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Specialties Pre and Post op Photos
Plastic Surgery of Kalamazoo respects the privacy of our patients. If you are interested in before and after surgery photos, please visit the American Society of Plastic Surgeons website (www.plasticsurgery.org ), which provides interactive surgery information and imagery. PSK has before and after pictures available to share with clients only during on-site consultations. Descriptions LASER FACIAL RESURFACING
Procedure: Smooth the face and smooth fine wrinkles using a carbon dioxide (CO2) laser device that treats layers of damaged skin. Softens lines around the eyes and mouth and minimizes facial scars and unevenly pigmented areas.Length: A few minutes to 1 hour. May require more than 1 session.
Anesthesia: Local with sedation, or general.
In/Outpatient: Usually outpatient, unless combined with other surgical procedures that require hospitalization.
Side Effects: Temporary swelling, discomfort. Lightening of treated skin. Acute sun sensitivity. Increased sensitivity to makeup. Pinkness or redness in skin that may persist for up to 6 months.
Risks: Burns or injuries caused by laser heat. Scarring. Abnormal changes in skin color. Flare-up of viral infections ("cold sores") and other infections (rare).
Recovery: Back to work: 2 weeks. More strenuous activities: 4-6 weeks. Complete fading of redness: 6 months or less. Return of pigmentation/light sun exposure: 6-12 months.
Duration of Results: Long-lasting, but does not stop aging. New wrinkles, expression lines may form as skin ages.
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FACELIFT
(Rhytidectomy)
Procedure: Improving sagging facial skin, jowls, and loose neck skin by removing excess fat, tightening muscles, redraping skin. Most often done on men and women over 40.
Length: Several hours.
Anesthesia: Local with sedation, or general.
In/Outpatient: Usually outpatient. Some patients may require short inpatient stay.
Side Effects: Temporary bruising, swelling, numbness and tenderness of skin; tight feeling, dry skin. For men, permanent need to shave behind ears, where beard-growing skin is repositioned.
Risks: Injury to the nerves that control facial muscles or feeling (usually temporary but may be permanent). Infection, bleeding. Poor healing; excessive scarring. Asymmetry or change in hairline.
Recovery: Back to work: 10 to 14 days. More strenuous activity: 2 weeks or more. Bruising: 2 to 3 weeks. Must limit exposure to sun for several months.
Duration of Results: Usually 5 to 10 years.
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EYELID SURGERY
(Blepharoplasty)
Procedure: Correct drooping upper eyelids and puffy bags below the eyes by removing excess fat, skin, and muscle. (Upper-eyelid surgery may be covered by insurance if used to correct visual field defects)
Length: 1 to 3 hours.
Anesthesia: Usually locally with sedation or general.
In/Outpatient: Usually outpatient.
Side Effects: Temporary discomfort, tightness of lids, swelling, bruising. Temporary dryness, burning, itching of eyes. Excessive tearing, sensitivity to light for first few weeks.
Risks: Temporary blurred or double vision. Infection, bleeding. Swelling at the corners of the eyelids. Dry eyes. Formation of whiteheads. Slight asymmetry in healing or scarring. Difficulty in closing eyes completely (rarely permanent). Pulling down of the lower lids (may require further surgery). Blindness (extremely rare).
Recovery: Reading: 2 or 3 days. Back to work: 7 to 10 days. Contact lenses: two weeks or more. Strenuous activities, alcohol: about 3 weeks. Bruising and swelling gone: several weeks.
Duration of Results: Several years. Sometimes permanent.
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FOREHEAD LIFT
(Browlift)
Procedure: Minimize forehead creases, drooping eyebrows, hooding over eyes, furrowed forehead and frown lines by removing excess tissue, altering muscles and tightening the forehead skin. May be done using the traditional technique, with an incision across the top of the head just behind the hairline; or with the use of an endoscope, which requires 3 to 5 short incisions. Most often done on people over 40.
Length: 1 to 2 hours.
Anesthesia: Local with sedation, or general.
In/Outpatient: Usually outpatient.
Side Effects: Temporary swelling, numbness, headaches, bruising. Traditional method: Possible itching and hair loss.
Risks: Injury to facial nerve, causing loss of motion, muscle weakness, or asymmetrical look. Infection. Broad or excessive scarring.
Recovery: Back to work: 7 to 10 days, usually sooner for endoscopic forehead lift. More strenuous activity: several weeks. Full recovery from bruising: 2 to 3 weeks. Limit sun exposure for several months.
Duration of Results: Usually 5 to 10 years.
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NOSE SURGERY
(Rhinoplasty)
Procedure: Reshape nose by reducing or increasing size, removing hump, changing shape of tip or bridge, narrowing span of nostrils, or changing angle between nose and upper lip. May also relieve some breathing problems. (May be covered by insurance.)
Length: 1 to 2 hours or more.
Anesthesia: Local with sedation, or general.
In/Outpatient: Usually outpatient.
Side Effects: Temporary swelling, bruising around eyes, nose and headaches. Some bleeding and stiffness.
Risks: Infection. Small burst blood vessels resulting in tiny, permanent red spots. Incomplete improvement, requiring additional surgery.
Recovery: Back to work: 1 to 2 weeks. More strenuous activities: 2 to 3 weeks. Avoid hitting nose or sunburn: 8 weeks. Final appearance: 1 year or more.
Duration of Results: Permanent.
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BREAST ENLARGEMENT
(Augmentation Mammaplasty)
Procedure: Enhance the size of breasts using inflatable implants filled with saline.
Length: 1 to 2 hours.
Anesthesia: Local with sedation, or general.
In/Outpatient: Usually outpatient.
Side Effects: Temporary soreness, swelling, change in nipple sensation, bruising. Breast sensitive to stimulation for a few weeks.
Risks: Lack of implant permanence -- surgical removal or replacement of the implants may be required to treat problems, including: deflation; the formation of scar tissue around the implant (capsular contracture), which may cause the breast to feel tight or hard; bleeding or infection. Increase or decrease in sensitivity of nipples or breast skin, occasionally permanent. Mammography requires a special technique. (Note: Some women have reported symptoms similar to those of immune disorders. Ask your doctor about these and other FDA concerns.)
Recovery: Back to work: a few days. Physical contact with breasts: 3 to 4 weeks. Fading of scars: several months to a year or more.
Duration of Results: Variable. Implants may require removal or replacement.
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BREAST REDUCTION
Techniques for breast reduction vary, but the most common procedure involves an anchor-shaped incision that circles the areola, extends downward, and follows the natural curve of the crease beneath the breast. The surgeon removes excess glandular tissue, fat, and skin, and moves the nipple and areola into their new position. He or she then brings the skin from both sides of the breast down and around the areola, shaping the new contour of the breast. Liposuction may be used to remove excess fat from the armpit area.
In most cases, the nipples remain attached to their blood vessels and nerves. However, if the breasts are very large or pendulous, the nipples and areolas may have to be completely removed and grafted into a higher position. (This will result in a loss of sensation in the nipple and areolar tissue.)
Stitches are usually located around the areola, in a vertical line extending downward, and along the lower crease of the breast. In some cases, techniques can be used that eliminate the vertical part of the scar. And occasionally, when only fat needs to be removed, liposuction alone can be used to reduce breast size, leaving minimal scars.
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BREAST LIFT
(Mastopexy)
Procedure: Raise and reshape sagging breasts by removing excess skin and repositioning remaining tissue and nipples.
Length: 1 to 3 hours.
Anesthesia: Local with sedation, or general.
In/Outpatient: Usually outpatient. Sometimes inpatient.
Side Effects: Temporary bruising, swelling, discomfort, numbness, dry breast skin. Permanent scars.
Risks: Thick, wide scars; skin loss; infection. Unevenly positioned nipples. Permanent loss of feeling in nipples or breast.
Recovery: Back to work: 1 week or more. Strenuous activities: 1 month. Fading of scars: several months to a year.
Duration of Results: Variable; gravity, pregnancy, aging, and weight changes may cause new sagging. Results may last longer or be enhanced when breast implants are inserted as part of the procedure
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BREAST RECONSTRUCTION
While there are many options available in post-mastectomy reconstruction, you and your surgeon should discuss the one that's best for you.
Skin expansion. The most common technique combines skin expansion and subsequent insertion of an implant.
Following mastectomy, your surgeon will insert a balloon expander beneath your skin and chest muscle. Through a tiny valve mechanism buried beneath the skin, he or she will periodically inject a salt-water solution to gradually fill the expander over several weeks or months. After the skin over the breast area has stretched enough, the expander may be removed in a second operation and a more permanent implant will be inserted. Some expanders are designed to be left in place as the final implant. The nipple and the dark skin surrounding it, called the areola, are reconstructed in a subsequent procedure.
Some patients do not require preliminary tissue expansion before receiving an implant. For these women, the surgeon will proceed with inserting an implant as the first step.
Flap reconstruction. An alternative approach to implant reconstruction involves creation of a skin flap using tissue taken from other parts of the body, such as the back, abdomen, or buttocks.
In one type of flap surgery, the tissue remains attached to its original site, retaining its blood supply. The flap, consisting of the skin, fat, and muscle with its blood supply, are tunneled beneath the skin to the chest, creating a pocket for an implant or, in some cases, creating the breast mound itself, without need for an implant.
Another flap technique uses tissue that is surgically removed from the abdomen, thighs, or buttocks and then transplanted to the chest by reconnecting the blood vessels to new ones in that region. This procedure requires the skills of a plastic surgeon who is experienced in microvascular surgery as well.
Regardless of whether the tissue is tunneled beneath the skin on a pedicle or transplanted to the chest as a microvascular flap, this type of surgery is more complex than skin expansion. Scars will be left at both the tissue donor site and at the reconstructed breast, and recovery will take longer than with an implant. On the other hand, when the breast is reconstructed entirely with your own tissue, the results are generally more natural and there are no concerns about a silicone implant. In some cases, you may have the added benefit of a improved abdominal contour.
Follow-up procedures. Most breast reconstruction involves a series of procedures that occur over time. Usually, the initial reconstructive operation is the most complex. Follow-up surgery may be required to replace a tissue expander with an implant or to reconstruct the nipple and the areola. Many surgeons recommend an additional operation to enlarge, reduce, or lift the natural breast to match the reconstructed breast. But keep in mind, this procedure may leave scars on an otherwise normal breast and may not be covered by insurance.
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MALE BREAST REDUCTION
(Gynecomastia)
Procedure: Reduce enlarged, female-like breast in men using liposuction and/or cutting out excess glandular tissue. (Sometimes covered by medical insurance.)
Length: 1 hour or more.
Anesthesia: General or local.
In/Outpatient: Usually outpatient.
Side Effects: Temporary bruising, swelling, numbness, soreness, burning sensation.
Risks: Infection. Fluid accumulation. Injury to the skin. Rippling or bagginess of skin. Asymmetry. Pigmentation changes (may become permanent if exposed to sun). Excessive scarring if tissue was cut away. Need for second procedure to remove additional tissue.
Recovery: Back to work: 3 to 7 days. More strenuous activity: 2 to 3 weeks. Swelling and bruising: 3 to 6 months.
Duration of Results: permanent
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ABDOMINOPLASTY
(Tummy Tuck)
Procedure: Flatten abdomen by removing excess fat and skin and tightening muscles of abdominal wall.
Length: 2 to 5 hours.
Anesthesia: General, or local with sedation.
In/Outpatient: Either depending on individual circumstances and extent of surgery.
Side Effects: Temporary pain. Swelling, soreness, numbness of abdominal skin, bruising, tiredness for several weeks or months.
Risks: Blood clots. Infection. Bleeding under the skin flap. Poor healing resulting in conspicuous scarring or skin loss. Need for a second operation.
Recovery: Back to work: 2 to 4 weeks. More strenuous activity: 4 to 6 weeks or more. Fading and flattening of scars: 3 months to 2 years.
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LIPOSUCTION
(Suction-Assisted Lipectomy)
Procedure: Improve body shape by removing exercise-resistant fat deposits with a tube and vacuum device. Can be performed using the tumescent technique, in which targeted fat cells are infused with saline containing solution with a local anesthetic before liposuction to reduce post-operative bruising and swelling. Common locations for liposuction include chin, cheeks, neck, upper arms, above breasts, abdomen, buttocks, hips, thighs, knees, calves, ankles.
For larger volumes of fat or for fibrous body areas, ultrasound-assisted lipoplasty (UAL) may be used. UAL is a new technique in which a ultrasound probe is inserted beneath the skin to "liquify" the fat before it is suctioned.
Length: 1 to 2 hours or more. UAL: 20-40 percent longer than traditional liposuction.
Anesthesia: Local, epidural, or general.
In/Outpatient: Usually outpatient. Extensive procedures may require short inpatient stay.
Side Effects: Temporary bruising, swelling, numbness, soreness, burning sensation. Tumescent: Temporary fluid drainage from incision sites. UAL: Larger incisions for cannula.
Risks: Asymmetry. Rippling or bagginess of skin. Pigmentation changes. Skin injury. Fluid retention. Excessive fluid loss leading to shock. Infection. UAL: thermal burn injury caused by the heat from the ultrasound device.
Recovery: Back to work: 1 to 2 weeks. More strenuous activity: 2 to 4 weeks. Full recovery from swelling and bruising: 1 to 6 months or more. Use of tumescent technique or UAL may decrease post-operative bruising and swelling.
Duration of Results: Permanent, with sensible diet and exercise.
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SCAR REVISION
KELOID SCARS
Keloids are thick, puckered, itchy clusters of scar tissue that grow beyond the edges of the wound or incision. They are often red or darker in color than the surrounding skin. Keloids occur when the body continues to produce the tough, fibrous protein known as collagen after a wound has healed.
Keloids can appear anywhere on the body, but they're most common over the breastbone, on the earlobes, and on the shoulders. They occur more often in dark-skinned people than in those who are fair. The tendency to develop keloids lessens with age.
Keloids are often treated by injecting a steroid medication directly into the scar tissue to reduce redness, itching, and burning. In some cases, this will also shrink the scar.
If steroid treatment is inadequate, the scar tissue can be cut out and the wound closed with one or more layers of stitches. This is generally an outpatient procedure, performed under local anesthesia. You should be back at work in a day or two, and the stitches will be removed in a few days. A skin graft (see the section on skin grafting) is occasionally used, although the site from which the graft was taken may then develop a keloid.
No matter what approach is taken, keloids have a stubborn tendency to recur, sometimes even larger than before. To discourage this, the surgeon may combine the scar removal with steroid injections, direct application of steroids during surgery, or radiation therapy. Or you may be asked to wear a pressure garment over the area for as long as a year. Even so, the keloid may return, requiring repeated procedures every few years.
HYPERTROPHIC SCARS
Hypertrophic scars are often confused with keloids, since both tend to be thick, red, and raised. Hypertrophic scars, however, remain within the boundaries of the original incision or wound. They often improve on their own-though it may take a year or more-or with the help of steroid applications or injections.
If a conservative approach doesn't appear to be effective, hypertrophic scars can often be improved surgically. The plastic surgeon will remove excess scar tissue, and may reposition the incision so that it heals in a less visible pattern. This surgery may be done under local or general anesthesia, depending on the scar's location and what you and your surgeon decide. You may receive steroid injections during surgery and at intervals for up to two years afterward to prevent the thick scar from reforming.
CONTRACTURES
Burns or other injuries resulting in the loss of a large area of skin may form a scar that pulls the edges of the skin together, a process called contraction. The resulting contracture may affect the adjacent muscles and tendons, restricting normal movement.
Correcting a contracture usually involves cutting out the scar and replacing it with a skin graft or a flap. In some cases a procedure known as Z-plasty may be used. And new techniques, such as tissue expansion, are playing an increasingly important role. If the contracture has existed for some time, you may need physical therapy after surgery to restore full function.
FACIAL SCARS
Because of its location, a facial scar is frequently considered a cosmetic problem, whether or not it is hypertrophic. There are several ways to make a facial scar less noticeable. Often it is simply cut out and closed with tiny stitches, leaving a thinner, less noticeable scar.
If the scar lies across the natural skin creases (or "lines of relaxation") the surgeon may be able to reposition it to run parallel to these lines, where it will be less conspicuous. (See Z-plasty)
Some facial scars can be softened using a technique called dermabrasion, a controlled scraping of the top layers of the skin using a hand-held, high-speed rotary wheel. Dermabrasion leaves a smoother surface to the skin, but it won't completely erase the scar.
Z-PLASTY
Z-plasty is a surgical technique used to reposition a scar so that it more closely conforms to the natural lines and creases of the skin, where it will be less noticeable. It can also relieve the tension caused by contracture. Not all scars lend themselves to Z-plasty, however, and it requires an experienced plastic surgeon to make such judgments.
In this procedure, the old scar is removed and new incisions are made on each side, creating small triangular flaps of skin. These flaps are then rearranged to cover the wound at a different angle, giving the scar a "Z"pattern. The wound is closed with fine stitches, which are removed a few days later. Z-plasty is usually performed as an outpatient procedure underlocal anesthesia.
While Z-plasty can make some scars less obvious, it won't make them disappear. A portion of the scar will still remain outside the lines of relaxation.
SKIN GRAFTING AND FLAP SURGERY
Skin grafts and flaps are more serious than other forms of scar surgery. They're more likely to be performed in a hospital as inpatient procedures, using general anesthesia. The treated area may take several weeks or months to heal, and a support garment or bandage may be necessary for up to a year.
Grafting involves the transfer of skin from a healthy part of the body (the donor site) to cover the injured area. The graft is said to "take"when new blood vessels and scar tissue form in the injured area. While most grafts from a person's own skin are successful, sometimes the graft doesn't take. In addition, all grafts leave some scarring at the donor and recipient sites.
Flap surgery is a complex procedure in which skin, along with the underlying fat, blood vessels, and sometimes the muscle, is moved from a healthy part of the body to the injured site. In some flaps, the blood supply remains attached at one end to the donor site; in others, the blood vessels in the flap are reattached to vessels at the new site using microvascular surgery.
Skin grafting and flap surgery can greatly improve the function of a scarred area. The cosmetic results may be less satisfactory, since the transferred skin may not precisely match the color and texture of the surrounding skin. In general, flap surgery produces better cosmetic results than skin grafts.
Back to top TATTOO REMOVAL Laser is the best treatment for removal of tattoos. The response will be dependent on the depth, color and amount of dye used in the tattoo. Professional tattoos are harder to remove and will usually require more treatments. Certain dye colors (especially green and red) respond very slowly and sometimes not at all. There is no guarantee that the tattoo can be fully removed. There are some risks for the laser treatment of tattoos that include, but not limited to: swelling, bruising and bleeding, scarring, infection, “Ghost” appearance, allergic/inflammatory reaction to the dye, discomfort and weeping of the open wound. Treatments for the laser of tattoos are spaced out every 6 weeks to allow the tissues to heal.
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BOTOX
The cosmetic form of botulinum toxin, often referred to by its product name Botox®, is a popular non-surgical injection that temporarily reduces or eliminates frown lines, forehead creases, crows feet near the eyes and thick bands in the neck. The toxin blocks the nerve impulses, temporarily paralyzing the muscles that cause wrinkles while giving the skin a smoother, more refreshed appearance. Studies have also suggested that Botox is effective in relieving migraine headaches, excessive sweating and muscle spasms in the neck and eyes.
Back to top RESTYLANE Restylane is a safe and natural cosmetic dermal filler that restores volume and fullness to the skin to correct moderate to severe facial wrinkles and folds, such as nasolabial folds.Restylane is the first cosmetic dermal filler made of non-animal-based hyaluronic acid. Hyaluronic acid is a natural substance that already exists in the human body and is used to provide volume and fullness to the skin. Restylane is proven to deliver long-lasting results. Studies have shown that Restylane effects generally last for about six months. Treatments are typically scheduled twice a year.
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COLLAGEN / FAT INJECTIONS
Procedure: Plump up creased, furrowed, or sunken facial skin; add fullness to lips and backs of hands. Works best on thin, dry, light-colored skin.
Length: 15 minutes to 1 hour per session.
Anesthesia: Collagen: usually none; local may be included with the injection. Fat: local.
In/Outpatient: Outpatient.
Side Effects: Temporary stinging, throbbing, or burning sensation. Faint redness, swelling, excess fullness.
Risks: Collagen: allergic reaction including rash, hives, swelling, or flu-like symptoms; possible triggering of connective-tissue or autoimmune diseases. (A skin test is required before collagen treatment to determine whether an allergy exists.) Both: Contour irregularities, infection.
Duration of Results: Variable; a few months to 1 year.
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