Eyelid Surgery (Blepharoplasty)

 

Blepharoplasty, or eyelid surgery, can enhance your appearance and your self-confidence by removing droopy or sagging eyelids. As people age, the eyelid stretches, muscles weaken, and fat accumulates around the eyes, causing "bags", or excess skin to become prominent. During your consultation, the doctor will assess which of the four eyelids (top and bottom for both eyes) require surgery.

 

The best candidates for eyelid surgery are men and women who are physically healthy, psychologically stable, and realistic in their expectations. Generally patients for this procedure are 35 years or older. However, if sagging eyelids runs in your family, it is possible to have eyelid surgery at a younger age.

 

Eyelid surgery is performed under general or local anesthesia. If your doctor chooses local anesthesia, he will numb the area around your eyes, along with giving you a mild oral or IV sedative. The actual surgery takes one to three hours. The incisions made during the surgery follow the natural lines of your eye.

 

As with any procedure there is the possibility of complications occurring. For eyelid surgery, these include infection, or a reaction to the anesthesia used. Minor complications that commonly follow eyelid surgery include double or blurred vision for a few days, which is caused by swelling at the corner of the eyelids, and slight asymmetry in healing or scarring. Following surgery, some patients may have difficulty closing their eyes when they sleep. Adhering to the physician’s advice on pre- and post-op care will greatly reduce the risk of complications.

 

After your surgery, you may feel tightness in your eyes. An ointment and a bandage will cover your eyes, and a cold compress and elevation will help keep the swelling and bruising down. For the first few weeks following your surgery, you may also experience excessive tearing, sensitivity to light, and temporary changes in your vision such as blurring or double vision. Your stitches will be removed 2 to 7 days after your surgery.

 

 

Endoscopic Forehead/Brow lift

 

A forehead lift, or brow lift, is designed to reposition sagging eyebrows that can cause a person to look tired, sad or angry. Endoscopic brow lift, or forehead lift, is the most common endoscopic procedure used by cosmetic surgeons. With this method, instead of the usual ear-to-ear incision, two or more tiny incisions, or "puncture type" incisions are made just at the hairline. The eyebrows are then repositioned to a higher level, resulting in a more relaxed, refreshed and youthful appearance.

 

The best candidates for a forehead/brow lift are:

• Sagging or low position of the eyebrows creating a tired or sad appearance.
• Deep horizontal creases across the forehead.
• Frown lines, or furrows between the eyebrows and top of the nose.

 

Endoscopy is a surgical procedure that uses a tool called an endoscope, a special viewing instrument that allows your doctor to view images of the patient’s internal structures with minimal incisions. Endoscopy has been used in a number of different procedures, including gallbladder removal, tubal ligation, and knee surgery. Now the procedure is being used for cosmetic plastic surgery applications, in place of techniques that may leave behind undesirable, or excessively visible scars.

 

As with any surgical procedure, there is always the possibility of side effects occurring. Some side effects of a brow lift include infection, fluid accumulation under the skin, which may need to be drained, blood vessel damage, nerve damage or loss of feeling, internal perforation injury, and skin injury. Despite the known risks, endoscopic surgery complications are rare and it must be noted that endoscopy has been used successfully for decades in orthopedic, urologic, and gynecologic procedures, and the technique is continually improving. 

 

BEFORE	AFTER	BEFORE	AFTER
Brow Lift (Upper & Lower Eylid Surgery) DESCRIPTION: 52 year old wished to have appearance about her eyes improved. She liked the look when elevating the outer aspect of the eyebrow with her finger. G.N. was 5'4" and 117 lb. Patient had no recollection of the surgery after IV sedation by Dr. Pertsch. 'After' photographs taken 3 months one week after surgery. Patient also had upper and lower eyelid procedure at the same time.

 

 

Facial Implants

Men and women who wish to enhance their facial features may turn to this procedure. Facial implants can enhance your image as well as your self-esteem. Facial implants can help bring balance to the features of your face. These implants can bring the chin or cheekbones into balance or help define your chin. Others may use facial implants as a cosmetic enhancement to help bring a more youthful appearance to their aged face. Facial implant surgery can be performed alone, or in conjunction with a normal face lift. During facial implant surgery, your doctor may use local or general anesthesia, depending on the severity of the surgery.

 

The following is a brief description of the various facial implant procedures available. Each of these implants, in their own way, can bring your facial features into balance. During your consultation, the doctor can examine your current facial features and determine which implants will best serve your needs.

 

Chin Augmentation

Chin implant surgery may take 30 minutes to an hour. Your doctor will decide on the proper implant size, and insert it into a pocket over the front of the jawbone. The incision may be placed on the inside of your mouth, or in the skin just under the chin. Your sutures will be removed with in 5 to 7 days. Some swelling and discomfort may be present, and you may find it difficult to smile or talk.

 

BEFORE	AFTER	Chin Augmentation DESCRIPTION: Chin Augmentation: 31 year old male seeking improved profile: chin augmentation with silastic anatomical implant placed via incision hidden inside the mouth. Also: liposuction under his chin and neck.

 

Cheek Augmentation

Cheek implant surgery may take 35 to 45 minutes. If a cheek implant is being done in conjunction with another type of face lift procedure, the same incisions may be used; otherwise a small incision may be made inside your upper lip, or under your lower eyelid. Following surgery, your doctor will inform you of any dietary restrictions, as well as limitations. The ability to move your mouth and lips may be difficult for a few days.

 

BEFORE	AFTER	Cheek (Malar) Augmentation DESCRIPTION: 36 year old wished to reduce appearance of long, thin face. 5 foot 7 inch tall 160 lb. man underwent malar and submalar augmentation using Implantech Malar Shell size large via intraoral approach (incision just above the gum line inside the mouth). Patient had no recollection of surgery after IV local anesthetic technique by Dr. Pertsch. Post op photos taken 1 year and 11 months after surgery (patient had Dr. Pertsch touch-up another surgeon's rhinoplasty 1 year before these pictures were taken).

 

Lower Jaw Implants

Lower jaw implants usually take between 1 and 2 hours. Incisions are made inside the lower lip, and dissolving sutures are used. After your surgery, swelling may peak at 24 to 48 hours. Prolonged swelling may occur for several months. Your doctor will inform you of any dietary and exercise restrictions.

 

Otoplasty (Prominent Ear Reduction)

 

Otoplasty is a procedure designed to pin back the ears closer to the head or reduce their size. This procedure can be performed on younger individuals to avoid being teased from others. This results in more natural-looking ears. The otoplasty procedure varies with every patient and their degree of ear deformity.

 

The operation usually takes about two to three hours and is performed in an outpatient setting under general or local anesthesia with sedation. During the operation, an incision is made behind the ear to hide any obvious marks of surgical intervention. Multiple, strategically placed, sutures are placed to shape the cartilage into normal folds, which were missing pre-operatively. The cartilage is then reshaped using techniques of scoring, suturing, limited removal or combinations of the three.

 

The reshaped framework is then repositioned to achieve the best balance with the opposite side and to reduce excessive projection. The skin is redraped, any excess skin is removed, and the incision behind the ear is closed. A gentle pressure dressing is placed to prevent excessive fluid accumulation beneath the skin.

 

To reduce the swelling or collection of fluid beneath the skin, you'll have a dressing on your head to put gentle pressure on your ears and maintain their new position. After about two or three days, the dressing will be removed, and all of your incisions will be carefully closed with stitches. Some of the suture will dissolve while other sutures will require removal in 7 to 10 days. You'll be able to wash your hair as soon as your head dressing is removed on the second or third day after surgery.

 

Most patients experience very little pain following their procedure. There will be slight discomfort or soreness, mostly when you bump or move your ears. This will be for about a week or two. You'll notice some swelling in the ears for two to three weeks following surgery. Most bruising will resolve in the first week or two. During this time, you can cover your ears with your hair.

 

BEFORE	AFTER	Setback otoplasty DESCRIPTION: J.M. a 32 year old mother of 2 always wore her hair down to hide prominent ears. Post op photos taken 3 years 8 months after surgery.

 

 

Facelift

 

The facelift (rhytidectomy) is a surgical procedure designed to smooth the loose skin on your face and neck, and to reduce the most apparent signs of aging in the facial area, giving you a more youthful appearance. The procedure involves reducing the creases from the nose and mouth, the slacking jaw line and sagging jowls and fat deposits around the neck by removing excess fat and tightening underlying muscles, then redraping the skin on the face and neck. Although the procedure cannot stop the aging process, it can turn back the clock on your facial appearance, giving you a younger, fresher look, which can also have a positive effect on your self-confidence.

 

The best candidates for a facelift are those who:

• Have face and neck skin that has begun to sag, but still possess good skin elasticity and whose bone structure is strong and
  well defined.
• Experience the loss of a well-defined jaw line.
• Have deep wrinkles in the cheeks.
• Have loose skin, wrinkles or excess fatty tissue in the neck.

 

A facelift is performed by generally making an incision around the natural contour of the ear, and around your earlobe along your hairline. This helps keeps any scarring from being visible. Any incision can be easily masked by make-up or hair. If a neck lift is performed, you may have a small incision under your chin. After your surgery you may have a drain tube to allow excess fluid to drain from the incision. Your bandage will stay in place for 1 to 2 days. You may experience some increased swelling in the first 24 to 48 hours after your surgery. Most bruising will subside in about 2 weeks. Some numbness may occur, and your stitches will remain till your 1-week visit.

 

Since each individual has his or her own unique facial features, physical reactions and healing abilities, the results of a facelift vary with each patient and they are never 100% predictable. During a facelift, complications are infrequent and usually minor. Some complications that may arise include hematoma (blood under the skin that must be removed by your doctor), injury to the nerves that control facial muscles (usually temporary) infection, and reactions to the anesthesia. Smokers are more likely to experience poor healing of the skin.

 

BEFORE	AFTER	Facelift & neck lift DESCRIPTION: 58 year old woman considering facial improvements for years. The last 2 years she thought more seriously about facial improvements. Also: upper and lower eyelid (blepharoplasty) and forehead (browlift) procedures

 

 

Rhinoplasty

 

Surgery of the nose is one of the most common of all plastic surgery procedures. There are individuals who have been unhappy with the appearance of their nose for their whole life, and there are individuals who have had their nose altered as a result of injury. Rhinoplasty offers a solution to these individuals. The best candidates for a rhinoplasty are those people who are looking for an improvement in the way they look, not those searching for perfection. There are many ways rhinoplasty can improve upon one’s nasal appearance. This surgery can reduce or increase the overall size of your nose, change the shape of the tip or bridge, narrow or widen the nostrils. Not only can rhinoplasty enhance appearance, it can also help improve one’s breathing. The consultation is an important part of the process because it allows the doctor to examine the current state of the nose and determine what can be done to enhance its appearance.

 

The rhinoplasty procedure usually takes an hour or two, though more complicated procedures may take longer. The surgery starts with the skin of the nose being separated from its supporting framework of the bone and cartilage, which is then sculpted to the desired shape. The skin is then redraped over the new framework. After the surgery is complete, a splint is then applied to help the nose maintain its new shape. Nasal packs or soft splints may be placed in the nostrils to stabilize the septum; this is the dividing wall between the air passages.

 

After surgery, during the first twenty-four hours, the face will feel puffy, the nose may ache, and the patient may experience a dull headache. The patient should plan on resting with their head elevated for the first day. There will be swelling and bruising around the eyes, reaching a peak after two to three days. By the end of one week all packing, dressings, splints and stitches should be removed and the patient is able to return to school or work. It will be a few weeks following surgery before patients can resume more strenuous activities. Healing times vary with patients.

 

BEFORE	AFTER	BEFORE	AFTER
Rhinoplasty DESCRIPTION: 28 year old sought aesthetic improvement of her nasal appearance as well as improved nasal airway. Before surgery she felt her nose looked bigger when viewed from the right side. She wanted it less rounded from the side view. Examination revealed the nose crooked, deviated to the right. The tip was lower than the 'hump' of the nose giving the rounded side view she didn't like.   She always had trouble breathing from the left side of her nose. Breathing was worse at night. Internal exam revealed the septum (a midline supporting structure) shifted to the left and partially blocking the airway. Because of the combined airway and cosmetic procedures performed at the same operation general anesthesia was selected (anesthesiologist present).   After photos taken 1 year 2 months after surgery.

 

 

 

Buccal Fat Pad Removal

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Chemical Peel

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