FACIAL REJUVENATION

Face Lift
Facelifts are performed for men or women whose faces and necks have begun to sag. The goal of a facelift is to make you look more rested and fresher.

The facelift incision typically begins in the hairline above the ear and extends in a natural line in front of the ear. The incision continues behind the earlobe and into the lower hairline of the scalp. The underlying muscle is tightened, and extra skin is removed. In some cases fat may be removed from the neck and chin.

The procedure is performed under general anesthesia or conscious sedation, and patients may choose to spend the evening after surgery in the hospital. Most patients return to their usual daily activities after one or two weeks.

Brow Lift
A forehead lift (brow lift) is a procedure performed on men or women that restores a more youthful, refreshed look to the area above the eyes. The procedure helps to correct drooping brows and may improve wrinkle lines and furrows that can make you appear angry, sad or tired. Muscles and tissues that cause furrowing or drooping of the eyebrows may be altered to smooth the forehead and minimize frown lines. At the same time, the eyebrows are elevated and excess skin may be trimmed to help create a smoother, more youthful appearance.

The procedure is typically performed under general anesthesia or conscious sedation on an outpatient basis. Most patients return to their usual activities after one week.

Eyelid Surgery
Eyelid surgery (blepharoplasty) is a procedure designed to correct drooping upper eyelids and puffy bags below your eyes. Excess skin and fat may be removed from the upper and lower eyelids. The incisions follow the natural lines of your eyelids; in the creases of your upper lids, and just below the eyelashes of the lower lids. The incisions may extend into the laugh lines at the outer corners of your eyes. In some situations, the incision for the lower eyelid may actually be inside the eyelid, thereby avoiding an external incision. This procedure may be combined with a browlift or a skin resurfacing procedure to help eliminate wrinkles or crow’s feet. The procedure may be performed under local anesthesia, conscious sedation, or general anesthesia on an outpatient basis. Most patents return to their usual daily activities after one week.

Mid-face Lift
Mid-face lifts restore fullness to the cheek area and minimize the creases running from nose to lips. Depending upon the individual needs of each patient, the incision may be located in the hairline above the ear or beneath the lashes of the lower lid. In certain cases, a dissolvable device is placed beneath the cheek skin. This device helps to elevate the deeper layers of the cheek. The procedure may be performed in conjunction with other facial procedures, and may be performed under conscious sedation or general anesthesia on an outpatient basis. Most patients resume their usual daily activities after one week.

Rhinoplasty
Rhinoplasty is a procedure designed to change the shape of your nose. This may narrow the nose, reshape the tip of the nose, narrow the size of the nostrils, or remove bumps from the nose. Rhinoplasty surgery may also correct birth defects or breathing problems.

Typically, surgery is performed after the growth of the nose is complete, usually around 15 or 16 for girls, somewhat later for boys. However, rhinoplasty may be performed on adults as well.

The nose is sculpted in order to achieve a more aesthetically pleasing appearance. After surgery, a splint is applied to the nose in order to maintain its new shape. Nasal packs or soft plastic splints may also be placed in your nostrils to stabilize the nose. The procedure is typically performed under general anesthesia or conscious sedation on an outpatient basis. Most patients return to their usual daily activities after one to two weeks.

Chin and Cheek Implants
Chin and cheek implants may be used to balance your facial features, fill out a face that appears "sunken," or add volume to the cheeks and/or chin.

Cheek augmentation involves placing an implant under the skin and over the cheekbone. The incision is typically placed inside the mouth, thereby avoiding visible incisions.

Chin augmentation involves inserting an implant under the skin and over the jawbone. A small incision is made, either inside the lower lip or underneath the chin. The implant is inserted inside the mouth, directly over the jawbone.

These procedures may be performed under conscious sedation or general anesthesia on an outpatient basis. Most patents return to their usual daily activities in less than one week.

HAIR TRANSPLANTATION

Hair Transplantation
Hair transplantation transfers individual or several hair follicles from the back of the head to treat male pattern baldness. Occasionally, this procedure is also performed in women. Depending upon the area treated, more than one session may be required. The procedure is typically performed with local anesthesia and conscious sedation, and most patients resume their usual activities after one week.

Breast Augmentation
This operation remains one of the most popular cosmetic surgery operations for women. Over the years, many different types of materials have been used to enlarge the breast — currently the most commonly used is the saline-filled breast implant.

Women who choose this operation may not have developed adequate breast tissue or may have lost breast volume as a result of pregnancy, breast-feeding, or aging.

There are several ways to perform breast enlargement. In order to tailor the procedure to your unique needs, it is very important to discuss your expectations with your plastic surgeon. The implant may be inserted through different incisions (in the fold beneath the breast, in the pigmented skin around the nipple, underneath the arm) and placed either under the breast tissue or under the pectoralis muscle.

The procedure is typically performed under general anesthesia on an outpatient basis. Most women return to their usual daily activities after one week.

Breast Lift
A breast lift (mastopexy) is designed to tighten and reshape the breast by removing excess or loose skin. The surgical method is determined by the degree of laxity or looseness of the breast skin. The incision is made using one of a variety of techniques. Most commonly, the incision appears as an upside down "T". If an implant is used to make the breast larger, it is usually placed through the same incision.

The procedure is typically performed under general anesthesia on an outpatient basis. Most women return to their usual daily activities after one to two weeks.

BREAST RECONSTRUCTION

Breast Reconstruction
Breast reconstruction is the rebuilding of a breast that has been removed due to cancer or other diseases.

Breast reconstruction is nearly always performed under general anesthesia and requires a hospital stay. There are a variety of techniques used to reconstruct the breast, and Dr. Schechter will review these with you.

Tissue Expansion:
Tissue expansion utilizes a balloon-like device that is inserted beneath the skin and chest muscle. It has a one-way valve through which a saline solution is instilled. Over a period of several weeks, Dr Schechter will gradually fill the expander with the saline solution; as the device expands, the overlying skin is stretched into the shape of a breast. When the expansion process is complete, the temporary device is removed and replaced by a permanent implant. Under certain conditions, the expander may be used as a permanent implant, and no further surgery is needed. Dr. Schechter participates in an FDA study enabling the placement of silicone gel implants in selected patients.

Flap Reconstruction:
An alternative approach to implant reconstruction involves creation of a flap using tissue transferred from a different area of your body, such as the back or abdomen.

Transverse Rectus Abdominus Muscle Flap (TRAM):
This procedure uses extra tissue and muscle from the lower abdomen. The tissue from this area alone is often enough to create a breast. In most cases, an implant is not needed. The skin, fatty tissue, blood vessels, and at least one of the abdominal muscles are tunneled under the skin from the abdomen to the chest area. This procedure results in a tightening of the lower abdomen or a "tummy tuck."

This tissue may also be transferred as a microvascular flap. In this technique, the abdominal tissue is removed from its blood supply on the abdomen and reattached to blood vessels in the chest. This flap is the most technically complicated of the three procedures, and requires the skills of a plastic surgeon who is experienced in microvascular surgery.

Regardless of whether the tissue is tunneled beneath the skin on a pedicle or transplanted to the chest as a microvascular flap, this type of surgery is more complex than skin expansion. Scars will be left at both the abdominal donor site and at the reconstructed breast. In addition, recovery is generally longer than with an implant.

Deep Inferior Epigastric Artery Perforator Flap (DIEP):
The DIEP Flap represents the evolution of the TRAM procedure in breast reconstruction. It is performed by microsurgical technique that involves separating the skin, soft tissue and tiny blood vessels, from the abdomen without disrupting the abdominal muscles. The blood vessels are matched to vessels at the mastectomy site, and a new breast is constructed. Less post-operative pain, a potentially shorter hospital stay, and a quicker recovery may be possible by leaving the abdominal muscles intact.

The tissue taken to create a new breast using the DIEP Flap is virtually the same as that taken for a cosmetic tummy tuck or abdominoplasty.

Superficial Inferior Epigastric Artery Flap (SIEA):
The SIEA Flap is similar to the DIEP Flap technique, the procedure uses skin and fatty tissue from the abdomen to replace the skin and soft tissue removed in a mastectomy. The advantage of this reconstruction over the DIEP Flap is that BOTH the Rectus Muscle and its overlying fascia are left untouched.

In some women, the superficial vessels of the abdominal fatty tissue provide the dominant source of blood flow to this region. In these cases, the SIEA vessels may be chosen as the source of blood supply for the borrowed tissue necessary to reconstruct the breast. The decision about which procedure to use — DIEP Flap or SIEA Flap — is made during surgery.

As with the DIEP Flap procedure, the SIEA Flap preserves the abdominal muscle and leaves a flat belly, similar to a tummy tuck.

Latissimus Dorsi:
This procedure transfers muscle and skin from the back. This extra tissue remains attached to its original site, retaining its blood supply. The flap is made up of skin, fatty tissue, and muscle. In most cases, an implant is used in conjunction with this flap in order to add volume to the reconstructed breast.

Breast Reduction
A breast reduction (reduction mammaplasty) is designed to make the breast smaller by removing skin, breast tissue, and fatty tissue. In addition, the breast is lifted, and the areola (pigmented skin around the nipple) is made smaller. This procedure helps alleviate symptoms of macromastia (large breasts) such as shoulder grooving or notching, upper back pain, and skin irritation beneath and between the breasts. The incision is made using one of a variety of techniques. Most commonly, the incision appears as an upside down “T”.

BODY CONTOURING

Abdominoplasty
This operation is designed to remove or tighten loose skin of the abdomen, repair the abdominal muscles (rectus abdominus), and narrow the waistline. Sagging or bulging pockets of fat may also be removed, sometimes with the assistance of liposuction. The procedure is typically performed under general or regional anesthesia (epidural anesthesia). In many cases, patients choose to stay in the hospital overnight. Most patients return to their usual activities two to three weeks after surgery.

Circumferential Lift
Circumferential lifts remove extra skin of the abdomen, back, and buttock after a large amount of weight loss. During this procedure, the patient is actually turned from back to front in order to treat the entire midportion of the body. This procedure is performed under general anesthesia and requires an inpatient hospital stay.

Liposuction
This operation is designed to remove localized areas of fat from many areas of the body. It is designed to sculpt these areas and not to treat obesity or tighten the skin. Small incisions are made, and the fat is removed through suction tubes called cannulae. In most instances, the area to be treated is distended with saline, a local anesthetic, and a medicine to constrict blood vessels. This is known as tumescent fluid. Depending upon the amount of fat to be removed and the number of body areas requiring treatment, the procedure may be performed under conscious sedation or general anesthesia and as an outpatient or overnight stay. Recovery also depends upon the number of areas treated, but most patients resume their usual activities after one to two weeks.

Thigh and Arm Lift

Arm Lift
This operation is designed to tighten the loose skin of the upper arms as well as to remove fatty tissue beneath the skin. Liposuction is often used in conjunction with this surgical procedure. The incision is placed on the inner and under surface of the arm and often extends into the armpit or axilla.

Thigh Lift
This operation is designed to tighten the loose skin of the thigh. Liposuction is often used in conjunction with this surgical procedure.

This procedure is typically performed under a general anesthetic. Depending upon the extent of surgery, this may be performed on an outpatient basis or require an overnight stay. Most patients resume their usual activities after two to four weeks.