Surgery of the ear also called “otoplasty,” is a surgery that can help to change the proportions, form, and location of the ears. With this procedure, the plastic surgeon can improve any defect in the structure or shape of the ear, either abnormalities present at birth or those that become evident during growth. Any deformity in the ears can be corrected with this procedure, so it can be considered either a cosmetic or a reconstructive procedure.

Through an otoplasty, the surgeon can create a natural ear shape to improve the symmetry of the ears with respect to the face. Even when the plastic surgeon corrects only minor defects, patients can obtain great benefits in their appearance and self-esteem. This procedure is typically done on both ears to optimize symmetry, and won’t change the location of the ears or alter the ability to hear.

Correction of a posttraumatic auricular deformity was described for the first time in 1845, but it was not until 1881 that a doctor first described cosmetic otoplasty. Over the next 20 years, tissue grafting became a popular procedure.

It is estimated that five percent of white individuals are affected with abnormal ears. In the case of protruding ears, 59% of affected individuals have a family history (it is a genetic condition). Approximately 20 to 30 percent of newborn children have deformities of the external ear. This can be either congenital or acquired in the birth canal. In some cases, self-correcting occurs in a week. If, after this time, the deformity has not self-corrected, medical assistance should be sought.

Who is a candidate for ear surgery?

Ear surgery is perfect for patients with disfigured ears, or for patients who feel that their ears are sticking out from their head (protruding ears). Other perfect candidates are patients with abnormal ears as a consequence of injuries or birth defects.
Patients with deformed or big ears typically camouflage their deformity with their hair because they feel ashamed, but after surgery, they often feel comfortable enough to wear their hair short or combed back.

Specifically, an otoplasty can correct excessively large ears (macrotia) when present in one or both ears, or in different protruding degrees. The plastic surgeon can also correct unsatisfactory results from prior surgeries.

Patients with prominent or deformed ears since birth can be severely affected both emotionally and behaviorally, but this condition typically does not affect a child’s self-esteem or self-image until the child is older than 5 or 6 years, which is why this surgery is best performed at this age; furthermore, at this age, the ears’ development and growth is completed.

What are the contraindications of ear surgery?

Otoplasty is contraindicated in any patient with unrealistic expectations. This is why the plastic surgeon takes his time to have appropriate preoperative counseling. The surgeon will take note of any existing facial asymmetry, as each patient is unique and the goal of the surgery is the restoration of the anatomic balance of the face.

If a patient is unable or unwilling to cooperate with postoperative care, he/she is not a candidate for surgery. If the patient has a history of hypertrophic scarring or keloids, these may occur after otoplasty and possibly distort an otherwise excellent surgical result.

What causes a prominent ear?

– Angle: It is normal for the ear to stick out from the sides of the head; however, when the patient has an angle of separation greater than 35 degrees, they tend to be unsatisfied with their appearance.

– Excessive cartilage: When the ear’s cartilage is overdeveloped, it tends to look prominent or protruding.

– Lack of cartilage: When the ear’s cartilage is underdeveloped, the borders of the ear don’t fold toward the head, so it looks prominent.

– Previous injuries: If the patient has suffered prior traumas or injuries in the ears, they can present an altered and prominent shape.

What is the preoperative care for an ear surgery?

During the first consultation, it is normal for the doctor to ask the patient about any history of excessive bleeding, poor wound healing, and keloid formation. The patient should communicate any medications or medical conditions, especially ear infections (current or past). It is important that the patient be committed to cooperate with the postoperative regimen.

During the physical examination, the surgeon will perform a general assessment of the auricles (pinna), and any asymmetry or irregularity noted by the doctor will be discussed with the patient. At this point, the doctor will assess, measure, and document the irregularities in the pinna to recommend and determine treatment options.

It is common for the surgeon to take preoperative photographs in standard frontal, lateral, and oblique positions. Patients should understand the scope of the surgery and communicate to the doctor their cosmetic expectations and hopes for the completed procedure. Likewise, they should make sure to understand the potential risks.

The doctor will ask the patient to stop smoking before surgery and during recovery, as this affects the healing process and predisposes the patient to bleeding. In the same way, the patient should not consume medications that could increase bleeding.

How much does ear surgery cost?

According to 2014 statistics from the American Society of Plastic Surgeons, the average cost of otoplasty is $2,963. However, the cost can vary widely according to the difficulty of the surgery and the extra costs of anesthesia, operating room facilities, the surgeon’s cost (which varies according to their experience, and the type of procedure), or other related expenses.

When the ear surgery is an aesthetic procedure, it is not covered by health insurance plans, but they may cover it when it is performed to relieve medical symptoms or to restore hearing function.

What is the general procedure of ear surgery?

In some patients, the plastic surgeon prefers to use sedation combined with local anesthesia (generally in adults), but general anesthesia may be used in some patients that undergo this procedure (in the case of a child). An ear surgery always varies between patients, according to the patient’s needs. The techniques that will be used vary in the amount of cartilage that should be eliminated, the type of incision, and the scars that they leave. The procedure typically takes about two to three hours, but it can be longer or shorter depending on the patient’s requirements.

When using the most common method of cosmetic ear surgery, a surgeon makes a cut in the back of the ear and removes the skin; this will allow access to the cartilage for the procedure. The standard otoplasty incision is elliptical and based just lateral to the post-auricular crease, with the auricle in a lateralized position.

An alternative of this incision begins over the mastoid surface. The incision crosses the post-auricular crease and extends along the medial surface of the pinna. The incision turns away from the helical margin and again crosses the post-auricular sulcus onto the mastoid skin. Once exposed, the specific cartilaginous abnormalities are addressed.

A less common incision is made by the plastic surgeon in the internal creases of the ear. Through this technique, excessive cartilage and skin can be removed.

At this point the surgeon can choose between two techniques of otoplasty. One, called splitting, involves cutting out the cartilage (the main structural component of the ear), and another involves folding and stitching the cartilage instead of cutting it, which is called sparing. In the second case, the surgeon, after placing the cartilage in the right position, secures it with stitches. Sometimes excessive skin from behind the ear is also removed.
After that, the plastic surgeon closes the external incisions. Techniques are individualized, taking care not to distort other structures and to avoid an unnatural “pinned back” appearance.

What is the postoperative care of ear surgery?

Most otoplasties are done as an outpatient procedure. The day of the surgery, the patient should wear loose-fitting and comfortable clothing, and should avoid wearing a shirt with a collar. It is recommended to wear a shirt with buttons (that is not pulled over the head).
In most cases, if the patient is an adult, they can go home the same day, but in the case of a child, the doctor may prefer to make them stay in the hospital one night. In more complex procedures, the patient may need to stay in the hospital overnight, even if the patient is an adult. The patient always has to plan for another adult to drive them home and stay with them the first night. Some surgeons recommend the patient to go to a consultation the first and second postoperative day to inspect for any sign of hematoma or complication.

Any tenderness and discomfort can be controlled with oral medication, but it is important for the patient to contact the doctor immediately if the discomfort increases while taking pain medication.

The ears will be covered with a thick bandage after surgery, and the patient should use that bandage even while they sleep (all the time for the first four days). The patient should avoid sleeping over their side in order to keep pressure off of the ears. It’s very important that the patient follows the doctor’s instructions on how to handle the bandage to ensure a smooth recovery.

Usually, the ear bandages are removed after two to four days. After that, the patient may wear a light head wrap or headband between 2 and 6 weeks to help the area heal, and to help keep the ears in the right position if the patient rolls over in the bed while sleeping. It is prohibited to wash the hair while the patient still has bandages over the ears.

Generally, if the patient has stitches that need to be taken out (stitches that don’t dissolve by themselves), the surgeon will perform this procedure about one week after surgery. At this time, if the patient is a child, they can go back to school and resume normal activities. The same thing occurs with work if the patient is an adult. Most plastic surgeons say that the maximum time of healing is three weeks. Moderate ecchymosis and edema are expected, but usually resolve within the first 2 weeks.

Experts recommend avoiding all activities that can increase the risk of trauma or injury in the ears until the healing process is completed. Therefore, swimming should be avoided for approximately 8 weeks, and physical contact sports are completely prohibited for at least the first 3 months.

Both pediatricians and child psychologists agree that it is important to wait until children have sufficient maturity to understand all that the procedure involves. Likewise, the desire to change the appearance of the ears should come from the child.

What are the complications and side effects of ear surgery?

All surgeries involve risks, but in the case of ear surgery, complications are rare and most people are extremely satisfied with the results.

However, the patient should expect to experience pain and swelling. Although complications are uncommon, in the case of fever, excessive bleeding, or swelling, or any trauma in the surgical site, the patient should contact their doctor immediately.

Other risks of this procedure are areas of numbness, an increased feeling of being cold, recurrence of the ear deformity, keloids, and other scars, and poor results.

Incomplete correction of prominent ears is probably the most common undesirable outcome of otoplasty, but if the surgeon is careful during the preoperative analysis, he can prevent an incomplete reconstruction.

Meanwhile, chondritis is probably the most feared complication of otoplasty because it can deform the ear beyond recognition. Typically, clinical signs of infection begin three to five days after surgery. This infection may require drainage and debridement of infected cartilage.

What are the results of ear surgery?

Most patients can appreciate the results of otoplasty surgery as soon as the bandages are removed, and these changes are permanent. Some patients require a period of psychological adjustment to their new appearance. Usually, scars are very light and are hidden in the creases behind the ears. It is common that children need a second procedure if the ear sticks out again, but if the patient is an adult and is not satisfied with their results, they should discuss the possibility of revision surgery with the surgeon.

Dr. Amjadi MD, DDS, FACS

Certified by the American Board of Plastic Surgeons

915 Gessner Rd #870

Houston, TX 77024

713-465-6198

The post Ear Surgery appeared first on Plastic Surgery Houston | Cosmetic Surgeon & Dermatologist.

When the eyebrows are at rest in a young person, they are over the edges of the upper eyelids, in the form of an arch, with their highest point in the middle. But when people get older the eyebrow tends to adopt a horizontal position. With a brow lift, the patient can rejuvenate the upper part of the face.

When is an eyebrow lift surgery recommended?

With this procedure, the plastic surgeon can reduce the wrinkle lines that develop horizontally in the middle of the forehead, as well as those that occur on the bridge of the nose and between the eyes; likewise, he can improve frown lines, the vertical creases that develop between the eyebrows.

Another thing that the surgeon can achieve with this procedure is raising sagging brows that are covering the upper eyelids, placing the eyebrows in a youthful position. In some cases, the patient may require other cosmetic procedures, like upper and or lower eyelid tucks, facelifting, and skin resurfacing techniques.

Who is a good candidate for an eyebrow lift?

Patients that are a good candidate for an eyebrow lift include those that are tired of having excessive skin in the eyelids that gives them a tired, angry, or sad appearance; those who have deep creases in the upper face, with scowl lines between the eyes and eyebrows; those with excessive fat tissue in the eyelids; if the patient is a woman and has problems applying makeup in the upper eyelid, which occurs when the skin in this area is really saggy due to the aging process; or patients that desire to remove the sagging skin in the eyelids to achieve a younger appearance. All of these are good candidates for the surgery.

However, younger people with inherited traits—problems like a low brow, among others—are also candidates for the surgery. The patient should be physically healthy, a non-smoker with a positive outlook and realistic goals. The patient always should be evaluated by a plastic surgeon to find out if he/she would benefit, as he/she desires, from a brow lift.

What are the advantages of an eyebrow lift?

– This surgery recovers a youthful position of the eyelids, eyebrows, and forehead.

– After the surgery, the patient will look more friendly and happy.

What are the disadvantages of an eyebrow lift?

– Before undergoing this procedure, the patient should visit a qualified surgeon. He/she can then decide which is the best technique and if this surgery is the most recommended treatment to achieve the desired results.

– In some cases, the procedure should be performed with others, like eyelid surgery, to improve the appearance of the lower eyelid.

How much does an eyebrow lift cost?

According to 2014 statistics from the American Society of Plastic Surgeons, the average cost of a brow lift is $3,201, but the costs can vary widely, depending on the extension of the surgery, desired outcomes, and the experience of the surgeon.

The average fee referenced above does not include anesthesia, operating room facilities, or other related expenses. Because a brow lift is an elective surgery, insurance does not cover the cost.

What should the patient do before an eyebrow lift surgery?

First, the patient should have a consultation with his or her surgeon, in which should be discussed the patient’s goals, so that the surgeon can explain if their desires are realistic or if they would need an additional procedure.

Likewise, the surgeon will ask about the patient’s current health and his/her medical history. In the physical examination, the surgeon will evaluate the entire forehead region, including the upper eyelids, paying especial attention to the muscles. The surgeon may ask the patient to make a series of facial expressions so that he can best see exactly how to help. Based on this personal information, the doctor can establish the best way to proceed to suit the individual’s needs.

There might be some lifestyle adjustments that the patient has to make before a brow lift. The surgeon will give to the patient detailed instructions about what he/she needs to do, such as quit smoking before and after the surgery and avoid alcohol and certain medications (like aspirin or other anti-inflammatories, as taking these medications can increase bleeding). In some cases, if the patient’s hair is long and will get in the way of the procedure, he/she may have to trim it. On the other hand, if the hair is shorter, he/she may leave it to grow enough to cover the scars.

What is the general procedure of an eyebrow lift?

The patient should undergo this procedure only when it is performed by an experienced and skilled plastic surgeon. This procedure is commonly performed between 1 and 2 hours, according to the amount of skin to be removed. Depending on the patient, general anesthesia can be applied (the patient remains totally asleep during the surgery), or the surgeon can use local anesthesia (the patient is asleep during the procedure).

Usually, the eyebrow lift is performed as an outpatient procedure. The plastic surgeon can choose between two techniques to perform the brow lift: classic lift and endoscopic lift.

– Classic lift: In this technique, the plastic surgeon creates a continuous incision in the forehead, approximately at the same level of the edge of the ears, just where the hairline is located. In any case, the plastic surgeon uses the hairline to hide the scars. After that, the plastic surgeon lifts the skin, so the wrinkles are erased or at least smoothed, and the brows get a new and younger position. All the excessive skin is cut.

– Endoscopic lift: In this case, the surgeon begins with a lot of incisions in the scalp, but all of them are quite small. An endoscope (a camera placed in a narrow tube) is used to observe on a screen the area that will be treated, simply by making those small incisions.

After that, the plastic surgeon inserts other instruments through the other incisions to reshape and repair the muscles, repositioning the eyebrows and stretching the forehead skin to eliminate wrinkles and deeper lines; small anchors are used to fix these issues. In this technique, the incisions are small, and the surrounding tissues are less affected, so the patient should have to rest for less time and scarring is minimal.

After the skin is removed, the surgeon closes the incisions with sutures and cleans the area. Elastic bandages are applied, which are specially created to avoid swelling and excessive bleeding. Once the procedure is finished, the patient must remain for minutes or hours in the recovery area, to await his/her complete recovery from the anesthesia.

What is the postoperative care of an eyebrow lift?

The recovery time will be different according to the technique used to perform the procedure (classic or endoscopic). It is essential for the patient to follow the surgeon’s directions regarding incision care and the frequency with which he/she should change the bandages, as this can help to reduce the recovery time. Usually, after this procedure, the plastic surgeon does not leave drains under the skin.

If the plastic surgeon uses stitches or staples, they will be removed in approximately 7 days. Likewise, if other supplements were used to bring support to the new forehead, they should be removed between 7 and 14 days later. The surgeon can ask the patient to come back to his office a day or two after the surgery to evaluate the healing. The patient can take a shower or bath the day after the procedure. Shampooing and using hair conditioner is allowed; however, the patient should be careful when untangling his/her hair or when using hot water, hair dryers, hard brushes or combs; this is because the scalp may be numb during the first days, and the patient will not feel the heat, which can burn the scalp and nearby skin.

For 2 days (or more) following surgery, the patient should keep his/her head elevated, with the aim to reduce swelling, and it is best for the patient to sleep with his/her back and head elevated for approximately five to seven days. Likewise, he/she should put cold compresses or ice packs on the treated area (around the eyes) for forty-eight hours to reduce the swelling. The patient may experience swelling and bruising that not only affects the treated areas but other areas of the face as well. It is important that the patient be diligent about taking care of the swelling, but it should subside approximately 7 days after the procedure.

Patients who undergo the classic surgery can experience a lot of pain and itching during the recovery, compared to the endoscopic procedure. For these cases, the plastic surgeon will prescribe a painkiller. These symptoms can last for months. However, a lot of patients that choose the endoscopic method need to take painkillers. These patients may also experience itching, which is common in endoscopic procedures; however, it is less common or milder in patients who undergo the traditional technique. Other common symptoms are numbness and tingling, but these symptoms will disappear with time, and are common with the classic procedure too.

Regarding the recovery time, in most cases, the patient may return to his/her work or school in 10 days or less, depending on which procedure he/she underwent, the level of activity that he/she develops, and his/her personal rhythm of healing. However, in all cases, the patient should avoid weight and heavy or vigorous exercises for at least a couple of months after the procedure. But the patient should move and be mildly active immediately after the surgery, including going for walks to aid circulation in the lower extremities.

Likewise, it is important for the patient to know the normal symptoms that he/she will experience because, in case of signs of any potential complications, he/she should call the plastic surgeon immediately.

What are the results of an eyebrow lift?

Once the healing process is completed (the swelling and bruising has decreased), results will be beautiful, noticeable, and natural-looking. Even six months can elapse before the patient can see the final results. In addition to looking better, most patients will feel better and more like themselves at that time. The new position of the eyebrows creates a brighter and younger-looking appearance; likewise, as scars are covered by the hair, they are not visible when the healing process is completed.

The patient should remember that aging and gravity can cause sagging eyebrows again, but areas that were treated with surgery—like the wrinkles in the forehead or expression lines—will be less visible than they were before the procedure. Only after a lot of years can they become visible again, but never as deep as before the surgery. It is recommended for the patient to use sunscreen and to maintain a healthy lifestyle to preserve the results of the procedure and prolong his/her new appearance.

What are the risks of an eyebrow lift surgery?

All cosmetic procedures involve certain probability of risks, but in a brow lift surgery, fortunately, the risk is minimal. To avoid complications, the patient must be honest with the surgeon during the consultation. Possible complications may include infection in the operated areas, bad reaction to anesthesia, losing the part of the hair where the incisions are made, difficulty moving the muscles in the forehead and eyebrows, and scarring.

When the patient undergoes an endoscopic brow lift, he/she may experience fewer side effects. However, other common side effects that the patient may experience, but that should disappear after some weeks or months, can be swelling and bruising, numb sensation in the scalp or other treated areas, and general discomfort—among others.

Dr. Amjadi MD, DDS, FACS

Certified by the American Board of Plastic Surgeons

915 Gessner Rd #870

Houston, TX 77024

713-465-6198

The post Eyebrow Lift appeared first on Plastic Surgery Houston | Cosmetic Surgeon & Dermatologist.

The aging process causes many changes in the periocular area. In the upper eyelid, it is mainly characterized by an excess and sagging of the eyelid skin. This change causes an aesthetic alteration, but in some cases it can also cause an alteration of the patient’s field of vision and lead to eye fatigue.

Another condition associated with aging is the presence of ptosis (eyelids drooping), produced by laxity of the fibers of the levator muscle of the upper eyelid.

The most common condition that patients want to treat with eyelid surgery is droopy eyelids, also called “blepharoplasty” or “eye lift,” which removes and tightens excessive eyelid skin for a more alert, youthful appearance.

Usually, with aging, the lower eyelid becomes lax because of the changes in the fibrous-tendinous structures. At first, the orbital fat (which occupies the most of the orbit) herniates forward, becoming visible through the skin, which is colloquially known as “bags.” And, in second place, it stretches the skin and tendons of the orbicular eyelid muscle, resulting in wrinkles, folds, and lowering eyelids down.

What is an eyelid surgery or blepharoplasty?

An eyelid surgery, also called blepharoplasty, is a surgery that helps to recover a youthful appearance in the eyelids by tightening the skin and tissues at the edges of the eyes. The surgery may be used on the upper or lower lids, or both. Sometimes blepharoplasty can also improve the patient’s vision by providing a less obstructed field of view.

With blepharoplasty, the plastic surgeon can remove excessive skin, muscle, or fat tissue from the eyelids. The patient might need only skin removal, but not muscle removal, or he/she might need the procedure to be done on both upper and lower eyelids. Some people confuse eyelid surgery with upper eyelid ptosis surgery, but they are not the same thing; an eyelid ptosis surgery lifts the border (especially of the upper eyelid) by recovering the normal form of the muscles and tendons that elevate it; during this procedure, the plastic surgeon does not eliminate excessive skin and fat tissue.

Blepharoplasty may elevate the eyelid border if the cause of droop is heavy with excessive skin.

In some cases, the problem seems to be the eyelids, but the real problem is in the forehead skin and eyebrows. If the patient wants to improve his/her appearance or is having functional problems with his/her eyelids, this procedure can make the area around his or her eyes look younger. Remember that the eyelids are part of the face.

This surgery may correct conditions such as the following:

– The excessive and sagging skin may be so much that it can decrease the patient’s vision.

– The appearance of puffiness, especially in the low eyelid, due to an excess of fat tissue.

-The drop in the lower eyelids, which makes the patient’s sclera to be shown more than usual.

The surgery can help to eliminate the wrinkles in the eyelid with the cut skin.

Who is an ideal candidate for eyelid surgery?

An ideal candidate is a physically healthy patient without diseases that may impair healing or any serious eye conditions, a patient with realistic expectations, and a patient that only desires to remove the excessive skin, wrinkles, and fat from the eyelids. This is more common in patients 35 years of age and older, but if droopy eyelids are common in his/her family, it may be done earlier.

The plastic surgeon should evaluate the patient’s anatomy thoroughly to discover the causes of the eyelids dropping, and to determine what procedures might be the best remedy for them.

What is the difference between cosmetic and functional blepharoplasty?

A cosmetic blepharoplasty is a surgical procedure that is only performed to improve the patient’s appearance (the patient has no medical indications), while a functional blepharoplasty is eyelid surgery that the patient needs due to medical problems.

These medical reasons may include: eyelids drooping so much that the grade of the drop is high and diminishing the patient’s vision; the excessive skin makes it difficult to wear glasses or even use contact lenses in one or both eyelids; irritation in the eyelids, caused by excessive rubbing between the eyelids or between the eyelids and the forehead skin; or discomfort or tiredness from the effort required to maintain the sagging eyelid skin above the field of vision.

What should the patient do before a blepharoplasty?

During the consultation, the patient should discuss with the plastic surgeon his/her surgical goals and his/her complete medical record, including all previous diseases, allergies, and previous medical treatments, and specifically any problems he/she has had with his/her eyes.

The surgeon should evaluate the patient’s general health condition and determine potential risk factors; he/she will discuss eyelid surgery options to recommend both a course of treatment and likely outcomes of eyelid surgery, as well as any potential risks.

The patient may need to undergo some lab tests, adjust his/her medications, not smoke or take drugs that may promote bleeding, and should not wear makeup of any kind on the day of surgery.

What is the general procedure of a blepharoplasty?

A blepharoplasty is considered a minor surgery, so it can be performed in either the plastic surgeon’s office or in a hospital. Usually, the procedure lasts from one to three hours, and the patient can be under local or general anesthesia. While the patient is lying down during blepharoplasty, the surgeon will make precise markings to show where excessive skin and fat pads need to be removed.

When the plastic surgeon approaches the upper eyelid, he/she creates an incision along the natural crease of the eyelid, and through it the plastic surgeon can eliminate fat tissue, tighten the muscles, and even cut excess skin.

During this procedure, two incisions may be used by the plastic surgeon—one in the lash line, and the other inside the eyelid (commonly called trans-conjunctival). With these incisions, the plastic surgeon can remove or reposition the excess skin and the fat of the lower eyelid.

On the other hand, the trans-conjunctival incision eliminates excessive eyelid tissue with non-visible scars (concealed within the natural structures of the eyelid region); this is also used to correct lower eyelid skin and fat. With this technique, no skin is removed.
During the procedure, the surgeon will make judgments about how much skin, muscle, and/or fat should be removed based on a preoperative evaluation of factors such as the patient’s underlying facial muscle structure, bone structure, and symmetry of his/her eyebrows.

The plastic surgeon may combine this technique with laser resurfacing or carbon dioxide (CO2), improving the skin of the face in general, which at the same time allows the surgeon to eliminate any lines or wrinkles that may remain in the operated area. The plastic surgeon closes the incisions in this procedure with removable sutures; however, he/she also can use other methods.
In some cases, the plastic surgeon will recommend combining the eyelift with a brow lift, especially when the eyebrows are sagging.

What is the postoperative care?

In most cases, the patient can go home the day of surgery, but he/she will need to arrange for another person to drive him/her home after the surgery. The patient should also have someone stay with him/her the night of the procedure.

Before the patient leaves, the doctor or nurse will cover his/her eyes and eyelids with ointment and a bandage. The patient may feel the eyelids to be sore and heavy as secondary effects of sedation; however, this is easily manageable with oral painkillers.

The patient should keep his or her head raised as much as possible for several days. He/she should place cold packs over the area to reduce swelling and bruising, but should make sure to wrap the cold pack in a towel before applying it (this helps to prevent cold injury of the eyes and skin).

During the first days, it is recommended to use cold packs over the treated area in sessions of 10 or 15 minutes. This helps to reduce swelling and bruising. However, after 48 hours, the patient should change out the cold compresses for warm compresses.

The plastic surgeon should know if the patient suffers from dry eye because in this case, to avoid worsening the condition, he or she can’t remove large amounts of tissue. This is also a common side effect. The doctor may recommend eye drops to reduce burning or itching, but if this symptom is lasting more than two weeks, the patient should contact his or her doctor.

In most cases, the plastic surgeon uses absorbable sutures, so the stitches dissolve by themselves. But when the plastic surgeon needs to use non-dissolving sutures, they may be cut in approximately in 7 days.

Commonly, the patient is able to see well after 2 to 3 days, but should not wear contact lenses for at least 2 weeks. It is recommended to keep activities to a minimum for 3 to 5 days, and avoid strenuous activities for at least 3 weeks.

The doctor will remove the stitches 2 to 7 days after surgery. The patient will have some bruising, which may last 2 to 4 weeks. In some cases, he/she may notice lacrimation, feeling the skin to be sensitive, and blurred vision, but these symptoms should disappear during the first weeks.

Likewise, it is important for the patient to use a topical antibiotic in the form of ointment or drops; in some cases, the plastic surgeon may suggest eye patches. Some creams and moisturizers can be prescribed to help reduce bruising and other undesirable changes in the treated skin. The doctor will provide all relevant recommendations to the patient and will also prescribe painkillers if needed; usually, though, the patient can control the pain with non-prescription painkillers. If the patient experiences severe pain or changes in quality of vision, he/she should call his/her plastic surgeon immediately.

During recovery, the eyes may be swollen and red, especially during the first days after the procedure; the sclera may also become red. Total recovery can take weeks, and during this period of time it is prohibited to use eye makeup.

Contact lenses may be used as soon as the patient does not feel discomfort using them, and if he/she wears eyeglasses, he/she can put them on any moment after the procedure, as long as they are careful.

Regarding the results, most patients who undergo a blepharoplasty are satisfied with the results in both cosmetic and functional cases. The patient’s self-image and field of vision improve significantly.

What are the results of a blepharoplasty?

Scars may remain slightly pink for 6 months or more after surgery, but they tend to disappear to a thin or invisible line with time. In most cases, the results of the surgery are permanent.

How much does a blepharoplasty cost?

The average cost of eyelid surgery, according to 2014 statistics from the American Society of Plastic Surgeons, is $2,874, but blepharoplasty costs can vary widely with the added costs of anesthesia, operating room facilities, and other related expenses.
When the eyelid surgery obeys medical conditions (functional), it may be covered by some insurances.

What are the risks or possible complications of a blepharoplasty?

One of the potential complications of the surgery is the incapacity to close the eyes (the eyelids are very short), this prevents the ability to lubricate the
eyes, so they become very dry; this may be controlled with eye drops or taping the eyes closed during the night (to lubricate them), and this condition is commonly resolved in a few months. When this condition is present for more than 3 months, the plastic surgeon may perform an additional surgery to restore the eyelids, allowing them to close completely.

Other potential (less common) risks of the surgery include: retrobulbar hemorrhage (which can cause loss of vision), infection, changes in the vision quality, noticeable scars, shoddy eyelids, undercorrection (leaving excessive skin), overcorrection (eliminating too much skin), sensitivity to sun or other bright light, ectropion (an outward rolling of the eyelid), and numbness.

There are some medical conditions that can make blepharoplasty riskier, such as diabetes, dry eye or not enough tear production, heart diseases or disorders of the blood vessels, high blood pressure or other circulatory disorders, and thyroid problems such as hypothyroidism and graves disease.

Dr. Amjadi MD, DDS, FACS

Certified by the American Board of Plastic Surgeons

915 Gessner Rd #870

Houston, TX 77024

713-465-6198

The post Eyelid Surgery (Blepharoplasty) appeared first on Plastic Surgery Houston | Cosmetic Surgeon & Dermatologist.

A facelift, also called rhytidectomy, is a very common procedure to effectively remove the wrinkles and sagging skin that appear as a consequence of the aging process. This type of cosmetic surgery reshapes the lower third of the face and improves the signs of aging in the face and even in the neck by removing excess skin, tightening deep tissues and muscles, or re-draping the face and neck’s skin.

Signs of aging usually include: saggy skin in the middle of the face, deep wrinkles under the eyes, deep wrinkles that extend from the nose to the mouth, loss of fat tissue in the cheeks, and visible jowls due to the sagging skin under the chin (this can occur even in people at their ideal weight; when the skin loses its tone, it creates the appearance of a double chin). The loss of youthful contours in the face can be due to a variety of factors, including inheritance, gravity, environmental conditions, and stress.

To achieve the best results, this procedure is usually combined with additional procedures addressing the forehead and brows (brow or forehead lift) and eyes (eyelid surgery). Statistics from the American Society of Plastic Surgery say it was one of the most popular aesthetic procedures during 2011, and this procedure is increasingly popular among both men and women.

This surgery cannot change the essential appearance of the face, and it can only recover a youthful appearance temporarily, but although there are non-surgical methods to achieve a more youthful appearance, none of them can produce the same results.

Who is an ideal candidate for a facelift?

The ideal candidates for this procedure are people with evident signs of aging in their face and neck but who still have elasticity in their skin. Age is not a limiting aspect; however, most patients that can benefit from this surgery are between 40 and 70 years old (though younger and older people can undergo a facelift too).

The patient should be healthy (not having medical conditions that may delay the healing process) and be conscious of the scope of the surgery; it can create a fresher and younger appearance, but the face will not completely be without signs of aging.

Usually, patients who undergo this surgery feel that their facial appearance is too old compared to their spirit. They believe that their appearance is causing problems in their social life and career. Some other patients consider that typical things like the aging process and sun exposure, among other factors, have caused changes in their face, and they don’t desire to look that way.

What are the advantages of facelift surgery?

– This procedure can improve different parts of the face at the same time.

– It can achieve a look 10 to 15 years younger than the patient’s actual age.

– The results can be maintained for at least 10 years (though it can be more).

– This surgery also can improve the appearance of the neck in the same procedure.

What are the disadvantages of facelift surgery?

– By undergoing this procedure, the patient can only achieve a younger-looking face, not a completely new face.

– The patient will need recovery time that will vary according to the procedure performed.

– Some patients with a lot of excessive skin and fat may need a second procedure to achieve the desired results.

How much does a facelift cost?

According to 2014 statistics from the American Society of Plastic Surgeons, the average cost of a facelift is $6,550, but the costs can vary widely, depending on the extension of surgery, desired outcomes, and the experience of the surgeon.

However, that average cost does not include other expenses like hospital fees and other expenses. Because a facelift is an elective surgery, insurance does not cover these costs.

What should the patient do before a facelift surgery?

The patient preparing for a facelift should discuss any questions about the procedure with the plastic surgeon. The first consultations should include why the patient wants to undergo the procedure, the results that he/she has in mind, the patient’s medical record, and all the medication and supplements that the patient is currently taking—among other topics.

Likewise, the plastic surgeon should examine the patient to determine the areas of the face that need to be treated and to discover any health conditions that could increase the risk of complications; they should discuss the different options for facelift surgery in order to choose the best method of treatment and the optimal expected outcomes of the surgery (it may be that the patient doesn’t actually need a facelift, and with an even minor procedure, his/her goals might be achieved). The plastic surgeon can recommend other techniques to the patient, such as facial implants or an eye or eyebrow lift.

The surgeon will ask the patient to stop smoking six weeks before the surgery to promote proper healing and to reduce scarring, and to avoid taking anti-inflammatory drugs and vitamins/homeopathic regimens to avoid the risk of bleeding. Regardless of the type of surgery to be performed, hydration is very important before and after surgery for a safe recovery, and if the patient dyes his/her hair, he/she should do it just before surgery or else he/she will need to wait at least a month.

It is recommended to wear loose clothes—clothes that are easy to take off and that are comfortable—during the day of the procedure. For example, the patient may wear a button-down shirt so that they don’t need to pull it over their face to take it off.
What is the general procedure of a facelift?

This surgery can be done in an outpatient facility with local anesthetics and sedatives to relax the patient; however, in some cases, surgery can be performed under general anesthesia and the patient may stay in the hospital overnight. The surgeon will choose the best treatment for each patient.

Depending on the patient’s needs, the procedure can be between 2 and 6 hours long. The facelift can be performed in the forehead, mid-face, or lower part of the face; this last option is the most common, treating the jaw, jowls, and cheeks in the same procedure.

According to the areas that the plastic surgeon will treat and the results that the patient desires, the surgeon can make different incisions; the patient can choose from traditional, limited incision, or neck lift.

– Traditional facelift: To perform the procedure, the plastic surgeon starts making an incision at the patient’s temple, following along the hairline; after that, incisions are performed behind the ear, and in some cases even on part of the lower scalp. Through these incisions, the surgeon can relocate the deposits of fat in the face and repair the underlying tissues, lifting the muscles. Finally, the skin is tensed to cut the excess.

In some cases, the plastic surgeon will need a second incision below the chin to reach the neck tissues. There are optional incisions to perform a traditional facelift, using short incisions on the temple, going to the back of the ears, and then going to the eyelids or to the internal part of the upper lip.

– Limited facelift: In this case, the incisions are shorter than in the traditional technique. The plastic surgeon starts the incisions on the temple of the patient to later continue to the natural creases of the ears, completing the procedure with incisions in the lower eyelids or upper lip.

– Neck lift: This type of incision starts in front of the earlobes to later round the ear in the back and continue the incision on the lower part of the scalp. Finally, the plastic surgeon creates an incision under the chin. With this procedure, the plastic surgeon can correct excess of skin and fat in the jowls and neck.

The incision is commonly made on the hairline or on any part where it can be concealed by the natural creases, so they are almost invisible after the procedure; for men, the incision is aligned to accommodate the natural beard lines.

When the plastic surgeon has made the incisions, he/she needs to reach the underlying tissues, which allows him/her to repair the deeper layers of tissues to achieve better results. When this surgery is performed together with a neck lift, the muscles of the neck should be repaired. The plastic surgeon will stitch them together, especially in the midline, bringing better support to the jaw and neck. Finally, the surgeon trims the skin excess over the new underlying structure and the incisions are then closed with sutures and staples.

In some cases a drain is placed under the skin behind the ear, which allows the body to drain off any blood and fluid excess; this drainage tube is removed a day or two after the procedure. Bandages are applied over the incisions.

When the patient uses other procedures after a facelift, the results can be improved. This is because these techniques can act on the repositioned or tightened tissues and create an even more youthful face. Some patients need to use techniques such as fat transfer or placing implants to recover his/her younger appearance; resurfacing techniques are also used to improve the tone and texture of facial skin and wrinkle reduction.
Nowadays, plastic surgeons can use new methods to do a facelift, which allows them to improve the cosmetic procedure:

– Lasers: In this case, an incision of approximately one inch should be made on the chin, and the patient only needs to be under local anesthesia. It is a facelift procedure that uses lasers, and is called laser neck and jaw liposculpture and resurfacing.

– Endoscopy: This is a technique that allows the surgeon to perform the facelift through small incisions. This technique is less invasive, so the plastic surgeon causes less trauma to the underlying tissues and the patient has a shorter period of healing. In this case, the excess of tissue is raised, and in most cases, cuts are not needed.

– Liposuction: This method is used to remove focal deposits of fat in the face, usually in the area between the chin and neck (jowls). Liposuction can be combined with a facelift or performed separately.

What are the results of a facelift?

The final results of the procedure will be completely noticeable once the swelling and bruising have disappeared. This new appearance creates a more youthful look on the patient’s face, thus improving the patient’s self-confidence and self-esteem. The appearance alterations that are produced by this surgery usually remain between 4 and 10 years.

The goal of the plastic surgeon and the entire staff is to help the patient achieve the most beautiful and natural-looking results and to make the surgical experience as easy and comfortable as possible.

What is the postoperative care of a facelift?

The surgeon will give specific instructions to the patient, including the right way of taking care of the treated areas, emptying the drains, medication that should be taken in case of pain, drugs used to avoid infection (pain and discomfort are usually minimal and medication can be given to relieve it), and any question or concern that the patient could have about the recovery period. They will also discuss when the patient should return to the plastic surgeon for a consultation (this will be several times during a two to three-week period to check on the bruising and swelling, and to remove the stitches about five to ten days after surgery).

After a facelift, the patient will experience bruising and swelling, which lasts about two to three weeks. Some people heal more quickly than others. During the first days, the patient may feel his/her face to be stiff or sensitive; likewise, the patient should be prepared to see a new appearance in the mirror, and it is normal for the patient to take a little time to get used to that. The patient should begin to feel well in the first several days after surgery and the bandages will be removed in a short time, too. The surgeon will also instruct the patient to keep his/her head elevated when lying down, to avoid as much activity as possible, and to report any undue discomfort.

Usually, the day after the procedure, the patient can resume some activities, but he/she should be careful during the first week. In most cases the patient can resume his/her normal level of activity between 2 and 3 weeks after the procedure. Vigorous activity should be avoided for some time. Some patients wait approximately a year for the scars to become less visible.

The patient may have rough and dry skin during the first few months. Likewise, if the patient is a man, he might need to shave different places than usual, because the position of the skin has changed; to solve this, the patient can undergo other procedures like electrolysis or laser.

Most patients are very satisfied with the results of their facelift; most of them agree that they have a youthful appearance after the surgery. This is experienced by both genders, male and female. To maintain and extend as much as possible the results of the procedure, the patient should have a healthy lifestyle, and he/she should stop smoking, drinking alcohol, and having direct sun exposure.

Dr. Amjadi MD, DDS, FACS

Certified by the American Board of Plastic Surgeons

915 Gessner Rd #870

Houston, TX 77024

713-465-6198

The post Facelift appeared first on Plastic Surgery Houston | Cosmetic Surgeon & Dermatologist.

This medical condition can cause psychological problems in the patient, affecting his self-esteem and confidence. The condition can be so severe that the patient tends to avoid some activities, including being shirtless in public areas, or it can even create intimacy problems with his significant other. This condition is not usually a threat to the man’s health; however, it can be indicative of other diseases, or it can simply be embarrassing for the patient.

The characteristics of this condition are an excess of fat localized in the breasts, excessive glandular breast tissue, and in some cases, excessive skin in one breast (unilateral) or both breasts (bilateral).

What causes gynecomastia?

Usually, the enlargement of breasts in men is a consequence of excessive fat tissue due to obesity; however, this is not the only reason—sometimes the patient gets his amount of glandular tissue increased due to a hormonal disequilibrium.

Gynecomastia is mainly caused by a lack of testosterone in comparison with the level of estrogen; these hormones are in charge of developing the male and female sex characteristics. Testosterone is in charge of developing male characteristics, like the amount of muscle mass and the distribution and amount of body hair; on the other hand, estrogen is in charge of developing female characteristics, including the development and size of breasts.

The causes of this testosterone decrease can be one or more of several conditions that block the effects of testosterone, or a condition that increases the estrogen level. Several things can upset the hormone balance, including:

– Excessive alcohol, marijuana, or other drug intake (by liver failure)

– Using some drugs, especially steroids, like the stomach acid drug cimetidine, the heart drug spironolactone, the prostate cancer drug bicalutamide, and several other drugs

– Congenital diseases—the patient can have this condition from birth

– A dramatic weight loss; in this case, the main problem is excess of skin

– Diseases like an overactive thyroid, cirrhosis of the liver, cancer, etc.

– Gynecomastia in infants: It is very common for boys to have this condition from birth.

This is caused by the transmission of estrogen from the mother to the infant; it acts on the baby’s breast tissue, causing enlargement. This condition commonly recedes by itself after three weeks.

– Gynecomastia during puberty: During puberty, the body suffers a lot of changes, potentially including gynecomastia. Once the level of hormones is stabilized, the gynecomastia disappears between 6 months and 2 years later.

– Gynecomastia in men: There is an increase in the appearance of gynecomastia between 50 and 80 years of age. At least 1 in 4 men in this age group are affected; in this case, it is mainly due to the diseases discussed above.

There are cases when the cause of gynecomastia is not easy to determine, but in any case, it is important to consult a doctor. Even when gynecomastia is not an aesthetic or psychological problem for the patient, it can indicate endocrine diseases that need to be treated to avoid other consequences.

Can gynecomastia be prevented?

There are a few factors the patient can control that may reduce the risk of gynecomastia:

– Do not use illegal drugs (nonprescription steroids and androgens, amphetamines, heroin, and marijuana).

– Avoid alcohol. Don’t drink alcohol, or drink in moderation.

– The patient should review his medications. If he is taking medication known to cause gynecomastia, he should ask his doctor if there are other options.

How is gynecomastia treated?

If gynecomastia is caused by obesity or cirrhosis (liver disease caused by excessive alcohol consumption), the patient should try to eliminate the excessive fat tissue in the breasts with a balanced diet and exercise. However, if gynecomastia is caused by an underlying condition, the treatment for that disease should be indicated. If a man is taking medications that can cause gynecomastia, his doctor may recommend stopping them or substituting them with other medications.

When these options fail, surgery is recommended. Before undergoing surgery, the patient should visit a doctor to consider other methods and treatments.

Ideal candidates for gynecomastia surgery are:

-Patients who have tried to correct the condition using traditional or alternative medical options without success

-Patients who are physically healthy and near their ideal weight (this includes not suffering from chronic diseases that may increase the risk of complications during the surgery or the recovery period)

-Men with realistic expectations and defined goals who are optimistic about the procedure

-Men who might have emotional problems as a consequence of the size of their breasts

Even adolescents can benefit from this surgery, but in some cases, they need subsequent procedures to correct new enlargements in the breasts.

What is a male breast reduction or gynecomastia surgery?

This is a plastic surgery that reduces the man’s enlarged breasts, makes his chest flatter, and enhances his contours. When the patient has a lot of fatty tissue, the nipple-areola complex may be enlarged too. If this occurs, the surgery can also correct this problem. Medically speaking, this surgery is called reduction mammaplasty.

What is the general procedure of a gynecomastia surgery?

Gynecomastia surgery is usually carried out under general anesthesia and takes around 90 minutes or more. The plastic surgeon begins by making an incision around the nipple-areola complex; for this, he/she can use 2 techniques:

– Liposuction: When gynecomastia is mainly caused by an excess of fatty tissue, the liposuction can be performed alone. This surgery removes the fat but not the breast gland tissue.

In this technique, the plastic surgeon inserts a cannula or micro-cannula (a narrow tube) through some little incisions; after that, the surgeon moves the cannula back and forth to loosen the fat tissue which can then be removed through suction.

Different liposuction techniques can be used. The method used to facilitate removal of fat can vary; among the options are: suction assisted, ultrasound assisted, power assisted, water assisted, laser assisted, tumescent, etc.

– Mastectomy or excision: This type of surgery removes the breast gland tissue. The surgery is often done endoscopically (meaning only small incisions are used); this less invasive type of surgery involves less recovery time.

If the patient has too much tissue to be removed, the incisions can be extended from the areola contour and down into the chest, for later repositioning of the nipple-areola complex. This technique is very useful when the nipple-areola complex should be resized and reshaped to obtain a more masculine shape in the breasts.

– Combinations of liposuction and mastectomy techniques: In some cases, the plastic surgeon combines both techniques to achieve better results.

Advantages of gynecomastia surgery:

– The man can feel comfortable revealing his chest contours, clothed or unclothed.

– The man can gain more social confidence.

– The man can enjoy permanent results.

Disadvantages of gynecomastia surgery:

– Scarring may make the patient feel self-conscious.

– The man may be disappointed with his final results.

– Weight gain following this surgery will compromise results.

How much does a gynecomastia surgery cost?

The average cost of gynecomastia surgery is $3,333, according to 2014 plastic surgery statistics from the American Society of Plastic Surgeons; however, the costs can vary widely because the average cost referenced above does not include anesthesia, operating room facilities, or other related expenses; likewise, the surgeon’s cost may be based on his experience and the type of procedure used. In most cases, correction of gynecomastia is not eligible for insurance coverage.

What should the patient do before a gynecomastia surgery?

During the consultations prior to the surgery, there are some things that the patient should discuss with the plastic surgeon. It is important for the patient to make his desires clear, and the surgeon should know the complete medical record of the patient, including allergies, current medication, supplements, and habits, and if he has undergone surgeries before.

After the medical record is complete, the plastic surgeon proceeds to the physical exam to determine the patient’s health condition and to discover any condition that may represent a potential risk; likewise, he/she will examine the patient’s breast to determine the skin quality, shape and size of the breasts, and the position of the nipple-areola. Some laboratory tests are required to determine the cause of gynecomastia.

During the consultation, the patient and plastic surgeon should also decide the technique that will be used to correct all the characteristics that cause concerns on the patient, and discuss both the benefits and the risks of each technique, and the type of anesthesia that will be used.

It is important for the patient to take some precautions before the procedure, including neither smoking nor drinking alcohol, and not using drugs that could increase the risk of bleeding. A responsible adult should take care of the patient during the first days after the procedure.

What are the results of a gynecomastia surgery?

The results of a male reduction surgery are visible immediately after the procedure. However, when the swelling has completely disappeared and the scars have become less visible, the patient can then observe the final results. Satisfaction with the patient’s new image should continue to grow as he recovers from surgery. The plastic surgeon tries to mask the incision scars, hiding them in the natural contours of the man’s chest; however, some visible scars may remain after the procedure. In any case, when the patient is comfortable about how the upper part of his chest looks, his self-esteem and confidence will be restored, and he will be able to perform activities with his chest uncovered.

The results are usually permanent, but weight gain, hormonal imbalances, and the use of certain drugs can cause the breast area to enlarge again. In general terms, the patient is normally satisfied with the results of the procedure. With plastic surgeries there are no guarantees, and some patients need extra procedures to achieve their desired results; usually, during subsequent surgeries, the plastic surgeon will repair again the deep tissues or solve any complication that may appear.

What is the postoperative care of a gynecomastia surgery?

During the recovery process, the patient should use some dressings and compression bandages, especially over the incisions, in order to help reduce the swelling and bring support to the chest during the healing period. In some cases, the plastic surgeon leaves drains under the skin, helping to eliminate an excess of blood or fluids from the treated area.

The plastic surgeon will explain all the steps of the healing process to the patient, including the time that he should spend resting, and when to resume his normal level of activity; the rhythm of healing is different for each patient. However, the patient should rest the first three days though it is allowed for the patient to walk short distances and to sit. Movement of the shoulders and arms should be restricted and gentle during the first days after the procedure, and lifting the arms vertically is completely prohibited.

Some oral medications will be suggested to control the pain and avoid the risk of infection (painkillers and antibiotics, respectively). The patient should also know when to visit his plastic surgeon again (5 to 7 days after the procedure). The surgeon will provide detailed instructions about the normal symptoms the patient will experience and any potential signs of complications.

When the 2 techniques are combined, the patient usually recovers in a week, and at this point he can go back to work; in most cases, the healing process is mild for the patient.
It is recommended for the man to wait 2 to 3 weeks after the procedure to resume exercises of low impact; however, for exercises that involve resistance in the arms, he should wait between 3 and 6 weeks postoperatively to guarantee an adequate healing time. Likewise, direct sun exposure should be avoided for at least 6 weeks in order to prevent the scars from becoming more visible.

Usually, patients notice alterations in the sensation of the treated area and adjacent tissues. Changes in sensation are more frequent in patients who undergo liposuction or who need a lot of tissue removed. However, patients commonly recover their normal sensitivity levels approximately a year after the procedure.

Does gynecomastia surgery have risks?

All surgical procedures have some degree of risk; however, serious complications are uncommon in this type of surgery. The specific risks of gynecomastia surgery for each patient will be determined during his consultation. Among the most common complications are: bad or allergic reaction to anesthesia, excessive accumulation of blood or fluids in the treated areas, infection, alterations in the skin sensation, scarring problems, injuries in deeper tissues or organs, unsatisfactory results after the procedure, and the formation of clots.

If the patient follows the instructions of the plastic surgeon and is careful during the recovery process, he can avoid complications both during and after the procedure.

Dr. Amjadi MD, DDS, FACS

Certified by the American Board of Plastic Surgeons

915 Gessner Rd #870

Houston, TX 77024

713-465-6198

The post Gynecomastia appeared first on Plastic Surgery Houston | Cosmetic Surgeon & Dermatologist.