Frequently Asked Plastic Surgery Questions
Breast | Plastic Surgery
How do I choose my breast implant size?+
It is very difficult for plastic surgery patients to understand the effect a particular size implant will have on their appearance. There are many anatomical variations that affect this resolved and the final shape and look to the breast. Also, simply placing a certain size implant with in a bra does not necessarily show the patient how their breast will actually look following plastic surgery.
Dr. Schneider utilizes an approach that is very different. We prefer that the patient show us photos of breasts that they think are ideal. We then utilize those photos as a guide during surgery. A pocket under the muscle is created for breast implant. Sizers are placed within the pocket to determine what size implant will best match the patients photo. The appropriate size implant is then chosen and inserted. In using this technique, we have an extremely high satisfaction.
What is implant profile and how does it affect the shape of my breast?+
The implant profile is how round or flat an implant looks when it is placed flat on a surface. Implants come in a variety of profiles and shapes. A very high-profile implant will tend to have a very narrow base diameter, however its profile will project significantly and create a very round shape to the breast. Low-profile implant has a wider base diameter and has significantly less projection and us create a more natural shape to the breast.
When we discuss breast shape with plastic surgery patients I ask them whether they desire something that looks very round, something that looks natural, or something in between. The profile of implant I then choose is based on the patient’s preference for resultant breast shape and her anatomy.
What are the new shaped gummy bear breast implants?+
The new shaped gummy bear breast implants are been FDA approved and utilize a highly cohesive silicone gel breast implant that maintains its shape even if the implant is cut in half. The implants come in a variety of different profiles. Some are wider and shorter and others are taller and have greater projection. This allows Dr. Schneider to tailor the plastic surgery procedure based on the patient’s individual anatomy and their desire for enhancement.
The gummy bear implants are called fifth generation implants and represent a significant technological advantage compared to other implants on the market. Dr. Schneider’s patients have been extremely happy with how soft and natural their breasts feel using this implant.
When can I return to work after my breast augmentation?+
Dr. Schneider performs the breast augmentation a little bit differently than most surgeons. Instead of typically using an incision under the breast or around the Areola, Dr. Schneider uses a 1.5 inch incision located in the axilla (the under arm) and an endoscope. This allows Dr. Schneider to create an incision that is smaller and is placed far away from the pressure created from the breast implant in the breast.
If we place an incision on the breast, that incision must be protected from the pressure caused by the implant for several weeks. This is to ensure that the incision does not inadvertently open.
However, because the underarm incision is far away from the pressure, patients are able to return to their normal physical activities 24 hours following the plastic surgery procedure. They are able to drive, return to work, and go to the gym as soon as they feel comfortable. For most people this means they are able to return to work in 2-3 days follow their plastic surgery procedure and they’re in the gym exercising their arms and chest within 5-7 days.
What kind of bandages or straps will I need after my breast augmentation?+
Many surgeons will require the patients to wear special straps and bandages following their breast augmentation procedure because of incisions that are placed on the breast. The straps are used to help lower the position of the implants which are usually too high on the chest right after plastic surgery. The straps counteract the effect of wearing a bra that causes the implants to sit too high.
However, because Dr. Schneider in most cases uses an underarm incision for the breast augmentation procedure, his patients are able to go bra-less and they are able to begin normal physical activities within 24 hours after plastic surgery. This physical activity and not wearing a bra helps promote the lowering of the implants and thus no special straps are needed.
Do I have to have a breast lift if I have some sagging in my breasts?+
The breast lift is designed to reposition the breast tissue and nipple if they sit below the inframammary fold of the breast. This is the crease that’s sits under your breast. However, if the patient is happy with the basic shape of her breasts even with some sagging, then a breast lift is unnecessary.
Instead, in these patients, what we perform is called a bi-planar or dual plane augmentation. In this plastic surgery procedure a breast implant pocket is created under the muscle and then into the breast tissue so that the implants it’s partially under the muscle and partially within the breast. This allows us to file the sagging area of the breast with the implant. The advantage of this technique in the patient who was happy with the basic shape of her breasts it is that she avoids any incisions on her breasts. Dr. Schneider performs this technique through a small hidden armpit incision.
Should I put antibiotic ointment on my incisions as they are healing?+
No! We do not like patients to put antibiotic on their incisions during the healing phase. Though on television you will see commercials that show that scars heal better with antibiotic ointment, when these are placed on the newly closed incision they can cause bacteria to become trapped and cause the wound edges to heal poorly.
What we prefer is that patients keep their incisions clean and dry during the healing phase. Most patients are able to shower and get the incisions wet within 24-48 hours following the plastic surgery procedure. Ask our office specifically before you do this. Patients do not need to apply any creams or appointments to the incisions. After your incision has begun to heal for several weeks Dr. Schneider may instruct you to begin massage to the incision line. In some patients we may also apply a special tape that helps the scar heal much finer.
I was thinking of having a breast augmentation during the school holidays. When will I be able to return to school?+
Most patients who have a breast augmentation have a fairly quick recovery in terms of returning to their normal activities. Dr. Schneider likes to have patients return to normal physical activity as soon as they feel comfortable doing it. For most this means being able to drive, return to work or return to school between three and seven days following their plastic surgery procedure. The sooner the patient starts using their arms and upper body and returning to full activities, the sooner the implants drop into position and the patients discomfort goes away.
We have literally seen patients in the gym doing overhead press with weights five days following their breast augmentation procedure.
Is it possible to place silicone implants through an armpit incision?+
Yes it is possible to place silicone implants through an armpit incision. When we place saline implants, the implant is placed through the incision into the pocket with the implant deflated. Therefore, classically, the incision required for a saline implant was significantly smaller than silicone implant.
However, over the last several years, Dr. Schneider has been utilizing a device called the Keller funnel. The funnel allows us to place silicone implants through the same size incision as we use for a saline implant. The funnel also allows us not to touch the implant which we believe decreases the risk of contamination of the implant and capsule contracture.
Body | Plastic Surgery
What is the Brazilian Butt Lift?+
The Brazilian Butt Lift, otherwise known as fat transfer to the gluteal region, is designed to enhance the shape and size of the buttocks. This plastic surgery technique utilizes minimal incisions and allows for a fairly fast recovery and return to normal activity.
Fat transfer is a plastic surgery technique that is several decades old but has only within the last years, become fairly standardized and routine. In the past, fat transfer was fraught with fat loss and volume loss after the fat was transferred.
How is Liposuction used for the Brazilian Butt Lift?+
Dr. Schneider uses liposuction to harvest fat from one region of the body and then concentrates the fat and injects it into another. The plastic surgery procedure starts by making a tiny hidden incision in the area for liposuction. Then a fluid called tumescent solution is injected into the fat of the area. The tumescent solution helps prevent bleeding and also provides anesthesia to the area. Classically patients are sedated or asleep for the procedure, however, many have opted to have the operation done while they were awake.
How do Fat Injections work during Butt Augmentation?+
The patient is then repositioned for the fat transfer. Several small punctures are made in the gluteal region. The concentrated fat is then injected into the gluteal region in small aliquots until the desired shape and size is created.
How long is the recovery on the Brazilian Butt Lift?+
Band-aids are then applied. Patients are instructed not to sit or lay on the area for several days but they may shower and begin activities the next day. The result: an enhanced more shapely buttocks and a contoured smaller region that underwent liposuction.
Face | Plastic Surgery
What is the recovery from having my ears pinned back (otoplasty)?+
The otoplasty procedure takes about one hour to be performed. For most patients this is done with light sedation. However, some patients may opt to only have the procedure done with a local anesthetic. There are two main parts to that ear that area operated upon: the Concha or the cup of the ear, and the anti-helix or that inside rim of the ear. Some patients need only one part operated upon while others require both.
Following the plastic surgery procedure patients wear a headband over their ears when they go home. The sutures are all dissolvable and do not need to be removed. Patients may shower and get their head went the day following the procedure. There is a small amount of bruising and swelling and patients wear the headband for about six weeks while they sleep. Most patients are comfortable returning to work one week following the procedure.
What causes sagging skin in the face and neck?+
At the outer level of the neck are three main components that exhibit the signs of aging. These are the skin, a layer of fat, and the platysma muscle. Aging in the neck is manifest by loss of elasticity in the skin, wrinkling in the skin, and sagging in the platysma muscle, and changes is fat distribution.
How is necklift surgery different than facelift surgery?+
Most patients present Necklift Plastic Surgery to a plastic surgery professional initially complaining of sagging bands in their neck. This aging is manifested by one or two sagging bands first starting above the Adams apple and eventually descending along the entire neckline. The bands that develop in the neck are due to the flaccid drooping of the platysma muscle.
What is a Necklift?+
A necklift is designed to repair the aging changes isolated in the neck. It is almost always included in a modern facelift. Some facelift “factories” that specialize in your “lifestyle” may try and include it as an after charge to an old style facelift. The necklift is designed to isolate and correct the aging changes from the jaw line down. This is a very important point to understand because the jowl often has a facial component and a neck component. Plastic surgery patients often believe that a necklift will completely correct the jowl. However, the necklift is really designed to only correct the neck component of the jowl.
What different types of Necklifts are available?+
There are many different types of necklift incisions and procedures in plastic surgery. Typically the operation uses a transverse incision under the chin for access to the front of the neck. It also uses an incision behind the ear for access to the backside of the neck. These limited incisions give the surgeon access to the neck from the jaw line down. The surgeon will use either liposuction to contour the fat or excise the fat directly. The muscle is lifted in the midline and the right and left sides are sutured together via a variety of techniques and then tightened in the back. The incision in the front is then closed and the skin is advanced in a posterior – behind the ear direction, to eliminate the loose skin.
What is the recovery time for the Necklift procedure?+
For most patients who are correct candidates, the recovery involves very little discomfort and minimal swelling. Most patients are able to return to work within a week. For more information to see if the neck lift is right for you, please see your Plastic Surgeon.
What is causing my face to look “Hollow” as I age?+
Below the skin sitting on top of and around the muscles, is a collection of fat pads. The volume of the different fat pads changes with the aging process. Some compartments tend to decrease in size while others increase and some remain the same. Fat regions that decrease in size tend to produce characteristic hollowing of the aged face. These are located in the temples, in the cheeks and in the chin. As they sit next to areas that may stay the same or increase, this accentuates what patients see as the jowl, parentheses lines (nasolabial folds), and marionette folds.
How does loss of bone thickness effect skin sagging?+
In addition to changes in fat pad volume, the face also undergoes loss of bone thickness. This is seen in the orbit, the bones that hold the eyes in position, and in the maxilla and mandible, the bones in the central portion of the face and jaw. The sagging in the face that accompanies aging is due partially to this loss of volume. The skin and soft tissue structures do not shrink so this larger envelope now sags on a smaller frame.
What surgery options do I have to restore Face Volume?+
True rejuvenation aims to reset the clock of aging by restoring volume. This can be done surgically with fat transfer or, it can be done non-surgically with Sculptra Injections.
Sculptra™ is made from the same material as absorbable sutures. It comes as a powder that the Dr. Schneider mixes with water and xylocaine (a local anesthetic). When Sculptra™ is injected into the soft tissues it stimulates the body to produce new collagen. This new collagen adds volume to the region where the product was injected.
Gradually, over six weeks, Sculptra™ works its magic and the body gradually produces collagen to fill in the regions treated. In numerous studies, Sculptra™ has been demonstrated to last a minimum of two years. Most plastic surgery patients will occasionally come in for a touch up of volumization as they see the continued effects of the aging process.
What is a Facelift?+
A face lift is a surgical procedure designed to lift and correct the sagging in the face that occurs as a result of aging. Not every patient sees the same problems in their face and so the facelift family of procedures needs to be tailored to the patient’s individual problems and their goals. A facelift is a generic term that can cover several different regions of the face.
What regions of the face is a Facelift performed on?+
Plastic Surgeon’s divide the face into the upper region called the brow, the eyelid region that is sub-divided into the upper and lower eyelids, the mid-face region that runs from the cheeks to the jawline, and the neck that runs from the jawline to the collarbone. A facelift can include all of these regions or it can be broken down into individual regions based on a patient’s choice.
What are the most common Facelift procedures?+
Most commonly, patients considering a lifting procedure often choose to have the mid-facial and neck region performed together. This combination rejuvenates the loose skin and fat from the neck (often times called a turkey neck), the jowl, and the nasolabial folds (parentheses lines). Often the outside part of the eyebrow region would also benefit from elevation and the lateral browlift accomplishes this. For most patients, this is what is considered a facelift.
Should I get a Facelift and Volume Restoration?+
As the face ages, it loses volume in the bone and volume in the fat of certain regions. This causes the surrounding tissues and skin to sag. If the volume loss is small and the sagging minimal, then sometimes volume restoration alone, performed with fat injections, is enough to produce the desired result. Many times, a combination of lifting techniques and volume restoration is necessary to produce a natural, youthful, rejuvenation. One technique, one type of plastic surgery, is never the standard technique used for every patient. When considering a facial rejuvenation procedure, meet with your surgeon, discuss what you see as your goals, and make sure the approach addresses your desires.
Should I wait to have a Facelift?+
Ideally, it would be great if patients never needed surgery for facial rejuvenation. What we do, and what we recommend, depends upon the aging changes that we see in each individual face. As plastic surgery technologies advance, there are more and more options that allow us to put off the need for delay the need for a facelift.
These include treatments to restore volume that has been lost due to aging, noninvasive, painful, non-surgical treatments that shrink the jowl and tighten the neck, and changes we can make in the skin to eliminate wrinkles. Usually, these noninvasive technologies and treatments can restore many of the characteristics of the youthful face. When they are used on a patient who is just starting to have aging changes, they can maintain a youthful look for many years.
What types of Face Injectables are available?+
There are several different things that we can inject into the face to create a more youthful look: fat, Botox, Juvederm, Restyline, Artifil, Sculptra, Belotero, and many more volume adding and muscle stimulating procedures. What we choose is based on the specific findings in the face that we see. Several products are specifically used for wrinkles and these include Botox, juvederm, restyline, and belotero. Botox, which is similar to Xeomin, and Dysport, temporarily paralyzed the muscles which create wrinkles in the forehead, crows feet, between the eyebrows, and under the eyes.
What are Face Volume Fillers?+
Face Volume Fillers are used to actually fill out a wrinkle to make it less noticeable. These can be used anywhere on the face and depending on the product used as long as one year. Dr. Schneider’s favorite in this group of products is Jupiter because it is the most comfortable for the facial rejuvenation patient when injecting, and he thinks has the smoothest results.
What are Deep Volume Face Fillers?+
The last group of injectables or deep volume fillers. As the face ages who tend to lose fat, and bone that makes the face look smaller and more drawn. These volume losers volumizers can restore this lost volume and make the face look more youthful. In this category, fat injections will last the longest and for many patients fat will last the rest of their life. Sculptra is another volumizer that has a very long lifespan, lasting for most plastic surgery patients over two years. Voluma is a very quick deep volumizer that is used over the cheekbones to restore this volume and lasts about one year.
How Does EXILIS Fat Reduction and Skin Tightening Work?+
EXILIS is an FDA approved treatment for non-surgical fat reduction and tissue tightening anywhere in the body. The procedure uses radio-frequency energy to target fat cells for shrinking, and tissue collagen for skin tightening.