Robert F. Garza, MD, FACS

BREAST AUGMENTATION (MAMMOPLASTY)

Breast augmentation, also known as mammoplasty, is a surgical enhancement procedure to change the size and shape of a woman’s breasts. Reasons for considering breast augmentation include:

→ increase breast size if breasts are too small

→ increase breast volume after pregnancy and nursing

→ equalize difference in breast size

→ breast reconstruction following a mastectomy or injury

During this surgery, a small incision is made to insert a breast implant into the breast. Normally performed while the patient is under general anesthesia, there are several locations for the incision – lower portion of the breast, in the armpit, around the areola or in the belly button. During surgery, the breast tissue is raised in order to create a pocket under the tissue or chest wall muscle. The implant (usually containing a saline solution or silicone gel) is inserted.

Following surgery, patient orders include rest, limited movement, bandages to minimize the movement of the breasts and pain medication if needed. After the bandages are removed, a surgical bra must be worn for several weeks.

BREAST LIFT (MASTOPEXY) 

A breast lift, also known as a mastopexy, is a surgical procedure to raise and reshape sagging breasts. Reasons for considering breast lift surgery include:

• raise the breasts due to sagging caused by aging and gravity
• firm the breasts if they have lost substance due to pregnancy and nursing
• realignment of the nipples if they point down or to the side
• return of suppleness after weight loss

This surgery most commonly involved an anchor-like incision along the underside of the breast. When excess skin has been removed, the nipple and areola are moved to a higher position. The skin surrounding the areola is brought down and together to reshape the breast. Recent innovations in breast lift techniques include minimally invasive incision techniques. Surgery usually takes 90 minutes to three hours. Following surgery, patient orders include rest, limited movement, bandages to minimize movement of the breasts an pain medication if needed. After the bandages are removed, the patient must wear a specialized surgical bra for several weeks to aid in healing.

BREAST REDUCTION

Breast reduction, also known as reduction mammoplasty, is a surgical procedure that reshapes the breasts in order to make them smaller, lighter and firmer. Reasons for considering breast reduction include:

• back, neck or shoulder pain caused by heavy breasts
• sagging breasts due to size
• oversized breasts for body size
• restriction of physical activity due to heavy and oversized breasts

While surgical techniques vary, the most common procedure is an incision that circles the areola with the incision going down and following the natural curve of the breast. Excess tissue, fat and skin are removed and the nipple and areola repositioned higher and stitched in place.
Following surgery, patient orders include rest, limited movement, bandages to minimize movement of the breasts and pain medication if needed. Once the bandages are removed, a specialized surgical bra must be work for several weeks to assist in healing.

BODY LIFT

Clinically known as a belt lipectomy, a Body Lift is a surgical procedure that sizes and reshapes sagging body contours. With aging, skin loses some elasticity, causing the mid-section to lose its shape and firmness. This procedure removes loose skin and fat deposits. Body lifts can be applied to the lower torso (abdomen, waist, inner/outer thighs, buttocks, hips and upper legs). Liposuction may be used in conjunction with the Body Lift.

Reasons for a Body Lift: Reshape mid-body contour.

• Correct sagging skin and fat due to aging or excessive weight loss.
• Remedy weight gain and stretched skin caused by multiple pregnancies.

What to Expect

The exact procedure will vary with each patient. Generally, a Body Lift requires an incision following the upper and/or inner thigh to the waistline. In more extensive surgeries the incision will go completely around the waist and lower back. Excess skin is removed along with underlying fat deposits. The remaining skin is pulled taught and sutured into place. The surgery can last between 3-7 hours and will, obviously, require general anesthesia.

Recovering from Body Lift

Patients will require plenty of rest and light movement to speed healing. Bandages will be applied to minimize swelling and to provide support. Frequently drainage tubes are left in place. Scars resulting from the incisions are permanent, but carefully placed to minimize visibility. Patients do report minor pain associated with the surgery which is managed by oral pain medications. Recovery times will vary based on the extent of the procedure. Complications from the surgery are rare, however, careful compliance with the post-operative directions will help minimize potential problems.

CHIN AND CHEEK IMPLANTS

A strong jaw line with high cheek bones together with the eyes form the most photogenic aspects of a person’s face. Your profile can be enhanced when your facial proportion and balance is improved. Chin and Cheek Implants are permanent solutions to a rejuvenated, youthful facial profile.

EAR SURGERY (OTOPLASTY) 

Otoplasty, surgery of the ear, is a surgical procedure done to reduce the protrusion of the ears away from the head or “ears that stick out.” Reasons for considering otoplasty include:

• ears that protrude out from the head too much
• correction of lop ear (folded ear tips)
• reshaping of earlobes
• correction of congenital defects
• correction of an accidental injury.

Otoplasty surgery is performed under general anesthesia for children and local anesthesia for adults. It begins with an incision hidden in the crease behind the ear. For standard otoplasty, the incision allows the cartilage behind the ear to be reshaped and positioned closer to the head. This procedure takes one to two hours.

Following surgery, large bandages are wrapped around the head to secure the ear and help with healing. Patient orders include rest, limited movement and pain medication if needed. Bandages are normally removed within a week and replaced with smaller dressings until the site is fully healed.

 EYELID SURGERY (BLEPHAROPLASTY)

Blepharoplasty, commonly known as eyelid surgery, is a corrective procedure to reduce dark circles or bags under the eyes, remove wrinkles, lines and puffiness. Reasons for considering blepharoplasty include:

• dark circles or bags under the eyes
• skin or excess skin surrounding the eyelids
• puffiness or tired appearance.

This surgery involves tiny incisions made in the natural contours around the eyes. Work is first done on the upper eyelids to tighten loose skin and remove excess skin. Then the lower eyelids are done to get rid of dark circles and puffiness. The surgery normally takes one to three hours and may be done in the surgeon’s office.

Following surgery, patient orders include rest, limited movement and pain medications if needed. The healing process for this surgery is a bit longer than most other types of cosmetic surgery.

FACELIFT (RHYTIDECTOMY)

A facelift, also known as a Rhytidectomy, is a surgical procedure to smooth and firm the skin which provides the patient with a youthful appearance. Reasons for considering a facelift include:

• sagging skin, muscles and fat in the face and neck
• excess skin and fat on the neck
• sagging jaw line
• crease lines along the nose, mouth and chin.

During this surgery, small incisions are made inside the hairline following the contour in front of the ear and continuing under the earlobe to the back of the ear and lower scalp. Tissue and fat deposits are separated, skin stretched and tightened and excess skin removed. For the neck, an incision is made under the chin and the same procedure followed. Very small stitches are used to close these incisions and metal clips or staples used at the hairline. A face life may take several hours depending on what procedures are scheduled for the patient.

Following surgery, patient orders include rest, limited movement, bandages to decrease recovery time and swelling and pain medication if needed. Stitches, clips or staples are normally removed within a week.

FAT TRANSFER

Sometimes a patient’s own unwanted areas of body fat can be used to enhance other areas of the body. Aging and gravity along with weight and hormone fluctuations change the body contour. Unwanted fat in the abdomen, back, buttocks and thigh can be removed with Liposuction and injected into areas that need filing out. Typically, these areas are in the face, breasts and buttocks. Injecting fat to the cheeks, forehead, nose, chin, under-eye area, jawline, temples and lips can reduce frown lines or depressions. Sometimes Fat Transfer is done in conjunction with a face lift.

Women with smaller breasts can achieve fuller breasts, natural-looking results with a Fat Transfer Breast Augmentation.

Fat Transfer to augment the buttock (sometimes called the Brazillian Butt Lift)
is a procedure that may last between 1-4 hours. Fat will be removed from other areas of the body and transferred to the buttock with use of a local anesthetic. If Liposuction is performed over many areas of the body, general anesthesia may be used.

In all cases of Liposuction a medicated fluid is injected into the area where the fat is to be removed. This fluid carries a numbing agent and also expands the tissues making removing fat cells easier. Once the area is numbed, the removal process will begin.

Body fat is stored on top of your muscles, just under the skin. A suction device removes the fat. Your surgeon will make a series of incisisions in your skin to enable a small tube-like suction device to each the fat tissue. The tube will leave shallow tunnels under your skin that will collapse over the weeks following the surgery.

The harvested fat cells will be examined, isolated and cleaned. The cells are then combined with stem cells before being injected into their new ‘home’ in your body. The same tube-like device will implant them into the new area.

Sometimes the incision areas will require a stitch to close them and sometimes they are left to heal on their own. A surgical drain may be inserted in order to prevent fluid buildup. Absorbent pads are applied to protect the incision sites.

Recovering from Fat Transfer Surgery
Generally, you will be allowed to go home within 2-4 hours of your surgery. You will probably wear a compression garment for a few weeks to support the contour and minimize swelling. Pain medication may be needed for the first few days.
Expect to rest for several days before you return to daily activity. Some bruising is normal and typically fades within a couple of weeks. Swelling can occur for several months following the procedure.
Surgical bandages and drains will be removed within the first week. Any non-dissolvable stitches will be removed in 7-10 days. You will need to follow instructions about sleeping and sitting positions in order to avoid complications.

Understanding Risks and Results of Fat Transfer Surgery
You will notice immediate results from your procedure, but it may take up to one year before final results are produced. Occasionally, more than one procedure will be required to achieve your desired result.

There are some risks for the development of cysts, infection, small mineral deposits and death of the fat cells. You and your surgeon should discuss these prior to the procedure.

Your results will change as you gain or lose weight and Fat Transfer does not prevent the growth of additional fat in the area from which it was harvested. Further, over time, transferred fatty tissue may disperse. Proper expectations and maintenance should maintain your results or several years.

LASER SKIN RESURFACING

Laser skin resurfacing is a procedure using lasers to create new skin. The laser destroys the outer layers of the patient’s skin. This triggers the body to create a new layer of skin cells. Reasons for considering laser skin resurfacing include:

• to improve sun-damaged skin
• to reduce lines and wrinkles on the face
• to correct pigmentation problems
• to treat scars from acne, birthmarks, moles and tattoos
• to tighten skin that has lost its elasticity

During this procedure performed with a local anesthetic, the face is cleansed of oils followed by an antibiotic ointment. Then the laser destroys the outer layers of the skin.

Following the procedure, patient orders include rest, limited movement, antibiotic cream, pain medications if needed and bandages to help the healing process, control swelling and prevent infection.