Procedure: Face Lift

A facelift or "rhytidectomy" is a procedure designed to alleviate some of the changes to the face that occurs with aging, gravity, and the effects of the environment. The operation is performed through incisions placed in natural skin creases in front of each ear. These extend up into the temporal hair and also up into the hair behind the ear. The skin of the face and the underlying deeper tissue are tightened, eliminating most of the wrinkles and creases. An incision may also be made under the chin to remove fat from the neck and tighten the neck muscles. In most cases, this operation is combined with other procedures to more completely rejuvenate the face.

Surgery

At times, a mini-facelift or cheek lift can be performed if the amount of wrinkling is not extensive. This is a less extensive procedure taking less time and costing less and can be decided in conjunction with your physician. An upper and lower eyelid lift or "blepharoplasty" may also be performed. A browlift may also be performed to elevate the eyebrows, which droop with age and gravity, and to eliminate wrinkles and creases from the forehead. Any combination of these procedures may be performed depending on your individual condition and your individual goals.

Anesthesia The procedure is performed under general anesthesia or under heavy sedation and local anesthesia as an outpatient. In some cases you may stay at the surgical facility overnight or in a nearby hotel with a private nurse. The anesthesiologist and the surgical facility will bill separately for their services.

Duration of Surgery The operating time will vary depending on the patient and the extent of the procedure, and whether any additional procedures are performed. Generally the time is approximately 4 hours.

Before Surgery Do not take aspirin, ibuprofen or products that contain aspirin for at least 3 weeks prior to surgery. Also refrain from consuming any energy drinks and herbal supplements, as some may have an effect on increasing bleeding during the course of surgery. Remove all makeup and mascara from your eyelids. If you wear contacts lenses, it would be preferable that you wear glasses when you arrive to the surgery center.

Photographs Photographs are taken at the time of your consultation. These are important aids in the preparation of surgery and become a permanent part of your record. Post-surgical photographs are also taken.

After Surgery

A bulky dressing is applied after the procedure and this is changed to a light type dressing in 2-3 days. A small drain is usually placed and is removed in 3 days. Sometimes an elastic wrap or support is used to give gentle compression to the operated areas after the dressings are removed. Ice packs are applied to the sides of the face to help reduce discomfort and swelling. There is usually a moderate amount of swelling and bruising after a facelift. You should try to sleep with your head and shoulders elevated to help reduce the amount of swelling. You may bathe the day after surgery, but do not get the dressings wet. You may shower and shampoo your hair once your physician has removed the dressings. You may remove the elastic support to shower or bathe. Men should be able to shave after approximately 3 to 5 days.

Initial discomfort is controlled with oral medication but typically the pain is minimal. Stitches are usually removed in 5 to 7 days.

Return to Normal Activity Most people return to their usual activities and to work approximately 1 to 2 weeks after surgery. It is acceptable to apply make up after 3 to 5 days. Strenuous sports and other activities should not be performed for 3 to 4 weeks. You may drive when driving does not cause pain, or when you are no longer taking pain medication. This usually takes 3 to 6 weeks.

Scars You should expect a scar in front of each ear, with an extension upward into the hair of the temple region and downward around the earlobe and into the hair behind the ear. The location will vary slightly depending on the hairline. The scars are placed in natural skin creases and will fade with time. This usually takes 6 to 9 months. All scars are however permanent. The width, height and color of scars are unpredictable. Wear a sunscreen of at least SPF of 30 or greater when outside to protect the scars from sunlight during the healing process.

Diminished Sensibility As with any surgical procedure, small sensory nerves to the skin surface may be cut when the incision is made or when skin is undermined. Portions of your face will feel numb or have less than full feeling. The sensibility in these areas gradually returns, usually with 2 to 3 months as the nerve endings spontaneously heal. During the healing process the skin of the face may become hypersensitive for as period of time. Some diminished sensibility may last indefinitely.

Swelling and Bruising Swelling and bruising of the face and neck or any site following surgery is normal. During the first 1 to 2 weeks your face will feel and look swollen. The swelling will start to subside after the first postoperative week. It may take as long as 2 months for the last bit of swelling to recede.

Complications

HEMATOMA This is the most common complication and occurs when a collection of blood forms under the areas of undermined skin. It occurs in about 1 to 2% of patients and is more common in men. The body will absorb minimal bleeding. A larger collection may necessitate aspiration to drain the collection. Occasionally it will require additional surgery. This may also lead to some firm areas (scar) under the skin that may require massages post surgery.

EDEMA This is a normal consequence of surgery and is best treated simply by elevating the head of the bed. The application of ice packs or cold compresses is usually done for the first 1 to 2 days.

NERVE INJURY In addition to the small sensory nerves to the skin noted above, the other main nerve that is at risk is the facial nerve. Injury to this nerve occurs in less than 1% of cases. When it does occur it results in weakness of the face when smiling. If the nerve or one of its branches is injured due to stretching it may take 2 to 6 months for recovery. If the nerve is cut there may be either partial or complete weakness of a certain area.

ABNORMAL SCARS A small percentage of patients will develop scars that are unacceptable despite meticulous attention to detail both during and after surgery. The scars may widen, stay red or raised. If the scars are problematic a steroid ointment or injection will be used to improve their appearance. In some cases the scars need to be revised surgically.

SKIN LOSS This is also a rare occurrence. It may be due to cigarette smoking in the days to weeks before and after surgery, or due to undo tension at the site of the incision, which could be compounded by swelling or hematoma. Usually this is managed without the need for additional surgery.

INFECTION This complication is also rare. Prevention is the key and antibiotics are given both before and for a period of time after surgery.

I mention these complications not to alarm or frighten you since the usual outcome after this surgery is quite favorable. The majority of patients are very satisfied. I present this information to you to fully educate you on the side effects, undesirable sequelae and complications no matter how remote they may be. Should you not understand any of this information, or should you want further information, please call our office and ask. If necessary a second consultation can be scheduled.

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Procedure: Mid-Face Lift (Cheek Lift)

A mid-facelift or "cheek suspension" is a procedure designed to improve on the ptosis (sagging) of the structures of the midface. These structures are the lower eyelids, nasolabial folds (smile lines), nasojugal folds (the junction between the eyelids and cheeks), and the cheek fat pads. As aging occurs there is a progressive downward drift of these structures resulting in the prominence of the nasolabial folds and decrease in the prominence of the cheekbone. This results in an increase in jowls and nasolabial lines. This process results in what we all see as the first signs of aging, an accentuation of the "smile lines".

The midface lift corrects a majority of these areas by lifting these structures (skin, fat, and muscle) off the underlying bone and reattaching them higher. This decreases the nasolabial folds and increases the prominence of the cheekbones. The procedure is performed by making an incision along the eyelid margins and dissecting the tissues off the underlying bone. During the aging process, the tissues slowly drift downward off the bone. It is therefore necessary to resuspend these tissues to a higher position in an attempt to mimic the original youthful position. Permanent sutures anchored to bone in a more superior position allow for maintenance of the new position. Dissolvable sutures are used to close the eyelid incision. A minimal amount of skin is removed from the lower eyelid. In most cases, this operation is combined with other procedures to more completely rejuvenate the face.

Surgery

This procedure is often performed in conjunction with an upper and/or lower blepharoplasty (eyelid lift) to decrease the eyelid fat pads and skin. A browlift (lifting the eyebrows) may also be performed to elevate the eyebrows, which fall lower with age and gravity, and to eliminate wrinkles and creases from the forehead. Any combination of these procedures may be performed depending on your individual condition and your individual goals.

Anesthesia The procedure is performed under general anesthesia as an outpatient. In some cases you may stay at the surgical facility over night, or in a nearby hotel with a private nurse. The anesthesiologist and the surgical facility will bill separately for their services.

Duration of Surgery The operating time will vary depending on the patient and the extent of the procedure, and whether any additional procedures are performed. Generally, the time for a mid-facelift is approximately 2 hours.

Before Surgery Do not take aspirin or ibuprofen or products that contain aspirin for at least 3 weeks prior to surgery. Also refrain from consuming energy drinks or any herbal supplements, as some may have an effect on increasing bleeding during the course of surgery. Remove all makeup and mascara from your eyelids. If you wear contacts lenses, it would be preferable that you wear glasses when you arrive to the surgery center.

After Surgery No dressings are necessary for just a mid-facelift and only antibiotic ointment applied to the lower eyelid is used postoperatively. If other procedures are performed then there may be some dressings. Ice packs are applied to the sides of the face and over the eyes to help reduce discomfort and swelling. There is usually a moderate amount of swelling and bruising after a mid-facelift. You may experience swelling of the upper eyelids that may result in not being able to open your eyes completely. This swelling should dissipate in 2-3 days. You should try to sleep with your head and shoulders elevated, in an effort to help reduce the amount of swelling.

Taking the herbal medication (Arnica Montana), fresh pineapple and/or papaya will also assist in decreasing the swelling and bruising. You may bathe 24 hours after surgery, but do not get the dressings wet. Men should be able to shave after approximately 3 to 5 days.

Initial discomfort is controlled with oral medication but typically the pain is minimal. Most stitches are dissolvable but those that are not are usually removed in 5 to 7 days. You should apply antibiotic ointment (Neosporin or Polysporin) to the incisions twice daily.

Return to Normal Activity Most people return to their usual activities and to work approximately 1 to 2 weeks after surgery. It is acceptable to apply make up after 3 to 5 days. Strenuous sports and other activities should not be performed for 3 to 4 weeks. You may drive when your eyelids are no longer swollen and vision is not a concern, when driving does not cause pain, or when you are no longer taking pain medications. This usually takes 1 to 2 weeks.

Scars You should expect a scar on each lower eyelid. These are usually well concealed in a natural skin crease of the lower eyelid. In some cases, a lower eyelid incision is made on the inner aspect of the eyelid, in which case, there will be no visible external scar. All of the locations mentioned are tolerated quite well. All scars are however permanent. The width, height, and color of scars are unpredictable. Wear a sunscreen of at least SPF 30 or greater when outside to protect the scars from sunlight during the healing process.

Diminished Sensibility As with any surgical procedure, small sensory nerves to the skin surface may be cut when the incision is made or when skin is undermined. Portions of your eyelids and cheek will feel numb or have less than normal feeling. The sensibility in these areas gradually returns, usually within 2 to 3 months as the nerve endings spontaneously heal. There is a nerve along the bone just under the lower eyelid that provides feeling to your cheek, upper lip and one side of your nose that may be stretched or traumatized thus resulting in numbness of those areas. Typically the feeling returns but there may be some permanent diminished feeling. During the healing process the cheek area may become hypersensitive for a period of time. Some diminished sensibility may last indefinitely.

Complications

ECTROPION This is a retraction of the lower eyelid in a downward direction and may be due to a tight scar forming an attachment to the underlying bone. This may occur in less than 3 % of the time. It can also be from an excess amount of skin removed from the lower eyelid. It can be a very disconcerting problem and is best treated initially with massages along the lower eyelid in a horizontal motion as well as steroid injection. It would be unlikely for this to require surgery but in certain circumstances, further surgery may be necessary.

NERVE INJURY In addition to the small sensory nerves to the skin noted above, the other main nerve that is at risk is the facial nerve. Injury to this nerve occurs in less than 1% of cases. When it does occur, it results in weakness of the face when smiling. The other main nerve is the nerve that gives feeling to the cheek, upper lip and side of the nose. Injury to this nerve is very unusual. When it does occur, it results in partial loss of feeling to that side of the face. Some numbness after surgery is normal but if the nerve is injured, then there could be permanent loss of feeling. If the nerve or one of its branches is injured due to stretching it may take 2 to 6 months for recovery. If the nerve is cut there may be either partial or complete weakness of a certain area.

EDEMA (Swelling) This is a normal consequence of surgery and is best treated simply by elevating the head of the bed. The applications of ice packs or cold compresses over the eyes are usually helpful for the first 3 to 4 days. Swelling along the lower eyelids and upper cheek may take 4-6 weeks to totally resolve. Taking Arnica Montana and fresh pineapple are also helpful.

ASYMMETRY There is usually some asymmetry of the lower eyelids and cheeks and in some people this is marked and is the reason they seek surgery. All efforts are made to have the cheeks and eyelids as symmetrical as possible but it is important to understand that perfect symmetry may be difficult to attain. A slight asymmetry may be acceptable after surgery. A greater amount of asymmetry may require additional surgery to correct.

ABNORMAL SCARS A small percentage of patients will develop scars that are unacceptable despite meticulous attention to detail both during and after surgery. The scars may widen, stay red or raised. In some cases hair may not grow around them. If the scars are problematic, a steroid ointment or injection may be used to improve their appearance. In some cases the scars need to be revised surgically.

INFECTION This complication is also rare. Prevention is the key and antibiotics are given both before and for a period of time after surgery.

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Procedure: Cheek Augmentation

Cheek augmentation is a procedure performed to highlight the cheekbones. In some individuals the cheekbone is somewhat deficient resulting in a more flat appearance to the face. This can be easily seen in certain ethnic groups, in certain congenital abnormalities, and post injuries to the face. It is also evident in many normal individuals as part of the norm. Cosmetic makeup (blush) is utilized to highlight the cheekbones, as prominent cheeks are considered aesthetically pleasing. Improving on the prominence of the cheekbones in the older age group also has a secondary effect of tightening the facial skin and soft tissues. Augmenting the cheeks will also provide a stabilizing effect on the lower eyelids and help prevent drooping. It also provides augmentation of the nasolabial folds (smile lines) with an improvement in the overall appearance.

Surgical enhancement of the cheeks can be performed through an augmentation type procedure using artificial implants. There are several types of implants available to produce this enhancement and the choice is dependent on your anatomy and your surgeon's choice. The predominant implant type used is Medpor (polyethylene), but silicone, Gortex and hydroxyapatite (coral) and one's own bone can also be used. The Medpor implant is preferred because of its stability and predictability of results. Dr. Morales has been instrumental in developing a specific type of Medpor cheek implant that provides a very normal, aesthetically pleasing contour. He has a large experience in its usage.

Surgery

The procedure is usually performed through an intra-oral incision, just above the gum line. The dissection of a pocket to insert the implant is performed, staying on top of the bony surface of the cheek. The implant is positioned in the appropriate position and stabilized using a screw that provides stability to each implant during the healing phase. The screw is left in permanently. The internal incisions are closed with stitches that dissolve.

The appropriate size of the implant and the amount of augmentation is decided ahead of time during consultation with your physician. Specific measurements are performed to help decide the implant size. This should be performed to provide a natural balance and proportional aesthetics to your face.

Anesthesia The procedure is typically performed under general anesthesia as an outpatient. In some cases you may stay at the surgical facility overnight or in a nearby hotel with a private nurse. The anesthesiologist and the surgical facility will bill separately for their services.

After Surgery

There is little discomfort associated with a cheek augmentation. There will be a moderate amount of swelling around the cheek area and possibly under the eyes. This peaks at 48 to 72 hours after surgery and then starts to subside. Crushed ice or "frozen peas" applied to the cheeks will help during this time. Most of the visible swelling will disappear by 2 weeks. There may still be a feeling of numbness, which means that some swelling is still present. It will take several weeks before the last bit of swelling has resolved. You should not sleep on your face. You should try to sleep with your head and shoulders elevated to help reduce the amount of swelling. Sometimes an elastic wrap or support is used to give gentle compression to the operated areas after the dressings are removed. You may bathe the day after surgery.

Initial discomfort is controlled with oral medication but typically the pain is minimal. Stitches are usually dissolvable. You should be able to brush your teeth after surgery but be careful with brushing the upper teeth. Your diet should be liquids (juices, milk, shakes, broths, etc.) the first 24 hours then you may start a soft diet. You should not eat foods that are hard or sharp (chips, Doritos, etc.).

Return to Normal Activity Most people return to their usual activities and to work approximately 1 to 2 weeks after surgery. It is acceptable to apply make up after 3 to 5 days. Strenuous sports and other activities should not be performed for 2 weeks. After 2 weeks you may gradually increase your activity so that you are back to your usual routine by 3 weeks. You may drive when vision is not impaired by swelling, or when you are no longer taking pain medication.

Scars Incisions are located inside the mouth and should heal without any problems. You should expect a scar on the underside of the upper lip. These incisions should not be visible. The scars are rarely problematic. The scars will typically fade with time. Nevertheless, you should be aware that all scars are permanent and their height, width and final color are unpredictable.

Complications

Some swelling and bruising of the cheeks and around the eyes is expected after a cheek augmentation. This peaks at 48 to 72 hours after surgery and then starts to subside. Complete resolution of swelling may take several weeks.

BLEEDING This is unusual but may occur after cheek augmentation. It occurs in about 1 to 2% of patients and is more common in men. The body will absorb minimal bleeding. Ice packs to the face will help decrease this potential; however, in some cases additional surgery may be necessary.

ASYMMETRY Occasionally, a minor deformity may persist following surgery. Everyone's face is never totally symmetrical. Some asymmetry may be a result of the asymmetry already present. If the asymmetry is more apparent, than a second procedure may sometimes be necessary.

EDEMA This is a normal consequence of surgery and is best treated simply by elevating the head of the bed. The application of ice packs or cold compresses is usually done for the first 1 to 2 days.

NERVE INJURY In addition to the small sensory nerves to the skin noted above, the other main nerve is the nerve that gives feeling to the cheek, upper lip and side of the nose. Injury to this nerve occurs in less than 1% of cases. When it does occur, it results in partial loss of feeling to that side of the face. Some numbness after surgery is normal but if the nerve is injured, then there could be permanent loss of feeling. If the nerve or one of its branches is injured due to stretching it may take 2 to 6 months for recovery.

ABNORMAL SCARS Scars are rarely a problem but a small percentage of patients will develop scars that are unacceptable despite meticulous attention to detail both during and after surgery. If the scars are problematic a steroid injection will be used to improve their appearance and consistency. In rare cases the scars need to be revised surgically.

INFECTION This complication is also rare. Prevention is the key and antibiotics are given both before and for a period of time after surgery.

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Procedure: Blepharoplasty (Eyelid Lift)

A blepharoplasty (eyelid lift) is a procedure on both upper and lower eyelids to remove a combination of excess skin and fat and to restore a more youthful and refreshed look.

A blepharoplasty (eyelid lift) is one of the most commonly performed plastic surgical procedures. As aging occurs there is a tendency for an excess amount of skin and fat to accumulate along both the upper and lower eyelids. This may result in a "hooding" effect of the upper eyelid and at times a drooping of the eyelid. The lower eyelid will become full and sag with an excess amount of skin and fat resulting in a "baggy" lower eyelid and a tired appearance.

Surgery

On the upper eyelid a combination of excess skin and fat is removed to restore a more youthful and refreshed look. This gives a more "open" look to the eyes and assists in correcting the "double eyelid" appearance. This is performed through an incision along the eyelid crease. It is not uncommon for the excess skin of your upper eyelid to be a result of "drooping" of your eyebrows. In this instance, it may be necessary to perform a brow lift to lift up the position of the eyebrows and hence, correct the excess skin of the upper eyelids.

On the lower eyelid, mostly fat and a small amount of excess skin are removed for the same purpose. This is performed through an incision made just below the eyelashes or through the inner aspect of the lower eyelid, which leaves no scar on the visible side of the lower eyelid. The muscle of the lower eyelid is also redraped and tightened to help eliminate the sagging appearance. This procedure is performed by itself or with another procedure to rejuvenate the entire face. It is not uncommon to have laser resurfacing or chemical peel be performed around the eyes at the same time as the blepharoplasty to help tighten up the skin and smooth out the wrinkles. Depending on the elasticity of your lower eyelids, it may be necessary to tighten the tendon at the corners of your eyes (canthoplasty). This will help reduce the potential for drooping of the lower eyelid postoperatively.

Anesthesia The procedure is usually performed as an outpatient under local anesthesia. If you have other procedures performed at the same time, then general anesthesia will be necessary. On occasions sedation can be performed using intravenous medications. The anesthesiologist and the surgical facility will bill separately for their services.

Duration of Surgery The operating time will vary depending on the patient and the extent of the procedure, and whether any additional procedures are performed. Generally, the operative time for either an upper or lower blepharoplasty is approximately 1 - 1 ½ hours. It would take 2 – 2 ½ hours for both upper and lower blepharoplasties.

Before Surgery Do not take aspirin and ibuprofen or products that contain aspirin for at least 3 weeks prior to surgery. Also refrain from energy drinks or any herbal supplements, as some may have an effect on increasing bleeding during the course of surgery. Remove all makeup and mascara from your eyelids. If you wear contacts lenses, it would be preferable that you wear glasses when you arrive to the surgery center.

After Surgery

There are no dressings. Stitches are dissolvable and will be gone in 5 to 7 days. Ice packs and/or iced-soaked gauze may be applied to help reduce discomfort and swelling. There is usually a moderate amount of swelling and bruising after a blepharoplasty. You should try to sleep with your head and shoulders elevated to help reduce the amount of swelling. You may shower the day after surgery. Initial discomfort is controlled with oral medication. Do not wear your contact lenses after surgery. You may try to reinsert your contacts once the swelling subsides, but do not be discouraged if you are not able to initially.

Return to Normal Activity Most people return to their usual activities and to work approximately 1 week after surgery. It is acceptable to apply make-up after 3 to 5 days. Strenuous sports and other activities should not be performed for 3 to 4 weeks, as this may raise your blood pressure and result in further swelling or bleeding. You may drive when you are no longer taking pain medication and when the swelling is no longer a concern.

Scars You should expect a scar on each upper eyelid. These are usually well concealed in an upper eyelid skin crease. The lower eyelid scar will likewise be concealed in a natural skin crease of the lower eyelid just below your eyelashes. In some cases, a lower eyelid incision is made on the inner aspect of the eyelid, in which case, there will be no visible external scar. All of the locations mentioned are tolerated quite well. All scars are however permanent. The width, height, and color of scars are unpredictable and will vary from patient to patient. Wear a sunscreen of at least SPF 30 or greater when outside to protect the scars from sunlight during the healing process.

Swelling and Bruising Swelling and bruising of the eyelids or any site following surgery is normal. During the first 1 to 2 weeks your eyelids will feel and look swollen. The swelling will start to subside after the first postoperative week. It may take as long as 2 to 3 weeks for the last bit of swelling to recede. The bruising will also take 1-2 weeks to subside. Taking the herbal medication, Arnica Montana, as well as fresh pineapple and/or papaya will help decrease the swelling and bruising. Be aware that normal lubrication of your eyelids may be altered until the swelling settles. Lubricating eyedrops may be necessary post surgery.

Scars Incisions may be located inside the nose, however, occasionally a small incision is necessary on the column of skin between the nostrils on the under surface of the nose. This incision usually heals very well. In some cases the nostrils may be too wide and is narrowed by making incisions in the crease between the nostril and the cheek. The scars are rarely problematic. Nevertheless, you should be aware that all scars are permanent and their height, width and final color are unpredictable.

Complications

Some swelling and bruising around the eyes is expected after a blepharoplasty. This peaks at 48 to 72 hours after surgery and then starts to subside. Complete resolution of swelling may take several weeks.

HEMATOMA This is the most common complication and occurs when a collection of blood forms under the areas of undermined skin. It occurs in about 1 to 2% of patients. The body will absorb minimal bleeding. Only on rare occasions will it require additional surgery. On very rare circumstances, bleeding could result in intense pain behind the eye and may lead to visual impairment or loss.

EDEMA This is swelling, which is a normal consequence of surgery and is best treated simply by elevating the head of the bed. The application of ice packs or cold compresses is very helpful for the first 2 to 4 days.

ABNORMAL SCARS A small percentage of patients will develop scars that are unacceptable despite meticulous attention to detail, both during and after surgery. The scars may widen, remain red or raised. If the scars are problematic, a steroid ointment or injection may be used to improve their appearance. On rare occasions scar may result in drooping of the lower eyelid (ectropion) causing an irritation of your eyes. This usually corrects itself with time, massages and patience. In rare cases, the scars may need to be surgically revised to correct the drooping.

INFECTION This complication is also rare. Prevention is the key, and antibiotics are given both before and after surgery.

ASYMMETRY There is usually some asymmetry of the eyelids; in some people this is marked and is the reason they seek surgery. All efforts are made to have the eyelids as symmetrical as possible but it is important to understand that perfect symmetry may be difficult to attain. A slight asymmetry may be acceptable after surgery; a greater amount of asymmetry may require additional surgery to correct.

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Procedure: Endoscopic Brow Lift (Forehead Lift)

A browlift (forehead lift) procedure is performed to elevate the eyebrows and to reduce or eliminate wrinkles and creases from the forehead. The eyebrow position is very important and typically should be slightly above the bony ridge. Aging and gravity tend to pull the eyebrows down, especially laterally, resulting in a "sad" or tired appearance. As a reflex you tend to elevate your eyebrows using the muscles of your forehead. This will increase the wrinkles of your forehead. There may even be apparent excess skin of the upper eyelid giving the impression that one needs to have the upper eyelid skin removed (blepharoplasty). By surgically elevating the eyebrows to a more normal position, an "open" almond-shaped appearance of the eyes is achieved. By elevating the brows an upper blepharoplasty may not be necessary.

Surgery

The browlift procedure was, until a few years ago, performed through an incision completely within the hair of the scalp extending from one ear to the other. This incision is seldom used now. Today, three small incisions are made in the hairline, just above the forehead. An endoscope (a telescope with a lens, light source and camera attached) is used to assist in visualization so smaller incisions can be made and consequently less scarring occurs. The muscles of the forehead are cut to weaken them, thus reducing forehead wrinkles. The forehead skin is shifted up and back to elevate the eyebrows. Suspension sutures are used to maintain the elevated position.

In certain circumstances, a direct browlift can be performed by incising just above the eyebrows and removing a segment of skin. This results in directly raising the eyebrow. This is an excellent approach and is usually reserved in severe brow drooping with an excess of forehead wrinkles.

These procedures can be performed in conjunction with other procedures to rejuvenate the entire face since all components of the face age simultaneously.

Anesthesia The procedure is performed under general anesthesia or under heavy sedation and local anesthesia as an outpatient. Other procedures may be combined with a forehead lift, especially a blepharoplasty. The anesthesiologist and the surgical facility will bill separately for their services.

After Surgery

A light dressing is applied after the procedure to give gentle compression to the operated areas. Ice packs will also be applied to help reduce bruising and swelling. There is usually a moderate amount of swelling and bruising after a browlift. You may experience swelling of the upper eyelids that may result in not being able to open your eyes completely. This swelling should dissipate in 2-3 days. You should try to sleep with your head and shoulders elevated, in an effort to help reduce the amount of swelling. Taking the herbal medication (Arnica Montana), fresh pineapple and/or papaya will also assist in decreasing the swelling and bruising. You may shower once the dressing is removed, usually within 48 hours after surgery. If you bathe, do not allow the incisions to soak under water.

Initial discomfort is controlled with oral medication but typically the pain is minimal. The stitches are usually dissolvable and will usually be gone in 10-14 days. You should apply antibiotic ointment (Neosporin or Polysporin) to the incisions twice daily.

Return to Normal Activity Most people return to their usual activities and to work approximately 1 week or less after surgery. It is acceptable to apply makeup after 3 to 5 days. Strenuous sports and other activities should not be performed for 3 to 4 weeks. You may drive when the swelling goes down (3-4 days), or when you are no longer taking pain medication.

Scars You should expect several scars (usually 3), each about ½ inch behind the hairline above your forehead. Each incision is usually no larger than ¼ inch. The location will vary somewhat depending on the hairline. Most scars will be covered by hair. All scars are however permanent. The width, height and color of scars are unpredictable. Apply sunscreen of at least SPF 30 or greater when outside to protect the scars from sunlight during the healing process. You can improve on the scars by massaging with Vitamin E.

Diminished Sensibility As with any surgical procedure, small sensory nerves to the skin surface may be cut when the incision is made or when skin is undermined. Portions of your forehead and scalp will feel numb or have less than normal feeling. The sensibility in these areas gradually returns, usually within 2 to 3 months as the nerve endings spontaneously heal. During the healing process the forehead and scalp may become hypersensitive for a period of time. Some diminished sensibility may last indefinitely.

Swelling and Bruising Swelling and bruising of the forehead and face or any surgical site following surgery is normal. During the first 1 to 2 weeks your forehead will feel and look swollen. The swelling will start to subside during the first week. It may take as long as 2 months for the last bit of swelling to recede.

Complications

EDEMA (Swelling) This is a normal consequence of surgery and is best treated simply by elevating the head of the bed. The applications of ice packs or cold compresses over the eyes are usually helpful for the first 3 to 4 days. Taking Arnica Montana and fresh pineapple are also helpful.

ABNORMAL SCARS A small percentage of patients will develop scars that are unacceptable despite meticulous attention to detail both during and after surgery. The scars may widen, stay red or raised. In some cases hair may not grow around them. If the scars are problematic, a steroid ointment or injection may be used to improve their appearance. In some cases the scars need to be revised surgically.

INFECTION This complication is also rare. Prevention is the key and antibiotics are given both before and for a period of time after surgery.

ASYMMETRY There is usually some asymmetry of the brows, in some people this is marked and is the reason they seek surgery. All efforts are made to have the eyebrows as symmetrical as possible but it is important to understand that perfect symmetry may be difficult to attain. A slight asymmetry may be acceptable after surgery. A greater amount of asymmetry may require additional surgery to correct.

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Procedure: Neck Lift

A "neck lift" is a procedure that improves the overall contour of the upper neck. It helps to define the chin-neck angle providing a more definite demarcation between the two. In most instances there is a combination of excess fat along with relaxation of the superficial neck muscles giving rise to the "turkey gobbler neck". When neck skin is loose then the skin can be tightened by excising some of the excess. This is usually performed in conjunction with a facelift procedure to be able to remove the maximal amount possible. If a full facelift is not necessary then a mini-facelift can be combined with the neck lift to provide more tightening.

Surgery

Most neck lift procedures begin with liposuction to remove excess fat. Fat is removed through a small incision just below the chin. The muscle (platysma) is sutured together, if necessary, to tighten the upper neck muscles thus decreasing the sagging appearance. The incision is then sutured and the areas treated are covered by a bandage or garment to help redrape the skin and contain the swelling. In more limited situations two incisions are made, one in front, under and/or behind each ear. Sections of skin are trimmed and lifted into place and sutured. Tightening the platysma (neck muscle), requires an incision below the chin. These same incisions can be used for liposuction of the neck and tightening loose skin.

Anesthesia The procedure is usually performed as an outpatient under local anesthesia. If you have other procedures performed at the same time, then general anesthesia will be necessary. On occasion sedation can be performed using intravenous medications. The anesthesiologist and the surgical facility will bill separately for their services.

Duration of Surgery The operating time will vary depending on the patient and the extent of the procedure, and whether any additional procedures (face lift or mini-facelift) are performed. Generally, the operative time for a neck lift is approximately 1 ½-2 hours.

Photographs are taken at the time of your consultation. These are important aids in the preparation of surgery and become a permanent part of your record. Post-surgical photographs are also taken.

After Surgery

A bulky dressing is applied after the procedure and this is changed to a light type dressing in 2-3 days. A small drain is usually placed and is removed in 3 days. Sometimes an elastic wrap or support is used to give gentle compression to the operated areas after the dressings are removed. Ice packs are applied to the sides of the face and neck to help reduce discomfort and swelling. There is usually a moderate amount of swelling and bruising after a neck lift. You should try to sleep with your head and shoulders elevated to help reduce the amount of swelling. You may bathe the day after surgery, but do not get the dressings wet. You may shower and shampoo your hair once your physician has removed the dressings. You may remove the elastic support to shower or bathe. Men should be able to shave after approximately 3 to 5 days.

Initial discomfort is controlled with oral medication but typically the pain is minimal. Stitches are usually removed in 5 to 7 days.

Swelling and Bruising Swelling of the neck and lower face or any site following surgery is normal. During the first 1 to 2 weeks your neck will feel firmer due to the swelling and scar formation. The skin may appear shiny due to the swelling. The swelling will start to subside after the 4th postoperative day. It may take as long as 2 months for the last bit of swelling to recede. You may expect about 50% of the final improvement at 2 weeks and about 75% at 1 month. You will continue to see improvement out to 6-9 months. The bruising will also take 1-2 weeks to subside. Taking the herbal medication, Arnica Montana, as well as fresh pineapple and/or papaya will help decrease the swelling and bruising.

Diminished Sensibility As with any surgical procedure, small sensory nerves near the surface of the skin are interrupted during a neck lift. Portions of your neck and face will feel numb or have less than full feeling. The sensibility in these areas gradually returns, usually within 2 to 3 months as the nerve endings spontaneously heal. During the healing process the skin of the face may become hypersensitive for a period of time. Sensibility returns over several months, but some diminished feelings may last indefinitely.

Scars You should expect a scar under your chin and possibly in front of each ear, with an extension upward into the hair of the temple region and downward around the earlobe and into the hair behind the ear. The location will vary slightly depending on the hairline. The scars are placed in natural skin creases and will fade with time. This usually takes 6 to 9 months. All scars are however permanent. The width, height and color of scars are unpredictable. Wear a sunscreen of at least SPF of 30 or greater when outside to protect the scars from sunlight during the healing process.

Complications

When neck surgery is performed complications are infrequent and usually minor. Nevertheless, as with any operation, there are risks associated with surgery and specific complications associated with this procedure.

HEMATOMA A collection of blood under the neck skin may occur in 1 - 2% of patients. The body will absorb minimal bleeding. A larger collection may necessitate aspiration to drain the collection. Only on rare occasions will it require additional surgery. On very rare circumstances, bleeding could result in intense pain along the upper neck with a marked amount of swelling requiring surgical intervention.

ABNORMAL SCARS A small percentage of patients will develop scars that are unacceptable despite meticulous attention to detail, both during and after surgery. The scars may widen, remain red or raised. If the scars are problematic, a steroid ointment or injection may be used to improve their appearance. This usually corrects itself with time, massages and patience. In rare cases, the scars may need to be surgically revised.

WRINKLING As the neck skin heals there may be scar formation from beneath that result in wrinkling of the overlying skin. Occasionally the wrinkling may be pronounced enough that external massage or ultrasound therapy or steroid injections may be necessary. Most of the time the amount of wrinkling is very mild, if any, and should resolve on its own. These problems are usually mild and require no additional treatment.

NERVE INJURY In addition to the small sensory nerves to the skin noted above, the other main nerve that is at risk is the facial nerve. Injury to this nerve occurs in less than 1% of cases. When it does occur it results in weakness of the face when smiling. If the nerve or one of its branches is injured due to stretching it may take 2 to 6 months for recovery. If the nerve is cut there may be either partial or complete weakness of a certain area.

INFECTION This complication is also rare. Prevention is the key and antibiotics are given both before and for a period of time after surgery.

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Procedure: Lip Augmentation

Lip augmentation is a procedure designed to improve on the overall appearance and shape of both the upper and lower lips. Some individuals are blessed with lip fullness that provides an adequate show of vermillion (red part of the lip). This allows for an easier application of lipstick or coloring. This amount of aesthetically pleasing vermilion show is not present in everyone. It is also difficult for some individuals to even apply lipstick because of the lip deficiency. The junction of the vermillion to that of the skin should have a slight roll that accentuates the desired lip pout and Cupid's bow. Lip augmentation can be performed to provide fullness and pout to the central part of the lip.

It is also evident that with aging there is some decrease in fullness of the lip resulting in less pout and an increase in the fine wrinkles of the upper and lower lips. There are procedures (CO2 laser, dermabrasion and chemical peel) that have been shown to improve on the wrinkles of the lips. Lip augmentation can also assist in correcting a minimal amount of wrinkles and at the same time enhance the fullness of the lips.

Surgery

There are currently several methods that could be utilized to achieve this end. Collagen injection has been performed but the results are very short lasting (usually no more than 6-10 weeks). Fat injection has also been used and the results are variable with loss of the augmentation over 1 year. Gortex has also been used with a longer lasting result, but this material is artificial and not incorporated into one's own tissue. There have also been reports of the Gortex becoming exposed with time. Alloderm (dermal graft) is also used as a graft substitute that with time will incorporate into the body's tissue. It is cadaver tissue that has been treated to remove any of the proteins that could result in a reaction. This material has been used for a variety of reconstructions and is longer lasting but also resorbs (dissolve) over time.

The current choice is Silicone injection to both upper and lower lips. This procedure has been performed in many patients with excellent results and is permanent. This is a medical grade silicone that is injected under local anesthesia. It typically takes 15 minutes to perform. It should be noted that the material is not FDA approved and is an off-label use. The results have been very favorable with this material and patients are delighted, as this procedure is permanent. This is the current method of choice.

A surgical procedure can also be performed in which the inner aspect of the lip can be rolled out to increase the lip fullness and the lip pout. This is called a V-Y advancement or a W-plasty. This is accomplished by making several incisions on the inner aspect of the red portion of the lip and rolling the lip out. This provides for a minimal to moderate amount of augmentation.

Anesthesia The procedure is performed under local anesthesia with nerve blocks in the office and usually requires approximately 15 minutes for the injection technique and approximately 1 hour for the surgical procedure. Sedation is usually not necessary and one could return home immediately after.

Duration of Surgery The operating time will vary depending on the patient and whether one or both lips are augmented and whether any additional procedures are performed. Generally the time is approximately 15 minutes for an augmentation of both lips. It is usually 1 hour if the surgical procedure of a W-plasty is performed.

Before Surgery Do not take aspirin or ibuprofen or products that contain aspirin for at least 3 weeks prior to surgery. Also refrain from consuming any energy drinks or herbal supplements, as some may have an effect on increasing bleeding during the course of surgery. Remove all makeup and mascara from your eyelids. If you wear contacts lenses, it would be preferable that you wear glasses when you arrive to the surgery center.

After Surgery

No dressings are necessary and only antibiotic ointment is applied to the entire lip and especially over the stitches. Ice packs are not necessary. There is usually a moderate amount of swelling and very little if any bruising. You should try to sleep with your head and shoulders elevated to help reduce the amount of swelling. You may bathe the day after surgery. The antibiotic ointment should be applied twice daily for one week.

Initial discomfort is controlled with oral medication. Stitches are dissolvable and should be gone by one week. You should be careful on eating items that are hard or that have rough or sharp edges (like chips or Doritos). You should be extremely careful about placing items in your mouth as the feeling to your lips will initially be decreased and you may not be aware of injury or burn to your lips.

Return to Normal Activity Most people return to their usual activities and to work the following day. It is acceptable to apply lipstick after 2 days. Strenuous sports and other activities should not be performed for 3 to 4 weeks.

Scars No scars will be visible if the injection technique is used. You might be able to feel some lumps on occasion but this can generally be smoothed out with massages. You should expect scars on the underside of the lips if the surgical procedure is performed. These scars usually heal very well with minimal visibility. Scars of the lip usually heal so well that they are usually imperceptible but scars are however permanent. The width, height and color of scars are unpredictable. The lip usually feels somewhat firm in the beginning but will soften with time. Wear a sunscreen of at least SPF of 30 or greater when outside to protect the scars from sunlight during the healing process.

Diminished Sensibility As with any surgical procedure, small sensory nerves to the skin surface may be cut when the incision is made or when skin is undermined. Portions of your lip will feel numb or have less than full feeling. The sensibility in these areas gradually returns, usually with 2 to 3 months as the nerve endings spontaneously heal. During the healing process the skin of the lip may become hypersensitive for as period of time. Some diminished sensibility may last indefinitely.

Swelling and Bruising Swelling and bruising of the lips or any site following surgery is normal. During the first 1 to 2 weeks your lips will feel and look swollen. The swelling will start to subside after the first postoperative week. It may take as long as 6 weeks for the last bit of swelling to recede.

Complications

HEMATOMA This is the most common complication and occurs when a collection of blood forms under the areas of undermined skin. It occurs in less than 1% of patients. The body will absorb minimal bleeding. A larger collection may necessitate aspiration to drain the collection. Occasionally it will require additional surgery.

EDEMA This is a normal consequence of surgery and is best treated simply by elevating the head of the bed. The application of ice packs or cold compresses may be performed but is not necessary.

ABNORMAL SCARS A small percentage (less than 1 %) of patient will develop scars that are unacceptable despite meticulous attention to detail both during and after surgery. The scars may widen, stay red or raised. If the scars are problematic a steroid ointment or injection will be used to improve their appearance. In some cases the scars need to be revised surgically.

SKIN LOSS This is also a rare occurrence. It may be due to cigarette smoking in the days to weeks before and after surgery, or due to undo tension at the site of the incision which could be compounded by swelling or hematoma. Usually this is managed without the need for additional surgery.

INFECTION This complication is also rare. Prevention is the key and antibiotics are given both before and for a period of time after surgery.

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Procedure: Otoplasty

Otoplasty is a procedure performed to set prominent ears back closer to the head or to reduce size of large ears. For the most part, the operation is done on children between the ages of four and fourteen but there are many adults who seek the same correction. Ears are almost fully grown by age 7, and the earlier the surgery, the less teasing and ridicule the child will have to endure. Ear surgery on adults is also possible, and there are generally no additional risks associated with ear surgery on an older patient.

It is recommend that parents stay alert to their child's feelings about protruding ears; don't insist on the surgery until your child wants the change. Children who feel uncomfortable about their ears and want the surgery are generally more cooperative during the process and happier with the outcome.

Surgery

Ear surgery is usually performed as an outpatient procedure in a hospital, or in our office-based surgical facility. Typically a small incision is made in the back of the ear to expose the ear cartilage. The cartilage is then sculpted and bent back toward the head. Skin is removed and stitches are used to fold the cartilage back on itself to reshape the ear without removing cartilage. Permanent stitches are then placed internally on the cartilage to maintain the new shape.

Anesthesia The procedure is usually performed as an outpatient under local anesthesia. If you have other procedures performed at the same time, then general anesthesia will be necessary. If your child is young, a general anesthetic is recommended, so your child will not experience the operation. For older children or adults, the surgeon may prefer to use local anesthesia. On occasions sedation can be performed using intravenous medications. The anesthesiologist and the surgical facility will bill separately for their services.

Photographs are taken at the time of your consultation. These are important aids in the preparation of surgery and become a permanent part of your record. Post-surgical photographs are also taken.

After Surgery

The patient's head and ears will be wrapped in a bulky head bandage to minimize the swelling and bruising, for protection and to help mold the ears. The ears may throb or ache a little for a few days, but this can be relieved by oral medication. The typical complaint is that the head will itch and you will have to refrain from sticking your fingers or other items under the dressing to scratch. This may result in an infection or hinder the normal wound healing process. A fan or hair dryer set on "cool" will help dry the sweat under the dressing that is the culprit for the itching.

The bulky bandages will be removed by the 5th day and replaced by a lighter head dressing (tennis sweat-band) similar to a headband. Be sure to follow the directions for wearing this dressing, especially at night. There is usually a moderate amount of swelling and bruising after the dressings are removed. Stitches are will dissolve in about 10 days. Antibiotic ointment will need to be applied to the back of the ears for 2 weeks.

Return to Normal Activity Any activity in which the ear might be injured or bent should be avoided for a month or so. Skiing, playing ball, wrestling, riding bikes, skateboarding or being on a trampoline should be avoided. Most adults can go back to work within five days after surgery. Children can go back to school after seven days or so if they are careful about playground activity. You may want to ask your child's teacher to keep an eye on your child for a few weeks. You should try to sleep with your head and shoulders elevated to help reduce the amount of swelling. You may shower after the dressings are removed. Strenuous sports and other activities should not be performed for 3 to 4 weeks, as this may raise your blood pressure and result in further swelling or bleeding. You may drive when you are no longer taking pain medication and when the swelling is no longer a concern.

Scars Incisions will be located behind the ears; however, occasionally a small incision is necessary on the front of the ear. These incisions usually heal very well. The scars are rarely problematic. Nevertheless, you should be aware that all scars are permanent and their height, width and final color are unpredictable. Wear a sunscreen of at least SPF 30 or greater when outside to protect the scars from sunlight during the healing process.

Swelling and Bruising Swelling and bruising of the ears or any site following surgery is normal. During the first 1 to 2 weeks your ears will feel and look swollen. The swelling will start to subside after the first postoperative week. It may take as long as 2 to 3 weeks for the last bit of swelling to recede. The bruising will also take 1-2 weeks to subside. Taking the herbal medication, Arnica Montana, as well as fresh pineapple and/or papaya will help decrease the swelling and bruising.

Complications

ABNORMAL SCARS A small percentage of patients will develop scars that are unacceptable despite meticulous attention to detail, both during and after surgery. The scars may widen, remain red or raised. If the scars are problematic, a steroid ointment or injection may be used to improve their appearance. This usually corrects itself with time, massages and patience. In rare cases, the scars may need to be surgically revised.

INFECTION This complication is also rare. Prevention is the key, and antibiotics are given both before and after surgery. Occasionally, patients may develop an infection in the cartilage, which can cause scar tissue to form within the ear. Such infections are usually treated with antibiotics; rarely, surgery may be required to drain the infected area.

ASYMMETRY There is usually some asymmetry of the ears; in some people this is marked and is the reason they seek surgery. All efforts are made to have the ears as symmetrical as possible but it is important to understand that perfect symmetry may be difficult to attain. A slight asymmetry may be acceptable after surgery; a greater amount of asymmetry may require additional surgery to correct.

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Procedure: Rhinoplasty

Rhinoplasty is the operation to correct a deformity of the nose. The primary purpose is to improve the appearance of the nose and in some cases to improve nasal breathing. The procedure is performed by removing excess cartilage and /or bone and reshaping the nose. After alteration of these structures the skin is allowed to re-drape over the newly shaped framework. This will give the nose its new appearance. These changes will be subtle or dramatic depending on the needs of the patient. At times a septoplasty (correction of the inner aspect of the nose) is performed in conjunction with a rhinoplasty. This allows for an improvement in breathing if the septum is deviated.

The goal of a rhinoplasty is a nose that appears natural, functions properly and is in balance with the rest of the face. The patient's wishes with regard to the type of nose desired are always considered. There are however limiting factors. The texture and thickness of the skin, previous injury, individual differences in healing and differences in facial proportions play an important role in what can be achieved.

Surgery

Depending on the individual patient additional procedures may be combined with rhinoplasty. Since your entire face will be assessed at the time of your consultation we can discuss these options. The most commonly performed additional procedures are septoplasty, chin augmentation to correct a weak or receding chin or cheek implants to enhance the appearance of the cheek bones. Occasionally, the nostrils may be wide and flared and out of proportion to the nose and may require a reduction to bring the entire nose into the best balance possible.

Anesthesia In most instances surgery is performed under general anesthesia. You will recover easily usually with no side effects. In certain circumstances the surgery may be performed under local anesthesia. The anesthesiologist's services are billed separately.

Duration of Operation The procedure will typically last from 1-2 ½ hours depending on what areas are treated and how difficult the nasal procedure is. A repeat rhinoplasty will be more difficult and will usually involve more surgical time.

Hospitalization Vs Office Surgery Nasal surgery is usually performed on an out patient basis. You come to the surgical facility on the day of the procedure and return home several hours after the procedure. In certain cases, hospitalization may be necessary.

Before Surgery It is imperative that aspirin and ibuprofen or products containing aspirin not be taken at least 3 weeks prior to surgery. Also refrain from consuming any energy drinks and herbal supplements, as some may have an effect on increasing bleeding during the course of surgery. Remove all makeup and mascara from your eyelids. If you wear contacts lenses, it would be preferable that you wear glasses when you arrive to the surgery center. You should shower well on the day of surgery prior to coming to the surgery center. It is okay to brush your teeth the morning of surgery.

After Surgery

There is very little discomfort associated with a rhinoplasty. Most of the discomfort is due to not being able to breathe through your nose when nasal packing is used. Oral pain medication is all that is necessary to control the discomfort. The nose is usually packed with a minor sponge-like gauge for about 3 days. If septal surgery is also performed, then the packing may stay in for about 5 days. Internal incisions are closed with stitches that dissolve; the external incision may have stitches that need to be removed in 5 to 7 days.

After the nasal packing is removed then Afrin nasal decongestant spray should be used twice daily for one week. This will assist in decreasing the internal nasal swelling. A saline nasal spray should also be used intermittently for humidification. Refrain from vigorous nose blowing as this may cause nasal bleeding.

The external splint will be removed in approximately one week. Some swelling will still be present at this time. Most of the visible swelling will disappear by 2 weeks. There will still be a feeling of numbness and stiffness at the tip of the nose, which means that some swelling is still present. It will take several months before the last bit of swelling has resolved.

Return to Normal Activity Patients may go back to school or light work one week after surgery. You should avoid strenuous activity for 2 weeks. After 2 weeks you may gradually increase your activity so that you are back to your usual routine by 3-4 weeks. You should avoid excessive sun exposure (use sun block), avoid getting your nose hit, and avoid letting heavy glasses rest on your nose for 8 weeks.

Diminished Sensibility As with any surgical procedure, small sensory nerves to the skin surface may be cut when the incision is made or when skin is undermined. Portions of your nose will feel numb or have less than full feeling. The sensibility in these areas gradually returns, usually with 2 to 3 months as the nerve endings spontaneously heal. During the healing process the skin of the lip may become hypersensitive for as period of time. Some diminished sensibility may last indefinitely.

Swelling and Bruising Some swelling and bruising of the nose and around the eyes is expected after rhinoplasty. This peaks at 48 to 72 hours after surgery and then starts to subside. Crushed ice applied to the eyes will help during this time. During the first 1 to 2 weeks your nose will feel and look swollen. The swelling will start to subside after the first postoperative week. It may take as long as 6 weeks for the last bit of swelling to recede.

Complications

Some swelling and bruising of the nose and around the eyes is expected after a rhinoplasty. This peaks at 48 to 72 hours after surgery and then starts to subside. Complete resolution of swelling may take several months.

BLEEDING This is unusual but may occur after rhinoplasty. This may have to be treated with additional nasal packing; however, in some cases additional surgery may be necessary. Refrain from vigorous nose blowing or any vigorous activities post surgery.

ASYMMETRY Occasionally, a minor deformity or irregularities may persist following surgery. Usually this problem is correctable with another smaller procedure, which can usually be performed with a local anesthetic. At times a general anesthetic is necessary or requested and anesthesia and facility costs will be at the patient's expense.

EDEMA This is a normal consequence of surgery and is best treated simply by elevating the head of the bed. The application of ice packs or cold compresses is usually done for the first 1 to 2 days.

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MORALES PLASTIC SURGERY

5089 South 900 East. Ste 100
Salt Lake City, UT

Telephone: (801) 743-0700
Fax: (801) 743-0701

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