Tulsa Oklahoma Plastic Surgery: Kevin Paul Kunkel, MD

Products And Services

• Blepharoplasty

  Blepharoplasty (eyelid surgery) is a plastic surgery procedure for correcting sagging or drooping eyelids. The eyelid, because its skin is much thinner than that in other parts of the face, is often one of the first facial areas to exhibit signs of aging. Eyelids that sag or droop can affect peripheral vision, making daily activities such as driving more difficult. Blepharoplasty may become necessary when various factors, which include aging, sun damage, smoking and obesity, cause the muscles and tissue that support the eyelids to weaken. Reasons for Blepharoplasty Blepharoplasty tightens the eyelid's muscles and tissue, and removes excess fat and skin. Blepharoplasty eliminates the drooping of skin into the visual field, greatly improving peripheral vision. It is also performed for strictly cosmetic reasons. Functional Blepharoplasty If the eyelids begin sagging into the field of vision, a functional blepharoplasty may be required. The procedure may be covered by medical insurance if it is deemed medically necessary. A determination of how much vision is affected is done by checking the peripheral visual field with an instrument called the Humphrey Visual Field (HVF) Analyzer. Cosmetic Blepharoplasty Blepharoplasty can be performed on either the upper or lower eyelid, or on both, for cosmetic purposes. For a lower eyelid that needs fat rather than skin removed, a transconjunctival blepharoplasty is performed. During transconjunctival blepharoplasty, an incision is made inside the lower eyelid, so there are no visible scars, and the fat is removed. This procedure has no effect on vision, but results in a person's looking younger and more refreshed. It is important for a patient to have realistic expectations before undergoing cosmetic blepharoplasty. Although the procedure can enhance appearance and improve self-confidence, it does not radically alter the face. Candidates for Blepharoplasty The best candidates for blepharoplasty are those who are in good overall health, do not smoke, do not have any serious eye conditions, and have healthy facial tissue and muscle. People with eye disease, including glaucoma or retinal detachment, thyroid disorders, diabetes, cardiovascular disease or high blood pressure are not good candidates for blepharoplasty. The Blepharoplasty Procedure Blepharoplasty is typically performed as an outpatient procedure requiring local anesthesia and sedation. General anesthesia may be used for anxious patients. Patients can choose to have this procedure on their upper or lower eyelids, or both. The procedure can take anywhere from 45 minutes to 2 hours, depending on whether both the upper and lower eyelids are operated on. If the upper eyelid is being operated on, an incision is typically made along its natural crease. Once the incision is made, fat deposits are repositioned or removed, muscles and tissue are tightened, and excess skin is removed. For the lower eyelid, an incision is usually made just below the lash line so that excess skin can be removed. After the procedure, the incisions are closed with sutures, tissue glue or surgical tape, and usually loosely covered with gauze so the area can heal. Recovery After Blepharoplasty After blepharoplasty, patients may be advised to apply lubricating drops/ointment and cold compresses to aid in healing and minimize side effects. Most patients return to work within a few days to a week, but should avoid exercise and strenuous activities for at least 2 weeks. Stitches are usually removed after 3 or 4 days. Most swelling and other side effects typically subside within 2 weeks. Contact lenses and eye makeup may not be worn for 2 weeks after surgery. Patients are typically advised to wear dark sunglasses outside or in bright light for 2 weeks to protect their eyes from sun and wind. Risks of Blepharoplasty Although there may be swelling and bruising around the surgical site, they will subside on their own, and the eyelids will improve in appearance for up to a year. Uncommon side effects include infection, reaction to anesthesia, and double or blurred vision. Eyes may be irritated and dry due to a temporary change in tear distribution. Side effects such as uneven healing and permanent scarring are rare but, if they occur, may require surgical correction. The scars from blepharoplasty are well-concealed, and usually fade with time until they are virtually undetectable. Although the eyelids are still subject to aging, blepharoplasty produces long-lasting results.

  Link: Blepharoplasty

• Neck Lift

  A neck lift is a surgical procedure that smooths and tightens the neck‘s skin, which can sag from aging or weight loss. There are usually two components to a neck lift: cervicoplasty, which removes excess skin, and platysmaplasty, which removes or tightens muscles in the neck. A neck lift can be performed alone or as part of a facelift. A neck lift candidate is in good physical and emotional health, and has realistic expectations about the outcome of surgery. The results of a neck lift can last up to 10 years. Neck Lift Procedure A neck lift begins with a small, inconspicuous incision directly below the chin (platysmaplasty) and/or in front of the ear lobes, looping behind the ears and ending in the scalp near the back of the neck (cervicoplasty). Sagging skin is trimmed away and lifted during cervicoplasty; loose muscles that cause the "bands" around the neck to be prominent are tightened during platysmaplasty. In some cases, it is necessary to perform only one of the two procedures. Liposuction is sometimes used to remove excess fat; if so, it is performed before the neck lift. Incisions are glued and/or sutured closed. A neck lift usually takes 2 to 4 hours to perform, and the patient is given either general anesthesia or local anesthesia with sedation. Most neck lifts are performed on an outpatient basis. Bandages covering incisions are removed after a few days; sutures are typically removed after 7 to 10 days. Recovery from a Neck Lift Swelling and bruising from a neck lift can last up to 10 days. Applying cold compresses and keeping the head elevated for the first 48 hours following surgery minimizes swelling. Keeping the head still, and avoiding turning or twisting it for the first few days post-surgery, is recommended. Medication is prescribed to help alleviate discomfort. Most people return to work and other normal daily activities within 2 weeks, after which bruising and swelling have subsided. More strenuous activities should be avoided for 4 to 6 weeks. Risks and Complications of a Neck Lift Although rare, possible risks and complications of a neck lift include the following: Scarring Excessive bleeding Hematoma Tissue death Blood clots Numbness Intense itching Skin discoloration Persistent swelling A more serious complication, also rare, is facial nerve damage that can lead to muscle paralysis.

  Link: Neck Lift

• Rhinoplasty

  Rhinoplasty (nose surgery) is one of the most frequently performed plastic surgery procedures. During rhinoplasty, the nose is reshaped, reduced or augmented to improve its appearance. Rhinoplasty may be performed to correct a birth defect, or repair an injury such as a broken nose. It is also often performed strictly for cosmetic reasons. For a patient with ongoing sinusitis, rhinoplasty is sometimes performed in conjunction with endoscopic sinus surgery; for a patient with a deviated septum, it is often performed along with septoplasty, a procedure that corrects a deviated septum. In such cases, rhinoplasty effectively treats health and breathing problems, in addition to improving the patient's appearance. Candidates for Rhinoplasty Candidates for rhinoplasty have finished their facial growth. Girls should typically be at least 15 or 16 years old; boys should be at least 17 or 18. Patients considering rhinoplasty should be in overall good health and not smoke. It is important that candidates have realistic expectations about what rhinoplasty can do. Although undergoing rhinoplasty may boost self-confidence, it should not be viewed as a cure-all for personality or relationship issues, and should not be the result of social pressure. Goals of Rhinoplasty There are several goals of rhinoplasty; they include facilitating breathing as well as improving appearance. During rhinoplasty, the surgeon may attempt to do one or more of the following: Remove a hump Modify the bridge Reshape the tip Reshape or resize the nostrils Repair an injury Open breathing passages Increase or decrease size Rhinoplasty can involve modifying bone, skin or cartilage, or all three. The Rhinoplasty Procedure Rhinoplasty, which takes from 1 to 2 hours, is usually an outpatient procedure performed under IV sedation or general anesthesia. Two techniques are typically used. In closed rhinoplasty, incisions are made within the nostrils. In open rhinoplasty, an incision is made across the columella, the tissue between the nostrils. With both methods, the soft tissues covering the nose are gently lifted, and the bone and cartilage are sculpted to the desired shape. If additional cartilage is needed to augment the nose, it is frequently taken from the patient's nasal septum. If larger sections of tissue are required, cartilage may be surgically removed from the ear or other parts of the body as well. If the patient has a deviated septum, the septum and inner structures of the nose are adjusted to improve breathing. The tissues are then redraped and stitched closed. If necessary, nostrils are reshaped in the final stage of rhinoplasty. Recovery from Rhinoplasty Immediately after surgery, the patient's nose and eye area are usually bruised and swollen. Splints and nasal packing remain in the nose for a few days. During this period, the patient may experience some nasal pain or a dull headache, as well as some bleeding and drainage from the nose. Most patients feel like themselves within a few days and are able to return to regular activities in about a week. To increase comfort, and decrease bleeding and swelling, rhinoplasty patients are advised to follow these post-surgical directives: Avoid strenuous activities Take baths instead of showers Avoid blowing the nose Avoid becoming constipated Avoid exaggerated facial expressions Brush the teeth gently Avoid pulling clothing over the head Use sunscreen that has an SPF of 30 or higher Limit dietary sodium Do not use ice packs Although the patient usually looks "normal" a week or two after surgery, minimal swelling may be present for as much as a year. Risks of Rhinoplasty Complications associated with rhinoplasty are rare and, when they occur, usually minor. Surgical risks in general include infection or adverse reaction to anesthesia. In the case of rhinoplasty, specific risks include the following: Recurring nosebleeds Difficulty breathing through the nose Permanent numbness in or around the nose Persistent pain Discoloration of skin on the nose Scarring Perforation of the nasal septum It is possible that a patient is not satisfied with the results of the rhinoplasty. In such a case, a second surgery, called a revision rhinoplasty, may be performed at a later date.

  Link: Rhinoplasty

• Rhytidectomy

  Over time, gravity and sun exposure take their toll on the face and neck. Deep creases that run from each side of the nose to the corners of the mouth appear; the jawline slackens; and the neck develops loose folds and fat deposits. Rhytidectomy (facelift) counteracts these signs of aging by tightening muscle, removing fat, and trimming excess skin. Rhytidectomy improves the look of the lower and middle areas of the face, and the neck. It is most effective for correcting the following: Mid-face sagging Deep creases under the eyes Nasolabial folds Jowls Sagging fat Loose skin and fat under the chin and jaw Although rhytidectomy removes or reduces signs of aging, over time, they will gradually reappear. Rhytidectomy does not improve the look of the brow, eyelids and nose, and some parts of the mid-face. A patient who wants to improve those areas might combine rhytidectomy with a brow lift or eyelid surgery, and/or with injectable soft-tissue fillers, facial implants and skin resurfacing. Candidates for Rhytidectomy The best candidates for rhytidectomy want to correct one or more of the signs of aging indicated above; have some facial sagging, but still have elasticity in their skin; are generally healthy; do not smoke; and have realistic expectations about what rhytidectomy can do. It is very important that the surgeon ascertains whether the patient is only interested in rhytidectomy because of pressure from someone else. Types of Rhytidectomy Rhytidectomy is typically performed as an outpatient procedure in an office-based facility, surgery center or hospital. Patients may have a choice of IV sedation or general anesthesia. The procedure takes about 2 hours. The way a facelift is performed depends on the surgeon, the patient's facial structure, and the extent of correction desired. Traditional Rhytidectomy A traditional rhytidectomy is a "full" facelift that rejuvenates the face, jowls and neck, and includes sculpting and redistributing of fat; lifting and repositioning of muscle and deeper tissues; and trimming and re-draping of skin. The incision begins at the temples and travels down to the front of the ear, around the earlobe and behind the ear to the lower scalp at the hairline. Sometimes, another incision is made under the chin. Limited-Incision Rhytidectomy A limited-incision rhytidectomy improves the area around the eyes and mouth by reducing nasolabial folds and other deep creases. Short incisions are made at the temples and around the ear, and possibly in the lower eyelids and/or under the upper lip. In both methods, incisions are closed with stitches or tissue glue. Scars are hidden in the hairline and natural contours of the face. Recovery from Rhytidectomy After rhytidectomy, the surgeon wraps the incisions in bandages, and may insert drainage tubes; if so, they are taken out the next day. If surgical clips are holding some incisions closed, they are removed, along with any stitches, 1 week after the procedure. Post-rhytidectomy, swelling, numbness, bruising and a feeling of tightness or tension in the face and neck may be felt. The face may look uneven or distorted, and facial muscles may feel stiff. Most of these side effects resolve within 3 to 6 weeks, and sensation typically returns to normal within a few months. Scars become less red, raised, lumpy and itchy over time. Many patients return to work by the third week. Camouflage cosmetics can be used to minimize the appearance of bruising. Results of Rhytidectomy Results of rhytidectomy are not permanent, and some patients choose to undergo another in 5 or 10 years. In some sense, however, effects are permanent; years later, the face continues to look better than if rhytidectomy had not been performed. Risks Associated with Rhytidectomy Possible complications of rhytidectomy include bleeding, infection, bruising, swelling or discoloration, allergic reaction to the anesthesia, skin blistering (usually only in smokers), nerve injury, and temporary or permanent loss of sensation in the face.

  Link: Rhytidectomy

• Augmentation Mammaplasty

  Augmentation mammaplasty (breast enlargement) is performed to increase breast size and/or fix breast asymmetry. Candidates include women who want larger breasts, and those who want to restore the breast volume often lost as a result of pregnancy or significant weight loss. Breasts can be enlarged with implants or by fat transplantation. Augmentation mammaplasty is not a substitute for mastopexy, which is a procedure to "lift" breasts that sag significantly. Augmentation Mammaplasty with Implants Silicone and saline are the two implant types most commonly used in augmentation mammaplasty. Silicone implants feel more like natural breasts than saline ones. However, if a saline implant ruptures, the saline is naturally absorbed by the body, whereas if a silicone implant has an extracapsular rupture (a rupture to the outer capsule), silicone filler leaks into the body, possibly resulting in inflammatory nodules or enlarged lymph glands. Implants are placed behind each breast, underneath either breast tissue or the chest-wall muscle. The procedure lasts 1 to 2 hours, and is typically performed with general anesthesia, although local anesthesia combined with a sedative may be used. Incisions are made in inconspicuous places (in the armpit, in the crease on the underside of the breast, or around the areola) to minimize scar visibility. The breast is then lifted, creating a pocket into which the implant is inserted. Advantages of implant placement behind the chest-wall muscle include a possible reduced risk of capsular contracture (hardening of scar tissue around implant), and less interference during mammograms. Disadvantages include the possible need for drainage tubes, and a longer recovery period. Advantages of implant placement beneath breast tissue include that the breasts move more naturally as the patient uses her chest muscles, and that slight breast sagging is corrected. Other types of implants include "gummy bear," round, smooth and textured. Augmentation Mammaplasty with Fat Transplantation Augmentation mammaplasty with fat transplantation (fat transfer) uses liposuction to harvest excess fat from other parts of the body; the fat is then injected into the breasts. Augmentation mammaplasty is appropriate for women who are not looking for a dramatic increase in breast size, and want breasts that look and feel as natural as possible. For a number of weeks prior to augmentation mammaplasty, tissue expanders may be placed below the muscles of the chest wall to expand the breasts, and increase the amount of fat they can hold. When the tissue has expanded enough, augmentation using fat transfer can begin. First, fat is removed using liposuction, in which a cannula (a thin, hollow tube) is inserted through small incisions, and then moved back and forth to loosen excess fat, which is suctioned out using a vacuum or a cannula-attached syringe. The harvested fat cells are then purified. In the second procedure, which takes place on the same day, the fat is injected into the breast through small incisions. The procedure takes approximately 4 to 5 hours. Recovery from Augmentation Mammaplasty After augmentation mammaplasty with implants, drainage tubes may be inserted; incisions are stitched, taped and bandaged. A surgical bra is typically put over the bandages to minimize swelling and support the breasts. For a few days postsurgery, most patients feel tired and sore, but many return to work within a week. Stitches are removed in 1 week to 10 days; postoperative pain, swelling and sensitivity diminish during the first few weeks. Scars begin to fade in a few months. After augmentation mammaplasty with fat transplantation, recovery time is short, with normal activities being resumed as soon as the patient feels comfortable. Compression garments are typically worn over the areas that received liposuction. Risks of Augmentation Mammaplasty In addition to the risks associated with surgery and anesthesia, those related to augmentation mammaplasty using implants include the following: Capsular contracture Implant leaks and ruptures Implant deflation or shifting Temporary or permanent change in nipple/breast sensation Irregularities in breast contour/shape Asymmetry Partial or total loss of nipple/areola The risks related to augmentation mammaplasty using fat transplantation include those related to liposuction, as well as the following: Calcification Fat embolism Fat necrosis Oil cysts Loss of volume Because of the loss of volume that occurs when fat is reabsorbed by the body, touch-up injections of fat are often necessary. Injections can be performed using local anesthesia.

  Link: Augmentation Mammaplasty

• Breast-Implant Revision Surgery

  Women who opt for breast augmentation (breast enlargement) with implants may not be happy with the results for a number of reasons: The implants' shape, size and/or placement may be problematic, or postsurgical complications, such as leaking, wrinkling, implant displacement, capsular contracture or symmastia, may have occurred. Although considered safe, revision surgery to correct problems with breast implants may be more complicated, cost more and take longer to recover from than the initial surgery. Reasons for Breast-Implant Revision Surgery After undergoing breast augmentation with implants, women who become pregnant, or lose significant amounts of weight, may no longer be happy with how their breasts look, and decide to undergo revision surgery. Other reasons for breast implant revision surgery include those below. Unhappiness with Size of Implants Chosen Wanting a different implant size is the most common reason that a patient seeks revision surgery. A patient is advised to wait up to 1 year after the initial procedure before undergoing revision surgery; time is needed before swelling subsides and the implants settle, allowing for a true evaluation of the surgical outcome. Exceptions are when there is a pronounced asymmetry between the breasts, or the implant has leaked or ruptured. During revision surgery, the incisions made during the initial surgery are often used to remove the implants and replace them with either larger or smaller ones. If larger implants are wanted, the pockets in the breasts that hold the implants are made larger. If smaller implants are wanted, the pockets are made smaller using sutures; a mastopexy (breast lift) may also be performed. Implants Are Leaking Implants can leak because of age or defect, injury to the breast, or overfilling. Whatever the reason, a leaking implant should be replaced as soon as possible. The incisions made during the initial surgery are often used when replacing the implant. A leak to a saline implant is immediately noticeable; the implant deflates and the saline is absorbed by the body. When there is a leak in the types of silicone implants used today, because the silicone is designed to hold its shape, leaks are often only discovered during routine mammograms. Implants Are Causing Complications There is always a risk complications from a breast-implant procedure. They include wrinkling and rippling of the implant (usually a saline implant); capsular contracture, in which scar tissue forms around the implant, hardening the breast and changing its look and feel; and symmastia, in which the implants drift together and meet in the middle of the chest. Even when breast-implant revision surgeries are successful, new implants are still subject to the same problems as the original implants.

  Link: Breast-Implant Revision Surgery

• Mastopexy

  Mastopexy (breast lift) is a surgical procedure for lifting and reshaping sagging breasts. Aging, pregnancy, weight loss and gravity can all cause breasts to sag. By trimming excess skin and tightening supporting tissue, breasts can be made to sit higher on the chest and be firmer to the touch. In addition, the nipple and areola can be repositioned or resized to further enhance breast appearance. Because mastopexy does not change breast size, it is often combined with breast augmentation or reduction. Candidates for Mastopexy An eligible mastopexy candidate is in good overall health, maintains a stable weight, and has realistic expectations about what mastopexy can do. A woman who chooses to undergo mastopexy has one or more of the following: Sagging breasts Breasts that have lost shape or volume Breasts that are flat or elongated Nipples or areolas pointing downward One breast lower than the other A woman planning to have (more) children should not undergo mastopexy because pregnancy and nursing can counteract its benefits. The Mastopexy Procedure Mastopexy is performed on an outpatient basis under general anesthesia, and usually takes 1 to 3 hours. Depending on the size and shape of the breasts, as well as the degree of sagging and amount of excess skin, one of the following types of incisions is often used: Two rings, one larger than the other, around the areola A keyhole shape, around the areola and down to the breast crease An anchor shape, beginning in the breast crease, and extending up to and around the areola The first type of incision (above) is used for small breasts and leaves the least amount of scarring; the third type is used for breasts with significant sagging. After the incisions are made, breast tissue is removed and reshaped to achieve the desired breast contour. The nipple and areola are usually moved higher on the breast or resized. Excess skin is trimmed to create a tighter, more defined appearance. Incisions are closed with stitches. Recovery from Mastopexy For a few days following mastopexy, patients are likely to have bruising, soreness and swelling. Breasts are usually wrapped in an elastic bandage or a surgical bra for about a week; a support bra is then worn continuously for a month. Stitches are removed after 1 to 2 weeks. Most patients return to work within a week; exercise and other strenuous activity should be avoided for about a month. Results of Mastopexy Mastopexy produces immediate results. As swelling subsides and scars fade, breasts continue to improve in appearance. Patients who thoroughly discussed their goals prior to surgery, and had realistic expectations of what it could provide, report high satisfaction levels. Although the breasts are still subject to the effects of aging, mastopexy produces long-lasting results. Risks of Mastopexy In addition to the usual risks associated with surgery and anesthesia, risks specific to mastopexy include the following: Temporary or permanent change in nipple/breast sensation Irregularities in breast contour/shape Asymmetry Partial or total loss of nipple/areola Depending on the incision type used, mastopexy can produce visible scars. Although some incisions can be concealed in the natural breast contours, others cannot. In most cases, however, scars fade over time, becoming much less apparent.

  Link: Mastopexy

• Reduction Mammaplasty

  Women who are unhappy about having large breasts and/or want to treat symptoms such as back pain, breathing problems and poor posture, may benefit from reduction mammaplasty (breast reduction), during which fat, glandular tissue and skin are removed from the breasts. The resultant smaller breasts increase patient comfort, and look more in proportion to the rest of the body. Ideal candidates for reduction mammaplasty are women with oversized breasts that are causing medical problems, low self-esteem, and/or physical or social discomfort. Women who are pregnant or breastfeeding cannot undergo reduction mammaplasty. The Reduction Mammaplasty Procedure Reduction mammaplasty is performed under general anesthesia. Depending on the technique used and the individual case, it takes from 2 to 5 hours to perform. One of the following incisions is often used: Two rings, one larger than the other, around the areola A keyhole shape, around the areola and down to the breast crease An anchor shape, beginning in the breast crease, and extending up to and around the areola Liposuction alone is sometimes used to reduce breast size. One advantage is that it leaves little-to-no scarring. However, because liposuction removes only fatty tissue, patients must have more fatty than glandular tissue in their breasts. Liposuction is also often used on men whose breasts are enlarged. Recovery from Reduction Mammaplasty After reduction mammaplasty, patients typically experience soreness, swelling and bruising for several days. Bandages are removed after 2 days, and replaced with a surgical bra. Physical activity should be limited for 1 to 2 weeks, while exercise and other strenuous activity should be avoided for at least 4 weeks. Stitches are removed after 2 to 3 weeks, at which point most patients return to work and other regular activities. The results of reduction mammaplasty are noticeable immediately after surgery. As swelling and bruising subside, the breasts' appearance improves. Scars fade with time, and usually cannot be seen when a patient wears a bathing suit or low-cut top. Risks of Reduction Mammaplasty In addition to the risks associated with any surgery, risks related to reduction mammaplasty, depending on the technique used, include the following: Loss of sensation Scarring Asymmetry Excessive firmness Inability to breast-feed Loss of skin/tissue where incisions meet Partial or total loss of areola and nipple Although reduction mammaplasty provides long-lasting results, breasts are still subject to the effects of aging and gravity.

  Link: Reduction Mammaplasty

• Abdominoplasty

  Abdominoplasty (tummy tuck) helps flatten the abdomen by removing excess fat and skin, and tightening muscles. The best candidates for abdominoplasty are in good physical condition, with pockets of fat or loose skin that have not responded well to diet and exercise. Abdominoplasty can also be appropriate for slightly obese people whose skin has lost some of its elasticity, and for women with skin and muscles stretched from pregnancy. Anyone planning on losing a significant amount of weight, and women planning on having (more) children, should wait before undergoing abdominoplasty. The Abdominoplasty Procedure Abdominoplasty takes approximately 2 to 5 hours to perform; the patient is placed under general anesthesia. Two incisions are made: one from hipbone to hipbone close to the pubic area, and another around the navel. Skin is separated from the abdominal muscles, which are then pulled together and stitched into place for a firmer abdomen and narrower waist. The skin flap is then stretched down over the newly tightened muscles, excess skin is removed, and the navel is reattached where it looks natural. The incisions are then closed, and sterile surgical dressings are applied over the sutured areas. Recovery After Abdominoplasty After surgery, a temporary tube may be inserted to drain excess fluid from the surgical site. An overnight hospital stay may be necessary. Recovery time ranges from 2 weeks to 2 months. Abdominoplasty leaves a scar spanning the lower abdomen from hip to hip, although it is low enough to be concealed by a bikini. Maintaining weight with a balanced diet and regular exercise provides long-lasting results. Risks of Abdominoplasty In addition to the usual risks associated with surgery and anesthesia, risks associated with abdominoplasty include the following: Asymmetry Poor aesthetic result Unsightly scarring Loose skin Numbness in skin sensation Need for revisional surgery Patients who have had previous abdominal surgery may find that their old scars look more raised, have stretched or are more noticeable in general. Undergoing a scar revision may minimize their prominence.

  Link: Abdominoplasty

• Liposuction

  Liposuction is a minimally invasive cosmetic procedure that uses a thin, hollow tube called a cannula to remove localized areas of body fat. The cannula is inserted through extremely small incisions, and then moved back and forth to loosen excess fat, which is suctioned out using a vacuum or a cannula-attached syringe. Treated areas look slimmer and more contoured, and in better overall proportion to the rest of the body. However, liposuction is not a method for losing weight, and is not effective in eliminating cellulite, or tightening loose and sagging skin. The ideal candidate for liposuction is in good overall health, but has one or more areas of fat that do not respond to diet or exercise. Areas that are often treated with liposuction include the thighs, abdomen, arms, back, hips, buttocks, chest, face, calves and ankles. Liposuction can be performed alone, or in conjunction with other cosmetic procedures, such as thighplasty and abdominoplasty. The Liposuction Procedure One of the most common liposuction techniques is tumescent liposuction, which may get an assist from ultrasound or laser. It is performed on an outpatient basis. During tumescent liposuction, a solution comprising saline solution, lidocaine (an anesthetic) and epinephrine (a blood-vessel contractor) is injected into the area being treated. The solution causes the targeted tissue swell and become firm, which makes it easier to remove via the cannula. The advantages to this technique are that the anesthetic is built in, so there is no need for general or IV sedation, and blood loss is minimized because the epinephrine constricts blood vessels. In laser-assisted tumescent liposuction, a laser is used to liquefy the fat, which makes removing it easier. The laser can also be used to tighten treatment-area skin after fat is removed. Similarly, ultrasound-assisted liposuction uses ultrasound energy to liquefy fat. Recovery from Liposuction After liposuction, patients experience mild swelling, bruising and discomfort in the treated area. Compression garments or elastic bandages are typically worn to help reduce these symptoms as the area heals. Patients can return to work and other regular activities as soon as they feel comfortable, which is usually after a few days. Exercise and other strenuous activities should be avoided for a few weeks. Risks of Liposuction In addition to the usual risks associated with surgery, risks associated with liposuction include the following: Loose or rippled skin Worsening of cellulite Asymmetry Contour irregularities Pigmentation irregularities When large amounts of fat are removed, surgery to remove excess skin may be necessary. Results of Liposuction Results of the liposuction procedure may not be apparent until swelling and bruising subside, which usually takes a week; swelling should completely subside within a few months. Incisions are rarely sutured, and scarring is almost nonexistent, because the incisions used for the cannula are so small. The results of liposuction are long-lasting, unless a substantial amount of weight is gained.

  Link: Liposuction

• BOTOX® Cosmetic

  BOTOX® Cosmetic is a prescription drug that, when injected, temporarily paralyzes muscles. It contains a purified and safe form of botulinum toxin A, which is produced by the microbe that causes botulism. Manufactured by Allergan, Inc., it is used to treat permanent furrows and deep wrinkles in the skin that are formed by the continual contraction of facial muscles. In addition to its cosmetic applications, it is used to treat a number of medical problems, including excessive sweating, overactive bladder, neck spasms, crossed eyes, chronic back and jaw pain, and migraines. Applications for BOTOX Cosmetic Although originally approved by the U.S. Food and Drug Administration for the treatment of eye and muscle spasms, BOTOX Cosmetic was quickly recognized for its cosmetic value. Properly placed injections of BOTOX Cosmetic block nerve impulses sent to muscles, weakening them to the point where they cannot contract, and temporarily eliminating moderately severe furrows and lines. BOTOX Cosmetic is used to treat the following: Forehead furrows Frown lines Crow's feet Skin bands on the neck According to Allergan, BOTOX Cosmetic has been "extensively researched, with approximately 2500 studies." BOTOX Cosmetic Procedure and Results Using a very fine needle, BOTOX Cosmetic is injected directly into facial muscles that are causing furrows and lines. Receiving the injections requires no anesthetic, but some doctors choose to numb the area to be injected with ice packs or a topical anesthetic cream. Results can usually be seen within a few days of treatment, and typically last up to four months, although areas that are treated on a regular basis may retain results longer. Injections should be given only by qualified medical professionals. Side Effects of BOTOX Cosmetic Injection-site side effects of BOTOX Cosmetic are usually mild and temporary, and include the following: Pain Infection Inflammation Tenderness Swelling Redness Bleeding Bruising Normal activities may be resumed immediately after receiving injections.

  Link: BOTOX® Cosmetic

• Juvéderm® XC Injectable Gel

  JUVÉDERM® XC injectable gel is a U.S. Food and Drug Administration-approved dermal filler that, according to its manufacturer, Allergan, Inc., is designed to "temporarily treat moderate to severe facial wrinkles and folds such as nasolabial folds" in people older than 21. Unlike the original JUVÉDERM injectable gel, JUVÉDERM XC is infused with lidocaine to make its injection more comfortable. JUVÉDERM XC is a smooth-consistency gel that restores volume to the skin, and smooths away moderate-to-severe facial wrinkles and folds. It is made of hyaluronic acid (HA), a sugar that occurs naturally in the body. In terms of the skin, HA's role is to deliver nutrients and hydration, and act as a cushioning agent. Young, healthy skin contains a lot of HA, but factors that include aging and sun exposure reduce the amount, causing skin to lose structure and volume. JUVÉDERM XC is most effective in improving the appearance of nasolabial folds, the lines that run from the bottom of the nose to the corner of the mouth on both sides of the face. JUVÉDERM XC Injectable Gel Procedure JUVÉDERM XC injections take about 15 minutes to administer in a doctor's office. A fine needle is used for the injection, which is given under the skin in the targeted area to add volume or fill in wrinkles and folds. Because JUVÉDERM XC contains lidocaine to improve comfort, an anesthetic may not be needed. However, a doctor may still elect to use a topical anesthetic on the area to be treated before giving the injection. Afterword, the doctor may gently massage the treated area(s). Once treatment is completed, patients can return, with virtually no downtime, to their regular activities. For the first 24 hours after treatment, to reduce the risk of complications, patients should avoid strenuous exercise, excessive sun or heat exposure, and alcohol consumption. Results of JUVÉDERM XC Injectable Gel The results of JUVÉDERM XC are visible immediately after injection; any swelling and bruising, to which ice can be applied, should subside during the next few days. Results can last 6 to 9 months, and, in some cases, up to year. However, according to its manufacturer, "Results from injectable dermal filler vary and correction is temporary. Supplemental 'touch up' treatments may be required to achieve and maintain optimal correction of . . . wrinkles and folds." Risks of JUVÉDERM XC Injectable Gel Although JUVÉDERM XC is considered safe, there is a risk of side effects. They are usually limited to the injection site, and include the following: Redness Pain or tenderness Firmness Swelling Lumps or bumps Bruising Itching Discoloration Infection For customized treatment, Allergan, Inc., offers two types of JUVÉDERM XC: JUVÉDERM Ultra XC, which is suitable for superficial facial lines and folds, and JUVÉDERM Ultra Plus XC, a stronger formulation that is used for deeper facial folds and lines. JUVÉDERM XC is the first HA filler that is FDA-approved for use on people of color.

  Link: Juvéderm® XC Injectable Gel