FACIAL CONTOURING
(plastic surgery of the profile)

INTRODUCTION:
The profile of your face is provided primarily by your forehead, your nose, your cheekbone, your jaw and your chin.

FACIAL CONTOURING AIM TO CORRECT THE HARD TISSUES OF THE FACE.

Most patients’ complaints for the nose, malar eminences or the chin region. For the plastic surgery of the profile, the more frequent modification is made in the nose.

PLASTIC SURGERY OF THE CHIN:
Many patients have the typical receding facial profile, with a convex nasal dorsum and small lower jaw. The soft tissue of the chin is several to many millimeters behind the aesthetic profile line. A generally convex nasal dorsum and prominent osteocartilaginous vault contribute to the receding nature of the profile. Facial contouring surgery that doesn’t affect the occlusion is often the best choice: rhinoplasty with chin augmentation (GENIOPLASTY).

Genioplasty includes both alloplastic implant and osteotomy procedures.
Alloplastic augmentation is ideal for patients whose only requirement is less than 5 mm of projection and/or 1 cm of transverse widening. We use SILASTIC IMPLANTS.
Nowadays, we have another possibility as THE BIOPLASTIA (filler with synthetic product, PMMA).

Cervical liposuction often complement the facial contour alteration simultaneously with the skeletal surgery.

PLASTIC SURGERY OF THE MALAR REGION:
Augmentation of the malar complex with alloplastic implants and liposculpture of the midfacial fat pad will help the patient achieve that high cheekbone and hollow cheek look so desired.

WHAT’S A MASTECTOMY?
It’s a surgical operation to remove a woman’s breast for breast cancer or significant risk factors for breast cancer.

BREAST’S ANATOMY
The breast is a mound of glandular, fatty and fibrous tissue located over the pectoralis muscles of the chest wall and attached to these muscles by Cooper’s ligaments. The breast itself has no muscle tissue.
The glands have the capacity for milk production, blood vessels, milk ducts to transfer the milk from the glands to the nipples and sensory nerves that give feeling to the breast. Most breast cancer begins in the lining of the ducts and sometimes the milk glands.

TIMING OF BREAST RECONSTRUCTION

1. INMEDIATE RECONSTRUCTION: reconstructive surgery performed at the same time as the mastectomy. It has positive psychological benefits for women. It offers major advantages for obtaining an optimal result.

1. DELAYED RECONSTRUCTION: reconstructive surgery performed from a few days to years after the mastectomy. It allows the breast tissues time to heal, she can plan the timing, more time to plan the surgery to achieve breast symmetry. The patient has time to recover from adjunctive therapy. But as risks she may experience depression from mastectomy, she may never “get around” to having reconstruction, additional cost of two surgeries.

SURGICAL OPTIONS FOR BREAST RECONSTRUCTION
Breasts can be reconstructed using implants or expanders and the tissue remaining after the mastectomy or with flaps of muscle or muscle and skin oftained from the abdomen, back, hips or buttocks and then transferred to the chest wall.
The choice of reconstructive method depends on the amount and quality of the tissue remaining after the mastectomy, our team plastic surgeon’s experience and your preferences and expectations.

RECONSTRUCTION WITH AVAILABLE TISSUE:
The implant or expander is the simplest method of breast reconstruction. New scars are not created. A second operation will be required to reconstruct the nipple-areola and if necessary to make appropiate adjustments in implant size, shape and position or to release the capsular contracture.
Basically, there are,

• IMPLANTS with fixed-volume
• EXPANDERS: implants in wich the volume can be changed after they are implanted

Implant reconstruction is indicated for the woman who has available and healthy tissue after mastectomy, her chest muscles are preserved. Benefits: symmetric appearance, suitable for bilateral reconstruction.

Expander recosntruction is indicated for the woman who desire a simpler reconstructive approach, but the taut skin in the area of the mastectomy is streched and expanded. Benefits: usually without additional breast scars, patient can help make the final determination of the volume and size; suitable for bilateral reconstruction. Drawbacks: it’s time intensive.

FLAP RECOSNTRUCTION:
The two most common sources of tissue for breast reconstruction with the patient’s own tissue are the lower abdominal wall and the back.

1. Reconstruction with the Lower Abdominal (TRAM) flap: this technique allows to restore a woman’s breast with her own tissues without the need for a silicone breast implant, and at the same time give her a slimmer abdomen. It’s indicated for the woman who prefers a breast reconstruction without a breast implant and she will accept the prospect of having a “tummy tuck”. But TRAM FLAP blood supply is precarious in the overweight woman, the hypertensive woman, if she has had radiation therapy, certain types of abdominal scars and the woman who is a cigarette smoker. When the woman’s abdominal wall is very thin or she doesn’t want scars in this region. It isn’t indicated for the women with medical problems such as diabetes mellitus or heart disease, or who have had liposuction across their upper abdomen.

1. Reconstruction with the Latissimus Dorsi (Back) flap: is selected when additional tissue is needed to reconstruct mastectomy defects. It’s indicated when the patient does not want a TRAM flap or a TRAM flap would pose too much risk. Benefits: it permits the formation of a more naturally shaped, fuller, larger breast. The healthy skin added is often thicker than the thin expanded skin. It’s indicated for patients who have skin grafts or irradiated skin. Drawbacks: when a large amount of skin and fat are removed from the back, the resulting scar can be unattractive. This procedure adds an implant or expander because the skin and the muscle are thin

CONCLUSIONS:

BREAST RECONSTRUCTION MEANS,

1. To reconstruct a good cutaneous coverage.
2. To achieve a suitable volume and shape.
3. Creating a nipple-areola.
4. To achieve symmetry making the necessary adjustments in the opposite breast.

BREAST RECONSTRUCTION IS A HUMAN RIGHT AND A NEED TO RECONSTRUCT THE LOST ANATOMY AND TO CONTRIBUTE TO AND FEEL GOOD IN A RELATIONSHIP.
THE BREAST ARE AN ESSENTIAL PART OF THE FEMININITY.

DEFINITION: a pathology that is characterized by chronic edema, progressive, reversible to the beginning and then irreversibly, determined by alterations of the
lymphatic system of the lower limbs.

CLASSIFICATION:

1. PRIMARY: for fail in the development of the normal lymphatic.
2. SECONDARY:

• • Traumatism
  • Infection
  • Neoplasia
  • Treatment of  radiotherapy and surgical interventions

MEDICAL HISTORY:
Three stages:

1. STAGE I: reversible lymphedema. Edema is pitting and the swelling may become temporarily reduced by simple elevation of the affected limb.
2. STAGE II: irreversible lymphedema. Elevation of the limb will not reduce the swelling any more.
3. STAGE III: lymphostatic elephantiasis characterized by a tremendous increase in volume, leading to the association with the limb of an elephant.

COMPLICATIONS:

1. FUNCTIONAL: inability to walk, to sit down and only to change position with help.
2. INFECTION
3. DELAY OF THE SCARRING
4. OVERWEIGHT
5. AESTHETICS AND PSYCHOLOGICAL

TREATMENT:
Medical/surgical treatments.
Complex descongestive physiotherapy. First, hygienic measures and the erradication of fungal affections are mandatory. Antibacterial treatment. Second, manual lymph drainage. Third, from de beginning of the treatment, bandages are applied over the the lymphedematous limb. Fourth, remedial exercises. Fifth, at the end of the treatment, wich lasts approximately four weeks, an elastic support, as strong as can be tolerated by the patient, made to measure, must be prescribed.

GYNECOMASTIA is the development of enlarged male breasts.
These may be quite small, causing a pointed protrusion of the nipple-areolar complex or massive, involving the subcutaneous fat and glandular tissue.
Male breast enlargement can occur in up to 75% of adolescent boys and is persistent in 7% of cases.
Other pathologic states that may be associated with gynecomastia are testicular tumors, cirrhosis of the liver, lung cancer, hyperthyroidism, carcinoma of the prostate.
Induced gynecomastia with therapy with either estrogen or androgen.
Other pharmacologic agents may also cause gynecomastia.

INDICATIONS:
Liposuction or / and direct surgical excision removing excess glandular tissue will benefit those with the following conditions:

- persistent gynecomastia in a patient older than age 17 years.
- cases of steroid-induced gynecomastias in athletes who self-administer anabolic steroids
- patients with other patologic states depend
- liposuction is indicated when gynecomastia is quite small (50% of cases).
- for massive gynecomastia direct surgical excision and mastectomy may be indicated.

CONTRAINDICATIONS:
- We will not operate if we believe that your objective is not realistic. IT IS IMPOSSIBLE TO OPERATE ON PEOPLE WITH EXAGERATED OR FANTASY EXPECTATIONS. I recommend you read the chapter “Psychological Aspects of Plastic Surgery” of this website.
- If you  have poor health, above all cardiovascular and mental disorders we cannot operate.
- Those patients who smoke should stop completely at least one month before the operation because this operation may produce the loss of tissues.
- Patients who are  addicted to drugs or alcohol.
- Patients who worry too much about small defects that in reality are very minute.
PLANNING:
Before the operation and after the first consultation, we will be able to propose in writing the possible modifications.
We always do a photo session as a fundamental part of evaluating your case.
WITHOUT PHOTOS WE DO NOT OPERATE. IT IS ALSO VERY IMPORTANT THAT YOU REMEMBER THAT ALL THE INFORMATION YOU RECEIVE IN WRITING, SHOW AN ESTIMATION OF THE FINAL RESULT.
Between you, the patient and me the Plastic Surgeon, we should agree on the results that we are able to achieve.

1. We ask for blood tests regularly.
2. Do not drink alcohol at least 24 hours before operating.
3. Do not take ASPIRIN 15 days before operating.
4. Organize your activities so that you are able to rest  after the operation.
5. This is an outpatient procedure.

ANESTHESIA:
Local Anesthesia without or with sedation is used.
RECOVERY: see LIPOSUCTION
FINAL RESULTS:
Generally the planned results are obtained. It is to obtain a well proportioned figure.
THE FINAL RESULTS WILL NOT BE SEEN 6 MONTHS AFTER THE OPERATION.
The effect is permanent.
Lymphatic drainage 3 times a week for at least two months.
POSSIBLE COMPLICATIONS: see LIPOSUCTION

* Profesor Dr. Eduardo Civila

Dermatólogo y Médico Esteticista

Diplomado por la Unión Internationale de Medicine Esthetique

Ex Profesor Agregado de la Facultad de Medicina
Vice-Presidente de la Sociedad Uruguaya de Medicina Estética.

You wake up one morning and look in the mirror. Suddenly, you notice facial lines that just weren’t there yesterday.

What can you do?

SMOOTHING OUT THE WRINKLES

Facial wrinkles and creases begin to appear as the underlying collagen and elastin fibers begin to break down and and wear out. While this breakdown is part of the natural aging process, it can also result from excessive squinting, frowning and smiling.

Rejuvenation by filling depressions consists of filling creases and facial depressions with synthetic materials (hyaluronic acid, puragen and restylane), and then we can smooth out wrinkles and most scars.

Indications:

• Deeper frown lines
• Forehead lines
• Crow’s feet at the eyes
• Nasal labial furrows
• Oral commissures
• Cheek depressions
• Smoker’s lines around the mouth
• To increase lips thickness, for those with very thin lips or with lips with aging atrophy
• Dimples and facial scars

Procedure:
It takes around 20 minutes, with or without local anesthesia.
Discomfort is minimal
On the following days, may occur swelling, who disappear after 48 hours.
The recovery is fast.
Allergic reactions are rare.

Results:
Results are immediate.
After treatment, most people return to their normal activities.
Results may last up to six months or longer. The results last depending on the skin, lifestyle and the product.
Most patients come in one to two times a year for touch-ups

ANTIWRINKLE SHOCK: Rejuvenation of the Aging

Chemical Peel: Forehead, Eyelid, Periorbital and Facial Skin.

“Antiwrinkle shock” that we have developed represents an exclusive procedure in our country with rapid and lasting recovery of the skin by means of the use of chemical formula applied in the form of “Triple Peeling”.
It doesn’t need anesthesia and it’s realized in one session.

The products promote the spare of the superficial and middle layers of the skin, causing after 11 days a new, smooth and vital skin in which it has eliminated the wrinkles as a consequence of the cutaneous intrinsic aging, as well as the wrinkles, the spots and keratoses consequence of the actinic damage. These products reduce the facial expression lines also, depressions, the scars of acne, surgical or for accidents.

STIMULANT EFFECT ON THE CELLS: the base of this is the stimulant effect on the cells that produces a marked increase in collagen in a lamellar distribution, an increase in the density of associated fibroblasts, an increase in elastic tissue in the dermis, as well as the renewal of the cells in the basal layer of the epidermis.
It settles also a new vascular superficial network that assures the suitable blood and circulation of lymph.
These phenomena determine that the skin retracts on the tissues that it covers, adapting itself perfectly to them without the folded of the wrinkles, lessening the flaccidity and recovering the elasticity of the skin of a child.
THE FINAL EFFECT IS NOTICEABLE REJUVENATION WITHOUT ALTERATION OF THE FEATURES.

After the 11th day you should be able to return to your everyday activities and to begin your social life normally.
Avoid the sun for the first 3 months. Make up can be used.

* Professor Dr. Eduardo Civila

Dermatologist and  Aesthetician Doctor

Diplomate of the Unión Internationale de Medicine Esthetique

Professor of Faculty of Medicine, University of Uruguay

Vice-President of Uruguayan Society Of Aesthetic Medicine.

INTRODUCTION:
For centuries, a woman’s lips have been viewed as a sign of her sensuality.
Luscious lips are a key element of almost every photo in every fashion magazine. Unfortunately, not everyone is blessed with a naturally and beautiful lips. The few who are don’t get to keep them without a little help. Over time the sun, the elements, smoking and the aging process take their toll.

• The corners of the mouth begin to droop.
• The V-shaped area of the upper lip known as Cupid’s Bow begins to flatten out and lose its youthful fullness.
• Vertical wrinkles or Smoker’s Line begin to appear, causing your lipstick to bleed.

That once sensual look is gone or greatly diminished.

Thanks to today’s many medical advances there is help. Aging lips can be rejuvenated and less full lips can be enhanced.

TREATMENT OPTIONS:
Lip enhancement and rejuvenation are two of the most frequently requested cosmetic procedures. Your options range from,

• Laser treatment.
• Chemical peels.
• Natural injectable fillers
• Synthetic injectable fillers.

WHAT IS RECOVERY LIKE?
Following lip enhancement with one of the injectable products, your lip remain swollen for a few hours only. You may return to normal activities the same day. Touch-up treatments may be necessary.

Discomfort is minimal. Some swelling may last up to a week. Elevating your head and applying cold compresses during the first 24 hours will help keep this to a minimum. Postoperative discomfort can be controlled with medication.
Chewing food and brushing your teeth may be a little uncomfortable for a few days.
There may be some bruising wich can be covered with make-up.

The ear is a complex of skin and cartilage.
The prominent ears are one of the conditions that more influence in the self-steem..

INDICATIONS:

You’ll benefit from this ears surgery if you have,
- protruding ear deformities.
- large ears.
- ears with defects from birth.
- ears with traumatic shortcomings.
- at least 5 years old

CONTRAINDICATIONS:
* We will not operate if we believe that your objective is not realistic. IT IS IMPOSSIBLE TO OPERATE ON PEOPLE WITH EXAGERATED OR FANTASY EXPECTATIONS. I recommend you read the chapter” Psychological Aspects of Plastic Surgery” of this website.

SURGICAL OBJECTIVES:

1. To create an ear with normal characteristics.
2. To reduce the size of the ears.
3. To remodel the cartilage.
4. To change the angle between the ear and the head.

PLANNING THE YOUR NASAL SURGERY:
BEFORE THE OPERATION,
* First you must undergo a complete medical examination. Then we will be able to give you in writing, the modifications that are suitable for you. We always do a photo session as a fundamental part of evaluating your case.
WITHOUT PHOTOS WE DO NOT OPERATE. IT IS ALSO VERY IMPORTANT THAT YOU REMEMBER THAT ALL THE INFORMATION YOU RECEIVE IN WRITING, SHOW AN ESTIMATION OF THE FINAL RESULT. Between you, the patient and me the Plastic Surgeon, we should agree on the results that we are able to achieve.
We ask for blood tests regularly.

ANESTHESIA:

- For children general anesthesia.
- For adults local anesthesia with sedation.

PROCEDURES:

- Each defect is corrected with a different technique.
RECOVERY:

1. Generally the patient stays in hospital for a few hours after the operation and is able to go home the same day (outpatient),
2. wearing a dressing around the head and protecting the ears.
   -     The first day must be spent in a lying position with the head semi-elevated.
3. after that, wear a tennis player style headband
4. Your ear will probably have some pain and you will feel somewhat swollen but pain killers will help. ASPIRIN MUST NEVER BE TAKEN, AS IT CAUSES BLEEDING.
5. the stitches are removed 7 days after surgery
6. Infections are rare, we only give antibiotics if there is risk of infection.
7. Exposure to the sun and swimming in the ocean are recommended for 45 to 60 days after the operation, or when the bruising has disappeared. Using always 30 plus sunscreen.
8. the patient may return to normal activities after one week.

Remember to always clarify your doubts before and after operating, remember that all questions are valid.
FINAL RESULTS:

Generally, a well planned and timed operation, following all the indications necessary obtains satisfactory and natural results, usually permanent. You’ll not need to hide your ears anymore. You can wear your hair pulled back. You can wear earrings.

POSIBLE COMPLICATIONS:
Complications are rare but do exist. REMEMBER THAT PERFECT AND RISK FREE PLASTIC SURGERY DOES NOT EXIST.

- infection of cartilage
- hematomas need to be drained.
- excesssive scarring.
- recurrence of the protrusion wich requires another surgery.

LIPOSUCTION IS THE RESHAPE OF THE BODY BY REMOVAL OF ADIPOSE TISSUE.
It’s a safe surgical procedure of sculpturing the fat under the skin.
In 1976, Illouz of Paris developed a technique to remove localized subcutaneous deposits of adipose tissue by blunt cannula through a small incision with the aid of suction.

INDICATIONS:
This surgery will benefit those with the following conditions:

1. Men or women who have localized fat that does not disappear with dieting or vigorous exercise.
2. Older than 18 years of age, with normal weight and good skin turgor.
3. Excess of fat in the face (cheeks) and neck (submental area, jowles).
4. Excess of fat in the back (Dowager’s hump).
5. Excess of fat in the axillary breast and breasts.
6. Excess of fat in the abdomen and waist; upper abdomen, peri-umbilical and lower abdomen.
7. Excess of fat in the suprapubic – Mons pubis.
8. Excess of fat in the hips, buttocks (gluteal fold enhacement), thighs (lateral and medial).
9. Excess of fat in the knee, calf, and ankle.

LIPOSUCTION IS NOT A WEIGHT LOSS METHOD.
IT’S A COMPLEMENT TO THE TRADITIONAL METHODS OF DIET AND PHYSICAL EXERCISES
CONTRAINDICATIONS:
We will not operate if we believe that your objective is not realistic. IT IS IMPOSSIBLE TO OPERATE ON PEOPLE WITH EXAGERATED OR FANTASY EXPECTATIONS. I recommend you read the chapter “Psychological Aspects of Plastic Surgery” of this website.
- If you  have poor health, above all cardiovascular and mental disorders we cannot operate.
- Those patients who smoke should stop completely at least one month before the operation because this operation may produce the loss of tissues.
- Patients who are  addicted to drugs or alcohol.
- Patients who worry too much about small defects that in reality are very minute.
PLANNING:
Before the operation and after the first consultation, we will be able to propose in writing the possible modifications.
We need to know the following in order to plan the surgery:

1. Tone and elasticity of the skin.
2. Excess and maldistribution of fat. THIS METHOD IS NOT UTILIZED FOR GENERAL OBESITY
3. Scars and Striae (stretch marks).
4. Hernias. We always request ultrasound scan, echography, to discard the same ones in the liposuction of abdomen..

We always do a photo session as a fundamental part of evaluating your case.
WITHOUT PHOTOS WE DO NOT OPERATE. IT IS ALSO VERY IMPORTANT THAT YOU REMEMBER THAT ALL THE INFORMATION YOU RECEIVE IN WRITING, SHOW AN ESTIMATION OF THE FINAL RESULT.
Between you, the patient and me the Plastic Surgeon, we should agree on the results that we are able to achieve.

1. We ask for blood tests regularly.
2. If you have the flu or are menstruating, please communicate 3 days beforehand.
3. Do not drink alcohol at least 24 hours before operating.
4. Do not take ASPIRIN 15 days before operating.
5. Organize your activities so that you are able to rest  after the operation.
6. This is an outpatient procedure.

ANESTHESIA:
Local Anesthesia without or with sedation is used.
PROCEDURES:

1. We use the tumescent technique where we infuse with a frozen saline solution containing a local anesthetic and adrenalin to decrease blood loss and allow an easier renoval of the fat.
2. We make little incisions, 8 mm; no scars are visible.
3. Then we introduce a very fine canula to remove fat by a tube and a vacuum device with syringe or a pressure controlled suction (TRADITIONAL TECHNIQUE)
4. THE GOAL FOR ALL METHODS ARE THE SAME

RECOVERY:

1. The patient will be in the hospital for a few hours and go home at the same day.
2. The first 24 hours must be spent resting in bed in a semi-lying position But it is important to move your legs regularly to prevent thrombophlebitis.
3. we can walk carefully.
4. You can return to normal activities after 48 hours.
5. Eat well with alimentation full of protein and lots of vitamin C. But do not eat excessively.
6. THE APPLICATION OF TAPE IS EXTREMELY IMPORTANT; AS IMPORTANT AS THE ENTIRE PROCEDURE. Its purpose is to support the tissues against gravity, to produce compression over the treated area.
7. Pressure support garments wich include abdominal binders, long-leg, side opening support girdles and the application of elastic strech bandages for lower extremities.

DO NOT WORRY IF IN THE FIRST DAYS YOU EXPERIENCE:

1. Swelling and bruising, which may be more noticeable on the second day.
2. Some discomfort.
3. If you have some pain, you can take analgesics, BUT NEVER TAKE ASPIRIN, IT CAUSES BLEEDING.
4. Showering and bathing are allowed after 1 day.
5. We give antibiotics for the first five days to prevent infection.
6. All sutures/stitches are removed 1 week after the operation.
7. During the first 45 days and elastic compression garment must be worn.
8. Physical activity can be begun 1 month after the operation.
9. You must keep out of the sun for the first 3 months.
10. Loss of sensitivity can take around 6 to 8 to fully recover.
11. If you have any doubts or worries do not hesitate in consulting your surgeon or doctor.

FINAL RESULTS:
Generally the planned results are obtained. But this is not an operation to lose weight, it is to obtain a well proportioned figure.
THE FINAL RESULTS WILL NOT BE SEEN 6 MONTHS AFTER THE OPERATION.
The effect is permanent and must be augmented with a sensible diet and consistent exercise.
Lymphatic drainage 3 times a week for at least two months.

POSSIBLE COMPLICATIONS:
They are uncommon. Complications are less than 0.5% when not combined with other procedures and about 1% in combined procedures. This is LESS than any other cosmetic procedure. But remember that plastic surgery without risks does not exist.

1. Hematoma and Seroma.
2. Infection (rare).
3. Permanent altered sensation (rare).
4. Chronic pain (rare).
5. Pulmonary embolism (very rare).
6. Fat embolism (very rare).
7. Thrombophlebitis (occasional).
8. Injury to major vessels and nerves (rare).
9. Perforation of the abdomen (very rare)
10. Chronic induration.
11. Redundancy of skin.
12. Permanent skin irregularities.
13. Hypopigmentation and hyperpigmentation

WHAT ARE SILICONE BUTTOCK IMPLANTS? IS SILICONE SAFE TO USE IN HUMANS? DOES SILICONE PRODUCE CANCER?
Silicone buttock implants are devices made up of an outer layer or envelope of silicone elastomer that is in contact with the body tissues and are filled with silicone gel. This gel is what maintains the shape of the implant. There are also implants of silicone gel that are enveloped with polyiurethane.
SINCE THE DISCOVERY OF SILICONE, SILICONE HAS HAD MANY APPLICATIONS IN EVERY DAY LIFE, MEDICAL APPLICATIONS, PHAMACEUTICAL APPLICATIONS AND ALIMENTATION DURING THE PAST 50 YEARS. For example: Artificial joints, pumps, shunts, drains, ocular implants, pacemakers, breast implants, penile implants, testicular implants, tablets and capsules with silicone (anti-acids), lipstick, lotions, sunscreens, deodorants etc.
WE ARE CONSTANTLY EXPOSED TO SILICONE IN OUR EVERY DAY LIVES. UNTIL NOW, THERE IS NO SCIENTIFIC EVIDENCE THAT SILICONE PRODUCES CANCER. Different scientific investigations have been carried out by the U.S. National Cancer Institute, International Epidemiology Institute y Karolinska Institute de Sweden, Danish Cancer Registry, Fred Hutchinson Cancer Research Center, Institut Gustave Roussy en France, Alberta Canada Cancer Board, U.S. Centres for Disease Control and Prevention y University of Southern California School of Medicine). THAT IS WHY YOU SHOULD NOT BE AFRAID.
IS THERE A SPECIAL RISK FOR WOMEN WHO ALREADY HAVE SILICONE IMPLANTS THAT ARE ENVELOPED WITH POLYURETHANE?
Silicone implants enveloped with polyurethane, which was introduced at the beginning of the 70´s, have the advantage that capsular contractures are less frequent. But they have the disadvantage that the implant fixes itself strongly in place and therefore is difficult to remove. There are scientific studies that show that the polyurethane (the most external layer of the implant) can break away therefore become a conventional implant. Between the chemical elements of polyurethane, a substance called toluen diamina (TDA), that has produced cancer in laboratory animals. AT THIS POINT IT IS NOT CLEAR IF IT CAN BE PRODUCED IN HUMAN BEINGS. The Food Drugs and Administration of the U.S.A. show that it is very improbable that a women will produce cancer because of the use of this type of implant (probability of 1 in 1 000 000 throughout the whole life of the patient).
CAN IMPLANTS CAUSE CONNECTIVE TISSUE OR AUTOIMMUNE DISEASE IN HEALTHY WOMEN?
Silicone, just like most other substances can produce an allergy. However allergies to Silicone are very uncommon. Some rare disorders such as lupus erythematosus, dermatomyositis, scleroderma, and rheumatoid arthritis. THERE IS NO EVIDENCE THAT IMPLANTS PRODUCE THESE DISSORDERS.
Scientific investigations have been carried out by,  Mayo Clinic, Harvard Medical School, University of Michigan School of Public Health, Emory University, University of Kansas Artritis Center, University of Washington Fred Hutchinson Cancer Research Center, University of Toronto, University of Maryland, University of Pittsburg, University of California, SanDiego y Johns Hopkins University Schools of Medicine.
WHY IS IT PROHIBITED TO USE LIQUID SILICONE ON ITS OWN?
Because liquid silicone migrates through the blood and the lymphatic vessels working its way to different organs, such as the liver, kidneys, brain and pancreas etc. SILICONE GEL (different to liquid silicone) IS NOT PROHIBIDED
THE DIFFERENT TYPES OF IMPLANTS
DEPENDING ON THE  SHAPE:

1. Round
2. Oval

THE SIZE:

1. Variable, from 180cc(cubic centimeters) to 350cc

THE SURFACE:

1. Smooth
2. Textured
3. Polyurethane

THE FILLING:
- Silicone Gel
INDICATIONS:
This surgery will benefit those with the following conditions:
Flat buttocks.
CONTRAINDICATIONS:
We will not operate if we believe that your objective is not realistic. IT IS IMPOSSIBLE TO OPERATE ON PEOPLE WITH EXAGERATED OR FANTASY EXPECTATIONS. I recommend you read the chapter “Psychological Aspects of Plastic Surgery” of this website.
- If you  have poor health, above all cardiovascular and mental disorders we cannot operate.
- Those patients who smoke should stop completely at least one month before the operation because this operation may produce the loss of tissues.
- Patients who are  addicted to drugs or alcohol.
- Patients who worry too much about small defects that in reality are very minute.
- Patients who will not accept the final scaring. ALL OF THESE OPERATIONS LEAVE SOME SCARING AND THE QUALITY OF THESE SCARS DEPENDS ON MANY UNKNOWN FACTORS.
- Previous allergies to substances or materials.
- If you have an infection in any part of the body.
- If you have a history of bad scaring.

SURGICAL OBJECTIVES:

1. Increase the size of your buttocks with implants, if you have an inadequate volume, to improve your self-esteem.
2. The place of the implants, the incisions will be definded after medical consultations and undergoing a careful and detailed study.

PLANNING THE SURGERY:
BEFORE THE OPERATION

First you must undergo a complete medical examination. Then we will be able to give you in writing, the modifications that are suitable for you. We always do a photo session as a fundamental part of evaluating your case.
WITHOUT PHOTOS WE DO NOT OPERATE. IT IS ALSO VERY IMPORTANT THAT YOU REMEMBER THAT ALL THE INFORMATION YOU RECEIVE IN WRITING, SHOW AN ESTIMATION OF THE FINAL RESULT.

Between you, the patient and me the Plastic Surgeon, we should agree on the results that we are able to achieve. We ask for blood tests regularly.

1. If you have the flu or are menstruating, please communicate 3 days beforehand.
2. Do not drink alcohol at least 24 hours before operating.
3. Do not take ASPIRIN 15 days before operating
4. Organize your activities so that you are able to rest  after the operation.
5. Do not drive your car for at least 30 days after the operation.
6. Only begin physical exercise gradually 2 months after the operation.

ANESTHESIA:

1. Peridural or General Anesthesia.

PROCEDURES:

1. The patient may be outgoing or ingoing.
2. The estimated time of the operation is 3 hours.
3. The incision is located between the two buttocks and is hidden when the patient is in a standing position.
4. We then put the implant below the muscle.
5. The implant is situated in the top 2/3 of the buttock.
6. Drainage for the first 48 hours.

RECOVERY:

1. The patient may be outgoing or ingoing.
2. 12 days of bed rest, lying face down.
3. If you need to sit during the first 30 days you must rest on your thighs.
4. After these first 24 hours you may be able to start to walk around.
5. Eat well, food high in protein and lots of vitamin C.
6. You must keep the sterile tapes in place for 24 hours.

DO NOT WORRY IF IN THE FIRST DAYS YOU HAVE:

1. Bruising and swelling, which can be more prominent on the second day.
2. Some discomfort.
3. We use a drain for around 48 hours after the operation.
4. If you are in pain, take analgesics, BUT NEVER TAKE ASPIRIN, BECAUSE IT CAUSES BLEEDING. Generally placing the implant behind the pectoral muscle causes more discomfort or pain.
5. We give antibiotics to prevent infection.
6. Full showers can be taken from after 2 to 3 days.
7. Stitches can be removed 2 weeks after the operation.

1. Sterile tapes and or bandages are to be changed every 3 days during a 2 week period.
2. For 30 days a special elastic garment is to be used.
3. From 2 weeks onwards we indicate 10 lymphatic drainage sessions to help the recovery process, eliminate toxins and improve the circulation.

As the days go by you will begin to feel better and better but be

An attractive abdomen has contours formed by the muscles and fat. A bad diet, in quality and quantity, pregnancies, lack of physical activity and genetics are all factors that affect ones physical appearance and therefore self-esteem.

ABDOMINOPLASTY IS THE RESHAPE OF THE ABDOMEN IN ITS 3 DIFFERENT ASPECTS.

• · SKIN
• · FAT
• · MUSCLE

INDICATIONS:

This surgery will benefit those with the following conditions:

- Men or women who have excess fat that does not disappear with dieting or vigorous exercise.

- Maldistribution of fat with excess skin. Generally found in women between 30 and 45 years old, who have not given birth to a child or have had one child only.

- Musculofascial laxity of the lower abdomen with maldistribution of fat and excess skin.

- People with excess skin, excess fat and musculofascial laxity in both the upper and lower abdomen. Often found in women who have had multiple pregnancies.

- Thin people with excess skin.

- Skin with striae, strech marks.

-          Not aesthetic scars.

CONTRAINDICATIONS:

We will not operate if we believe that your objective is not realistic. IT IS IMPOSSIBLE TO OPERATE ON PEOPLE WITH EXAGERATED OR FANTASY EXPECTATIONS. I recommend you read the chapter “Psychological Aspects of Plastic Surgery” of this website.

- If you  have poor health, above all cardiovascular and mental disorders we cannot operate.

- Those patients who smoke should stop completely at least one month before the operation because this operation may produce the loss of tissues.

- Patients who are  addicted to drugs or alcohol.

- Patients who worry too much about small defects that in reality are very minute.
- Patients who will not accept the final scaring. ALL OF THESE OPERATIONS LEAVE SOME SCARING AND THE QUALITY OF THESE SCARS DEPENDS ON MANY UNKNOWN FACTORS.

SURGICAL OBJECTIVES:

According to each individual case:

-          Correction of the musculofascial laxity.

-          Liposuction or Lipectomy of excess fat.

-          Removal of excess skin with short scars being hidden below the bikini line.

PLANNING:

Before the operation and after the first consultation, we will be able to propose in writing the possible modifications to your abdomen.

We need to know the following in order to plan the surgery:

-          Excess of skin.

-          Excess and maldistribution of fat.

-          Musculofascial laxity.

-          Scars and Striae (stretch marks).

-          Hernias. We always request ultrasound scan, echography, to discard the same ones.

We always do a photo session as a fundamental part of evaluating your case.

WITHOUT PHOTOS WE DO NOT OPERATE. IT IS ALSO VERY IMPORTANT THAT YOU REMEMBER THAT ALL THE INFORMATION YOU RECEIVE IN WRITING, SHOW AN ESTIMATION OF THE FINAL RESULT.

Between you, the patient and me the Plastic Surgeon, we should agree on the results that we are able to achieve.

-          We ask for blood tests regularly.

-          If you have the flu or are menstruating, please communicate 3 days beforehand.

-          Do not drink alcohol at least 24 hours before operating.

-          Do not take ASPIRIN 15 days before operating.

-          Organize your activities so that you are able to rest  after the operation.

-          Do not drive your car for at least 30 days after the operation.

-          Only begin physical exercise gradually 2 months after the operation.

ANESTHESIA:

General Anesthesia or Epidural Anesthesia is used.

PROCEDURES:

According to the patients needs, the according technique will be used.

-          If you only have excess and maldistribution of fat, we only use liposuction.

-          If you have excess and maldistribution of fat and excess skin, we will use miniabdominoplasty. Firstly using Liposuction and then the removal of the excess skin, leaving a minimum horizontal scar below the bikini line.

-          If you have excess and maldistribution of fat, excess skin and musculofascial laxity below the umbilicus, with a normal upper abdomen we use Liposuction with Miniabdominoplasty combined with Muscular Plicature (a series of horizontal mattress sutures joining the muscles).

-          If you have excess and maldistribution of fat throughout the whole abdomen, excess skin and musculofascial laxity throughout the whole abdomen, we use Liposuction with Abdominoplasty combined with Muscular Plicature (a series of horizontal mattress sutures joining the muscles). Lipoabdominoplasty technique from Dr. Juárez Avelar- Osvaldo Saldanha.

-          If you have a Hernia, it should be operated on by a general surgeon, this can be done at the same time.

-          Striaes (stretch marks) and other scars below the umbilicus can only disappear if there is an excess of skin.

ASSOCIATED PROCEDURES:

Only Liposuction and Abdominoplasty.

We never perform gynaecological operations.

RECOVERY:

-          If the patient only has Liposuction, the operation is outpatient. But if you have Abdominoplasty, it is inpatient, depending on the individual case.

-          The first 24 hours must be spent resting in bed in a semi-lying position and then the next 20 nights sleep should also be in a semi-lying position. But it is important to move your legs regularly to prevent Thrombophlebitis.

-          The same day as the surgery or better still 24 hours after, one can begin to walk carefully with small steps.

-          Eat well with alimentation full of protein and lots of vitamin C. But do not eat excessively.

-          The first bandages can be removed after the first 24 hours.

DO NOT WORRY IF IN THE FIRST DAYS YO EXPERIENCE:

- Swelling and bruising, which may be more noticeable on the second day.

- Some discomfort.

- If you are more than 40 years old and have a history of Thrombophlebitis, Obesity, problems with your veins or use the contraceptive pill you will receive (Heparin).

- Generally the drainage tubes will be removed between 3 and 7 days after the operation.

- If you have some pain, you can take analgesics, BUT NEVER TAKE ASPIRIN, IT CAUSES BLEEDING.

- Showering and bathing are allowed after 2 days.

- We give antibiotics for the first five days to prevent infection.

- All sutures/stitches are removed 2 weeks after the operation.

- After 2 weeks we start Lynphatic drainage.

- During the first 45 days and elastic compression garment must be worn.

- You will be able to drive a car after the first month.

- Physical activity can be begun 2 to 3 months after the operation.

- You must keep out of the sun for the first 3 months.

- Loss of sensitivity can take around 6 to 8 to fully recover.

- Scarring takes around 1 to 2 years to reach the final result.

- If you have any doubts or worries do not hesitate in consulting your surgeon or doctor.

FINAL RESULTS:

Generally the planned results are obtained. But this is not an operation to lose weight, it is to obtain a well proportioned figure.

THE FINAL RESULTS WILL NOT BE SEEN UNTIL 12 TO 18 MONTHS AFTER THE OPERATION.
POSSIBLE COMPLICATIONS:

They are uncommon. But remember that surgery without risks does not exist.

-          Hematoma and Seroma.

-          Minor skin Slough.

-          Infection (1%).

-          Thrombophlebitis and Pulmonary Embolism (1%).

UNSEEN COMPLICATIONS: Will be corrected later, also seeking the planned final result.

Eyelids are a very important part of the eyes because they protect them. They are formed with skin (the thinnest of the whole body), muscle (that enables the eyelids to close), cartilage and conjunctive. Inside the eyelids you have a lot of glands, including tear glands that produce tears. If you do not produce tears, the eyes dry out and cause the loss of vision.

Behind the upper eyelid there are two bags of fatty cellular tissue and three bags behind the lower eyelid. All fatty cellular tissue goes through changes of size and volume as time goes by.

Aging affects the eyelids too. Remember when someone looks at your face, one of the first things they notice are you eyes and therefore your eyelids.

INDICATIONS:

You will benefit from this surgery if you have any of the following conditions:

• Excess skin, that can also impede the vision.
• The development of bags that make your face appear tired.
• Excess of muscle.
• Fallen lower eyelid (ectropion).
• Alterations of your eyelashes.

CONTRAINDICATIONS:

We will not operate if we believe that your objective is not realistic. IT IS IMPOSSIBLE TO OPERATE ON PEOPLE WITH EXAGERATED OR FANTASY EXPECTATIONS. I recommend you read the chapter” Psychological Aspects of Plastic Surgery” of this website.

SURGICAL OBJECTIVE:

• Obtain a normal appearance and assure the eyes function correctly.
• Obtain a youthful look.

PLANNING THE SURGERY:

First you must undergo a complete medical examination. Then we will be able to give you in writing, the modifications that are suitable for you. We always do a photo session as a fundamental part of evaluating your case.

WITHOUT PHOTOS WE DO NOT OPERATE. IT IS ALSO VERY IMPORTANT THAT YOU REMEMBER THAT ALL THE INFORMATION YOU RECEIVE IN WRITING, SHOW AN ESTIMATION OF THE FINAL RESULT.

Between you, (the patient) and me (the Plastic Surgeon), we should agree on the results that we are able to achieve.

We ask for blood tests regularly.

It is important to know if you use glasses or contact lenses.

COMBINING WITH OTHER PROCEDURES:

This surgery can be combined with the removal of wrinkles, using the “peeling” technique and facelifts.

ANESTHESIA:

• Local anaesthetic with or without sedation.

PROCEDURES:

UPPER EYELID SURGERY:

• Basically the upper eyelids enable the removal of excess skin and fat from the 2 bags found within the eyelids, through an incision along the fold which is located 1cm above the eyelashes.
• Very few stitches are required, which are removed from 2 days after the operation.

LOWER EYELID SURGERY:

• Basically the lower eyelids enable the removal of excess skin and fat from the 3 bags found within the eyelids, through an incision which is located just 2mm below the eyelashes.

Sometimes, often with younger patients, when there is only excess of fat and no excess of skin, the incision can be made on the inner side of the eyelid.

RECOVERY:

• The patient is outgoing.
• The first bandages must be kept in place for the first 24 hours.
• The first 3 days must be spent in a lying position with ice bags being applied to reduce the swelling.
• Antibiotics must be taken every 8 hours for 5 days.
• Aspirin must not be taken for at least 2 weeks before and after the operation.
• Stitches are removed 2 days after the operation.
• For 2 weeks after the operation sunglasses should be used.
• You can use make-up two weeks after the operation.
• Contact lenses should not be used until 2 weeks after the operation.
• You can go back to work 3 days after the operation.

FINAL RESULTS:

Generally the final results match the planned results.

You will look younger. There is no perfect age to undergo Aesthetic Plastic Surgery, however better results can be achieved from 40 years of age and onwards.

Logically the process of aging continues and the final results also depend on the genetics and the lifestyle of the patient. Patients that have the operation will have a better look than before.

In some cases a final touch up is needed.

POSSIBLE COMPLICATIONS:

• Hematoma.
• Infection.
• A sensation of dry eyes.
• Scleral show.
• Ectropion (lowered position of lower eyelids).
• Persistent swelling.
• ALL OF THE MENTIONED COMPLICATIONS ARE UNCOMMON.

Unpredicted complications will be corrected at a later date.

Silicone breast implants were created in the U.S.A by two American Plastic Surgeons, CRONIN and GEROW, in 1962. The modern times of breast implants had finally arrived. Aesthetic Plastic Surgery (augmentation mammaplasty, with an aesthetic objective) and Reconstructive Plastic Surgery (e.g. due to cancer and other diseases). Having Silicone Breast Implants is an important personal decision because it changes your physical appearance, selt-esteem and confidence and your general well being.

BREAST COMPOSITION

The breasts are formed with glandular tissues, connective and fatty tissue stroma with lactiferous ducts (to drain the milk to the nipple), arteries and veins, lymphatics and nerves, all of which are found underneath different qualities of skin that envelop the breast.

The breasts are situated over the Pectoralis Major and Minor Muscles. The implants can be placed in front of (subglandular) or behind (subpectoral) these Muscles. The proper implant position will depend on various factors, such as the width of the breast tissue and the quality of skin.

Subcutaneous fat and intraparenchymal fat produce the softness of the breast and influence the shape and contours of the breast. But the shape also depends on the elasticity of the skin. A young females breasts are made up of more glandular tissues than fatty tissues, therefore making the breasts firmer. Glandular tissue gradually gets replaced by fatty tissue as the years go by. Therefore breasts with more fatty tissue than glandular tissue are less firm.

Pregnancies, breast feeding, diets, getting older and other factors also affect the shape of the breast.

As well as these factors, gravity also affects the upper pole, leaving it emptier. BREASTS DO NOT HAVE MUSCLE. NO GYM ACTIVITY WILL INCREASE THE SIZE OF YOUR BREASTS.

WHAT ARE SILICONE BREAST IMPLANTS? IS SILICONE SAFE TO USE IN HUMANS? DOES SILICONE PRODUCE CANCER?

Silicone breast implants are devices made up of an outer layer or envelope of silicone elastomer that is in contact with the body tissues and are filled with silicone gel. This gel is what maintains the shape of the implant. There are other types of implants that are filled with normal saline solution, in which the volume can be altered after the implantation (expanders). There are also implants of silicone gel that are enveloped with polyurethane.

SINCE THE DISCOVERY OF SILICONE, SILICONE HAS HAD MANY APPLICATIONS IN EVERY DAY LIFE, MEDICAL APPLICATIONS, PHAMACEUTICAL APPLICATIONS AND ALIMENTATION DURING THE PAST 50 YEARS. For example: Artificial Joints, pumps, shunts, drains, ocular implants, pacemakers, breast implants, penile implants, testicular implants, tablets and capsules with silicone (anti-acids), lipstick, lotions, sunscreens, deodorants etc.

WE ARE CONSTANTLY EXPOSED TO SILICONE IN OUR EVERY DAY LIVES. UNTIL NOW, THERE IS NO SCIENTIFIC EVIDENCE THAT SILICONE PRODUCES CANCER. Different scientific investigations have been carried out by the U.S. National Cancer Institute, International Epidemiology Institute and Karolinska Institute of Sweden, Danish Cancer Registry, Fred Hutchinson Cancer Research Center, Institut Gustave Roussy in France, Alberta Canada Cancer Board, U.S. Centres for Disease Control and Prevention y University of Southern California School of Medicine).

THAT IS WHY YOU SHOULD NOT BE AFRAID.

IS THERE A SPECIAL RISK FOR WOMEN WHO WHO ALREADY HAVE SILICONE IMPLANTS THAT ARE ENVELOPED WITH POLYURETHANE?

Silicone implants enveloped with polyurethane, which was introduced at the beginning of the 70´s, have the advantage that capsular contractures are less frequent. But they have the disadvantage that the implant fixes itself strongly in place and therefore is difficult to remove. There are scientific studies that show that the polyurethane (the most external layer of the implant) can break away therefore become a conventional implant. Between the chemical elements of polyurethane, a substance called toluen diamina (TDA), that has produced cancer in laboratory animals. AT THIS POINT IT IS NOT CLEAR IF IT CAN BE PRODUCED IN HUMAN BEINGS. The Food Drugs and Administration of the U.S.A. show that it is very improbable that a women will produce cancer because of the use of this type of implant (probability of 1 in 1 000 000 throughout the whole life of the patient).

WILL IMPLANTS INTERFERE WITH MAMMOGRAMS?

Breast implants are radiopaque (meaning they are completely white), therefore can pose some breast imaging problems. That is why a woman with breast implants must tell the radiologist beforehand, so that a well defined and additional views can be taken.

A regular self check of the breasts and clinical examinations are fundamental.

CAN IMPLANTS CAUSE CONNECTIVE TISSUE OR AUTOIMMUNE DISEASE IN HEALTHY WOMEN?

Silicone, just like most other substances can produce an allergy. However allergies to Silicone are very uncommon. Some rare disorders such as lupus erythematosus, dermatomyositis, scleroderma, and rheumatoid arthritis. THERE IS NO EVIDENCE THAT IMPLANTS PRODUCE THESE DISORDERS.

Scientific investigations have been carried out by,  Mayo Clinic, Harvard Medical School, University of Michigan School of Public Health, Emory University, University of Kansas Artritis Center, University of Washington Fred Hutchinson Cancer Research Center, University of Toronto, University of Maryland, University of Pittsburg, University of California, SanDiego y Johns Hopkins University Schools of Medicine).

WHY IS IT PROHIBITED TO USE LIQUID SILICONE ON ITS OWN?

Because liquid silicone migrates through the blood and the lymphatic vessels working its way to different organs, such as the liver, kidneys, brain and pancreas etc. SILICONE GEL (different to liquid silicone) IS NOT PROHIBITED.

CAN SILICONE FROM SILICONE BREAST IMPLANTS BE TRANSMITTED THROUGH BREAST MILK? CAN A MOTHER WITH BREAST IMPLANTS GIVE MILK?

YES, THERE IS NO SCIENTIFIC EVIDENCE THAT SILICONE IS PASSED THROUGH BREAST MILK AND THERE IS NO PROBLEM BREAST FEEDING.

The thing that can alter the lacteous level in the breast milk, is if the lactiferous ducts are damaged while undergoing the periareolar incision.

THE DIFFERENT TYPES OF IMPLANTS

DEPENDING ON THE  SHAPE:

• Round
• Anatomic

THE SIZE:

• Variable

THE PROFILE:

• High and low

THE SURFACE:

• Smooth
• Textured
• Polyurethane

THE FILLING:

• Saline
• Silicone Gel

INDICATIONS:

Plastic Surgery can benefit the following conditions:

- Augmentation of the breasts for aesthetic reasons, for small breasts.

-    Breasts that have reduced in volume after lactation.

-    Breasts that have become less consistant.

-    Unsymmetrical  breasts, one being bigger than the other.

-    Poland´s syndrome, augmentation and correction of the shape.

-    Breast reconstruction after mastectomy (removal of cancer).

-    Abnormalities of the breast and thorax wall.

-    Replacement of implants for medical or aesthetic reasons.

CONTRAINDICATIONS:

We will not operate if we believe that your objective is not realistic. IT IS IMPOSSIBLE TO OPERATE ON PEOPLE WITH EXAGERATED OR FANTASY EXPECTATIONS.

I recommend you read the chapter “Psychological Aspects of Plastic Surgery” of this website.

- If you  have poor health, above all cardiovascular and mental disorders we cannot operate.

- Those patients who smoke should stop completely at least one month before the operation because this operation may produce the loss of tissues.

- Patients who are  addicted to drugs or alcohol.

-    Patients who worry too much about small defects that in reality are very minute.

- Patients who will not accept the final scaring. ALL OF THESE OPERATIONS LEAVE   SOME SCARING AND THE QUALITY OF THESE SCARS DEPENDS ON MANY UNKNOWN FACTORS.

- If you have FIBROCYSTIC CHANGE of the breasts.

-          If you have local breast cancer or disseminated.

-          Insufficient tissue, because of irradiated tissue or Radical Mastectomy.

-          Previous allergies to substances or materials.

-          Dissatisfaction with previous augmentation mammaplasties.

-          If you have an infection in any part of the body.

-      If you have a history of bad scaring.

SURGICAL OBJECTIVES:

-          Increase the size of your breasts with implants, if you have an inadequate volume, to improve your self-esteem.

-          The place of the implants, the incisions will be definded after medical consultations and undergoing a careful and detailed study.

-          Achieve symmetry between the two breasts.

PLANNING THE SURGERY:

BEFORE THE OPERATION

First you must undergo a complete medical examination. Then we will be able to give you in writing, the modifications that are suitable for you. We always do a photo session as a fundamental part of evaluating your case.

WITHOUT PHOTOS WE DO NOT OPERATE. IT IS ALSO VERY IMPORTANT THAT YOU REMEMBER THAT ALL THE INFORMATION YOU RECEIVE IN WRITING, SHOW AN ESTIMATION OF THE FINAL RESULT.

Between you, the patient and me the Plastic Surgeon, we should agree on the results that we are able to achieve. We ask for blood tests regularly.

-          We always ask for a mammograms.

-          If you have the flu or are menstruating, please communicate 3 days beforehand.

-          Do not drink alcohol at least 24 hours before operating.

-          Do not take ASPIRIN 15 days before operating

-          Organize your activities so that you are able to rest  after the operation.

-          Do not drive your car for at least 30 days after the operation.

-          Only begin physical exercise gradually 2 months after the operation.

ANESTHESIA:

-     The first choice is General anesthesia

PROCEDURES:

-          The duration of the surgery is approximately 2 to 3 hours.

-          INCISIONS AND POSITIONING; there are 3 different incisions.

1)      Inframammary incision: it is an incision of about 4 to 5 cm below the breast. It is a good position but it leaves a visible scar.

2)      Periareolar incision: it is a semi-circular incision around the areolar (border of the nipple). In many cases this incision is unnoticed, depending on the patient, but it can reduce the erogenous sensation of the nipple. It is not recommended for patients with small areolars (smaller than 3.5 cm).

3) Axilar incision: Under the armpit, can be covered by hair and hidden below the arm and does not leave a scar on the breast. But the visualization of the entire breast pocket is difficult but made possible with endoscopic surgery. With the endoscopic axillary approach, special care is necessary to create symmnetric pockets.

PLACEMENT OF THE IMPLANTS:

1)      Subglandular or retrogladular:  placement behind the breast tissue, only when the women has good coverage. This produces more natural results. Also for body builders or athletes who want to avoid muscle contractions. But if the patient is slim or the coverage is too thin, we opt for one of the following positions.

2)      Submuscular: the placement in front of the chest wall and behind the pectoralis major and minor muscles and the serratus anterior muscle.

3)      Subpectoral: In front of the chest wall and behind the pectoralis major and minor muscles and the lower part of the implant behind the breast. This position contributes to the long term success and appearance.

RECOVERY:

-          It is an outpatient surgery.

-          24 hours of  bed rest.

-          After these first 24 hours you may be able to start to walk around.

-          Eat well, food high in protein and lots of vitamin C.

-          You must keep the sterile tapes in place for 24 hours.

DO NOT WORRY IF IN THE FIRST DAYS YOU HAVE:

-          Bruising and swelling, which can be more prominent on the second day.

-          Some discomfort when lifting your arms.

-          Generally you do not need drainage if the muscle has not been sectioned. If the pectoral muscle was cut to put the implant behind it, we use a drain for around 48 hours after the operation.

-          If you are in pain, take analgesics, BUT NEVER TAKE ASPIRIN, BECAUSE IT CAUSES BLEEDING. Generally placing the implant behind the pectoral muscle causes more discomfort or pain.

-          We give antibiotics to prevent infection.

-          Full showers can be taken from after 2 to 3 days.

-          Stitches can be removed from 7 days after the operation.

-          Sterile tapes and or bandages are to be changed every 3 days during a 2 week period.

-          For 30 days a special elastic bra is to be used.

-          From 2 weeks onwards we indicate 10 lymphatic drainage sessions to help the recovery process, eliminate toxins and improve the circulation.

-          As the days go by you will begin to feel better and better but be careful, this does not mean you are ready for intense physical activity. Take extra care with the arms as you can easily make the stitching come undone.

-          You should be able to return to everyday activities 2 weeks after the operation and drive a car 1 month after.

-          Intense physical activities can be taken up again some 60 days after the operation.

-           Full recuperation of your sensitivity can take place within a few months time.

-          The scars will be hidden behind your bra o bikini top. Generally they get better throughout 1 and 2 years, but they are permanent. Inframammary scars can be seen. Periareolar scars are not as visible. Axillary scars are visible when you lift your arm. THERE ARE MANY UNFORESEEN AND INDIVIDUAL VARIATIONS (such as wide and hypertrophic scars, depending on many factors such as the genetics of the patient.

-          Sun bathing should be avoided for at least 3 months.

-          Any increase in fever or if the area becomes red, or if there are any other unusual signs, contact your doctor or plastic surgeon immediately.

-          Naturally, because of ones anxiety to see the final result, the first couple of days one can be somewhat depressed. But this is temporary. BEING PATIENT IS FUNDAMENTAL.

-          After 6 months you will be able to get a good idea of the final result. Nevertheless the scars maintain some coloring and continue getting better until 1 to 2 years after the operation.

FINAL RESULTS:

Generally the results obtained are similar to what was planned.

More than 95% of women are happy with the long term results. They feel a lot better with their new image, proportional breasts, better form and volume, self-esteem and happiness.

The breasts will have an increased volume, improving consistency and shape. Remember there is different size implants, we always look for the best harmony between the size of the breasts and the size of the chest.

AN OPERATED BREAST PASSES THROUGH VARIOUS STAGES:

1) IMMEDIATE PERIOD: From the first until 30 days. The breasts will be bigger and better but will still be far from reaching the planned results.

2) MIDDLE PERIOD: It is variable, between 4 and 6 months. During this period the breast begins to evolve towards the end result. There are different grades of swelling. The scaring is in transitional phase. In the next period the will become even better still.

3) FINAL PERIOD: Extending from 6 months until 2 years. Here the breasts will reach their final result, in aspects such as scaring, shape, consistency, volume and sensitivity. This is when we take the final photographs to compare with the before photographs.  Any bikini top can be used.

POSSIBLE COMPLICATIONS:

They are rare, BUT REMEMBER, THERE IS NO PLASTIC SURGERY WITHOUT RISKS OR POSSIBLE COMPLICATIONS (even if they are minimum, they still exist). SMOKERS HAVE A HIGHER RISK FACTOR.

• · HEMATOMAS: Occurs between 0.5 – 3 %. If not reabsorbed, it shall be removed.
• · INFECTION: Occurs in 2.2% of patients. Generally due to Staphylococcus Epidermidis. We always give antibiotics during the operation and for 5 to 7 days afterwards. Local culture is recommended, followed by antibiotics, draining and occasional removal of the implant.
• · SEROMAS: The accumulation of Serous Liquids, just like the Hematoma, this can produce capsular contracture. Occasional draining is then used. The Seroma is not always acute. There are also late Seromas of unknown origin.
• · CAPSULAR CONTRACTURE: It is the most common problem encountered after breast implants. This phenomenon of unknown cause probably has a multi-factor cause. Different degrees of unilateral or bilateral capsular contracture produce asymmetry, distortion, firmness and discomfort. In this situation there are different treatments, such as removing the capsular and changing the placement of the implant. The manufactures advise against the external Capsulotomy procedure, which can cause the rupture of the implant.
• CALCIFICATIONS: Of unknown cause, this has been reported in tissue adjacent to those of the implantation at times calling for the removal of the implant.
• IMPLANT RUPTURE, HOLE OR CUT: Generally due to piercing instruments or accidents. Most cases happen during surgery. In this case the implant must be changed.
• · EXTRUSION: Unstable of compromised cover tissue, excessive stress or trauma occurring in the location of the implantation and/or interruption of the scaring process can lead to extrusion of the implant.
• · LOSS OF SENSIBILITY: Infrequent. It is almost always a process reversable with time.
• INTERFERENCE IN THE BREASTFEEDING: No study has shown that the silicone in the implant is transmitted by the maternal milk.
• INTERFERENCE WITH MAMMOGRAPHY: The patient shall be regularly submitted to mammography after surgery. The patient shall be advised to request the service of professionals who are familiar with mammography techniques with implants, and do not forget to show the PATIENT IMPLANT CARD to the radiologist. Ultrasounds can prove useful in conjunction with mammography and allow examinations to be made from any angle.
• DISPLACEMENT OF THE IMPLANT: This problem, associated with the operating technique, may cause discomfort to the patient and discomfort and distortion of the desired shape.
• FOLDS: Any fold can lead to medical complication, such as reduction of tissue thickness, abrasion and extrusion which may be mistaken for palpable tumors. Immediate investigation must be carried out whenever there is any doubt.
• ASYMMETRY: This may result from capsular contraction or rupture of the envelope, in the later case an assessment is required to decide whether or not there is the need to remove the implant.
• PAIN: Some patients may feel pain in the post operative period which should be investigated immediately.
• IMMUNOLOGICAL RESPONSE: Despite a number of studies there is no scientific proof of this cause and effect relation.
• CANCER: There is no scientific proof that implants produce cancer.

FINALLY WE WOULD LIKE TO ADD THAT THE IMPLANTS ARE NOT FOREVER. THEREFORE AT SOME TIME IN THE FUTURE THE REMOVAL OF THE IMPLANTS COULD BE INDICATED.

WHAT ARE  NORMAL BREASTS?

BREAST COMPOSITION

The breasts are formed with glandular tissues, connective and fatty tissue stroma with lactiferous ducts (to drain the milk to the nipple), arteries and veins, lymphatics and nerves, all of which are found underneath different qualities of skin that envelop the breast.

The breasts are situated over the Pectoralis Major and Minor Muscles.

Subcutaneous fat and intraparenchymal fat produce the softness of the breast and influence the shape and contours of the breast. But the shape also depends on the elasticity of the skin. A young females breasts are made up of more glandular tissues than fatty tissues, therefore making the breasts firmer. Glandular tissue gradually gets replaced by fatty tissue as the years go by. Therefore breasts with more fatty tissue than glandular tissue are less firm.

Pregnancies, breast feeding, diets, getting older and other factors also affect the shape of the breast.
As well as these factors, gravity also affects the upper pole, leaving it emptier.

BREASTS DO NOT HAVE MUSCLE. NO GYM ACTIVITY WILL INCREASE THE SIZE OF YOUR BREASTS.

BREAST SIZE

The lower pole of the breast has convexity from the nipple until the inframammary crease, and should measure between 5 and 7 centimeters.

The upper pole of the breast should have less volume and a soft convexity between the clavicle and the nipple and should measure between 19 and 21 centimeters.

The diameter of the areola should measure between 3.5 and 4.5 centimeters.

THE BREAST ARE NEVER EXACTLY SYMMETRICAL, THEY ARE ALWAYS DIFFERENT.

YOUNG BREASTS ARE ELEVATED AND FULL IN THE UPPER POLE BUT WHEN THE BREAST IS EMPTY AND FALLEN, IT IS A SIGN OF AGING.

DO I HAVE PTOSIS BREASTS/FALLEN BREASTS?

There are a lot of mechanisms that can produce a change of the position of the breast.

Ptosis is a result of the imbalance between the content of the breast and the skin. This causes the nipple to fall below the inframammary crease and below the horizontal line that passes at the height of the middle of the upper arm. The breasts fall down and the upper pole become empty.

Gravity, hypertrophy (increased breast volume), obesity followed by the loss of weight and changes in the amount of breast milk due to pregnancies cause stretching and loss of the elasticity of the skin and its attachment.

The breasts become saggy and often with stretch marks.

BREAST ARE CONSTANTLY CHANGES THEIR SIZE AND SHAPE.

INDICATIONS:

You will benefit if you have:

-          Sagging breasts, the size of the breast is not important.

-          If you have hypertrophy plus ptosis.

-          If you have breasts that have changed after pregnancy or the loss of weight.

-          Breasts with nipples bigger than 4.5 centimeters.

-          Saggy and heavy breasts that produce marks on the skin from the bra.

-          Lack of self esteem.

CONTRAINDICATIONS:

We will not operate if we believe that your objective is not realistic. IT IS IMPOSSIBLE TO OPERATE ON PEOPLE WITH EXAGERATED OR FANTASY EXPECTATIONS. I recommend you read the chapter “Psychological Aspects of Plastic Surgery” of this website.

- If you  have poor health, above all cardiovascular and mental disorders we cannot operate.

- Those patients who smoke should stop completely at least one month before the operation because this operation may produce the loss of tissues.

- Patients who are  addicted to drugs or alcohol.

- Patients who worry too much about small defects that in reality are very minute.
- Patients who will not accept the final scaring. ALL OF THESE OPERATIONS LEAVE SOME SCARING AND THE QUALITY OF THESE SCARS DEPENDS ON MANY UNKNOWN FACTORS.

SURGICAL OBJECTIVES:

-          Restore the breasts to a young and attractive shape.

-          Make the breasts firmer with a more natural shape.

-          Reposition the nipple-areolar.

-          Adjust the volume.

-          Eliminate excess skin.

PLANNING THE SURGERY

BEFORE THE OPERATION

First you must undergo a complete medical examination. Then we will be able to give you in writing, the modifications that are suitable for you. We always do a photo session as a fundamental part of evaluating your case.

WITHOUT PHOTOS WE DO NOT OPERATE. IT IS ALSO VERY IMPORTANT THAT YOU REMEMBER THAT ALL THE INFORMATION YOU RECEIVE IN WRITING, SHOW AN ESTIMATION OF THE FINAL RESULT.

Between you, the patient and me the Plastic Surgeon, we should agree on the results that we are able to achieve.

-          We ask for blood tests regularly.

-          We always ask for a mammograms.

-          If you have the flu or are menstruating, please communicate 3 days beforehand.

-          Do not drink alcohol at least 24 hours before operating.

-          Do not take ASPIRIN 15 days before operating

-          Organize your activities so that you are able to rest  after the operation.

-          Do not drive your car for at least 30 days after the operation.

-          Only begin physical exercise gradually 2 months after the operation.

ANESTHESIA:

- The first choice is General Anesthesia.

PROCEDURES:

-          MASTOPEXY is a surgical procedure that aims at lifting the breast.

-          There are different techniques depending on each individual case.

-          All the following aspects must be considered: the degree of ptosis, nipple-areolar position, breast volume, breast parenchymal distribution, the inframammary crease, possible constrictions, facial attachment and the skin and tissue quality.

-           Many of the techniques used here are also used in Reduction Mammaplasty. More information about these techniques can be found in the chapter “Reduction Mammaplasty”, also on this webpage.

-          In some cases the Liacyr Ribeiro technique is used, to fill the upper pole.

-          In other cases the Inferior Central Pedicle technique is used, normally when the breasts are very large.

-          When there is minimum Ptosis, breast implants may be used.

REMEMBER THERE WILL ALWAYS BE SCARING.

-          The most common technique leaves a scar similar to an anchor, situated around the nipple-areolar then moving down the center of the lower pole and a horizontal part below the breast.

-          Operating time is estimated around 3 hours. Outpatient, being able to go home within 24 hours. Optional drains.

RECOVERY:

-          It is an outpatient surgery.

-          24 hours of bed rest.

-          After these first 24 hours you may be able to start to walk around.

-          Eat well, food high in protein and lots of vitamin C.

-          You must keep the sterile tapes in place for 24 hours.

DO NOT WORRY IF IN THE FIRST DAYS YOU HAVE.

-          Bruising and swelling, which can be more prominent on the second day.

-          Some discomfort when lifting your arms.

-          Generally you do not need drainage.

-          If you are in pain, take analgesics, BUT NEVER TAKE ASPIRIN, BECAUSE IT CAUSES BLEEDING.

-          We give antibiotics to prevent infection.

-          Full showers can be taken from after 2 to 3 days.

-          Stitches can be removed from 7 days after the operation.

-          Sterile tapes and or bandages are to be changed every 3 days during a 2 week period.

-          For 30 days a special elastic bra is to be used.

-          From 2 weeks onwards we indicate 10 lymphatic drainage sessions to help the recovery process, eliminate toxins and improve the circulation.

-          As the days go by you will begin to feel better and better but be careful, this does not mean you are ready for intense physical activity. Take extra care with the arms as you can easily make the stitching come undone.

-          You should be able to return to everyday activities 2 weeks after the operation and drive a car 1 month after.

-          Intense physical activities can be taken up again some 60 days after the operation.

-           Full recuperation of your sensitivity can take place within a few months time.

-          The scars will be hidden behind your bra o bikini top. Generally they get better throughout 1 and 2 years, but they are permanent. Inframammary scars can be seen. Periareolar scars are not as visible.

THERE ARE MANY UNFORESEEN AND INDIVIDUAL VARIATIONS (such as wide and hypertrophic scars, depending on many factors such as the genetics of the patient.

-          Sun bathing should be avoided for at least 3 months.

-          Any increase in fever or if the area becomes red, or if there are any other unusual signs, contact your doctor or plastic surgeon immediately.

-          Naturally, because of ones anxiety to see the final result, the first couple of days one can be somewhat depressed. But this is temporary. BEING PATIENT IS FUNDAMENTAL.
FINAL RESULTS:

Generally the results obtained are similar to what was planned.

More than 95% of women are happy with the long term results. They feel a lot better with their new image, proportional breasts, better form and volume, self-esteem and happiness.

With the techniques mentioned earlier, the physiology of the breasts is preserved, including breastfeeding and the sensation of the nipple.

YOU WILL NOT SEE YOUR FINAL RESULT UNTIL 12 TO 18 MONTHS AFTER THE OPERATION.

POSSIBLE COMPLICATIONS:

They are rare, BUT REMEMBER, THERE IS NO PLASTIC SURGERY WITHOUT RISKS OR POSSIBLE COMPLICATIONS (even if they are minimum, they still exist). SMOKERS HAVE A HIGHER RISK FACTOR.

• · HEMATOMAS: Occurs between 0.5 – 3 %. If not reabsorbed, it shall be removed.
• · INFECTION: Occurs in 2.2% of patients. Generally due to Staphylococcus Epidermidis. We always give antibiotics during the operation and for 5 to 7 days afterwards. Local culture is recommended, followed by antibiotics, draining and occasional removal of the implant.
• · NIPPLE-AREOLAR PROBLEMS: Due to blood supply and changes in the sensation.
• · WIDE AND HYPERTROPHIC BREAST SCARS: 1.4%

UNSEEN COMPLICATIONS: Will be corrected later, also seeking the planned final result.

Silicone buttock implants are devices made up of an outer layer or envelope of silicone elastomer that is in contact with the body tissues and are filled with silicone gel. This gel is what maintains the shape of the implant. There are also implants of silicone gel that are enveloped with polyiurethane.

SINCE THE DISCOVERY OF SILICONE, SILICONE HAS HAD MANY APPLICATIONS IN EVERY DAY LIFE, MEDICAL APPLICATIONS, PHAMACEUTICAL APPLICATIONS AND ALIMENTATION DURING THE PAST 50 YEARS. For example: Artificial joints, pumps, shunts, drains, ocular implants, pacemakers, breast implants, penile implants, testicular implants, tablets and capsules with silicone (anti-acids), lipstick, lotions, sunscreens, deodorants etc.

WE ARE CONSTANTLY EXPOSED TO SILICONE IN OUR EVERY DAY LIVES. UNTIL NOW, THERE IS NO SCIENTIFIC EVIDENCE THAT SILICONE PRODUCES CANCER. Different scientific investigations have been carried out by the U.S. National Cancer Institute, International Epidemiology Institute y Karolinska Institute de Sweden, Danish Cancer Registry, Fred Hutchinson Cancer Research Center, Institut Gustave Roussy en France, Alberta Canada Cancer Board, U.S. Centres for Disease Control and Prevention y University of Southern California School of Medicine). THAT IS WHY YOU SHOULD NOT BE AFRAID.

IS THERE A SPECIAL RISK FOR WOMEN WHO ALREADY HAVE SILICONE IMPLANTS THAT ARE ENVELOPED WITH POLYURETHANE?

Silicone implants enveloped with polyurethane, which was introduced at the beginning of the 70´s, have the advantage that capsular contractures are less frequent. But they have the disadvantage that the implant fixes itself strongly in place and therefore is difficult to remove. There are scientific studies that show that the polyurethane (the most external layer of the implant) can break away therefore become a conventional implant. Between the chemical elements of polyurethane, a substance called toluen diamina (TDA), that has produced cancer in laboratory animals. AT THIS POINT IT IS NOT CLEAR IF IT CAN BE PRODUCED IN HUMAN BEINGS. The Food Drugs and Administration of the U.S.A. show that it is very improbable that a women will produce cancer because of the use of this type of implant (probability of 1 in 1 000 000 throughout the whole life of the patient).

CAN IMPLANTS CAUSE CONNECTIVE TISSUE OR AUTOIMMUNE DISEASE IN HEALTHY WOMEN?

Silicone, just like most other substances can produce an allergy. However allergies to Silicone are very uncommon. Some rare disorders such as lupus erythematosus, dermatomyositis, scleroderma, and rheumatoid arthritis. THERE IS NO EVIDENCE THAT IMPLANTS PRODUCE THESE DISSORDERS.

Scientific investigations have been carried out by,  Mayo Clinic, Harvard Medical School, University of Michigan School of Public Health, Emory University, University of Kansas Artritis Center, University of Washington Fred Hutchinson Cancer Research Center, University of Toronto, University of Maryland, University of Pittsburg, University of California, SanDiego y Johns Hopkins University Schools of Medicine.

WHY IS IT PROHIBITED TO USE LIQUID SILICONE ON ITS OWN?

Because liquid silicone migrates through the blood and the lymphatic vessels working its way to different organs, such as the liver, kidneys, brain and pancreas etc. SILICONE GEL (different to liquid silicone) IS NOT PROHIBIDED

THE DIFFERENT TYPES OF IMPLANTS

DEPENDING ON THE  SHAPE:

-          Round

-          Oval

THE SIZE:

-          Variable, from 180cc(cubic centimeters) to 350cc

THE SURFACE:

-          Smooth

-          Textured

-          Polyurethane

THE FILLING:

- Silicone Gel

INDICATIONS:

This surgery will benefit those with the following conditions:

Flat buttocks.

CONTRAINDICATIONS:

We will not operate if we believe that your objective is not realistic. IT IS IMPOSSIBLE TO OPERATE ON PEOPLE WITH EXAGERATED OR FANTASY EXPECTATIONS. I recommend you read the chapter “Psychological Aspects of Plastic Surgery” of this website.

- If you  have poor health, above all cardiovascular and mental disorders we cannot operate.

- Those patients who smoke should stop completely at least one month before the operation because this operation may produce the loss of tissues.

- Patients who are  addicted to drugs or alcohol.

- Patients who worry too much about small defects that in reality are very minute.

- Patients who will not accept the final scaring. ALL OF THESE OPERATIONS LEAVE SOME SCARING AND THE QUALITY OF THESE SCARS DEPENDS ON MANY UNKNOWN FACTORS.

- Previous allergies to substances or materials.

- If you have an infection in any part of the body.

- If you have a history of bad scaring.

SURGICAL OBJECTIVES:

-          Increase the size of your buttocks with implants, if you have an inadequate volume, to improve your self-esteem.

-          The place of the implants, the incisions will be definded after medical consultations and undergoing a careful and detailed study.

PLANNING THE SURGERY:

BEFORE THE OPERATION

First you must undergo a complete medical examination. Then we will be able to give you in writing, the modifications that are suitable for you. We always do a photo session as a fundamental part of evaluating your case.

WITHOUT PHOTOS WE DO NOT OPERATE. IT IS ALSO VERY IMPORTANT THAT YOU REMEMBER THAT ALL THE INFORMATION YOU RECEIVE IN WRITING, SHOW AN ESTIMATION OF THE FINAL RESULT.

Between you, the patient and me the Plastic Surgeon, we should agree on the results that we are able to achieve. We ask for blood tests regularly.

-          If you have the flu or are menstruating, please communicate 3 days beforehand.

-          Do not drink alcohol at least 24 hours before operating.

-          Do not take ASPIRIN 15 days before operating

-          Organize your activities so that you are able to rest  after the operation.

-          Do not drive your car for at least 30 days after the operation.

-          Only begin physical exercise gradually 2 months after the operation.

ANESTHESIA:

-          Peridural or General Anesthesia.

PROCEDURES:

-          The patient may be outgoing or ingoing.

-          The estimated time of the operation is 3 hours.

-          The incision is located between the two buttocks and is hidden when the patient is in a standing position.

-          We then put the implant below the muscle.

-          The implant is situated in the top 2/3 of the buttock.

-          Drainage for the first 48 hours.

RECOVERY:

-          The patient may be outgoing or ingoing.

-          12 days of bed rest, lying face down.

-          If you need to sit during the first 30 days you must rest on your thighs.

-          After these first 24 hours you may be able to start to walk around.

-          Eat well, food high in protein and lots of vitamin C.

-          You must keep the sterile tapes in place for 24 hours.

DO NOT WORRY IF IN THE FIRST DAYS YOU HAVE:

-          Bruising and swelling, which can be more prominent on the second day.

-          Some discomfort.

-          We use a drain for around 48 hours after the operation.

-          If you are in pain, take analgesics, BUT NEVER TAKE ASPIRIN, BECAUSE IT CAUSES BLEEDING. Generally placing the implant behind the pectoral muscle causes more discomfort or pain.

-          We give antibiotics to prevent infection.

-          Full showers can be taken from after 2 to 3 days.

-          Stitches can be removed 2 weeks after the operation.

-          Sterile tapes and or bandages are to be changed every 3 days during a 2 week period.

-          For 30 days a special elastic garment is to be used.

-          From 2 weeks onwards we indicate 10 lymphatic drainage sessions to help the recovery process, eliminate toxins and improve the circulation.

-          As the days go by you will begin to feel better and better but be careful, this does not mean you are ready for intense physical activity. Take extra care with the arms as you can easily make the stitching come undone.

-          You should be able to return to everyday activities 2 weeks after the operation and drive a car 1 month after.

-          Intense physical activities can be taken up again some 60 days after the operation.

-          Full recuperation of your sensitivity can take place within a few months time.

-          The scars will be hidden between the two buttocks. THERE ARE MANY UNFORESEEN AND INDIVIDUAL VARIATIONS (such as wide and hypertrophic scars, depending on many factors such as the genetics of the patient).

-          Sun bathing should be avoided for at least 3 months.

-          Any increase in fever or if the area becomes red, or if there are any other unusual signs, contact your doctor or plastic surgeon immediately.

-          Naturally, because of ones anxiety to see the final result, the first couple of days one can be somewhat depressed. But this is temporary. BEING PATIENT IS FUNDAMENTAL.

-          After 6 months you will be able to get a good idea of the final result. Nevertheless the scars maintain some coloring and continue getting better until 1 to 2 years after the operation.

IT IS PROHIBITED TO GIVE INJECTIONS IN THE BUTTOCK, IF NECESSARY YOU THEY MUST BE RECEIVED IN THE ARM.

FINAL RESULTS:

Generally the results obtained are similar to what was planned.

More than 95% of women are happy with the long term results. They feel a lot better with their new image, proportional buttocks, better form and volume, self-esteem and happiness.

The buttocks will have an increased volume, improving consistency and shape. Remember there are different size implants, we always look for the best harmony between the size of the buttocks.

POSSIBLE COMPLICATIONS:

They are rare, BUT REMEMBER, THERE IS NO PLASTIC SURGERY WITHOUT RISKS OR POSSIBLE COMPLICATIONS (even if they are minimum, they still exist). SMOKERS HAVE A HIGHER RISK FACTOR.

• · HEMATOMAS: Occurs between 0.5 – 3 %. If not reabsorbed, it shall be removed.
• · INFECTION: Occurs in 2.2% of patients. Generally due to Staphylococcus Epidermidis. We always give antibiotics during the operation and for 5 to 7 days afterwards. Local culture is recommended, followed by antibiotics, draining and occasional removal of the implant.
• · SEROMAS: The acumulation of Serosos Liquids, just like the Hematoma, this can produce capsular contracture. Occasional draining is then used. The Seroma is not always acute. There are also late Seromas of unknown origen.
• · CAPSULAR CONTRACTURE: It is the most common problem encountered after buttock implants. This phenomenon of unknown cause probably has a multi-factor cause. Different degrees of unilateral or bilateral capsular contracture produce asymmetry, distortion, firmness and discomfort. In this situation there are different treatments, such as removing the capsular and changing the placement of the implant. The manufactures advise against the external Capsulotomy procedure, which can cause the rupture of the implant.
• CALCIFICATIONS: Of unknown cause, this has been reported in tissue adjacent to those of the implantation at times calling for the removal of the implant.
• IMPLANT RUPTURE, HOLE OR CUT: Generally due to piercing instruments or accidents. Most cases happen during surgery. In this case the implant must be changed.
• · EXTRUSION: Unstable of compromised cover tissue, excessive stress or trauma occurring in the location of the implantation and/or interruption of the scaring process can lead to extrusion of the implant.
• LOSS OF SENSIBILITY: Infrequent. It is almost always a process reversable with time.
• DISPLACEMENT OF THE IMPLANT: This problem, associated with the operating technique, may cause discomfort to the patient and discomfort and distortion of the desired shape.
• FOLDS: Any fold can lead to medical complication, such as reduction of tissue thickness, abrasion and extrusion which may be mistaken for palpable tumors. Immediate investigation must be carried out whenever there is any doubt.
• ASYMETRY: This may result from capsular contraction or rupture of the envelope, in the later case an assessment is required to decide whether or not there is the need to remove the implant.
• PAIN: Some patients may feel pain in the post operative period which should be investigated immediately.
• IMMUNOLOGICAL RESPONSE: Despite a number of studies there is no scientific proof of this cause and effect relation.
• CANCER: There is no scientific proof that implants produce cancer.

FINALLY WE WOULD LIKE TO ADD THAT THE IMPLANTS ARE NOT FOREVER. THEREFORE AT SOME TIME IN THE FUTURE THE REMOVAL OF THE IMPLANTS COULD BE INDICATED.

We all change with aging, these changes are often not wanted, but this process is unavoidable. From 30 years of age onwards the skin starts to become slightly redundant, especially in the upper eyelids. Wrinkles then begin to appear around the eyes. From 40 years onwards wrinkles begin to appear on the forehead and between the eyebrows and grooves from the nose to the mouth begin to appear. From 50 years onwards wrinkles begin to become prominent on the neck, the jaw line begins to lose its definition, sometimes leading to a double chin and the tip of the nose falls.

THIS IS WHY WE THEN CONSIDER FACIAL AND NECK REJUVENATION.

SURGERY IS ONE OF THE MORE AFFECTIVE FORMS OF REJUVENATION, with different options like brow-lifting, facial-lifting and cervical lifting (lifting of the neck). Sometimes it can be associated with eyelid surgery and or nose surgery.

INDICATIONS:

This surgery will benefit you have:

FOREHEAD:

• Wrinkles and ptosis (sagging).
• Deep horizontal wrinkles.
• Vertical wrinkles, between the eyebrows.
• Fallen eyebrows.

EYELIDS:

• Redundancy of the eyelid skin.
• Excess fatty tissue (bags).
• Wrinkles around the eyes.
• Ptosis of the lacrimal gland.
• Loss of elasticity of the lower eyelid.

We recommend you visit the  chapter “ Surgery of the eyelid” found on this webpage.

LIPS:

• Vertical wrinkles that form around the lips.
• Increase in the distance between the nose and upper lip.
• Loss of the natural contour of the lip.
• Creases that start from the corners of the mouth and extend vertically down to the chin.

We recommend that you visit the chapter on “Lips”  also found on this webpage.

THE FACE:

• Sagging or falling cheeks.
• Grooves between the nose and lips.
• Loss of the jaw line.
• Wrinkles.

NECK:

• Double chin.
• The appearance of the platysmal bands.
• Redundant skin.
• Increased angle between the neck and chin.

CONTRAINDICATIONS:

We will not operate if we believe that your objective is not realistic. IT IS IMPOSSIBLE TO OPERATE ON PEOPLE WITH EXAGERATED OR FANTASY EXPECTATIONS.

I recommend you read the chapter ”Psychological Aspects of Plastic Surgery” of this website.

- If you  have poor health, above all cardiovascular and mental disorders we cannot operate.

- Those patients who smoke should stop completely at least one month before the operation because this operation may produce the loss of tissues.

- Patients who are  addicted to drugs or alcohol.

- Patients who worry too much about small defects that in reality are very minute.
- Patients who will not accept the final scaring. ALL OF THESE OPERATIONS LEAVE SOME SCARING AND THE QUALITY OF THESE SCARS DEPENDS ON MANY UNKNOWN FACTORS.

SURGICAL OBJECTIVES:

• The rejuvenation of the forehead, face and neck.
• This surgery is aimed at making you appear to be 10 years younger.

PLANNING THE SURGERY:

BEFORE THE OPERATION

First you must undergo a complete medical examination. Then we will be able to give you in writing, the modifications that are suitable for you. We always do a photo session as a fundamental part of evaluating your case.

WITHOUT PHOTOS WE DO NOT OPERATE. IT IS ALSO VERY IMPORTANT THAT YOU REMEMBER THAT ALL THE INFORMATION YOU RECEIVE IN WRITING, SHOW AN ESTIMATION OF THE FINAL RESULT.

Between you, the patient and me the Plastic Surgeon, we should agree on the results that we are able to achieve. We ask for blood tests regularly.

ANESTHESIA:

• Local plus sedation.

PROCEDURES:

The procedures depend on the problem that needs to be solved.

FOREHEAD:

• Surgery with or without Endoscopy.
• The incisions are hidden behind the hairline.
• Removal of the muscles that produce wrinkles.
• Lifting of the eyebrow to the desired position.
• Removal of excess skin.

FACE:

• Incisions around the ears.
• Treatment of the muscle layer.
• Removal of excess skin.

NECK:

• Removal of fat with Liposuction.
• Treatment of the muscle layer.
• Removal of excess skin.

RECOVERY:

-          The patient is outgoing.

-          Dressings are removed between 24 and 48 hours after surgery.

-          The first bandages must be kept in place for the first 24 hours.

-          The first 3 days must be spent in a lying position with ice bags being applied to reduce the swelling.

-          Antibiotics must be taken every 8 hours for 5 days.

-          Aspirin must not be taken for at least 2 weeks before and after the operation.

-          The stitches can be removed 1 week later.

DO NOT WORRY IF IN THE FIRST COUPLE OF DAYS YOU HAVE:

-          Swelling and bruising, which is often more noticeable from the second day of recovery.

-          Some discomfort, above all behind the ears.

-          Between the 2^nd and 7^th day you can begin showering and combing or brushing your hair very carefully. You can use a blow-dryer with warm air. Dyes can only be used 1 month afterwards.

-          If there are no complications you should be able to return to your everyday activities after 2 to 3 weeks.

-          After approximately 1 to 2 months, the swelling should have disappeared.

-          Sensibility can be completely recovered in around 6 to 8 months after the operation.

-          Scarring is hidden behind the hairline and behind the ears. Scars in front of the ear become very hard to notice. BUT THERE ALWAYS EXISTS UNFORSEEN AND INDIVIDUAL VARIATIONS.

-          Avoid the sun for the first 3 months. Make up can be used.

-          If you have any doubts or worries, consult your doctor or surgeon as soon as possible.

-          It is common to suffer from some depression in the early stages, but it is temporary, PATIENCE IS FUNDAMENTAL.

-          After 3 months you will be able to obtain an approximation of the end result, even though the scaring process has around 9 more months.

FINAL RESULTS:

Generally the final results match the planned results.

You will look younger. If you are 50 years old, you will appear to be 40. If you are 60 you will appear to be 50 years old. Generally the surgery will make you appear to be 10 years younger. There is no perfect age to undergo Aesthetic Plastic Surgery, however better results can be achieved from 40 years of age and onwards.

Logically the process of aging continues and the final results also depend on the genetics and the lifestyle of the patient. Patients that have the operation will have a better look than before.

POSIBLE COMPLICATIONS:

• Hematoma.
• Infection.
• Minor degrees of skin loss.
• Scarring.
• Nerve injury.
• ALL OF THE MENTIONED COMPLICATIONS ARE UNCOMMON.

Unpredicted complications will be corrected at a later date.

The treatment of male and female baldness, plays an important role in maintaining a youthful look. The loss of hair at an early age, mainly in the twenties and thirties, can make you appear to be a lot older than they really are and can lower your self- esteem.

Human hairs grow in certain parts of our head during all our lives. This growth is approximately 1cm per month and goes through various phases:

• · Anagen Active Growth Phase (2 – 6 years)
• · Catagen Involution Phase (1 – 2 weeks)
• · Telogen Resting Phase (3 – 6 months)

The duration of each of these phases are variable.

A good and healthy scalp has approximately 100 000 hairs. Of those, 90% are in the Anagen Phase, 1% in the Catagen Phase and the remaining 9% in the Telogen Phase. The hairs in the Telogen Phase do not grow and are slowly being pushed out of the scalp by the new hair which forms in the hair follicle (hair bulb). It is normal to lose up to 60 or 70 hairs per day.

There are different causes of hair loss:

• Androgenic Baldness produces the loss of hair in men and women. In this condition, hormones along with hereditary characteristics produce the loss.

Less common causes:

• Traumatism: physical, chemical or radiation.
• Infections.
• Hormones.
• Diet.
• Some medications, etc.

Generally men begin to lose hair from the front hairline, (receding hairline) or the vertex. Women generally begin to lose the density of their hair.

People often want to solve the problem with different inefficient products and wigs are often unaccepted. There is still no permanent solution to hair loss, however hair transplant surgery is one of the best options, nowadays offering even more natural results.

INDICATIONS:

This surgery will benefit those patients with the following conditions:

• · Androgenic baldness.
• · A patient who has a realistic objective.
• In other cases, the cause of baldness must be studied, and then treated if possible.
• There is no age limit.

CONTRAINDICATIONS:

• In some diseases, such as alopecia areata and trichotillomania.
  • We will not operate if we believe that your objective is not realistic. IT IS IMPOSSIBLE TO OPERATE ON PEOPLE WITH EXAGERATED OR FANTASY EXPECTATIONS. I recommend you read the chapter”

SURGICAL OBJECTIVE:

• Solve baldness and increase the amount of hairs seeking the most natural look possible.

PLANNING THE SURGERY:

BEFORE OPERATING:

First you must undergo a complete medical examination. Then we will be able to give you in writing, the modifications that are suitable for you. We always do a photo session as a fundamental part of evaluating your case.

WITHOUT PHOTOS WE DO NOT OPERATE. IT IS ALSO VERY IMPORTANT THAT YOU REMEMBER THAT ALL THE INFORMATION YOU RECEIVE IN WRITING, SHOW AN ESTIMATION OF THE FINAL RESULT.

Between you, the patient and me the Plastic Surgeon, we should agree on the results that we are able to achieve. We ask for blood tests regularly.

We always examine the patient in combination with a Dermatologist.

Remember hair transplant surgery can be suitable for almost all types of baldness. We can also implant hair to increase the density. In the case of a large area of baldness, more than one operation is required, normally between 2 to 3, with a period of 8 months waiting in between the procedures. In the first operation we are able to transplant between 2000 and 4000 hairs, in the second of third operation we are able to transplant an additional amount of hair.

ANESTHESIA:

• Local Anaesthesia, plus Sedation.
• The patient is outgoing.

PROCEDURE:

1 – Anesthesia is applied throughout the whole scalp.

2 – The removal of an area of scalp from the back of the patients head, where hair growth is dense. Normally we remove an area around 2 cm in width and 8 cm in length.

3 – The closure of the removed section with stitches.

4 – The preparation of the follicular units, using microscopes.

5 – Transplantation of the follicles in the bald area.

Operating time varies, depending on the amount of hair needed for transplanting, approximately 10 hours.

6 – After operating a bandage is places around the head, this can be removed between 24 to 48 hours.

EVOLUTION:

After the operation, the hairs start to grow, up to 5mm. After this period the hair begins to fall out. 3 to 4 months later the hairs start to grow again and will then grow permanently.

RECOVERY:

• The patient is outgoing.
• If you experience some discomfort, analgesics can be taken, but never Aspirin as it causes bleeding.
• We give antibiotics but infection is uncommon.
• 30 days after the operation we recommend you use Minoxidil (3%) for a 60 day period.
• A special shampoo is also recommended.

FINAL RESULTS:

- Hair transplantation gives the most natural results, the final results can be seen 1 year after the first operation.

POSIBLE COMPLICATIONS:

• Complications are uncommon, but remember plastic surgery without risks does not exist.
• 20% of patients can have fat pustules(cysts) and vesicles .

Aesthetic and functional causes can make women develop an exaggerated breast size (Hypertrophy) and therefore seek Plastic Surgery. Aesthetic causes that can strongly alter your self-esteem. It can make you feel unattractive, embarrassed, shy and can determine whether you want to go the beach, gym and can even cause the loss of sexual attraction and femininity.

Funcional causes can produce physical discomfort, pain in the neck, back and shoulders. They can also change your posture because it is normal to let your shoulders move forward in order to hide the large breast size. Breast pain is also common and there is risk of infection and a bad smell below the breast.
Generally the patients have a lot of difficulty finding attractive clothes. Therefore Reduction Mammaplasty is the only treatment that can help these patients. The advantages are in the loss of weight, which improves posture and at the same time making the body more elegant.

INDICATIONS:

Plastic surgery is for patients who:

-          Are between 17 and 60 years old.

-          Have very large and heavy breasts.

-          If your breasts cause pain, weight on your back, neck and shoulders.

-          Have bad posture that affects the spine.

-          Have marks on the skin from the bra.

-          Always try to hide the size of their breasts using bigger clothes.

CONTRAINDICATIONS:

We will not operate if we believe that your objective is not realistic. IT IS IMPOSSIBLE TO OPERATE ON PEOPLE WITH EXAGERATED OR FANTASY EXPECTATIONS. I recommend you read the chapter “Psychological Aspects of Plastic Surgery” of this website.

- If you  have poor health, above all cardiovascular and mental disorders we cannot operate.

- Those patients who smoke should stop completely at least one month before the operation because this operation may produce the loss of tissues.

- Patients who are  addicted to drugs or alcohol.

- Patients who worry too much about small defects that in reality are very minute.

- Patients who will not accept the final scaring. ALL OF THESE OPERATIONS LEAVE SOME SCARING AND THE QUALITY OF THESE SCARS DEPENDS ON MANY UNKNOWN FACTORS.

SURGICAL OBJECTIVES:

-          Skin removal and excision of fatty tissue and excess breast parenchyma.

-          Improve firm and attractive breasts.

-          Obtain a good relation between the height, position, size and symmetry of the breasts.

-          Preservation of the sensibility.

-          The least amount of scaring possible.

PLANNING THE SURGERY:

BEFORE THE OPERATION:

First you must undergo a complete medical examination. Then we will be able to give you in writing, the modifications that are suitable for you. We always do a photo session as a fundamental part of evaluating your case.

WITHOUT PHOTOS WE DO NOT OPERATE. IT IS ALSO VERY IMPORTANT THAT YOU REMEMBER THAT ALL THE INFORMATION YOU RECEIVE IN WRITING, SHOW AN ESTIMATION OF THE FINAL RESULT.

Between you, the patient and me the Plastic Surgeon, we should agree on the results that we are able to achieve.

-          We ask for blood tests regularly.

-          We always ask for a mammograms.

-          If you have the flu or are menstruating, please communicate 3 days beforehand.

-          Do not drink alcohol at least 24 hours before operating.

-          Do not take ASPIRIN 15 days before operating

-          Organize your activities so that you are able to rest  after the operation.

-          Do not drive your car for at least 30 days after the operation.

-          Only begin physical exercise gradually 2 months after the operation.

ANESTHESIA:

-          The first choice is General Anesthesia.

PROCEDURES:

The technique depends of the individual case. It is important:

-          Skin removal

-          Excision of fatty tissue and excess breast parenchyma.

-          Areas and volume of breast resection.

-          Areas of lateral and abdominal fullness

-          Scar length and placement

-          Preservation of breast function and nipple areola sensation, size and position.

-          Mild Hypertrophy: The Arie technique.

-          Moderate Hypertrophy. The Pitanguy technique.

-          Large Hypertrophy: Reduction based on Inferior Central Pedicle.

-          Large Hypertrophy and Ptosis: Reduction based on Inferior Central Pedicle.

-          Surgery time is normally around 2 to 4 hours and the patient is outgoing.

-          Optional drain.

RECOVERY:

-          It is an outpatient surgery.

-          24 hours of bed rest.

-          After these first 24 hours you may be able to start to walk around.

-          Eat well, food high in protein and lots of vitamin C.

-          You must keep the sterile tapes in place for 24 hours.

DO NOT WORRY IF IN THE FIRST DAYS YOU HAVE:

-          Bruising and swelling, which can be more prominent on the second day.

-          Some discomfort when lifting your arms.

-          Generally you do not need drainage.

-          If you are in pain, take analgesics, BUT NEVER TAKE ASPIRIN, BECAUSE IT CAUSES BLEEDING.

-          We give antibiotics to prevent infection.

-          Full showers can be taken from after 2 to 3 days.

-          Stitches can be removed from 7 days after the operation.

-          Sterile tapes and or bandages are to be changed every 3 days during a 2 week period.

-          For 30 days a special elastic bra is to be used.

-          From 2 weeks onwards we indicate 10 lymphatic drainage sessions to help the recovery process, eliminate toxins and improve the circulation.

-          As the days go by you will begin to feel better and better but be careful, this does not mean you are ready for intense physical activity. Take extra care with the arms as you can easily make the stitching come undone.

-          You should be able to return to everyday activities 2 weeks after the operation and drive a car 1 month after.

-          Intense physical activities can be taken up again some 60 days after the operation.

-           Full recuperation of your sensitivity can take place within a few months time.

-          The scars will be hidden behind your bra o bikini top. Generally they get better throughout 1 and 2 years, but they are permanent. Inframammary scars can be seen. Periareolar scars are not as visible. THERE ARE MANY UNFORESEEN AND INDIVIDUAL VARIATIONS (such as wide and hypertrophic scars, depending on many factors such as the genetics of the patient).

-          Sun bathing should be avoided for at least 3 months.

-          Any increase in fever or if the area becomes red, or if there are any other unusual signs, contact your doctor or plastic surgeon immediately.

-          Naturally, because of ones anxiety to see the final result, the first couple of days one can be somewhat depressed. But this is temporary. BEING PATIENT IS FUNDAMENTAL.

-          After 6 months you will be able to get a good idea of the final result. Nevertheless the scars maintain some coloring and continue getting better until 1 to 2 years after the operation.

FINAL RESULTS:

Generally the results obtained are similar to what was planned.

More than 95% of women are happy with the long term results. They feel a lot better with their new image, proportional breasts, better form and volume, self-esteem and happiness.

With the techniques mentioned earlier, the physiology of the breasts is preserved, including breastfeeding and the sensation of the nipple.

YOU WILL NOT SEE YOUR FINAL RESULT UNTIL 12 TO 18 MONTHS AFTER THE OPERATION.

POSSIBLE COMPLICATIONS:

They are rare, BUT REMEMBER, THERE IS NO PLASTIC SURGERY WITHOUT RISKS OR POSSIBLE COMPLICATIONS (even if they are minimum, they still exist). SMOKERS HAVE A HIGHER RISK FACTOR.

• · HEMATOMAS: Occurs between 0.5 – 3 %. If not reabsorbed, it shall be removed.
• · INFECTION: Occurs in 2.2% of patients. Generally due to Staphylococcus Epidermidis. We always give antibiotics during the operation and for 5 to 7 days afterwards. Local culture is recommended, followed by antibiotics, draining and occasional removal of the implant.
• · NIPPLE-AREOLAR PROBLEMS: Due to blood supply and changes in the sensation.
• · WIDE AND HYPERTROPHIC BREAST SCARS: 1.4%

UNSEEN COMPLICATIONS: Will be corrected later, also seeking the planned final result.

The nose is one of the main features of your face. Generally, when someone looks at your face, the nose is one of the first features that they notice. Then the eyes, but above all the size and shape of the nose.

It is one of the most frequent consultations in Plastc Surgery, being for aesthetic defects or funcional problems (nose obstruction). The Surgery looks at improving the appearance and/or function of the nose (improving breathing).

A PERFECT NOSE DOES NOT EXIST. All noses are different, due to ethnic factors, type of skin, age and the geographical location etc. Aesthetically it´s important to know the size and shape of your nose, in relation to the rest of the face. If there is or is not a disharmony? Functionally, it is important that your breath well. Every case is unique and must be studied in great detail.

INDICATIONS OF AESTHETIC RHINOPLASTY:

* For those who have an aesthetic defect, in the case of young females, they must be at least 14 years old and young males at least 15 years old. There is no age limit to remodel your nose

FUNCTIONAL RHINOPLASTY:

* For those who do not breath as they should because of the alteration of nasal septum and/or turbinates.

CONTRAINDICATIONS:

* We will not operate if we believe that your objective is not realistic. IT IS IMPOSSIBLE TO OPERATE ON PEOPLE WITH EXAGERATED OR FANTASY EXPECTATIONS. I recommend you read the chapter” Psychological Aspects of Plastic Surgery” of this website.

SURGICAL OBJECTIVES OF AESTHETIC SURGERY OF THE NOSE:

* Improve the shape and size of the nose in relation to the rest of the face, achieving a more natural nose, one that nobody can tell that has been operated on.

These are the different options:

-          decrease or increase the nasal dorsum

-          reduce the size and width of the nose

-          remodel the point of the nose

-          change the angle between the nose and the top lip

-          reduce the size of the nostrils

THE DIFFERENT OPTIONS OF FUNCIONAL SURGERY OF THE NOSE.

-          Correct the nasal septum.

-          Correct the possible alterations of the turbinates, above all the lower turbinate.

PLANNING THE YOUR NASAL SURGERY:

BEFORE THE OPERATION,

* First you must undergo a complete medical examination. Then we will be able to give you in writing, the modifications that are suitable for you. We always do a photo session as a fundamental part of evaluating your case.

WITHOUT PHOTOS WE DO NOT OPERATE. IT IS ALSO VERY IMPORTANT THAT YOU REMEMBER THAT ALL THE INFORMATION YOU RECEIVE IN WRITING, SHOW AN ESTIMATION OF THE FINAL RESULT. Between you, the patient and me the Plastic Surgeon, we should agree on the results that we are able to achieve.

We ask for blood tests regularly.

INTEGRATING DIFERENT SURGERIES:

Many people do not like to be photographed, others do not like to be photographed from certain angles and also prefer to look at themselves front on in the mirror. Some faces have a protruding nose and chin or a inverted chin, and even the smallest of these discrepancies can significantly reduce ones self- esteem.

Plastic Surgery of the chin is a type of Plastic Surgery that helps balance the face and can produce great aesthetic results. Sometimes the patient believes they have a big nose, but in reality have and inverted chin that causes an imbalance of the face. The nose is only one of the facial features.

The profile of your face is defined by the relation between;

YOUR FOREHEAD (the height is important, width, the angle of inclination and the area between the eyebrows).

THE NOSE (the angle between the nose and the forehead and the angle betweeen the nose and the lip).

THE LIPS (the height is important, the relation between the skin and mucosa-red part-)

THE CHIN AND MALAR: (Generally surgery of the nose, plus surgery of the chin is  associated with Rhinoplasty. I recommend you visit the chapter “Plastic Profiles” in this website for more information.

ANESTHESIA:

- The first choice is local anesthesia and sedation.
- In a certain cases general anesthesia is used.

PROCEDURES:

* In the first nasal operation, it almost always consists of an incision internal, that does not leave any visible scaring. I learnt this technique from the Profesor DR. Fernando Ortiz Monasterio from México, without doubt one of the true masters in the world of Plastic Surgery.

* In some selected cases, I use the open rhinoplasty. This involves an incision at the bottom of the nose, between the nostrils.

* The other surgical steps include:

- Hump resection to decrease dorsal prominence

- Modification of the cartilages.

- Lateral osteotomies to narrow the nose

- septoplasty to correct nasal deviation.

* CURING:

Once the operation is completed, a plug is placed inside the nostrils. This plug is kept in place for 48-72 hours. In selected cases longer, for example when you operate on the nasal septum. On the outer side of the nose, we apply a plaster cast that is kept in place for seven days.

The duration of the surgery is approximately 3 hours. If the operation is on the nasal septum, a little longer. DO NOT CONFUSE THIS WITH THE TOTAL TIME YOU WILL BE IN THE HOSPITAL OR CLINIC.

RECOVERY:

- Generally the patient stays in hospital for a few hours after the operation and is able to go home the same day.

- The majority of the patients are able to walk and active two days later. The first day must be spent in a lying position with the head semi-elevated.

-          Your nose will probably have some pain and you will feel somewhat swollen but pain killers will help. ASPIRIN MUST NEVER BE TAKEN, AS IT CAUSES BLEEDING.

-          Infections are rare, we only give antibiotics if there is risk of infection.

-          After three days the swelling and bruising around the eyes begin to go away. Do not panic. You should use ice packs for at least 3 days to help the healing process.

-          From 48 to 72 hours the plugs can be taken out, except for the case of a nasal septum operation.

-          It is common to experience some bleeding in the first couple of days. DO NOT PANIC. Put a small bandage below the nostrils, and change it when necessary

-          Try not to sneeze or blow your nose in the first couple of weeks, while the tissue is still healing.

-          After 7 days the plaster cast, BUT YOU WILL NOT BE ABLE TO SEE THE FINAL RESULT AT THIS STAGE, because the nose will still be swollen and the tip of the nose is somewhat elevated. Try to maintain the cast dry and resist the temptation to remove it.

-          You may experience some breathing difficulties for a few weeks after the operation due to internal swelling.

-          After 2 weeks you will be in a condition “presentable” and you will be able to return to your every day activities, BUT INTENSIVE PHYSICAL ACTIVITY MUST NOT BE UNDERTAKEN FOR A FEW MORE WEEKS.

-          Exposure to the sun and swimming in the ocean are recommended for 45 to 60 days after the operation, or when the bruising has disappeared. Using always 30 plus sunscreen.

-          Do not use glasses for at least one month, only if it is entirely necessary.

Remember to always clarify your doubts before and after operating, remember that all questions are valid.

FINAL RESULTS:

Generally, a well planned and timed operation, following all the indications necessary obtains satisfactory and natural results. But the final results appear 6 months to 1 year after the operation. Some patients can reach the final result sooner but only 3 months after the operation will you have an idea of the final result.

In some cases it is necessary to touch up the fine details. The result of nasal surgery lasts for almost your whole life. After a few years, like any part of your body you may see changes in the anatomy of the nose.

POSIBLE COMPLICATIONS:

Complications are rare but do exist. REMEMBER THAT PERFECT AND RISK FREE PLASTIC SURGERY DOES NOT EXIST.

-          Bleeding

-          Infection

Unpredicted complications will can be corrected later.