Dr. Massiha is
active in a variety of civic and social organizations, including the New Orleans
Opera Men's Club, while he was (until Oct. 1993) a member of the Board of Directors
of the Jefferson Performing Arts Society. He has been a recipient of several
awards from the hispanic community for his contribution as a non-hispanic, including
the Aplauso Award. Of special note is Dr. Massiha's avocation as a sculptor
of the human form.
Dr. Massiha and
the staff of the Massiha Plastic Surgery Center appreciate this opportunity
to provide you with the finest healthcare possible. Please accept our sincere
gratitude for your trust in our practice.
INTRODUCTION
TO PLASTIC SURGERY
The word plastic comes from the Greek plastikos, which means to
mold or give form. Plastic surgery enables us to mold or re-fonn the human body.
The plastic surgery specialty encompasses both reconstructive surgery and aesthetic
surgery, popularly referred to as cosmetic surgery. Reconstructive surgery restores
or improves physical function and minimizes disfigurement from accidents, disease
or birth defects. While not essential to physical health, aesthetic surgery
can make a significant contribution to the quality of life by improving the
appearance of normal body features and enhancing your self-image.
Statistics show
that each year, hundreds of thousands of Americans elect aesthetic surgery to
change the way they look. Some have noticeable changes made; others, subtle
refinements. Once considered the exclusive domain of women, aesthetic surgery
now is in demand by men who recognize the results and benefits it can bring.
The ideal candidate
for aesthetic surgery is an individual who recognizes a specific area in which
his or her appearance could be improved and has a strong personal desire to
make a change. This personal desire may be influenced to some degree by the
individual's role in society. Because our culture is youth-oriented, people
seek ways to counter the effects of aging on their appearance. Many elect surgery
to look as young as they feel, to build confidence after a lifestyle change
or to maintain their competitive edge in the workplace.
Whatever your reasons
for choosing aesthetic surgery, it is important to have realistic expectations.
Improving a feature of your face or body may give you greater self-confidence
and add to your sense of well-being, but it is not a guarantee of happiness
or better relationships with others. Surgery can enhance your appearance; the
rest is up to you.
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TO THE INDEX
CHOOSING
A QUALIFIED SURGEON
As with any surgery, the single most important factor in the success of aesthetic
surgery is the surgeon you select. Do not take this responsibility lightly.
Conduct your own research to verify the surgeon's training and experience; then
weigh your decision carefully.
There are a number
of ways to evaluate which surgeon is right for you.
Check for certification
by the American Board of Plastic Surgery. American Board of Plastic Surgery
(ABPS) certification means that the surgeon has completed undergraduate college,
medical school, an approved surgery residency of at least three years, and an
approved plastic surgery residency of an additional two to three years. Board
certification then is obtained only after the candidate has been in plastic
surgery practice for at least two years and has passed rigorous written and
oral examinations administered by experienced plastic surgeons.
Don't be confused
by other official-sounding boards and certifications. The American Board of
Plastic Surgery is the only board recognized by the American Board of Medical
Specialties (ABMS) to certify in the plastic surgery specialty. There is no
separate, ABMS-recognized certifying board for cosmetic surgery.
Remember-in most
states, it is legal for any physician who holds a medical license, with or without
surgical training, to advertise as a plastic or cosmetic surgeon. That's why
understanding board certification is so important for the prospective patient.
If there is confusion
about a surgeon's board certification, you may consult the ABMS Compendium
of Certified Medical Specialists or The Directoty of Medical Specialists available at most libraries.
Check for membership
in the American Society of Plastic and Reconstructive Surgeons (ASPRS) or the
American Society for Aesthetic Plastic Surgery (ASAPS). All members of these
professional societies are certified by the American Board of Plastic Surgery.
ASPRS represents the full scope of plastic surgery (reconstructive and aesthetic).
Members of ASAPS are also fully trained in plastic and reconstructive surgery
but choose to concentrate their practice primarily in aesthetic procedures.
Check the surgeon's
hospital affiliation. Qualified hospitals have been accredited by the Joint
Commission on Accreditation of Healthcare Organizations (JCAHO). An appointment
to a surgical staff of an accredited hospital indicates that a surgeon's capabilities
and performance have been reviewed and judged acceptable by medical colleagues.
Be sure that your surgeon has hospital privileges to perform the specific surgical
procedure in which you are interested -even if you plan to have your surgery
performed in an office-based surgical facility.
Talk candidly
with the surgeon. After you have checked the credentials of a plastic surgeon,
you should make an appointment for an initial consultation. During this consultation,
the surgeon will examine you, explain the operation and may give you literature
describing preoperative considerations and postoperative care. You should feel
comfortable discussing your expectations and questioning your surgeon on any
aspect of the surgery. A qualified and reputable aesthetic plastic surgeon will
be happy to answer your questions and to inform you of possible risks and side
effects associated with surgery.
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TO THE INDEX
WHAT
YOU SHOULD KNOW BEFORE ELECTING SURGERY
Fees and insurance.
Fees for aesthetic surgery traditionally are paid prior to surgery. Costs vary
widely and depend upon the complexity of the operation, where the surgery takes
place and which anesthetic is administered.
As a rule, aesthetic
plastic surgery is considered "elective surgery" and is not covered
by most insurance plans. However sometimes there is a fine line between whether
the surgery's prime objective is to improve appearance or to improve function.
For example, protruding or large ears may be considered a birth defect and ear
surgery deemed necessary to correct it. Similar judgments may be made regarding
eye surgery if drooping lids impair vision, or breast reduction if the weight
of the breasts causes pain or interferes with normal activity. If this is the
case, contact your insurance company before surgery to determine how it views
your particular surgery.
Surgical facilities
and anesthesia. Surgery can be performed in a number of locations, depending
upon the procedure and what your surgeon regards as appropriate. Generally,
aesthetic surgery takes place in a hospital or an ambulatory care setting-such
as an outpatient center or your surgeon's office-based surgical facility.
In many cases,
a local anesthetic will be administered to numb the area to be treated, along
with a sedative to relax you. For some aesthetic surgical procedures, however
you'll be given general anesthesia so you'll sleep through the entire operation.
Postoperative pain is normally controlled with medication.
Risks and complications.
Although some of the procedures described in this booklet appear to be relatively
simple operations, it is essential for you to understand that aesthetic surgery,
like all surgery, has attendant risks.
Plastic surgeons perform thousands of successful aesthetic procedures each week,
but in some cases a patient can have an adverse reaction to the anesthetic or
be affected by postoperative complications such as blood clots, infection or
poor healing. These problems can occur even when the surgeon has performed the
operation with the utmost skill. Since smoking may interfere with proper healing
and aspirin may increase the risk of excessive bleeding, you may be advised
to avoid them before and after surgery. Occasionally, surgical revisions may
be desirable to achieve optimal results.
It is important
to remember that aesthetic surgery molds and reshapes living tissue, and the
results are not absolutely predictable. Even the best surgeon cannot offer risk-free
surgery or guarantee a perfect result.
Recovering from
your surgery. Your surgeon will inform you of any restrictions to your normal
activities following surgery. In general, you should curtail strenuous exercise
and other activities that raise your blood pressure, including bending, for
several days to weeks (depending on what type of surgery was performed). It
takes time as well for the visible signs of healing to subside. Do not expect
to see the final results of your surgery right away. Plan your social activities
to allow sufficient time for recovery.
Other considerations.
The results achieved in some aesthetic procedures, such as surgery of the nose,
ears and chin, are permanent. In others, particularly those that diminish the
effects of aging, results may be long-lasting but not permanent. Your aesthetic
plastic surgeon may be able to turn back the clock but cannot stop it from running.
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TO THE INDEX
MINIMIZING
THE EFFECTS OF AGING
Nowhere does aging
leave its imprint more noticeably than on the face. Sun exposure as well as
aging contribute to facial wrinkling, as do diet, the amount of alcohol you
consume, and whether or not you smoke.
Facial rejuvenation
surgery may involve procedures of the face and neck, eyelids, forehead and eyebrow
areas, and procedures to reduce fine skin lines. These procedures can often
be performed at the same time or can be carried out in separate sessions.
Which procedure,
or combination of procedures, is right for you depends on your personal objectives
and the opinion of your surgeon.
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FACELIFT
Rhytidectomy
A facelift
can reduce sagging skin on the face and neck. Your bone structure, heredity
and skin texture all play a role in how many "years" a facelift can "remove"
and, to some extent, influence how long it will last. Nevertheless, it
is the aim of the procedure to make you look good and, it is hoped, feel
good for your age.
The surgeon
performs a facelift operation one side at a time working through incisions
that are placed in the hairline and then pass in front of and behind the
ears. The incisions are designed to keep the resultant scars as inconspicuous
as possible. When necessary, removal of fatty deposits beneath the skin
and tightening of sagging muscles is performed. The slack in the skin
itself is then taken up and the excess removed. The net effect is to give
the face an overall firmer and fresher appearance.
After surgery,
you will experience some temporary skin discoloration and perhaps a tightness
or numbness in the face and neck. Healing is gradual, so expect to wait
several weeks to months before optimal results are achieved. Most of your
scars will be hidden within the hairline or within normal lines and creases
in front of and behind the ear. The scars can usuallybe easily concealed
by the hair and with the judicious use of makeup.
Since your
skin will remain somewhat sensitive for a few months following the surgery,
you would be wise to limit sun exposure and protect your skin with a sunscreen.
You can wear cosmetics shortly after surgery.
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| Rhytidectomy
patient shown before surgery with deep cheek folds, jowls and loose
skin on the front and side of the neck. |
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| Incisions
are made on either side of the face from inside the hairline at the
temples, in front of the ear, around the earlobe, in the crease behind
the ear and to the lower scalp. The design of these incisions may
vary from patient to patient and according to the surgeon's personal
technique. |
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| Loose
skin is pulled up and backward, and the excess is removed. |
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| The
postoperative patient with smoother, firmer skin on the face and neck. |
|
EYELID
SURGERY
Blepharoplasty
The eyes
are the focal point of the face and contribute substantially to your overall
facial appearance. Bags beneath the eyes, wrinkled, drooping layers of
skin on the eyelids, and sagging eyebrows give the entire face a perpetually
tired or sad expression.
Aesthetic
eyelid surgery can brighten the face and restore a more youthful appearance
by reducing the fat and extra skin that cause these conditions. Blepharoplasty
is often performed along with a facelift or with other facial rejuvenating
procedures.
The surgeon
may operate on the upper and lower eyelids as necessary, removing excess
skin as well as collections of fat under the skin that create puffiness
and bagginess of the eyelids.
Sometimes
the problem is aggravated by a sagging of the eyebrows, and this may require
correction with a brow lift (described on page 12).
Because eyelid
skin is thin, you should expect some swelling and black-and-blue discoloration
after surgery. Your eyes may be temporarily sensitive to light and susceptible
to excess tearing or dryness. You may want to wear dark glasses for a
couple of weeks to protect your eyes from wind and sun irritation and
avoid eye strain from prolonged reading or television viewing. You will
be able to resume weaning makeup and contact lenses shortly after your
surgery.
Within six
weeks, the thin surgical scars should be barely visible and blend into
your eyes' natural lines and folds.
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| Blepharoplasty
patient shown before surgery with bags under eyes and wrinkled folds
of skin hooding eyelashes on upper lid. |
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| Incisions
following natural contour lines in upper and lower lids provide access
skin and fatty tissue. |
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| Sutures
close the incisions, leaving hairline scars that soon fade. |
 |
| The
postoperative patient with unobstructed upper eyelids and firmer,
smoother skin under the eyes. |
|
FOREHEAD
/ BROW LIFT
As aging
progresses, skin wrinkling and a loss of tone can occur in the forehead
area as it does in the eyelids and lower parts of the face. This may cause
sagging of the eyebrows, resulting in a tired or sad look and aggravating
the appearance of excess skin of the upper eyelids. It may also result
in deepening of the horizontal expression lines and wrinkling in the forehead
itself. There may be deep, vertical frown lines between the eyebrows in
the center of the forehead. The forehead/brow lift is designed to correct
or improve these problems.
The operation
is performed under local or general anesthesia. Incisions are placed behind
the hairline above the ear and pass over the top of the head. In some
cases, incisions may be placed in front of the hairline. Improvements
are made beneath the skin and on the deep muscles; the skin and-muscle
are then tightened to give a fresher more youthful appearance.
The forehead/brow
lift may be done in conjunction with other facial rejuvenating procedures.
After surgery,
there will be some temporary swelling and discoloration that may involve
the eyelids and lower portions of the face as well. There will also be
temporary numbness of the scalp.
You will
be permitted to wash your hair shortly after the surgery. The stitches
or skin clips will be removed a week or two after the operation.
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| Forehead
lift patient shown before surgery with drooping eyebrows and eyelid
tissues, creases in the forehead and frown lines between the eyebrows. |
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| An
incision is usually made across the top of the head, a few inches
behind the hairline. In preparation, the hair is tied with rubber
bands in front of and behind the incision area. |
 |
| The
forehead skin is gently pulled upward, and any excess skin is removed.
Some of the forehead muscles may be modified as neded to enhance the
appearance. |
 |
| The
postoperative patient with eyebrows elevated, unobstructed upper eyelids,
smoothing of the frown lines between the eyebrows and less wrinkling
in the forehead itself. |
|
CHEMICAL
PEEL AND DERMABRASION
Fine lines and
wrinkles around the mouth and on the forehead and cheek areas may be improved
with a wide range of skin treatments. For enhancing the overall texture of the
skin, there are gels, creams and lotions, including Retin-A* and products containing
glycolic ("fruity") acids, which you can apply yourself according to a schedule
prescribed by your surgeon.
Chemical peels
of varying strengths can be applied in your surgeon's office or operating facility.
A chemical peel solution is applied to the entire face or to specific areas,
such as around the mouth, to peel away the skin's top layers. Light chemical
peels are increasingly popular and can help correct a variety of skin problems.
For properly selected patients, several light to mediumdepth peels can often
achieve similar results to one deeper peel treatment, with less risk and shorter
recovery time.
A deeper chemical
peel or dermabrasion, a procedure in which a high-speed rotary wheel, similar
to fine-grained sandpaper, is used to abrade the skin, may be recommended when
there is extensive sun damage and heavy skin wrinkling. In addition, dermabrasion
can be used to improve the texture of pockmarked skin resulting from severe
acne or chicken pox.
A few days following
a deep peel or dermabrasion, a new skin emerges that is bright pink, resembling
an intense sunburn. This color will fade, over several months and may be covered
with makeup. Postoperative puffiness usually subsides within a few days, but
your skin will remain sensitive. Your surgeon will urge you to avoid exposure
to sunlight for the first few weeks and to use a sunblock when going outdoors.
You can wear cosmetics and engage in strenuous activities within a few weeks.
Following a deep
chemical peel or dermabrasion, your skin should appear firmer and smoother;
however permanent pigment changes (usually lighter in color) can occur, and
your skin may also appear shinier.
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TO THE INDEX
REDEFINING FACIAL FEATURES
Irregularities
of the nose, ears, cheeks or chin may upset the balance of the face and the
affect the overall apprearance, since these features are often viewed in relation
to one another.
Aesthetic surgery
can reshape the nose, diminish prominence of the ears and reshape the chin or
cheeks to improve excesses or deficiencies in these areas. In many cases, changing
a single feature can enhance your entire appearance and affect the way you feel
about yourself.
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TO THE INDEX
SURGERY
OF THE NOSE
Rhinoplasty
Rhinoplasty
can reshape your nose in a number of ways to improve its appearance and
proportion in relation to your other facial features. People most often
elect surgery to alter the size and shape of the bridge and tip of the
nose. Your surgeon may make one or more adjustments as necessary.
Although
there is no age limit for rhinoplasty, the mid-teens, a time when the
nose is near full development, is the earliest recommended age. With older
individuals, health is the primary consideration.
Reshaping
is generally done through incisions inside the nose, but there may also
be an incision passing across the central portion of the nose between
the nostrils. It is sometimes necessary to narrow the base of the nose
or reduce the size of the nostrils. This entails removing small wedges
of skin at the base of the nostrils. The resulting scars usually fade
very well and, ultimately, should be barely noticeable.
The nose
is reduced, or in some cases built up, by adjusting its supporting structures
-either removing or adding bone and cartilage. The skin and soft tissues
then redrape themselves over this new "scaffolding".
In some instances,
there may be an internal deformity of the nose that can affect breathing.
This may be due to an - - irregularity in the septum (the central structure
of cartilage and bone that separates the two sides of the nose) or the
turbinates (structures protruding internally from the lateral walls of
the nose). Adjustment of these structures to improve the nasal airway
may be made at the same time as alterations to the external appearance
of the nose.
After surgery,
some pain, swelling and bruising of the nose are to be expected, but they
will subside gradually, You will wear a splint for approximately a week
or longer and can wear cosmetics safely after it is removed. Your routine
will be severely restricted for only a day or two, but you should curtail
activities that raise your blood pressure-such as swimming, logging or
even bendingfor a few weeks.
Reserve judgment
on your rhinoplasty for several months, even a year, until your nose has
had an opportunity to fully heal and settle. Often, the best compliment
you can receive from your family and friends is that your nose does not
appear very different. Remember- the intention of rhinoplasty is for your
"new nose" to blend in naturally with your face.
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TO THE INDEX |
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| Rhinoplasty
patient shown before surgery with large nose, nasal hump, enlarged
tip and nose that hangs slightly where it meets the upper lip. |
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| Incisions
are made on either side of the nose inside the nostril to provide
assess to cartilage and bone which can be cut and reshaped to alter
the external appearance of the nose. The bridge of the nose can be
narrowed by moving the bone inward, as shown by the arrow. |
 |
| Areas
where cartilage and bone have been readjusted to improve the shape
of the nose are shown. |
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| The
postoperative patient with smaller nose, a straight nasal bridge,
smaller, better-defined nasal tip and an improved angle between nose
and upper lip. |
|
CHIN
AND CHEEK AUGMENTATION
Chin augmentation
(genioplasty, or mentoplasty) can strengthen the appearance of a receding
chin by increasing its projection. Simultaneously, it can create better
harmony between the chin and other facial features for a more balanced
profile. Chin augmentation does not affect your bite or jaw.
There are
two techniques for adding prominence and contour to your chin. One, performed
through an incision inside the mouth, involves moving the chinbone. The
other approach involves inserting a plastic implant. The incisions to
insert this implant may be made in the mouth or on the underside of the
chin. In the latter case, surgery will usually leave a negligible scar.
To permit
proper healing following chin augmentation, you may be placed on a liquid
diet for a day or two. The area may be taped or bandaged.
Similarly,
in some cases the cheekbones may be built up (augmented) by placing an
implant over them. This is usually performed through an incision within
the mouth, but it may be done through a lower eyelid or brow lift incision.
After a chin
or cheek augmentation, you will most likely be up and about the same day
as surgery and back to work within one to two weeks.
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TO THE INDEX |
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| Genioplasty
patient shown before surgery with receding chin. |
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| In
one approach, the lower section of bone is moved forward and wired
into position. |
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| An
alternative approach involves inserting an implant between the bone
and chin tissue through a short external incision under the chin or
through an incision made in the mouth between the lower lip and the
gum...Similarly, in some cases the cheekbones may be built up by placing
an implant over them as shown. |
 |
| The
postoperative patient with balanced profile and slight scar under
the chin. |
|
EAR
SURGERY
Otoplasty
Aesthetic
surgery can improve the positioning of your ears if they are large in
proportion to your other features or protrude more than normal. Surgery
is possible at any age, but it is often recommended for children as they
near total ear development at age five or six. When the ears are corrected
prior to the child entering school, the surgery helps eliminate potential
psycho- logical trauma.
In this
procedure, the ears are positioned closer to the head by reshaping the
cartilage (supporting tissue). This is usually accomplished through incisions
placed behind the ears so that subsequent scars will be concealed in a
natural skin crease.
After surgery,
a gauze dressing or bandage should be worn for several days to ensure
that the ears heal in their new, more natural position. Strenuous activities
and contact sports should be avoided for several weeks.
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TO THE INDEX |
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| Otoplasty
patient shown before surgery with ears that protrude. |
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| Surgery
seen from the back of the ear. (a) Incisions are made and a small portion
of skin removed. (b) The cartilage is recontoured to bring the ear
into its correct position and supported with sutures. (c) Sutures
close the incisions, leaving a faint scar. |
 |
| Surgery
seen from the front of the ear. Reshaped cartilage restores the ear
fold, making the ear lie flatter against the head. |
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| The
postoperative patient with ears that are normal in appearance. |
|
BODY CONTOURING
There are several
aesthetic procedures to reshape the breasts, abdomen and other parts of the
body. Dramatic advances have been made in recent years, particularly in suction
techniques that now often replace more extensive surgery to remove unwanted
fat.
The success of
body contouring-whether it is done to reduce, enlarge or lift-is influenced
by your age and the size, shape and skin tone of the area to be treated. While
some contouring procedures leave small scars, more noticeable scars may result
when surgical removal of fat and skin is neccessary to achieve desired results.
In such cases, you must be willing to accept these scars in exchange for looking
better in clothing.
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TO THE INDEX
LIPOSUCTION
A procedure
introduced in the United States in 1982, liposuction can remove localized
collections of fatty tissue in several areas of the body. By using a high
vacuum device, the surgeon can suction fat from the legs, buttocks, abdomen,
back, arms, face and neck.
The increasing
popularity of liposuction is due to the simplicity of the technique (in
the hands of a qualified surgeon) and the fact that it leaves only minute
scars, often as short as one-half inch in length or less.
Liposuction
is neither a substitute for proper diet and exercise nor a cure for obesity.
To get the most from this procedure, you should be of average weight with
extra fat localized in specific areas. It is also important that you have
healthy, elastic skin with the capacity to shrink evenly after surgery.
Since liposuction removes only fat, it cannot eliminate dimpling or correct
skin laxity.
If your
skin has lost much of its elasticity, your surgeon may recommend a skin
tightening procedure (thigh lift, buttock lift or arm lift). These procedures
are effective but leave more extensive scars.
Following
surgery, you will wear a snug dressing or garment for several weeks to
promote skin shrinkage and to minimize swelling and skin discoloration.
If you have had surgery below the waist, you may be advised to wear a
long-legged girdle for a few weeks as you resume your normal routine.
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TO THE INDEX |
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| Liposuction
patient shown before surgery with bulging hips, thighs and buttocks. |
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| Short
incisions are made through the skin to introduce the instrument that
will remove fat in the shaded areas. A similar technique may be used
to remove localized fat deposits from other areas of the body. |
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| A
long, hollow tube with a opening at one end is inserted. At the tube's
opposite end, a vacuum pressure unit suctions off fat. |
 |
| The
postoperative patient with slimmed lower body contour. |
|
BREAST
AUGMENTATION
Augmentation
Mammoplasty
Augmentation
mammoplasty is typically performed to enlarge small breasts, underdeveloped
breasts or breasts that have decreased in size after a woman has had children.
It is accomplished by surgically inserting an implant behind each breast.
Women who
have undergone breast augmentation in the past had the choice of several
types of implants. Some contained silicone gel, saline (saltwater) solution
or a combination of both. Currently, the Food and Drug Administration
is reviewing the safety and effectiveness of silicone breast implants
and has limited use of the gel-filled type to women participating in approved
studies. Saline- filled implants are the only type widely available for
breast augmentation at the present time. (Above information is current
as of July 1993.)
In breast
augmentation, an incision is made either under the breast, around the
areola (the pink skin surrounding the nipple or in the armpit. A pocket
is created for the implant either behind the breast tissue or behind the-
muscle between- the breast and the chest wall.
Following
surgery, you will wear a gauze dressing or surgical bra. Some swelling
or discoloration will occur but will disappear shortly after surgery.
Vigorous activities, especially arm movement, may be restricted for two
to three weeks.
The most
common of the known risks associated with breast implants is capsular
contracture, a tightening of scar tissue around the implant, which results
in varying degrees of breast firmness and may cause pain or changes in
the breast's appearance. Other known risks include implant rupture (saline
is harmlessly absorbed by the body) and temporary or permanent changes
in nipple or breast sensation. The presence of breast implants requires
special mammographic techniques and may compromise the effectiveness of
mammography for early cancer detection. Your surgeon will discuss with
you these and other possible risks which you should consider carefully.
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TO THE INDEX |
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| Augmentation
mammoplasty patient shown before surgery. |
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| An
incision is made either in the crease of the breast where it meets
the chest, around the lower edge of the areola (the pigmented area
surrounding the nipple) or in the armpit. |
 |
| Cross
section of the breast shows location of the implant, either in a pocket
directly under the breast tissue or underneath the chest muscle. |
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| The
postoperative patient with fuller breasts. |
|
BREAST
REDUCTION
Reduction Mammoplasty
Breast reduction
to correct overlarge, sagging breasts is normally classified as a reconstructive
procedure, since oversize breasts interfere with normal function and physical
activity by causing back pain, postural problems, deformities of the back
and shoulders, skin rashes under the breasts and breast pain.
However,
plastic surgeons also view breast reduction surgery as an operation with
an important aesthetic component; in addition to alleviating physical
problems, it can improve the shape of the breasts and nipple areas.
Breast reduction
involves removing excess breast tissue and skin, repositioning the nipple
and areola (the pink skin surrounding the nipple) and reshaping the remaining
breast tissue.
The operation
requires a general anesthetic, and you will most likely be hospitalized
for a short time. Although your surgeon will make every effort to keep
your scars as inconspicuous as possible, the incisions will ultimately
leave permanent, noticeable scars in the lower portion of the breasts.
Variations on the placement of incisions, different from the incisions
illustrated on this page, may be recommended in some cases.
After surgery,
the breasts may be wrapped in gauze or placed in a surgical bra. You will
have to wear a supportive bra for several weeks to promote healing. Loss
of sensation of the nipples and breast skin is possible but may improve
gradually. You should avoid excessive exercise and overhead lifting for
several weeks after surgery.
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TO THE INDEX |
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| Reduction
mammoplasty patient shown before surgery with oversize, heavy breasts
and shoulder indentations caused by tight bra straps. |
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| Incisions
are made in the breasts to define the area of excision and he new
location for the nipple. Breast tissue, fat and skin in the light
shaded areas are then removed. Skin is removed from the darker shaded
area, and the nipple is elevated. |
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| Skin
formerly located above the nipple is brought down and together to
reshape the breast. |
|
| The
postoperative patient shown with resultant scars around the areola,
extending vertically down the breast and horizontally along the crease
underneath the breast where, for the most part, the horizontal scar
is hidden. |
|
BREAST
LIFT
Mastopexy
The breast
lift operation raises and recontours loose, sagging breasts. Frequently,
a woman elects this surgery after losing a considerable amount of weight,
or losing volume and tone in her breasts after having children.
In a breast
lift, the surgeon relocates the nipple and areola (the pink skin surrounding
the nipple) to a higher position, repositions the breast tissue to a higher
level, removes excess skin from the lower portion of the breast and then
reshapes the remaining breast skin. If you have your breasts enlarged
as well as lifted, an implant may be placed behind your breast tissue
or chest muscle.
The illustrations
on this page show a commonly performed breast lift technique, resulting
in scars around the areola, extending vertically down the breast and horizontally
along the crease underneath the breast. In some cases, variations on the
placement of incisions may be recommended.
The breasts
will be wrapped in a gauze dressing or placed in a surgical bra immediately
after surgery. You will have to wear a supportive bra for several weeks
following the surgery. Swelling and discoloration will occur around your
incisions and subside gradually. You may experience decreased sensation,
which is usually temporary, in your nipples or breast skin.
Mastopexy
scars are permanent but will fade to some extent over time.
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| Mastopexy
patient shown before surgery with sagging breasts and low position
of nipples. |
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| Incisions
following the breast's natural contour define the area of excision
and the new location for the nipple. Skin in the shaded area is removed
and the nipple moved higher. |
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| Skin
formally located above and to the sides of the nipple is brought down
and together to reshape the breast. |
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| The
postoperative patient shown with scars resulting from a commonly performed
mastopexy technique. Scars are around the areola, extending vertically
down the breast and horizontally along the crease underneath the breast. |
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ABDOMINOPLASTY
Sometimes
after multiple pregnancies or large weight loss, abdominal muscles weaken,
and skin in the area becomes flacid.
Abdominoplasty
can tighten the abdominal muscles and , in some instances, improve stretch
marks. In men and women who have fat that is concentrated in the abdomen,
but who are otherwise of relatively normal weight, the procedure will
remove excess skin and fat. The surgery will not eliminate minor wrinkling
or take the place of dieting, but it can improve a loss of skin elasticity
in combination with slight obesity in older individuals.
For this
operation, you will most likely be hospitalized for a short time. To smooth
out the abdomen, the surgeon works through a low abdominal incision that
spans the hips. Because sagging skin will be pulled down over the abdomen
before it is removed, it is necessary to release the navel from its surrounding
skin and bring it out through a new skin opening. Resulting scars across
the pubic area and around the navel are permanent but flatten and lighten
in color over time.
This procedure
may sometimes be performed in combination with liposuction to reduce areas
of fat accumulation that would ordinarily not be improved by the abdominoplasty
alone. In some instances, when skin laxity and muscle weakness are confined
to the lower part of the abdomen, a modified abdominoplasty that limits
tissue removal and muscle repair to the area below the umbilicus may be
performed. This usually leaves a shorter scar and no scarring around the
navel. This procedure can often be performed on an outpatient basis.
As a result
of surgery, you will have a firmer, flatter abdomen and a narrower waist.
You will be advised to wear a light support garment for two to three months
and cautioned to restrict strenuous activity for a few weeks to ensure
proper and complete healing.
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| In
abdominoplasty, generally, an incision is made across the pubic area
and around the umbilicus. Skin in the shaded area is separated from
the abdominal wall. |
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| To
tighten the abdominal wall, the surgeon brings loose underlying tissue
and muscle together with sutures. |
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| Abdominal
skin is drawn downward, and the excess is removed. A small opening
is made to bring the umbilicus through. |
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| The
postoperative patient shown with reconstructed navel and resultant
scars. |
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CONCLUSION
This booklet has
provided an introduction to aesthetic plastic surgery by describing how it can
reshape facial features and other parts of the body to improve appearance. While
we hope this material has been helpful as an overview, it is not intended to
be your only source of information. If you are considering surgery, you should
consult a qualified plastic surgeon-one who is certified by the American Board
of Plastic Surgery. Your surgeon will give you additional, detailed information
about the specific procedure in which you are interested. This information should
include not only the benefits but also the possible risks and complications
associated with the procedure.
Your surgeon may
wish to discuss with you variations of, or alternatives to, the operations described
in this booklet. Advances are constantly being made in the field of aesthetic
plastic surgery. While "new" procedures do not always prove to be
better than established ones, your surgeon may feel that you can benefit from
some procedures that are performed less frequently than those we have described.
If there are aesthetic
procedures that you have read about in magazines or heard about on the radio
or television, ask about them. Your surgeon can advise you whether a specific
procedure would be beneficial to you. If there are problems or safety questions,
your surgeon will be able to alert you to them.
Above all, confide
your goals, expectations and concerns. Your aesthetic plastic surgeon's most
important job is to help you achieve good health and satisfaction with your
appearance.
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