Plastic Surgery Choices (cont.)
When do you have complete healing with breast augmentation?
It depends on what exactly we mean by complete healing. And by this I mean within several weeks most patients are reasonably comfortable after breast augmentation. They may have minor discomfort at this time, but certainly in two to four weeks they should be resuming normal activity.
However, if the patient develops firmness of the breast this can lead to discomfort relatively long after the procedure. Therefore, if the patient has continued discomfort months or even several years after surgery, he or she should return to see their surgeon. Firmness of the breast, or capsules, can result months or even years after surgery. Therefore, if an individual has the gradual onset of new discomfort, months or years after surgery, I would recommend that they return to see their surgeon. MEMBER QUESTION:
Could you go into some detail about removing dark bags from under eyes?
Well, of course I would have to see the patient to understand certain specifics. But, generally bags under the eyes are due to one or a combination of several things:
Darkening under the eyes can first be treated by products used at home, such as Retin-A or Retin-A in combination with bleaching creams. If this is unsuccessful, a variety of peeling techniques can be used to remove pigment.
I would like to remove two moles from my face for purely cosmetic reasons. One is in an obvious spot and I want to minimize scarring and discoloration. The moles are raised (one on my cheek and the other by my temple/hairline) and approximately the diameter of a pen cap. Do you recommend I see a dermatologist or a plastic surgeon for this type of procedure? Is scraping, cutting, or freezing best? Also, can you give a general guideline of the cost of such a procedure?
My prejudice would be that for any cosmetic result a plastic surgeon is the best person to see, because of his or her attention to surgical detail. Of course, there are good dermatologists who remove moles, and if other friends or family members have had a good experience with a dermatologist, this would be acceptable. However, in general, plastic surgeons are technically superior in surgical techniques.
The mole would need to be examined to determine the best method of removal and removal with a minimum scar. Certain growths can be readily removed by superficial techniques that require superficial removal only with a minimum scar. Other growths require an excision or scar for complete removal.
Cost is dictated by the size of the lesion, the number to be removed, and the surgical technique required for their removal. Because of this, specific prices would be difficult to give you without more detail.
I can't let my job know about having eyelid surgery. How long after will a person be bruised?
That varies according to the type of operation, the complexity of the operation, which eyelids are being operated on, upper eyelids or lower eyelids, and whether anything else is being done at the same time. Generally, patients' black and blues will be able to be concealed at 10 days to two weeks after surgery.
Is there a procedure to broaden shoulders?
Not that I know of. Anything's possible.
I have a question about a 2"- to 3"-long scar on my face that is 40 years old. I had eight stitches on my cheek, but the wound got infected several times. The scar is dimpled. Is it possible to have it repaired or made less obvious, even though I've had it so long?
Anything's possible. Without seeing you it is possible to review the scar; however, scar revision turns the clock back and the scar initially, over the next several months, will be visible. Scars that are many years old tend to be much fainter, but if there is a significant indentation, pucker, or other irregularity, consulting a plastic surgeon for correction is quite reasonable.
I was told that if you have a face-lift that nothing can be done with the neck. And that is why you see women all wearing turtlenecks. Is this true?
This is totally untrue, and the source of information is not well informed. Actually, virtually anytime that I do a face-lift the neck is also treated. In general, with regards to aging, the neck is often the first area to age. In fact, isolated treatment of the neck only, through incisions under the chin or through incisions that we use for a face-lift, is frequently utilized.
In the case of a revision face-lift, that is, in a patient who's had a face-lift and is undergoing another face-lift years later, often the neck has held up better than most other areas of the face. In short, the neck is an ideal area to treat to improve or reverse aging.
I get skin tags on my eyelids, my neck, under my arms, on my back, and worst of all, on my upper inner thighs. If I get them removed, will they just grow back? I know my family doctor can cut them off, but I don't want her cutting near my eyes, and she doesn't feel they are medically necessary to remove, so I might as well see a plastic surgeon since she thinks my concerns are purely cosmetic, even though they can be irritated (especially on my thighs). Your advice, please?
Skin tags are readily removed in any location by a most simple procedure, and eyelids would pose no problem. The skin tags shouldn't return, but if you have formed many skin tags previously, you may form some more.
Are there any special concerns for those with darker skin when considering plastic surgery?
Darker-skin people have a tendency to form thicker scars, although this is unusual in the eyelid area. There are also techniques in properly selected patients who can have the surgery done without a skin incision and rather an incision in the conjunctivi, or inside the eyelid. This incision is generally used in patients who have fat excess in the lower lids only and minimal excess skin.
Dr. Zins, before we wrap things up, do you have any final words for us?
I think perhaps the best question we had today was your first question on how to choose a plastic surgeon. There's been tremendous amount of media attention on plastic surgery in general, and cosmetic surgery in particular. The potential negative effect of this attention is to trivialize the importance and the seriousness of these operations. Therefore, choosing the best-qualified person to do your surgery is the most important decision that you'll make with regard to a cosmetic surgery procedure.
Plastic surgery is a very diverse field, and good plastic surgeons may perform many operations well but not necessarily all operations well; therefore, the experience of your surgeon with the specific problem with which you are dealing is most important.
Our thanks to James Zins, MD, the chairman of the department of plastic surgery at The Cleveland Clinic, for sharing his expertise with us.
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