the ear and into the scalp is used to allow for tightening the loose neck skin.
Manipulation of cheek fat is performed using internal sutures to reposition cheek fat, muscle and finally skin.
Sutures that are permanent or absorbable are used inside the skin and sutures that are fine and dissolve in 7-10 days are used on the visible skin. Sutures in the hair may be dissolve or require removal on a post op visit.
A drain to remove excess fluids may be used and usually is removed in 24-48 hours.
Additions to facelift surgery
The use of modern tissue glues can often decrease the bruising and speed recovery from a facelift. Richmond Surgical Arts offer a Fibrin Glue Facelift that can be incorporated into any of the styles of facelift you desire. It takes advantage of modern technology and goes along with our philosophy of minimally invasive cosmetic surgery. Fibrin glue is a substance which when spayed onto the tissues will seal small bleeding vessels and stick tissue surfaces together. Fibrin is a substance our body produces naturally in response to injury or surgery. We have several articles you may review about the use of fibrin glue in surgery.
Placement of implants during a facelift may be desirable to correct underlying bony atrophy or enhance skeletal form. You may desire a larger chin or cheekbones that can be placed as party of your operation. The use of you own tissue in the form of fat or dermal fascia fat grafts are often used to add soft tissue to areas of atrophy due to the aging process. Implants come in variety of shapes and materials and can be custom shaped to fit as needed.
Risks and complications of facelift surgery
The most common complications are numbness in areas of the skin. The feeling usually returns in about 6 weeks but may be permanent.
Loss of hair in the region where incisions are placed is also possible.
Infection is possible as well as is tissue loss that would require reconstructive surgery and possible hospitalization.
Bleeding that requires further surgery may occur.
Damage to the motor nerves that move the face is possible and may be permanent.
Poor healing and scarring may occur.
Smokers are well known to have a much higher rate of complications in facelift surgery and smoking should be stopped for at least 3 weeks before and after surgery.
While many people seek cosmetic eyelid surgery for “tired eyes” it is often actually the position of the brow or forehead that has sagged. A brow lift or forehead lift can be performed to lift the eyebrows as well as help reduce the wrinkles or lines along the forehead.
In the past a forehead lift required a long incision across the top of the head from ear to ear. Now using the endoscope we can elevate the deeper tissue and secure them in a higher position. There are only 3-5 short incisions hidden in the scalp.
Technical aspects of the operation
The procedure is performed in the surgery center under sedation or anesthesia. Local anesthetic solution is injected to reduce bleeding and bruising. Small incision (1 inch) are made in the hairline to insert the endoscope and endoscopic instruments.
The image from the endoscope is displayed on a TV monitor and the surgery is performed to release and remove excess muscle and lift the brow to a higher position.
Use of permanent sutures and possibly screws or tunnels in the bone are made to secure the brow tissue at a higher level.
Sometimes additional procedures such as fat grafting may be needed to fill in areas of deep wrinkles.
The small incisions are closed with sutures that dissolve in 2 weeks.
Bruising and swelling tends to resolve in 2 weeks.
Risks and complications from brow lift
The most common complications are numbness of forehead from stretching the nerves. This usually resolves in 6-8 weeks. Asymmetry of the position of the eyebrows is possible. Hair loss where the incisions are made may occur. Infection and need for removal of sutures or screws is possible.
Risks and complications of facelift surgery
This is a quick minimally invasive procedure to lift the eyebrows a small amount that can be done in the office under local anesthesia. It can often be used to shape the eyebrow to create a more pleasing shape to the eyebrow. If combined with upper eyelid surgery it may be done in the surgery center under sedation. The amount of lift is usually 2-3 millimeters.
The procedure uses local anesthesia to numb the area and reduce bleeding and bruising. The deeper tissues under the eyebrow are released similar to a brow lift procedure. Small sutures are then inserted in the eyebrow using a special instrument the suture is passed up to a higher location where it tightened and lifts the eyebrow up. Usually 2 sutures are used per eyebrow.
Risks and complication are minimal but include bruising, scarring, numbness, and possible infection that necessitate suture removal.
High prominent cheekbones have long been considered a sign of youth and beauty. The aging process or just the desire to have more prominent cheekbones may interest you in cheekbone augmentation.
The implants used may be made out of medical grade silicon or other material such as porous polyethylene. The implants come in a variety of shapes and can be custom contoured to fit you needs.
Technical aspects of the operation
Placement of cheekbone implant is usually done under sedation. The incision is place in the mouth so no visible scars are seen. The tissue over the bone is elevated and the implant position in place. A screw or suture may be used to hold the implant in position.
Risks and complications
The most common complication is asymmetry of implant placement. The implant may also be palpable under the skin and a ridge felt where the implant meets the bone. Since there are nerves and blood vessels in the region of implant placement bruising and temporary numbness may occur. Permanent nerve damage has occurred with implant placement.
The chin like the nose is a prominent facial feature and many patients seek to alter the chin to enhance their facial contour. Often chin surgery is combined with other operations to give the face harmony or balance in relation to other facial features.
Implants may be used to enlarge a chin and create a stronger profile.
Bone grafts or implant material may be used to lengthen a chin that appears too short.
Chin reduction surgery is also possible.
Technical aspects of the operation
Performed under sedation or general anesthesia depending on what procedure is performed. Using an incision in the mouth or under the chin the chin can be visualized for placement of an implant or reshaping. Implants or bony segments may need metal plates and screws to hold them in position. Incisions heal well with subtle scars and if done from within the mouth no visible scar is seen.
Risks and complications
Asymmetry of implant placement is the most common complication. Damage to nerves and numbness or pain in the region of the lower lip that may be permanent is possible. Infection of the implant requiring removal is possible. Formation of capsular scar tissue that is firm or deforming in nature is possible. Bony erosion under the implant has been reported.
This procedure is a minimally invasive procedure that is used to correct the so called “turkey neck deformity”. It has a faster recovery period then a traditional neck-lift and the incisions used are shorter and usually are only behind the ears and into the scalp.
Alloderm® is human tissue graft which has been specially prepared to allow your body to accept it and eventually replace it with you own tissue. Plastic surgeons have used this product for many years in burn reconstruction surgery.
Technical aspects of the operation
The procedure is performed under anesthesia in the surgery center. First through small incisions tumescent anesthesia is injected to allow for liposculpture that removes unwanted neck fat. After this a short incision under the chin is made to allow for further removal and recontouring of deeper neck muscles. Incisions behind the ear are made and a band of Alloderm® is inserted and sutured in place under tension to lift and support the neck tissues. Incisions are closed with sutures that dissolve in 7-10 days.
Gore-Tex® or other suture material can be used in a similar procedure to support the neck. We feel that using a product that becomes incorporated and replaced by your body offers advantages over products that do not.
Risks and complications
Risks and complications from this procedure are more limited but do include bleeding infection and possible permanent nerve damage. The neck is the only area treated with this procedure and this may be an excellent alternative to a facelift when only the neck desires rejuvenation.
A full lip is viewed as a youthful and attractive feature. As we age there may be a loss of volume and supporting structures in the lip as well as the rest of the body. You may have been born with thinner lips and desire augmentation to create a desired look.
There are a number of procedures available to change he lips.
Technical aspects of the operation
Lip augmentation is performed in the office under local anesthesia or in the surgery center under sedation. There are a number of materials on the market or coming on the market to augment the lips. We recommend injection of you own fat or use of Alloderm® to enhance the volume of you lips.
Fat is harvested from the hip or thigh region then prepared and injected in small amounts in the lips. Over correction is usually performed due to the knowledge that not all fat that is injected survives. How much fat survives can vary from none to 100%. The key in fat transfer is to use small amounts of fat and proper placement.
The postoperative course includes swelling and bruising which usually is gone in 7-10 days. Patients with a history of cold sores should be placed on prescription medicine to prevent an outbreak due to the stress of surgery. Since fat grafts may not live it is usual for this procedure to take 2 or 3 treatment to achieve a desired result. Some patients view fat grafting similar to Botox® or collagen injections and have it done 2 or 3 times a year to restore volume to areas of the face to create a more youthful appearance.
Alloderm® which is a human donor tissue graft can be inserted into the lips to augment them. Since this tissue is eventually replaced or resorbed by your body it may not be a permanent augmentation. The nice thing about this product is that it creates a soft natural feeling lip. Gore-Tex® has been reported to have a higher rate of infection and unnatural feel to the lips after augmentation. Occasionally after use of Alloderm® the lips remain swollen for 3-4 weeks. The risks and complications of bleeding and infection are present. Permanent nerve damage may occur but is rare.
Lip Lifts
This procedure is performed to raise the upper lip that has drooped and now cover more of the teeth then desired. By raising the upper lip more of teeth are seen during expressions such as smiling and create a more youthful look.
The procedure may be done in the office under local anesthesia or in the surgery center under sedation.
The procedure removes skin from right below the nose and tightens the peri oral muscles. The incision usually heals with an almost invisible scar hidden in the shadow below the nose. The most frequent complications include bleeding, infection and a visible scar.
Lip Reduction
Large lips can be inherited or result from a number of medical conditions.
The procedure may be done in the office under local anesthesia or in the surgery center under sedation.
The procedure removes excess lip tissue from inside the lip and leaves no external scars. The lip does remain swollen for several weeks before one can see the results of surgery.
The most frequent complications include bleeding, infection and a palpable scar.
Risks and complications
The risks and complication include asymmetry of the lips and possible permanent nerve damage.
There are now almost as many different types of lasers available as letters in the alphabet and a lot of media hype have made laser surgery very popular. Well-respected doctors have not reliably reproduced many of the claims of companies who sell these lasers. What this tells me is that we should be careful in what we offer patients because no one wants to pay hard earned money for “laser treatments” that do not give you satisfying results. Therefore we currently offer only CO2 or carbon dioxide laser resurfacing and rely on chemical peels and medical grade skin care products for excellent skin rejuvenation possibilities.
How does it work?
The CO2 laser essentially vaporizes tissue and creates a small amount of heat that shrinks you body’s tissue (collagen). The laser is able to precisely remove layers of tissue. As the body heals from laser surgery the new skin that forms is smoother and pinker and very sensitive to the sun. The laser is great for removal of fine wrinkles and can be used on large or small areas of the face. It is common to laser just around the eyes or mouth to remove fine wrinkles.
Who is a good candidate for laser resurfacing?
This is very important. People with fair skin tones and light colored eyes are the best candidates for laser skin resurfacing. This is because the heat from the laser often causes the new skin that forms to become hyper pigmented (darker) which may be blotchy and is not a desired result of surgery. This can be treated before and after surgery with creams to help prevent or lessen the risk. People with darker skin tones have a much greater risk of hyper pigmentation making the procedure too risky in my mind.
The procedure is performed under sedation in the surgery center.
What is the recovery from surgery?
After the procedure the surface is red and raw. There are a number of ways to care for the skin as it heals over the following 2 weeks. The two methods of wound care are the “open” or “closed” methods.
In the open method you place moisturizing creams and lotions on the face several times a day and wash and remove the crusting layer before replacing the new layer of cream. This method is easier for small areas but can be used on the whole face. It tends to be a bit messy and may be uncomfortable for some patients.
The closed method places a sheet of material over the treated area that is somewhat like a sheet of plastic wrap. This keeps your bodies tissue fluid in contact with the skin and limits crusting. It is replaced every few days until healing occurs to a point where creams can be used with limited crusting.
In general patients are very red and unable to wear make up for 2-3 weeks after this point in time they may wear makeup but they are very pink for up to 3 months. It is very important to wear a high SPF sunscreen during this time. Laser resurfacing may be a better procedure in the fall or winter because the down time is a bit long and we all like to enjoy being out in the sun during the summer.
Risks and complications
The most common are delayed healing, infection, hyper or hypo pigmentation or scarring.
Cosmetic nasal surgery used to be the most common cosmetic procedure. It has been surpassed by liposuction and breast augmentation over the last few years.
The nose is the most prominent facial feature people look at when they meet someone. People often desire a smaller nose or to removal of a large hump or bump on the nose. The tip of the nose can be made smaller and lifted to create pointier tip.
My goal in performing cosmetic nasal surgery is to understand exactly what the goals of the individual patient are and achieve these goals as best as possible. We have all probably seen people who have the small turned up “ski slope” nose after rhinoplasty and this new nose really does not fit every face.
Who is a good candidate for rhinoplasty?
People who have well defined goals of surgery that can be articulated and achieved in a safe reliable manner are good candidates for rhinoplasty. People 16 years old to 80 plus years old can undergo the procedure.
Technical aspects of the operation
The procedure is performed under sedation or anesthesia in the surgery center.
Most of the incisions for rhinoplasty are made inside the nose. Often a small incision under the nose is made to perform what is known as an “open rhinoplasty technique”. This small incision heals with an almost imperceptible scar.
The benefits of the open approach include being able to see exactly what supports the nose and what is casing the deformity that we are trying to correct.
Sculpting the cartilage and soft tissue is performed and often grafts of cartilage from the nasal septum are used to support the new nose. If a hump is removed osteotomies or fracturing the nose is performed to create a new narrower nose.
After the procedure the nose is taped and splinted with an external cast that stays on for 7-10 days. It is rare to need internal nasal packing.
After Surgery
The nose is bruised and swollen for several weeks. It is best to sleep with your head elevated (in a recliner chair) for the first 2 days after surgery. The inside of the nose may be gently cleaned with cotton swabs and dilute peroxide solution to remove crusting.
You should not blow your nose for several weeks to allow for proper healing. Neosporin type ointment is used to lubricate and coat the incision. The splint is removed in 7 days and the nose is cleaned and may be re taped lightly. 80 percent of the swelling goes down over 1 month with the last 20% often taking six months to go away.
If needed a small amount of steroid can be injected in the nose to help remove stubborn swelling.
Risks and complications
Rhinoplasty has a national average of revision of about 10%. By using primarily an open technique we hope to be much lower then 10%. Bleeding and infection are possible and may require further treatment. If your nose bleeds the best thing to do is gently pinch your nose and release it to continue to inhale through your nose for every breath and exhale through your mouth. You should expect the bleeding to stop in less than 7 minutes. We may have to pack the nose for a post rhinoplasty nasal bleed.
