There are few of us out there who do not wish to change something about our bodies. While nothing can substitute for a healthy lifestyle, including proper diet and exercise, despite our best efforts we cannot escape our genetics and, to some degree, our environments. Fortunately, there are a number of cosmetic surgical procedures that can enhance the appearance of our bodies. These procedures can produce very satisfying improvements in look and contour. In addition, they can also lead to an improvement in self-esteem.
A tummy tuck, is one of the most powerful surgical procedures in the plastic surgeon’s armamentarium. This procedure removes skin and fat from the abdominal region and is combined with a tightening of the inner abdominal corset (fascia) to ensure a lasting result. Incisions can usually be made below the upper border of where the underwear or a bikini bottom is worn, thus virtually “hiding” the scar. This procedure is performed under general anesthesia, usually in an outpatient setting. Patients are sent home with drains in place along with a pain pump that administers a Novocain-like substance into the abdominal wall to minimize postoperative pain, ultimately permitting patients to be out of bed for light activity almost immediately. Patients can usually shower after 48 hours. In addition, it is very important for patients to follow precise postoperative instructions which include taking two weeks off from work and no straining or lifting heavy objects for 6 weeks. Strict adherence to these instructions helps optimize successful and satisfying results.
Plastic surgery has the power to improve a person’s appearance as well as their confidence and overall outlook on life. With that concept in mind, one of the most personal aspects of a women’s body image can be the appearance of the labia and its effects on the appearance of the vaginal region as a whole. A dysmorphic or asymmetric appearance in this area can be the source of embarrassment and even discomfort when engaging in certain activities, particularly intimate or athletic ones.
Fortunately, there is a procedure known as a labiaplasty designed to improve and enhance the appearance of this anatomic region. Most commonly, women are troubled by the appearance of asymmetric or enlarged labia minora (the inner vaginal skin folds that surround the entrance to the vagina), especially when they protrude far outside of the labia majora (or outer vaginal skin folds outside of the labia minora).
For optimal patient comfort, labiaplasty is performed as an outpatient procedure under general anesthesia. During the procedure, the excess or asymmetric labial skin is meticulously trimmed and a careful closure is performed to minimize the appearance of any scarring. Following the procedure, a feminine pad is usually worn under usual clothing for about 2 weeks as a small amount of spotting may occur. Strenuous exercise (including intercourse), tampons and very snug clothing are restricted for several weeks, but there is little else in the way of limitations. Some discomfort and swelling is common, but is usually very well tolerated and successfully treated with oral pain medication. Within a few weeks, the swelling and discomfort subside and the appearance of the labia begins to take on its final form. Labiaplasty has the power to potentially restore both form and improve confidence, often helping to make a woman feel “whole” again.[/accordion_son][accordion_son title=”BODY CONTOURING After Massive Weight Loss” clr=”#ffffff” bgclr=”#2d308e”]
With the advent of stomach stapling surgery (a.k.a. gastric bypass, bariatric surgery), plastic surgeons have seen a surge in the number of patients who are seeking to improve their physical appearance after losing anywhere from 50-250 pounds. Improvements can be made in sagging breasts, sagging arm tissues, excess abdominal skin, loose thigh skin, and even a droopy buttock region. While each patient has different goals and desires, often several or all of these areas need to be addressed in an individual person. This undertaking often requires several surgical procedures performed at different times. As always, but specifically with regards to body contouring after massive weight loss, safety is a top priority. Dr. Peled coordinates your surgical procedures with the other physicians who are managing your diet and overall health to assess your specific needs and ensure an optimal outcome.
One of the most popular plastic surgical procedures available today, liposuction is a safe and effective way to achieve an improved body contour with small incisions and minimal scarring along with relatively limited downtime. Liposuction can be performed on the abdomen, the thighs, legs, the flanks (“love handles”), the chin, the arms, and even the back. Several small incisions are made at various points in relatively inconspicuous areas and a special solution (tumescent solution) is instilled into the subcutaneous tissues. Subsequently, a specific instrument known as a cannula attached to a vacuum device is used to remove the subcutaneous fat, thus sculpting a particular area of the body to the desired contour. After the operation, patients must wear a compression garment for three weeks to speed up the healing process. Bruising may be present for several weeks thereafter and because of the solution used, patients may initially appear “fuller” than before the operation. This appearance is temporary as the fluid is absorbed by the body over the first 1-2 weeks. The majority of patients often take no more than one week off from work. Clearly, the more extensive the liposuction procedure, the more recovery time will be necessary.
The presence of prominent breast tissue in a male can be a source of discomfort and embarrassment. Using a combination of surgical excision and liposuction, this excess breast tissue can be permanently removed yielding an improved contour. As with liposuction surgery, patients usually wear a compression garment for several weeks afterwards, but most people can return to work within a few days and to full activity within 3-4 weeks.
Many of the features of this procedure are similar to those noted for thigh lift. Unlike the thigh lift, usually a straight incision is made on the inner aspect of the arm so as to minimize scarring after the operation. As noted above, excess tissue is removed and the remaining tissues are tightened to improve overall appearance. Compression garments must be worn for several weeks postoperatively and light activity usually resumes within a few days. More strenuous activity may be resumed within several weeks.
Cosmetic breast surgery is one of the most common operations performed by plastic surgeons in the United States. Women may seek to alter the appearance of their breasts for any number of reasons including a desire for larger breasts, a desire for more youthful-looking breasts, to improve breast symmetry, or to replace volume lost after childbirth and breast-feeding. Today more than ever, there many choices with respect to incision placement, the type of implant used (silicone gel or saline), and the location of the implant (above or below the muscle). A thorough understanding of the options available is critical to a successful result and a satisfied patient.
Breast enlargement surgery involves several very important decisions. The implants can be filled with saline (salt water) or gel (silicone), the implants can be placed under the pectoralis muscle or directly underneath the breast gland, and the implants can be placed either through an incision underneath the breast or around the nipple. Most importantly, the decision to enlarge the appearance of one’s breasts is a decision that should be made only after careful consideration. For this final reason, every initial breast augmentation consultation involves speaking with the patient about both the risks and benefits of breast augmentation surgery. A second consultation is usually scheduled so that the patient has time to think about the information conveyed during the initial consultation and has the opportunity to try on implants by placing implant sizers in her bra. In addition, she has the opportunity to ask questions about the procedure.
Once the decision to have surgery is made, a surgical date is selected. The procedure itself is performed on an outpatient basis under general anesthesia and usually takes less than 2 hours. After the operation a supportive bra is worn for several days to weeks. The initial discomfort is controlled with local anesthesia given at the time of the operation and with oral medication. Patients may resume light activity after 1-2 days, but generally, most patients take a week off from work. Light exercise is permitted at two weeks. At first, there may be some swelling and bruising which temporarily affects the breast shape. Often, however, the final implant location “settles” after a few months. The final results of breast augmentation should only be judged three to six months after surgery.
Breast sagging (also known as ptosis [pronounced “toe-sis”]) often seems to be an inevitability that goes hand in hand with aging and breast-feeding. Breast lift surgery is designed to re-shape the breast, remove excess skin and to re-position the nipple to re-approximate that youthful breast position on the chest wall. As with breast augmentation, there are several techniques which can be used to achieve these results. In fact, breast lift surgery is often combined with breast augmentation.
Much like breast augmentation surgery, a breast lift is done under general anesthesia and takes 3-4 hours. Patients are advised to take one week off from work, but often feel well enough to begin non-strenuous exercise in two weeks; heavy exercise must wait for six weeks. Swelling and bruising are slightly more prominent than with breast augmentation but begin to improve within two weeks. The final outcome can be judged three to six months after surgery.
Very large breasts (macromastia) can result in back pain, neck pain, and shoulder pain, grooves where the bra straps meet the neck and occasionally skin irritation beneath the breast skin. Breast reduction surgery can often alleviate many of these symptoms as well as improve one’s self-image.
This procedure is performed under general anesthesia and often takes from 3-5 hours depending on the degree of reduction. An anchor-type incision is made through the skin, the excess breast tissue removed, and the skin re-draped to produce the final breast shape. The final breast appearance and position are usually seen 3-6 months after surgery. Occasionally, breast reduction is performed in conjunction with other procedures such as a tummy tuck (abdominoplasty).
Just as each patient is unique, there are a myriad of possibilities when it comes to the problem of breast asymmetry. Simple breast re-shaping with or without the use of implants of various kinds enables the surgeon to individualize the outcome to your specific problem and body-type. Post-operative pain is usually mild and recovery relatively quick, but there can be wide variability depending upon the exact nature of the procedure performed.
While all people are different, none of us can completely escape the effects of aging, sun exposure, and gravity on our faces and skin. As a person ages, the fullness and elasticity of the skin diminish and facial tissues droop, often in cosmetically unappealing ways. Because an aged face can camouflage someone who is truly young at heart, many otherwise healthy people appear “fatigued” and say that they look older than they feel. Fortunately, there are a number of procedures that can help restore youth and vitality to the face. Among these are face lift (rhytidectomy), eyelid lift (blepharoplasty), nose reshaping (rhinoplasty), and lip augmentation
Often have patients ask me “What can I do about my smile? I see too much of my upper gums when I smile and can’t seem to fix it!” For those who don’t suffer from this problem I know it may seem like a minor issue, but being self-conscious about one’s appearance when that person is supposedly at their happiest can cause numerous self-esteem issues.
What causes Excessive Upper Gingival Show, AKA a “gummy smile”? There are several factors that can cause this appearance. An abnormal eruption of your teeth, wherein the teeth push through the gums in an unusual manner, is one cause. Your teeth can also be covered by excessive gum tissue, which makes them appear short, regardless of their actual size. For many patients, however, the muscles controlling your upper lip are hyperactive thus forcing your upper lip to rise further than normal with an attempted smile. This hyperactivity causes your gums to become exposed more than the normal amount.
Fortunately, for this latter group there is now a relatively simple and straightforward way to deal with the problem of excessive upper gingival show. This treatment involves no surgery, only 2-4 Botox injections that take about 5 minutes to perform and can be safely done over your lunch break. The treatment effects typically last several months and can be repeated as necessary. The Botox works by relaxing some of the hyperactive smile muscles thus allowing your lip to rise more naturally and producing a result that you can be happy with. It will really give you something to smile about![/accordion_son][accordion_son title=”FACE LIFT” clr=”#ffffff” bgclr=”#2d308e”]
There are very few surgical procedures that compare to the rejuvenating effects of a facelift. Incisions are usually made within the hairline or along the hair margin above the ear and extend around the earlobe to the hairline behind the ear. The tissue layers beneath the skin, including the neck muscles are tightened, excess fat can be trimmed or repositioned, and the excess skin and soft tissue removed. The final result is usually evident within 4-6 weeks,but can be seen sooner and patients often see continued improvement for several months thereafter. While the results of facelift surgery can be quite dramatic, Dr. Peled, makes every effort to ensure that the final outcome is a more youthful, natural-looking face.
Sagging eyelids or puffiness below the eyes can cause many people to looked tired and appear older than they feel. Eyelid rejuvenation surgery (blepharoplasty) is a relatively straightforward procedure that can have a remarkable effect on aging eyes for both men and women. The procedure is usually performed on an outpatient basis under either local anesthesia or IV sedation. Incisions are placed below the lash lines (lower eyelid) and in the skin crease of the eyelid (upper eyelid) so as to “hide” them. During eyelid rejuvenation surgery, the excess skin and fat that cause the “tired” look of the eyes are removed and the tissues are tightened as necessary to produce a more youthful, vibrant appearance. Swelling and bruising can be obvious initially, but usually resolve over a period of 1-2 weeks. Post operative pain is usually minimal. During this time, the swelling and bruising can easily be camouflaged with makeup. Patients can usually return to work in about one week and begin exercising two weeks after the procedure. As with any aesthetic surgical procedure, Dr. Peled strives for a result that appears natural leaving the patient with a “refreshed” look.
The nose has often been referred to as the dominant feature of the face. This characterization likely comes not only because of it’s location at the center of the face, but also because it is the feature that projects the most from the facial planes. As a result, when a nose is out of proportion with the other facial features, it can distract from an otherwise beautiful face. Nasal reshaping or rhinoplasty can address many aspects of the nose such as wide nostrils, a bumpy nasal bridge, an overly “long” nose, and an unusual-looking tip. In doing so, the goal is always to re-establish the facial proportions and deemphasize a prominent nose. Rhinoplasty is performed in an outpatient setting using a general anesthetic. A temporary splint (plastic cover) is placed on the nose for approximately one week after the operation and packing of the nose is usually not required. A small amount of pain is common, but the swelling and bruising can sometimes be significant for up to two weeks depending on the degree of nasal re-shaping performed. Blowing of the nose or strenuous activity is prohibited for 14 days, but easy exercise is permitted at two weeks. More strenuous activity is not permitted until 4-6 weeks after the procedure. Final results are evaluated 6-12 months from the time of surgery.
Prominent ears can often make people feel self-conscious about their appearance. In particular, younger children are often teased during school as a result of their ears “sticking out too much”. Setting back the ears or (setback otoplasty) is a safe and effective procedure that addresses this problem. It too is performed as an outpatient procedure under general anesthesia. The incisions are placed behind the ears and hence are relatively “invisible”, even when the hair is worn up. A bandage is worn for about one week after the procedure. Younger patients may not engage in sports, any contact activities or swimming for two months. Adults may exercise as early as 14 days after their surgery.
MOHS/ GENERAL RECONSTRUCTION
Many people don’t realize that plastic surgeons do many types of surgical procedures other than those talked about on certain TV shows with famous zip codes. Reconstructive surgical procedures do far more than simply close wounds and correct acquired or congenital (those present at birth) defects. These operations have the power to restore both form and function and to make a person feel “whole” again. A perfect example is breast reconstruction after a cancer procedure in which the breast must be removed to save a life.
To describe the breadth of reconstructive options available to patients for any number of situations would require enough text to fill tens of thousands of pages. Indeed, reconstructive techniques and procedures have been developed for patients of all ages and for defects and conditions affecting just about every part of the body. Because of the comprehensive nature of his plastic surgical training at Harvard University, including participation in over 1700 procedures in 3 years, Dr. Peled has the ability to treat many such problems successfully. If you have a question about whether there are reconstructive options for your particular problem, please call the office to schedule a consultation.
Mohs surgery is often the most effective way to remove a skin cancer in areas of the body where preserving tissue is critical. Examples of such areas include the eyelids, nose, and face. Even certain parts of the hands and feet are relevant as a scar placed in the worng location may lead to loss of function. Mohs surgery is performed by a dermatologic surgeon specially trained in this technique. Occasionally, the cancer has spread further than anticipated and a larger defect is created in removing the entire tumor. In such cases, a plastic surgeon is often needed to reconstruct the area with an eye towards maintaining function, shape, contour, and preserving one’s appearance to optimize the aesthetic result. Dr. Peled has performed many such procedures all over the body and works with many Mohs surgeons in the San Francisco Bay area to make whole what cancer has taken away.
Many people would like to look younger and surgery is not the only way to achieve a more youthful or refreshed appearance. Nowadays, there are many non-surgical and inexpensive ways of treating your skin so that it appears more vibrant and toned.
For those patients who are beginning to show signs of aging, but who are not ready for surgery, we offer BOTOX®. Performed by Dr. Peled himself, BOTOX is a highly-purified substance administered in a non-surgical procedure and designed to minimize the effects of wrinkles caused by our facial muscles. Examples of these are the crow’s feet on the outside corners of the eyes and the wrinkles on the forehead. By temporarily weakening these muscles, the wrinkles caused by them can be eliminated or significantly reduced resulting in a more youthful appearance. Discomfort is minimal and brief and patients can resume their normal activities immediately. Occasionally, there is some redness in the treated area that dissipates within several hours. A significant improvement is usually seen in 5-7 days and the results will typically last 3-4 months.
Dysport is a recently FDA-approved botulinum toxin which, like Botox, can be used for cosmetic purposes. It represents the newest of the botulinum toxin products and is an exciting addition to the non-surgical techniques which can be used to achieve a more youthful appearance. We are pleased to announce the availability of Dysport in our practice. For more information about this remarkable new product, please call our office.
For those patients who are beginning to show signs of aging, but who are not ready for surgery, we also offer dermal fillers such as Juvéderm® which are used to minimize the appearance of moderate to fine wrinkles throughout the face. Examples of these types of wrinkles are the ones extending from the sides of the nose down to the corners of the mouth (nasolabial folds), the ones around the upper and lower lips (perioral rhytids), and those wrinkles which travel from the corners of the mouth down to the sides of the chin (marionette lines). Administered by Dr. Peled himself, Juvéderm® is the newest generation of a family of products called hyaluronic acids and is known for its smoothness and stability. What this means for the patient is a more precise placement and a more lasting result. Depending on the site of injection, a local anesthetic may be administered. Discomfort is minimal and brief and patients can resume their normal activities immediately. Occasionally there is some redness in the treated areas. A significant improvement can usually be seen right away and results often last 6 months or longer.
A good skin care regimen is essential to achieving a healthy appearance and patients of all ages can benefit from any number of skin rejuvenation products available today. Our physician-quality skin care solutions are not available commercially and are designed specifically to restore the youthful appearance of healthy skin, minimize fine lines, spots, and wrinkles, and protect against many of the skin problems which occur with sun exposure and aging. We are proud to carry the Vivité® skin care line of products from Allergan for overall skin care maintenance as well as NIA24TM for skin correction and protection from the harmful effects of the sun. Moreover, SkinMedica® is an innovative line of skin care products designed to help with the problems of hyperpigmentation, melasma (uneven skin pigmentation), sallowness, photodamage, as well as fine lines and wrinkles. These treatments can produce powerful results whether used alone or in conjunction with a surgical procedure, often require little downtime and have very low risks or side effects.[/accordion_son][accordion_son title=”LATISSE” clr=”#ffffff” bgclr=”#2d308e”]
Latisse® is the first and only product approved by the FDA which has been proven to grow lashes. When used for a specific period of time, lashes will become fuller, longer, and darker. Latisse® is easy to use and has very little downside in terms of risks or side effects. We are proud to offer this exciting new product in our office.[/accordion_son][/accordion_father]
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