Plastic Surgery FAQ

Facelift FAQ

What can I expect from a face lift?
A lower face lift treats hanging skin on the neck, jowl and cheek area. Areas of the forehead, eyes, nose, upper and lower lip are not improved by the lower face lift procedure. Other surgical procedures may be needed to improve those areas. Fine lines and wrinkles, as well as texture and tone problems are not improved with face lifts. Despite these limitations, most patients have an improved facial contour, and appear rejuvenated and rested after a face lift.

How old should I be when I get my first face lift?
There is no correct age for obtaining a face lift. The time for your first face lift is based on whether the lift can correct your concerns. As a general rule, patients today are obtaining face lifts earlier. Doing a face lift at a younger age (your 40′s) will give you a more natural appearing and longer lasting result. Performing face lifts at a later age will provide more dramatic results since the needs are greater.

What is a two-layer face lift?
Early face lifts involve skin re-draping without underlying muscle tightening. Most surgeons today perform a double- layered face- lift involving removal and re-draping of excess skin, as well as underlying muscle tightening. This technique allows for a more natural, and possibly longer lasting result. It restores not only the aging skin, but also the position of the aging muscles.

How long does a face lift last?
This question is probably the most commonly asked question during consultation. face lift surgery does not prevent the aging process. It simply resets the clock for an earlier time. However, there are some factors that will change the longevity of the lift. The condition of the skin is a major contributing factor. Skin that has lost elasticity through age, sun damage, smoking, and weight fluctuation will tend to recoil back to the pre-operative state sooner than more elastic skin. Younger, more elastic skin will maintain the longevity of the face lift. Some patients with severe skin elasticity problems may require an earlier secondary lift to obtain a desired result. Some surgeons over-correct the lift to allow for differences in skin type and skin quality. However, this must be done judiciously to avoid an unnatural result.

What can be done to avoid an unnatural, pulled appearance after a face lift?
The resulting face lift is directly related to the skin quality and underlying structure of the face, as well as your surgeon’s ability and artistry to carry out the desired result. Performing both skin and muscle tightening should aid in a natural appearing lift. It is important that your surgeon not only removes excess skin, but also rotates and re-drapes the facial skin correctly. Your surgeon’s understanding of aging vectors is necessary to provide you with a natural result.

What can I do to maintain the results of my face lift?
Unfortunately, the aging process is not halted by a face lift procedure. Sun avoidance, maintaining a stable weight, and not smoking will help to keep your face youthful. Also, a skin care program may help maintain and improve your skin, resulting from sun-damage, and environmental pollutants.

What is a Liquid Facelift?
The term “liquid face lift” refers to a non-surgical procedure that comprises Botox for the upper face, dermal fillers like JuvédermTM and Restylane® for the lower face and cheek area, skin rejuvenation with lasers and lights, and possibly non-surgical skin tightening.

Eyelid FAQ

Can hooded eyelids interfere with vision?
Upper eyelids, with time and gravity cause an excess or visor of skin, known as hooding. The hooding can be so severe that it obliterates the upper eyelid skin crease, and may interfere with peripheral vision, particularly when looking upward. Patients compensate for this by unknowingly lifting their eyebrows. This compensation can lead to eyelid strain and headaches, and in addition, result in an aged or crowded eye. Upper eyelid surgery, and in some cases a brow or forehead lift, can be used to correct this condition.

What can be done for dark circles under my eyes?
Dark circles may be treated by lower eyelid surgery if it results from shadowing due to bulging fat or bags. If the dark circles result from pigmentation changes of eyelid skin, skin bleaching creams or light chemical peels may improve this condition.

How old should I be to undergo eyelid surgery?
There is no correct age for obtaining eyelid surgery. Excessive skin in the upper lids, or bulging fat in the lower lids are commonly seen with signs of aging. However, young adults in their late teens or twenties have similar complaints (due to inherited traits) which may be corrected as well.

When should eyelid surgery be combined with a brow lift?
When the upper eyelids age, the skin looses its elasticity. In addition, the forehead and eyebrow position drops contributing to upper eyelid hooding. If brow ptosis (droopiness) is significant, a forehead/brow lift combined with upper eyelid surgery may be indicated.

What is done during eyelid surgery?
When performing this delicate surgery there are four lids: two uppers and two lowers. Upper eyelid surgery is performed by removing mainly excessive skin, and to a lesser extent fat, to contour the upper lids. When performing lower eyelid surgery, protruding fat is removed, as well as a minimal amount of skin. This procedure will improve over-hanging eyelid skin in the upper lids, and remove bags in the lower lids. Fine lines and wrinkles, as well as “crows feet” will have minimal improvement.

Will the shape of my eyes look different?
When performing eyelid surgery the globe (eyeball) is not altered. However, lid skin, or the framework around the globe is altered. Changing the frame around the globe will make the eye appear more open, rounder, and less tired. Eyelid surgery will not give you the “surprised” look.

Rhinoplasty FAQ

Why do patients undergo nasal surgery?
Nasal Surgery is a method used to reshape the nose, and/or correct a nasal airway obstruction. Reshaping the nose is done for one of two reasons: a traumatic nasal deformity in which an undesirable shaped nose is a result of an injury, or a cosmetically unacceptable deformity resulting from inheritance. A septoplasty (SMR) should not change the shape of the nose; rather it is performed to correct an obstructed nasal passage causing difficulty in breathing. However, in some cases, if your nose is crooked, septoplasty will help straighten the nose.

How can I be sure that my surgeon will sculpt my nose to my liking?
It is almost impossible to guarantee the results of Nasal Surgery. Through experience, your surgeon will be able in most cases, to predict the desired improvement. Your surgeon should be able to show you photographs of his/her work performed on previous Rhinoplasty patients. Remember, it is important to evaluate the surgical outcomes based on the difficulty of the pre-operative nose. It is also important for the surgeon to create a nose that fits, or is in proportion to the rest of the face. Nasal Surgery is one of the most difficult procedures in cosmetic surgery. It requires artistry, experience, and the ability to think in three dimensions. With today’s new and advanced techniques, the “operated look” should be a thing of the past.

How long will it take for my nose to heal?
Nasal Surgery is usually an operation that involves tip sculpting, as well as changing the shape of the dorsum (requiring nasal bone fracture). The nose is usually splinted and packed. The packing is usually removed within one to five days. The splint stays in place for one week. The majority of swelling and bruising should resolve within three weeks. The final result of your Nasal Surgery should be evaluated in one to two years. The nose will continue to remodel and change shape over a one to two year period of time.

I have a flat bridge with a full nasal tip and wide nostrils. What can be done to make my nose less ethnic and more “westernized”?
Special techniques in Nasal Surgery have been performed on ethnic noses to correct a low, flat dorsum, sculpt the tip, and narrow the nostrils. A technique known as Augmentation Nasal Surgery is used to add bone, cartilage, or synthetic materials to obtain the desired result.

When can my child undergo Nasal Surgery?
It is important to allow the nose to fully develop before performing Nasal Surgery. Most surgeons perform Nasal Surgery on patients at age sixteen. However, the decision to perform Nasal Surgery is based on nasal development. Nasal Surgery changes the way a patient looks unlike other facial cosmetic procedures which makes the patient look more youthful. It is important, as with all teenage surgeries, that the patient has the maturity to accept his/her new body image.

Will my insurance company pay for Nasal Surgery?
Insurance companies should pay for the correction of deformities that result from injury or trauma. They also should pay for medical conditions such as breathing difficulty. They will not pay for cosmetic deformities. However, with the philosophy of medical cost containment, and managed care, insurance companies have been making reimbursement for Nasal Surgery more difficult. It is therefore prudent for the patient to inquire about surgical fees, anesthesia fees, as well as operating room fees before surgery so that the patient may better understand his/her financial responsibilities.

Ear Pinning FAQ

How long do I have to wear bandages after otoplasty surgery?
When I perform otoplasty on adults I recommend head dressings for seven days. When the procedure is done on children I recommend had dressings for 14 days. After the head dressing is removed I recommend wearing a headband at night for 6 to 8 weeks. The head dressing and headband allows the ear to remain close to the head while the healing takes place.

After my otoplasty when can I work out?
You can start working out at three weeks after your surgery.

Does otoplasty or ear surgery affect my hearing?
Otoplasty reshapes or contours the external ear it has no effect on your ability to hear.

Torn Earlobe FAQ

How can I prevent my earlobe from tearing in the future?
Torn earlobes can result from wearing heavy earrings, sleeping with your earrings in place, persistent infections as a result of reactions to certain metals that are used to make your earrings, piercing the ears to low on the earlobe, wearing hoops or other dangling earrings that are pulled upon. An awareness of the causes of torn or elongated earlobe holes will prevent the need for a second surgical repair.

How long does the procedure take and what type of anesthesia do I need?
Torn earlobe repair takes approximately 20 min. per ear and can be done as an office procedure under local anesthesia.

After my earlobe repair when can I pierce my ear?
Your ear can be pierce eight weeks after the repair. Sutures that are placed at the time of the repair are removed at two weeks. It is my recommendation to pierce you ears using earrings that are studs and light weight. The earrings must remain in place for six weeks to allow the hole to mature and prevent re closing.

How many times can I repair my torn earlobe?
If recurrence occurs the earlobe can be repaired more than once. It is important to understand with each repair the earlobe will become smaller. As a result of multiple injuries and repairs the earlobe may not have the best anesthetic result. Prevention of future tears is prudent.

Breast Implant FAQ

Do breast implants interfere with mammograms?
It is more difficult to detect breast cancer on a patient who has breast implants. The technician uses additional views and special techniques to locate suspicious breast lesions. It is important to know that breast implants do not increase your chances for developing breast cancer.

Can I breast-feed with breast implants?
Women with breast implants can breast-feed. However, not all women are able to breast-feed with or without implants. The implants will not hurt the infant or the ability to produce milk. From a cosmetic point of view, breast-feeding may alter the shape of the breasts. However, for the best interest of the infant, breast -feeding is recommended for maternal bonding and infant antibody production.

What will pregnancy do to my implanted breasts?
Pregnancy causes undesirable changes in female aesthetics. There are factors that increase the possibility for changes such as increased age, excessive weight gain, and breast-feeding. Most patients will have a cosmetically acceptable breast shape after pregnancy. A small percentage may need additional surgery to maintain breast beauty, but this is independent of your decision to undergo breast enlargement.

Do breast implants cause autoimmune or collagen vascular disease?
There is no clinically proven increased incidence of auto immune or collagen vascular disease in implanted women. The development of such diseases is independent of breast implants.

How can I determine breast size?
Chest dimensions and preference determine breast size. There is no correct breast size. Most women prefer to be a ‘C’ cup size. Implant sizes are measured in volume ( 200cc’s, 300cc’s etc). Remember, your new size is a combination of your current breast size plus breast implant volume. Excessively large breasts tend to look unnatural and may lead to shoulder and neck discomfort.

Are saline breast implants safe?
As with any surgery complications can arise. Breast implants are foreign bodies and therefore are not naturally occurring. However, saline implants are particularly safe. In the event of a rupture, the body simply absorbs the salt -water solution. The silicone envelope tends to be stationary in the breast pocket and can easily be removed or replaced. At the present time there is no known illness associated with saline-filled implants. There are more than two million women with implanted breasts. Most women are happy with their results.

What happens if my saline implants rupture?
The replacement of a saline-implant (unlike silicone implants) is relatively simple. The surgeon can usually go through the same incision, remove the deflated bag, and replace it with a new implant. The operation is usually quicker and with far less discomfort than the original surgery.

What happens if I want to remove my implants when I am older?
From my experience, most women do not opt to remove their implants. However, if implants are removed at a later time, the breasts are older and also have been stretched by the implants. When the implants are removed, the breasts may look droopy and will definitely be smaller. Some patients may have a cosmetically acceptable breast mound and nipple position, while others may need a breast lift.

What happens if I am unhappy with my breast size?
After surgery, some patients are initially concerned about breast size. They may be nervous that the breasts are too big, while others are concerned that the breasts are too small. My suggestions to my patients are to wait a minimum of six months to one year to allow the breasts to drop and take a more normal shape, as well as allow sufficient time to adjust to this change. If after a one -year period, the patient is still unhappy, implants can be exchanged for a larger or smaller size.

Should I have my implants placed over or under the muscle?
In most cases, I recommend placing implants under the muscle for the following reasons: there is more padding of the implant under the muscle thereby leading to less rippling, and a more natural feeling breast and it is easier to detect a breast mass on mammograms. Also, this method provides more support to the implanted breast giving an improved shape over a longer term. However, it may be necessary to place the implants under the breasts (sub-glandular) in particular cases. Sub-glandular placements are usually recommended for patients who have droopy breasts and refuse breast lifts. These patients tend to have more breast tissue and therefore are able to pad the implant. There is however, less discomfort when the implant is placed sub-glandular, as compared to under the muscle.

Which implant type should be used?
Each surgeon has his/her own opinion about implant type and manufacturer. Two popular U.S. companies are Mentor and McGhan. Implants can be round or pear shaped, textured or smooth. A study that compared pear shaped to round implants demonstrated the round implant is more like a natural breast than the pear shaped implant when placed in the body and subjected to positional changes. It is the opinion of Dr. Farella that smooth, round implants, when properly filled and placed under the muscle have less rippling and appear more natural in most cases. At the time of consultation implant type and manufacturer can be individualized to your needs.

What is your opinion about silicone implants?
Silicone implants are superior when compared to saline implants as far as feel and look. The FDA recommends that silicone implants should not be used for primary breast enlargement. However, permission to use these implants can be obtained through special studies for various situations. Silicone implants can be used on secondary breast enlargements, enlargements with breast lifts, and for breast reconstruction through controlled FDA studies. Since silicone has been used medically in the body and ingested as a legal food additive, there has not been an epidemic of silicone toxicity. Even saline implants have silicone as the outer shell or envelope. Since the bankruptcy of Dow Corning, studies have supported the safety of silicone. Dr Farella has operated on several ruptured silicone implanted patients. At the time of rupture, the silicone is gelatinous and difficult to remove unlike saline implants. Since the ruptured silicone implants are less contained, it acts more like free silicone. Migration may be more of a factor. As a result, Dr. Farella rarely uses silicone implants. If silicone implants are used, it is recommended to change the implants every ten years.

What happens if I want to remove my implants when I am older?
From my experience, most women do not opt to remove their implants. However, if implants are removed at a later time, the breasts are older and also have been stretched by the implants. When the implants are removed, the breasts may look droopy and will definitely be smaller. Some patients may have a cosmetically acceptable breast mound and nipple position, while others may need a breast lift.

Breast Lift FAQ

How can I tell whether I need breast enlargement or a breast lift?
Patients undergo breast enlargement by placing implants to increase the size of their breasts, as well as improve the shape. However, breast enlargement will not improve nipple position or lift the breast mound. A Mastopexy (breast lift) will improve nipple position, nipple diameter, and breast mound contour, but will not increase breast size. In fact, a mastopexy may reduce the size of the breast mound due to skin removal and breast tissue compression. Women who want larger breasts as well as improved nipple position may need a combination of breast implants with a breast lift.

How long will my breast lift last?
As with any cosmetic surgery procedure, the aging process does not stop. Due to time and gravity the breast will continue to drop. Breast lifts tend to last longer on smaller breasted women. After a breast lift, fluctuations in weight as well as pregnancies may alter the results. Most women opt for this surgery after having their last child.

Does the nipple need to be completely removed before repositioning it?
In a breast lift procedure the nipple is not completely removed. It is left attached to its underlying dermal blood supply. An appropriate amount of skin is removed, the nipple is lifted, and the skin brassiere is tailored to the desired shape.

What type of scars should I expect from a breast lift?
Unfortunately, in an effort to improve nipple position, diameter, and breast shape, resulting scars are expected. The patient is thereby trading improved breast shape and nipple position for permanent visible scars. The resulting scars will be hidden under the patient’s bra. Scars may heal unpredictably, ranging from a thin, flat, hardly noticeable line, to a thick, raised pigmented line or scar. Depending on the severity of the droopy breasts, the surgeon will modify the incisions as needed.

Breast Reduction FAQ

Why do patients undergo breast reduction surgery?
Patients who undergo breast reduction are usually large breasted women who are self-conscious about breast size, and complain of neck pain, shoulder pain, breast pain, and shoulder bra strap grooving. Patients undergo breast reduction to reduce the size and weight of the breasts, and to alleviate their breast complaints. Breast reductions not only alleviate symptoms, but also improve nipple position, nipple diameter, and breast shape.

Does the nipple have to be completely removed when performing breast reduction?
Only in rare cases is the nipple completely removed. Most breast reductions leave the nipple on its dermal blood supply, removes breast tissue, repositions the nipple at a higher level, and tailors the skin brassiere. In essence, breast reductions are partial breast tissue removal with a breast lift.

Are the results permanent?
After breast reduction, your breasts should remain permanently smaller, however, weight gain/loss will affect breast size.

What scarring should be expected from breast reduction surgery?
Expected results from breast reduction surgery are scars that should be considered permanent and visible. These scars are hidden under the patient’s bra. The standard scar follows an anchor pattern. Scars from breast reduction surgery are unpredictable. They range from a thin, flat, linear scar to a raised, thick, pigmented scar.

Will insurance companies cover breast reduction surgery?
Insurance companies should cover procedures that cause medical conditions such as neck pain, back pain, breast pain, and spinal arthritis. Breast reduction surgery is known to alleviate these complaints and medical conditions. However, with the philosophies of medical cost containment, and managed care, insurance companies have made it difficult for physicians to obtain reimbursements for these procedures. It is therefore prudent for patients to obtain surgery fees, anesthesia fees, and operating room fees prior to surgery so that they better understand their financial responsibility.

Tummy Tuck FAQ

Can I get pregnant after a tummy tuck?
Yes. You can get pregnant after a tummy tuck without injury to yourself or to the infant. It is recommended however, to perform tummy tucks after childbearing to maintain the surgical result.

How do I know if I need a tummy tuck?
Abdominoplasty (tummy tuck) is used to remove skin and fat, and to tighten the muscles of the abdominal wall. Tummy tucks are used for patients with weakened abdominal wall muscles due to pregnancy or fluctuations in weight, and patients with excessive and hanging abdominal skin. For patients with localized fat and good skin tone liposuction is recommended. Abdominoplasty may be done on both men and women.

If I am obese can I still have abdominoplasty?
The decision to perform abdominoplasty on an obese patient is a judgment call by the surgeon. Most surgeons would recommend weight loss or liposuction prior to cosmetic abdominoplasty. Remember, liposuction and abdominoplasty cannot reduce fat in and around abdominal organs. There is a procedure used for morbidly obese patients with excessive fat and skin. This procedure is called a Panniculectomy. This is usually done to treat severe cases where hanging skin causes rashes, irritation, and personal hygiene problems.

Can abdominoplasty get rid of old scars and stretch marks?
Yes, depending on their location. Abdominoplasty can permanently remove stretch marks and scars of the lower abdomen beneath the umbilicus.

When can I resume sex?
You may resume gentle sexual activities after three weeks.

When can I resume exercise?
You should refrain from doing any abdominal exercises for two to three months. However, you may resume mild exercise (walking) within three weeks, gradually increasing your exercise program over time.

Liposuction FAQ

Who are ideal candidates for liposuction?
Liposuction is the permanent removal of fat cells from under the skin. Ideal candidates are patients who have localized fat under the skin and good skin elasticity. Patients should be on a diet and exercise program. Patients with generalized obesity or fat inside the abdomen are not good candidates. As with all cosmetic procedures patients should be in good health with realistic expectations.

What happens if I gain weight after liposuction?
Since liposuction permanently removes fat from a specific location, weight gain will shift to another target area. The new target area of weight gain may be desirable or undesirable. Therefore, maintaining or loosing weight after liposuction is imperative. It is important to know that weight loss/gain is a factor, but changes in percent body fat are also important. Liposuction is a body sculpting technique and is used for contouring not weight loss. Liposuction should compliment a proper diet and exercise.

What happens to the skin after liposuction?
Since liposuction will not tighten skin or develop muscle, the result will depend on the skin’s elasticity to regain its usual shape. For patients with loss of skin elasticity due to fluctuations in weight, sun damage, and pregnancies, liposuction may not be an option. Other techniques, such as abdominoplasty and lifts may be better options.

How do you know how much fat to remove?
The amount of fat to be removed is based on the surgeon’s experience. However, there are guidelines that surgeons use. A patient is marked in the upright position. Areas of excessive fat are carefully marked out. The amount of fat removed is estimated and measured. Using feel as well as the surgeon’s aesthetic eye, body contouring is performed. Fat removal is limited to 5,000 cc’s per operation for safety reasons. If additional fat removal is needed (which is rare), subsequent surgeries may be necessary.

Will I lose weight from liposuction?
Weight loss from liposuction is minimal. Most patients will notice an improved body contour and loss of inches rather than pounds. Patients can expect an improvement in body shape, and will probably fit in their current dress size more comfortably or even drop one size or two. As would be expected, liposuction does not improve the cardiovascular status of the patient. Exercise and diet is recommended.

Can liposuction eliminate cellulite?
Liposuction is generally not used for elimination of cellulite. Since cellulite appears to be a skin dimpling and skin contour problem, removal of fat will not improve skin quality. However, some patients have stated they have noticed an improvement. At the present time, the only modality to improve cellulite is endermology. Endermology involves several treatments with a sucking and rolling massage. In order to maintain the results from endermology, continued use of this procedure must be followed.

In your opinion, which type of liposuction technique is recommended?
Most surgeons would agree that super-wet tumescent liposuction should be used. This technique reduces blood loss and aids with intra and post- operative pain. As with any procedure, experience with this technique is mandatory. Liposuction has been performed by using suction alone, ultrasound-assisted, or using powered-assisted devices. The use of these techniques can provide similar results in trained hands. Dr. Farella, at the present time uses both suction-assisted and powered-assisted liposuction techniques. He feels these options give the best results with the least complications.

Is liposuction safe?
Yes. Liposuction is one of the most common cosmetic surgery procedures performed today. Keep in mind, as with anycosmetic surgery procedure complications can arise. It is important to choose a surgeon with experience in identifying, managing, and most importantly, preventing complications.

Will liposuction improve stretch marks?
No.

When can I resume sex after liposuction?
You may have gentle sex after two weeks.

Liposuction is not a substitute for healthy eating and exercise, and is not a treatment for obesity. This body contouring procedure is one of the few ways to permanently remove fat cells from a particular location on the body. The quality of the skin affects the quality of the look since liposuction relies on the skin’s ability to tighten. Several years ago, ultrasonic liposuction was promoted for its ability to tighten skin. Few surgeons use the procedure today.

Information on this page is not a substitute for medical consultation or advice. Please contact us to schedule an appointment to discuss the best treatments for you.