PatientNOW comes with a complete document management system that is fully integrated into the EMR.
Manage scanned images, emails, word processing, photos, diagnostic images, and faxes. Unique barcode system (BarcodeNOW) can reduce manual indexing and eliminate data entry errors. Pages will always be in the right chart.
The Patient Documents section looks like a paper chart. Colored tabs with tab names match what you have today. QuickVIEW is just like flipping through a paper file. Pages appear instantly as you flip through.
Scan paper, insurance cards, driver licenses and photos with the same scanner. Scan templates get the documents to the right place every time.
Image scanning an insurance card, both sides at once in color and zooming it to full page size. It is fast and perfect every time. See complete selection of Fujitsu scanners for more information.
Send documents for review, signature, pre-authorization, faxing and other. PatientNOW allows you to have assigned incoming documents for review, digital signing, etc. by different staff members. You can easily route work for high-cost medical professionals to more cost-effective and administrative support staff in a timely and fluid manner.
Physicians and staff can then always review what is in their specific queues so that documents and tasks from previous days never get forgotten. Alerts can be setup if a document stays in a queue for longer than a specific amount of time.
Tissue expansion is ideal for scalp repair because the stretched skin on the scalp retains normal hair growth. Most other body tissue does not grow hair to the same degree.
Following tissue expansion, the repaired scalp restores a more natural appearance.
With flap surgery, tissue, sometimes including underlying fat and muscle, is taken from the back and tunneled to the front of the chest wall to support the reconstructed breast.
The transported tissue forms a flap to cover a breast implant, or it may provide enough bulk to form the breast mound without an implant.
In a typical syndactyly, two fingers are fused together. The surgeon often uses zig-zag incisions to separate the fingers, creating triangular skin flaps.
Skin flaps cover most of the exposed areas between the fingers. Skin grafts are used to fill the shaded areas at the base of the fingers.
We bring back, refashion and restore to wholeness the features that nature gave but chance destroyed, not that they may be an advantage to the living soul, not as a mean artifice but as an alleviation of illness, not as becomes charlatans but as becomes good physicians and followers of the great Hippocrates. For though the original beauty is indeed restored . . . the end for which the physician is working is that the features should fulfill their offices according to nature’s decree.
Gaspare Tagliacozzi, 1597
It’s estimated that more that one million reconstructive procedures are performed by plastic surgeons every year. Reconstructive surgery helps patients of all ages and types – whether it’s a child with a birth defect, a young adult injured in an accident, or an older adult with a problem caused by aging.
The goals of reconstructive surgery differ from those of cosmetic surgery. Reconstructive surgery is performed on abnormal structures of the body, caused by birth defects, developmental abnormalities, trauma or injury, infection, tumors, or disease. It is generally performed to improve function, but may also be done to approximate a normal appearance.
Cosmetic surgery is performed to reshape normal structures of the body to improve the patient’s appearance and self-esteem.
Although no amount of surgery can achieve “perfection,” modern treatment options allow plastic surgeons to achieve improvements in form and function thought to be impossible 10 years ago.
This will give you a basic understanding of some commonly-used techniques in reconstructive surgery. It won’t answer all of your questions, since each problem is unique and a great deal depends on your individual circumstances. Please be sure to ask your doctor to explain anything you don’t understand. Also, ask for information that specifically details the procedure you are considering for yourself or your child.
There are two basic categories of patients: those who have congenital deformities, otherwise known as birth defects, and those with developmental deformities, acquired as a result of accident, infection, disease, or in some cases, aging.
Some common examples of congenital abnormalities are birthmarks; cleft-lip and palate deformities; hand deformities such as syndactyly (webbed fingers), or extra or absent fingers; and abnormal breast development.
Burn wounds, lacerations, growths, and aging problems are considered acquired deformities. In some cases, patients may find that a procedure commonly thought to be aesthetic in nature may be performed to achieve a reconstructive goal. For example, some older adults with redundant or drooping eyelid skin blocking their field of vision might have eyelid surgery. Or an adult whose face has an asymmetrical look because of paralysis might have a balancing facelift. Although appearance is enhanced, the main goal of the surgery is to restore function.
Large, sagging breasts are one example of a deformity that develops as a result of genetics, hormonal changes, or disease. Breast reduction, or reduction mammaplasty, is the reconstructive procedure designed to give a woman smaller, more comfortable breasts in proportion with the rest of her body.
In another case, a young child might have reconstructive otoplasty (outer-ear surgery) to correct overly-large or deformed ears. Usually, health insurance policies will consider the cost of reconstructive surgery a covered expense. Check with your carrier to make sure you’re covered and to see if there are any limitations on the type of surgery you’re planning. Work with your doctor to get pre-authorization from the insurer for the procedure.
When reconstructive surgery is performed by a qualified plastic surgeon, complications are infrequent and usually minor. However, individuals vary greatly in their anatomy and healing ability and the outcome is never completely predictable.
As with any surgery, complications can occur. These may include infection; excessive bleeding, such as hematomas (pooling of blood beneath the skin); significant bruising and wound-healing difficulties; and problems related to anesthesia and surgery.
There are a number of factors that may increase the risk of complications in healing. In general, a patient is considered to be a higher risk if he or she is a smoker; has a connective-tissue disease; has areas of damaged skin from radiation therapy; has decreased circulation to the surgical area; has HIV or an impaired immune system; or has poor nutrition. If you regularly take aspirin or some other medication that affects blood clotting, it’s likely that you’ll be asked to stop a week or two before surgery.
In evaluating your condition, a plastic surgeon will be guided by a se t of rules known as the reconstructive ladder. The least-complex types of treatments-such as simple wound closure-are at the lower part of the ladder. Any highly complex procedure-like micro-surgery to reattach severed limbs-would occupy one of the ladder’s highest rungs. A plastic surgeon will almost always begin at the bottom of the reconstructive ladder in deciding how to approach a patient’s treatment, favoring the most direct, least-complex way of achieving the desired result.
The size, nature and extent of the injury or deformity will determine what treatment option is chosen and how quickly the surgery will be performed. Reconstructive surgery frequently demands complex planning and may require a number of procedures done in stages.
Because it’s not always possible to predict how growth will affect outcome, a growing child may have to plan for regular follow-up visits on a long-term basis to allow additional surgery as the child matures.
Everyone heals at a different rate-and plastic surgeons cannot pinpoint an exact “back-to-normal” date following surgery. They can, however, give you a general idea of when you can expect to notice improvement.
In deciding how to treat a wound, a plastic surgeon must carefully assess its size, severity, and features: Is skin missing? Have nerves or muscles been damaged? Has skeletal support been affected?
As you and your plastic surgeon form your surgical plan, it’s important to have a clear understanding of what will happen during the procedure. Asking questions is key to making an informed decision.
Direct closure is usually performed on skin-surface wounds that have straight edges, such as a simple cut. Maximum attention is given to the aesthetic result, taking extra care to minimize noticeable stitch marks.
A wound that is wide and difficult or impossible to close directly may be treated with a skin graft. A skin graft is basically a patch of healthy skin that is taken from one area of the body, called the “donor site,” and used to cover another area where skin is missing or damaged. There are three basic types of skin grafts.
A split-thickness skin graft, commonly used to treat burn wounds, uses only the layers of skin closest to the surface. When possible, your plastic surgeon will choose a less conspicuous donor site. Location will be determined in part by the size and color of the skin patch needed. The skin will grow back at the donor site, however, it may be a bit lighter in color.
A full-thickness skin graft might be used to treat a burn wound that is deep and large, or to cover jointed areas where maximum skin elasticity and movement are needed. As its name implies, the surgeon lifts a full-thickness (all layers) section of skin from the donor site. A thin line scar usually results from a direct wound closure at the donor site.
A composite graft is used when the wound to be covered needs more underlying support, as with skin cancer on the nose. A composite graft requires lifting all the layers of skin, fat, and sometimes the underlying cartilage from the donor site. A straight-line scar will remain at the site where the graft was taken. It will fade with time.
Tissue expansion is a procedure that enables the body to “grow” extra skin by stretching adjacent tissue. A balloon-like device called an expander is inserted under the skin near the area to be repaired and then gradually filled with salt water over time, causing the skin to stretch and grow. The time involved in tissue expansion depends on the individual case and the size of the area to be repaired.
The advantages of tissue expansion are many-it offers a near-perfect match of skin color, sensation, and texture; the risk of tissue loss is decreased because the skin remains connected to its original blood and nerve supply; and scars are less apparent than those in flaps or grafts. The expander temporarily creates what can be an unsightly bulge, making this option undesirable for some patients.
Though success will largely depend on the extent of a patient’s injury, flap surgery and microsurgery have vastly improved a plastic surgeon’s ability to help a severely injured or disfigured patient. Using advanced techniques that often take many hours and may require the use of an operating microscope, plastic surgeons can now replant amputated fingers or transplant large sections of tissue, muscle or bone from one area of the body to another with the original blood supply in tact.
A flap is a section of living tissue that carries its own blood supply and is moved from one area of the body to another. Flap surgery can restore form and function to areas of the body that have lost skin, fat, muscle movement, and/or skeletal support.
A local flap uses a piece of skin and underlying tissue that lie adjacent to the wound. The flap remains attached at one end so that it continues to be nourished by its original blood supply, and is repositioned over the wounded area.
A regional flap uses a section of tissue that is attached by a specific blood vessel. When the flap is lifted, it needs only a very narrow attachment to the original site to receive its nourishing blood supply from the tethered artery and vein.
A musculocutaneous flap, also called a muscle and skin flap, is used when the area to be covered needs more bulk and a more robust blood supply. Musculocutaneous flaps are often used in breast reconstruction to rebuild a breast after mastectomy. This type of flap remains “tethered” to its original blood supply.
In a bone/soft tissue flap, bone, along with the overlying skin, is transferred to the wounded area, carrying its own blood supply.
A microvascular free flap is a section of tissue and skin that is completely detached from its original site and reattached to its new site by hooking up all the tiny blood vessels.
In addition to correcting cuts and other surface wounds, plastic surgeons also regularly treat both cancerous and non-cancerous growths and problems with the supporting structures beneath the skin.
Tumors, both cancerous and benign, vary widely in type, severity and recurrence. The removal method chosen will depend largely on the type of growth, what stage it’s in, and its location on the body.
Skin cancers and growths are usually removed by excision and closure, in which the growth is simply removed completely with a scalpel, leaving a small thin scar. If the cancer is large or spreading, major surgery may be necessary, using flaps to reconstruct the affected area.
Whether the defect is congenital or acquired, plastic surgeons can usually restore comfort, mobility, and normal appearance to patients with hand problems. Acquired defects include carpal tunnel and other painful conditions caused by pressure on the nerves (usually at the wrist or elbow); trigger fingers, a condition caused by swelling of a flexor tendon in the hand; ganglion cysts, a benign cystic growth and scar contracture which occurs when a wound or burn on the hand heals poorly and forms scar tissue that curls the fingers or restricts mobility. Dupuytren’s disease causes a similar problem of hand contracture.
Children born with syndactyly (webbed fingers) can benefit from finger separation, where a zig-zag-type incision separates the fingers and rearranges the tissue between them, preventing growth deformities. If a child had polydactyly (extra fingers), correction is often more than simply removing the extra digits. The surgeon may also need to balance the tendons of the hand and stabilize the remaining finger joints so that the hand functions as normally as possible. Plastic surgeons also reconstruct missing digits, including the thumb, which supplies half of the hand’s function.
In the past decade, laser technology has revolutionized many areas of plastic surgery. The laser’s allure comes from its ability to “blast” away or diminish imperfections or growths with a minimum of bleeding, bruising, and scarring.
Currently, there are many types of lasers available, with many more under development. Therefore, it’s important to understand that not all lasers are alike.
If you’re planning to have laser surgery, it’s best to find a doctor who is well experienced with, and has access to, a variety of lasers.
The yellow pulsed-dye laser uses a type of dye as its active medium. It has a pulsing beam that is heavily absorbed by hemoglobin, which gives blood its red color. This laser is often used for performing surgery on children who have pinkish birthmarks called port-wine stains. The laser destroys the abnormal blood vessels, lightening the birthmark to the point of being barely noticeable. Scarring, which was a problem with earlier laser models, is minimal with the yellow pulsed-dye laser.
The “pigment-blasting” laser family-the Q-switch ruby, the Q-switch YAG, and the alexandrite is a new group of lasers effective in eliminating the black and blue pigments of tattoos, pigmented lesions and the brown patches and spots that often occur with aging. Though the removal of decorative tattoos is considered a cosmetic procedure, the removal of “traumatic tattoos” is a reconstructive process. Traumatic tattoos occur when material particles are forced under the skin through an accident-as in an explosion or a collision.
The carbon dioxide laser, sometimes called the “workhorse” of lasers, is an invisible light absorbed by water, the primary component of human skin. When the beam is focused, it can cut tissue and seal blood vessels simultaneously. When defocused, it vaporizes. These characteristics make it the treatment of choice for removing warts and many types of skin growths.
The YAG laser has been shown to be effective in the surgery of various types of hemangiomas, which are skin growths with heavy concentrations of blood vessels. It delivers highly-focused energy and-unlike other lasers-its tip can be placed directly on the skin, mimicking a scalpel.
The argon laser is similar to the yellow pulsed-dye laser. The argon laser emits a blue-green light that is absorbed heavily by the color red. It is particularly effective in treating abnormalities that have a proliferation of blood vessels, such as blood blisters, “spider” blood vessels on the face, “strawberry” birthmarks, hemangiomas, and bulky vascular tumors.
The copper vapor laser is a newer type of laser that emits a yellowish light. Its uses include treating brown or red pigmented areas.
The number of laser treatments you’ll need depends largely upon the size and severity of the defect. A child with a large birthmark may need six to ten laser treatments to achieve satisfactory results. Only one treatment may be needed to remove some small spider veins on the face.
Lasers have a number of valuable uses, but a laser should not be viewed as a “magic wand” that improves the results of any type of surgery. For traditional kinds of surgery and most plastic surgery, the scalpel is still the proven instrument of choice.
Before surgery, these rhinoplasty patients have large, slightly hanging noses, with a hump and an enlarged tip.
If your nostrils are too wide, the surgeon can remove small wedges of skin form their base, bringing them closer together.
Incisions are made inside the nostrils or at the base of the nose, providing access to the cartilage and bone, which can then be sculpted into shape.
The surgeon removes the hump using a chisel or a rasp, then brings the nasal bones together to form a narrower bridge. Cartilage is trimmed to reshape the tip of the nose.
Trimming the septum improves the angle between the nose and upper lip.
A splint made of tape and an overlay of plastic, metal, or plaster is applied to help the bone and cartilage of the nose maintain their new shape.
After surgery, the patient has a smaller nose, a straighter bridge, a well defined nasal tip, and an improved angle between the nose and upper lip.
Rhinoplasty, or surgery to reshape the nose, is one of the most common of all plastic surgery procedures. Rhinoplasty can reduce or increase the size of your nose, change the shape of the tip or the bridge, narrow the span of the nostrils, or change the angle between your nose and your upper lip. It may also correct a birth defect or injury, or help relieve some breathing problems.
If you’re considering rhinoplasty, this information will give you a basic understanding of the procedure-when it can help, how it’s performed, and what results you can expect. It can’t answer all of your questions, since a lot depends on the individual patient and the surgeon. Please ask your surgeon about anything you don’t understand.
Rhinoplasty can enhance your appearance and your self-confidence, but it won’t necessarily change your looks to match your ideal, or cause other people to treat you differently. Before you decide to have surgery, think carefully about your expectations and discuss them with your surgeon.
The best candidates for rhinoplasty are people who are looking for improvement, not perfection, in the way they look. If you’re physically healthy, psychologically stable, and realistic in your expectations, you may be a good candidate.
Rhinoplasty can be performed to meet aesthetic goals or for reconstructive purposes-to correct birth defects or breathing problems.
Age may also be a consideration. Many surgeons prefer not to operate on teenagers until after they’ve completed their growth spurt-around 14 or 15 for girls, a bit later for boys. It’s important to consider teenagers’ social and emotional adjustment, too, and to make sure it’s what they, and not their parents, really want.
When rhinoplasty is performed by a qualified plastic surgeon, complications are infrequent and usually minor. Nevertheless, there is always a possibility of complications, including infection, nosebleed, or a reaction to the anesthesia. You can reduce your risks by closely following your surgeon’s instructions both before and after surgery.
After surgery, small burst blood vessels may appear as tiny red spots on the skin’s surface; these are usually minor but may be permanent. As for scarring, when rhinoplasty is performed from inside the nose, there is no visible scarring at all; when an open technique is used, or when the procedure calls for the narrowing of flared nostrils, the small scars on the base of the nose are usually not visible.
In about one case out of ten, a second procedure may be required-for example, to correct a minor deformity. Such cases are unpredictable and happen even to patients of the most skilled surgeons. The corrective surgery is usually minor.
Good communication between you and your physician is essential. In your initial consultation, the surgeon will ask what you’d like your nose to look like, evaluate the structure of your nose and face, and discuss the possibilities with you. He or she will also explain the factors that can influence the procedure and the results. These factors include the structure of your nasal bones and cartilage, the shape of your face, the thickness of your skin, your age, and your expectations.
Your surgeon will also explain the techniques and anesthesia he or she will use, the type of facility where the surgery will be performed, the risks and costs involved, and any options you may have. Most insurance policies don’t cover purely cosmetic surgery; however, if the procedure is performed for reconstructive purposes, to correct a breathing problem or a marked deformity, the procedure may be covered. Check with your insurer, and obtain pre-authorization for your surgery.
Be sure to tell your surgeon if you’ve had any previous nose surgery or an injury to your nose, even if it was many years ago. You should also inform your surgeon if you have any allergies or breathing difficulties; if you’re taking any medications, vitamins, or recreational drugs; and if you smoke.
Don’t hesitate to ask your doctor any questions you may have, especially those regarding your expectations and concerns about the results.
Your surgeon will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, taking or avoiding certain vitamins and medications, and washing your face. Carefully following these instructions will help your surgery go more smoothly.
While you’re making preparations, be sure to arrange for someone to drive you home after your surgery and to help you out for a few days if needed.
Rhinoplasty may be performed in a surgeon’s office-based facility, an outpatient surgery center, or a hospital. It’s usually done on an outpatient basis, for cost containment and convenience. Complex procedures may require a short inpatient stay.
Rhinoplasty can be performed under local or general anesthesia, depending on the extent of the procedure and on what you and your surgeon prefer.
With local anesthesia, you’ll usually be lightly sedated, and your nose and the surrounding area will be numbed; you’ll be awake during the surgery, but relaxed and insensitive to pain. With general anesthesia, you’ll sleep through the operation.
Rhinoplasty usually takes an hour or two, though complicated procedures may take longer. During surgery the skin of the nose is separated from its supporting framework of bone and cartilage, which is then sculpted to the desired shape. The nature of the sculpting will depend on your problem and your surgeon’s preferred technique. Finally, the skin is redraped over the new framework.
Many plastic surgeons perform rhinoplasty from within the nose, making their incision inside the nostrils. Others prefer an open procedure, especially in more complicated cases; they make a small incision across the columella, the vertical strip of tissue separating the nostrils.
When the surgery is complete, a splint will be applied to help your nose maintain its new shape. Nasal packs or soft plastic splints also may be placed in your nostrils to stabilize the septum, the dividing wall between the air passages.
After surgery-particularly during the first twenty-four hours-your face will feel puffy, your nose may ache, and you may have a dull headache. You can control any discomfort with the pain medication prescribed by your surgeon. Plan on staying in bed with your head elevated (except for going to the bathroom) for the first day.
You’ll notice that the swelling and bruising around your eyes will increase at first, reaching a peak after two or three days. Applying cold compresses will reduce this swelling and make you feel a bit better. In any case, you’ll feel a lot better than you look. Most of the swelling and bruising should disappear within two weeks or so. (Some subtle swelling-unnoticeable to anyone but you and your surgeon-will remain for several months.)
A little bleeding is common during the first few days following surgery, and you may continue to feel some stuffiness for several weeks. Your surgeon will probably ask you not to blow your nose for a week or so, while the tissues heal.
If you have nasal packing, it will be removed after a few days and you’ll feel much more comfortable. By the end of one or, occasionally, two weeks, all dressings, splints, and stitches should be removed.
Most rhinoplasty patients are up and about within two days, and able to return to school or sedentary work a week or so following surgery. It will be several weeks, however, before you’re entirely up to speed.
Your surgeon will give you more specific guidelines for gradually resuming your normal activities. They’re likely to include these suggestions: Avoid strenuous activity (jogging, swimming, bending, sexual relations-any activity that increases your blood pressure) for two to three weeks. Avoid hitting or rubbing your nose, or getting it sunburned, for eight weeks. Be gentle when washing your face and hair or using cosmetics.
You can wear contact lenses as soon as you feel like it, but glasses are another story. Once the splint is off, they’ll have to be taped to your forehead or propped on your cheeks for another six to seven weeks, until your nose is completely healed.
Your surgeon will schedule frequent follow-up visits in the months after surgery, to check on the progress of your healing. If you have any unusual symptoms between visits, or any questions about what you can and can’t do, don’t hesitate to call your doctor.
In the days following surgery, when your face is bruised and swollen, it’s easy to forget that you will be looking better. In fact, many patients feel depressed for a while after plastic surgery-it’s quite normal and understandable.
Rest assured that this stage will pass. Day by day, your nose will begin to look better and your spirits will improve. Within a week or two, you’ll no longer look as if you’ve just had surgery.
Still, healing is a slow and gradual process. Some subtle swelling may be present for months, especially in the tip. The final results of rhinoplasty may not be apparent for a year or more.
In the meantime, you might experience some unexpected reactions from family and friends. They may say they don’t see a major difference in your nose. Or they may act resentful, especially if you’ve changed something they view as a family or ethnic trait. If that happens, try to keep in mind why you decided to have this surgery in the first place. If you’ve met your goals, then your surgery is a success.
Microdermabrasion is a skin-freshening technique that helps repair facial skin that has become dull and damaged from the sun and the effects of aging. The plastic surgeon uses a device like a fine sandblaster to spray tiny crystals across the face, mixing gentle abrasion with suction to remove the dead, outer layer of skin. As with other skin rejuvenation techniques, more than one treatment may be needed to reduce or remove fine wrinkles and unwanted pigmentation.
Women may have liposuction performed under the chin, on their hips, thighs, and stomach, and in the under arm and breast area.
For men, common sites include under the chin and around the waist. Liposuction may also be used in the reduction of enlarged male breasts, a condition known as gynecomastia.
Healthy, normal-weight people with elastic skin and pockets of excess fat are good candidates for surgery.
The best candidates for liposuction are of normal weight with localized areas of excess fat– for example, in the buttocks, hips, and thighs.
The surgeon inserts a cannula through small incisions in the skin. At the other end of the tube is a vacuum-pressure unit that suctions off the fat.
A snug compression garment worn after surgery helps reduce swelling.
Improvement will become apparent after about six weeks, when most of the swelling has subsided.
As healing progresses, a more proportional look will emerge.
A slimmer body contour can help you feel more confident and comfortable.
Liposuction is a procedure that can help sculpt the body by removing unwanted fat from specific areas, including the abdomen, hips, buttocks, thighs, knees, upper arms, chin, cheeks and neck. During the past decade, liposuction, which is also known as lipoplasty or suction lipectomy, has benefited from several new refinements. Today, a number of new techniques, including ultrasound-assisted lipoplasty (UAL), the tumescent technique, and the super-wet technique, are helping many plastic surgeons to provide selected patients with more precise results and quicker recovery times. Although no type of liposuction is a substitute for dieting and exercise, liposuction can remove stubborn areas of fat that don’t respond to traditional weight-loss methods.
If you’re considering liposuction, this brochure will give you a basic understanding of the procedure — when it can help, how it is performed and how you might look and feel after surgery. It won’t answer all of your questions, since much depends on your individual circumstances. Please ask your doctor if there is anything about the procedure you don’t understand.
To be a good candidate for liposuction, you must have realistic expectations about what the procedure can do for you. It’s important to understand that liposuction can enhance your appearance and self confidence, but it won’t necessarily change your looks to match your ideal or cause other people to treat you differently. Before you decide to have surgery, think carefully about your expectations and discuss them with your surgeon.
The best candidates for liposuction are normal-weight people with firm, elastic skin who have pockets of excess fat in certain areas. You should be physically healthy, psychologically stable and realistic in your expectations. Your age is not a major consideration; however, older patients may have diminished skin elasticity and may not achieve the same results as a younger patient with tighter skin.
Liposuction carries greater risk for individuals with medical problems such as diabetes, significant heart or lung disease, poor blood circulation, or those who have recently had surgery near the area to be contoured.
In your initial consultation, your surgeon will evaluate your health, determine where your fat deposits lie and assess the condition of your skin. Your surgeon will explain the body-contouring methods that may be most appropriate for you. For example, if you believe you want liposuction in the abdominal area, you may learn that an abdominoplasty or tummy tuck may more effectively meet your goals; or that a combination of traditional liposuction and UAL would be the best choice for you.
Be frank in discussing your expectations with your surgeon. He or she should be equally frank with you, describing the procedure in detail and explaining its risks and limitations.
Individuals considering liposuction often feel a bit overwhelmed by the number of options and techniques being promoted today. However, your plastic surgeon can help. In deciding which is the right treatment approach for you, your doctor will consider effectiveness, safety, cost and appropriateness for your needs. This is called surgical judgment, a skill that is developed through surgical training and experience. Your doctor also uses this judgement to prevent complications; to handle unexpected occurrences during surgery; and to treat complications when they occur.
Your surgeon’s education and training have helped to form his or her surgical judgement, so take the time to do some background checking. Patients are encouraged to consider a doctor certified by the American Board of Plastic Surgery (ABPS). By choosing a plastic surgeon who is certified by the ABPS, a patient can be assured that the doctor has graduated from an accredited medical school and completed at least five years of additional residency – usually three years of general surgery (or its equivalent) and two years of plastic surgery. To be certified by the ABPS, a doctor must also practice surgery for two years and pass comprehensive written and oral exams.
Your surgeon will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding vitamins, iron tablets and certain medications. If you develop a cold or an infection of any kind, especially a skin infection, your surgery may have to be postponed.
Though it is rarely necessary, your doctor may recommend that you have blood drawn ahead of time in case it is needed during surgery.
Also, while you are making preparations, be sure to arrange for someone to drive you home after the procedure and, if needed, to help you at home for a day or two.
Liposuction may be performed in a surgeon’s office-based facility, in an outpatient surgery center, or in a hospital. Smaller-volume liposuction is usually done on an outpatient basis for reasons of cost and convenience. However, if a large volume of fat will be removed, or if the liposuction is being performed in conjunction with other procedures, a stay in a hospital or overnight nursing facility may be required.
Various types of anesthesia can be used for liposuction procedures. Together, you and your surgeon will select the type of anesthesia that provides the most safe and effective level of comfort for your surgery.
If only a small amount of fat and a limited number of body sites are involved, liposuction can be performed under local anesthesia, which numbs only the affected areas. However, if you prefer, the local is usually used along with intravenous sedation to keep you more relaxed during the procedure. Regional anesthesia can be a good choice for more extensive procedures. One type of regional anesthesia is the epidural block, the same type of anesthesia commonly used in childbirth.
However, some patients prefer general anesthesia, particularly if a large volume of fat is being removed. If this is the case, a nurse anesthetist or anesthesiologist will be called in to make sure you are completely asleep during the procedure.
The time required to perform liposuction may vary considerably, depending on the size of the area, the amount of fat being removed, the type of anesthesia and the technique used.
There are several liposuction techniques that can be used to improve the ease of the procedure and to enhance outcome.
Liposuction is a procedure in which localized deposits of fat are removed to recontour one or more areas of the body. Through a tiny incision, a narrow tube or cannula is inserted and used to vacuum the fat layer that lies deep beneath the skin. The cannula is pushed then pulled through the fat layer, breaking up the fat cells and suctioning them out. The suction action is provided by a vacuum pump or a large syringe, depending on the surgeon’s preference. If many sites are being treated, your surgeon will then move on to the next area, working to keep the incisions as inconspicuous as possible.
Fluid is lost along with the fat, and it’s crucial that this fluid be replaced during the procedure to prevent shock. For this reason, patients need to be carefully monitored and receive intravenous fluids during and immediately after surgery.
The basic technique of liposuction, as described above, is used in all patients undergoing this procedure. However, as the procedure has been developed and refined, several variations have been introduced.
Fluid Injection, a technique in which a medicated solution is injected into fatty areas before the fat is removed, is commonly used by plastic surgeons today. The fluid — a mixture of intravenous salt solution, lidocaine (a local anesthetic) and epinephrine (a drug that contracts blood vessels) — helps the fat be removed more easily, reduces blood loss and provides anesthesia during and after surgery. Fluid injection also helps to reduce the amount of bruising after surgery.
The amount of fluid that is injected varies depending on the preference of the surgeon.
Large volumes of fluid — sometimes as much as three times the amount of fat to be removed — are injected in the tumescent technique. Tumescent liposuction, typically performed on patients who need only a local anesthetic, usually takes significantly longer than traditional liposuction (sometimes as long as 4 to 5 hours). However, because the injected fluid contains an adequate amount of anesthetic, additional anesthesia may not be necessary. The name of this technique refers to the swollen and firm or tumesced state of the fatty tissues when they are filled with solution.
The super-wet technique is similar to the tumescent technique, except that lesser amounts of fluid are used. Usually the amount of fluid injected is equal to the amount of fat to be removed. This technique often requires IV sedation or general anesthesia and typically takes one to two hours of surgery time.
Ultrasound-Assisted Lipoplasty (UAL). This technique requires the use of a special cannula that produces ultrasonic energy. As it passes through the areas of fat, the energy explodes the walls of the fat cells, liquefying the fat. The fat is then removed with the traditional liposuction technique.
UAL has been shown to improve the ease and effectiveness of liposuction in fibrous areas of the body, such as the upper back or the enlarged male breast. It is also commonly used in secondary procedures, when enhanced precision is needed. In general, UAL takes longer to perform than traditional liposuction.
Liposuction is normally safe, as long as patients are carefully selected, the operating facility is properly equipped and the physician is adequately trained.
As a minimum, your surgeon should have basic (core) accredited surgical training with special training in body contouring. Also, even though many body-contouring procedures are performed outside the hospital setting, be certain that your surgeon has been granted privileges to perform liposuction at an accredited hospital.
Your doctor must have advanced surgical skills to perform procedures that involve the removal of a large amount of fat (more than 5 liters or 5,000 ccs); ask your doctor about his or her other patients who have had similar procedures and what their results were. Also, more extensive liposuction procedures require attentive after-care. Find out how your surgeon plans to monitor your condition closely after the procedure.
However, it’s important to keep in mind that even though a well-trained surgeon and a state-of-the art facility can improve your chance of having a good result, there are no guarantees. Though they are rare, complications can and do occur. Risks increase if a greater number of areas are treated at the same time, or if the operative sites are larger in size. Removal of a large amount of fat and fluid may require longer operating times than may be required for smaller operations.
The combination of these factors can create greater hazards for infection; delays in healing; the formation of fat clots or blood clots, which may migrate to the lungs and cause death; excessive fluid loss, which can lead to shock or fluid accumulation that must be drained; friction burns or other damage to the skin or nerves or perforation injury to the vital organs; and unfavorable drug reactions.
There are also points to consider with the newer techniques. For example, in UAL, the heat from the ultrasound device used to liquefy the fat cells may cause injury to the skin or deeper tissues. Also, you should be aware that even though UAL has been performed successfully on several thousand people worldwide, the long-term effects of ultrasound energy on the body are not yet known.
In the tumescent and super-wet techniques, the anesthetic fluid that is injected may cause lidocaine toxicity (if the solution’s lidocaine content is too high), or the collection of fluid in the lungs (if too much fluid is administered).
The scars from liposuction are small and strategically placed to be hidden from view. However, imperfections in the final appearance are not uncommon after lipoplasty. The skin surface may be irregular, asymmetric or even baggy, especially in the older patient. Numbness and pigmentation changes may occur. Sometimes, additional surgery may be recommended.
After surgery, you will likely experience some fluid drainage from the incisions. Occasionally, a small drainage tube may be inserted beneath the skin for a couple of days to prevent fluid build-up. To control swelling and to help your skin better fit its new contours, you may be fitted with a snug elastic garment to wear over the treated area for a few weeks. Your doctor may also prescribe antibiotics to prevent infection.
Don’t expect to look or feel great right after surgery. Even though the newer techniques are believed to reduce some post-operative discomforts, you may still experience some pain, burning, swelling, bleeding and temporary numbness. Pain can be controlled with medications prescribed by your surgeon, though you may still feel stiff and sore for a few days.
It is normal to feel a bit anxious or depressed in the days or weeks following surgery. However, this feeling will subside as you begin to look and feel better.
Healing is a gradual process. Your surgeon will probably tell you to start walking around as soon as possible to reduce swelling and to help prevent blood clots from forming in your legs. You will begin to feel better after about a week or two and you should be back at work within a few days following your surgery. The stitches are removed or dissolve on their own within the first week to 10 days.
Activity that is more strenuous should be avoided for about a month as your body continues to heal. Although most of the bruising and swelling usually disappears within three weeks, some swelling may remain for six months or more.
Your surgeon will schedule follow-up visits to monitor your progress and to see if any additional procedures are needed.
If you have any unusual symptoms between visits — for example, heavy bleeding or a sudden increase in pain — or any questions about what you can and can’t do, call your doctor.
You will see a noticeable difference in the shape of your body quite soon after surgery. However, improvement will become even more apparent after about four to six weeks, when most of the swelling has subsided. After about three months, any persistent mild swelling usually disappears and the final contour will be visible.
If your expectations are realistic, you will probably be very pleased with the results of your surgery. You may find that you are more comfortable in a wide variety of clothes and more at ease with your body. And, by eating a healthy diet and getting regular exercise, you can help to maintain your new shape.
Injectable collagen or fat can help improve the skin’s texture by filling in the laugh lines and facial creases that often occur with aging.
Years of squinting and other facial muscle movements can take their toll on the eye area, leaving crow’s feet and other noticeable lines
After treatment, the skin around the eye area appears smoother and more taut.
Lines and creases that form around the mouth are usually caused by gravity and a breakdown of tissues beneath the skin.
The lower face appears firmer and smoother after treatment with injectables. Lines around the mouth are filled in and nearly imperceptible.
With regular follow-up treatments, your refreshed look can be easily maintained.
As we age, our faces begin to show the effects of gravity, sun exposure and years of facial muscle movement, such as smiling, chewing and squinting. The underlying tissues that keep our skin looking youthful and plumped up begin to break down, often leaving laugh lines, smile lines, crow’s feet or facial creases over the areas where this muscle movement occurs.
Soft-tissue fillers, most commonly injectable collagen or fat, can help fill in these lines and creases, temporarily restoring a smoother, more youthful-looking appearance. When injected beneath the skin, these fillers plump up creased and sunken areas of the face. They can also add fullness to the lips and cheeks. Injectable fillers may be used alone or in conjunction with a resurfacing procedure, such as a laser treatment, or a recontouring procedure, such as a facelift.
If you’re considering a facial-rejuvenation treatment with collagen or fat, this brochure will give you a basic understanding of the procedure – when injectables can help, how the procedure is performed, and what results you can expect. It may not answer all of your questions, since a lot depends on your individual circumstances. Please ask your doctor if there is anything about the procedure you don’t understand.
Injected collagen and fat are primarily used to improve the appearance of the skin’s texture. They can help fill out deep facial wrinkles, creases and furrows, “sunken” cheeks, skin depressions and some types of scars. They can also be used to add a fuller, more sensuous look to the lips.
Injectables are usually not sufficient for severe surface wrinkles on the face, such as multiple vertical “lipstick lines” that sometimes form around the mouth. Instead, your plastic surgeon may suggest a resurfacing technique, such as chemical peel, dermabrasion or laser treatments. Rather than filling in facial lines, resurfacing methods strip away the outer layers of the skin to produce a smoother appearance.
Deep folds in the face or brow caused by overactive muscles or by loose skin may be more effectively treated with cosmetic surgery, such as a facelift or browlift. Injectables are sometimes used in conjunction with facial surgery procedures; however, injectables alone cannot change facial contour the way surgery can.
Keep in mind that a plastic surgeon is a specialist that can offer you the full gamut of the most advanced treatments ranging from cosmetic surgery, refinishing techniques, laser therapy, injectables and the use of other fillers. You and your surgeon may determine that a single procedure or a combination of procedures is the best choice for you.
ASPS brochures are available on chemical peel, dermabrasion, laser treatments, facelift and browlift. If you and your doctor think that one of these other procedures might be more appropriate for you, ask your plastic surgeon to provide you with a copy.
This brochure deals with the two most commonly used types of injectable fillers, collagen and fat. However, to a lesser extent, a number of other filler materials are also being used for facial-rejuvenation purposes. They include: Fibril, a gelatin powder compound that’s mixed with a patient’s own blood and is injected to plump up the skin (similar to injectable collagen); and Gortex, a thread-like material that is implanted beneath the skin to add soft-tissue support.
Each of these options has its own set of risks and benefits. If you’re considering any of these alternative filler treatments, tell your doctor.
The most important fact to remember about injectable fillers is that the results are not permanent. Injected material is eventually metabolized by the body. You should not expect the same long-lasting results that may be gained from cosmetic surgery.
In some individuals, the results may last only a few weeks; in others, the results may be maintained indefinitely. Researchers believe that age, genetic background, skin quality and lifestyle as well as the injected body site may all play a role in the injected material’s “staying power.” However, the precise reason for the variation of results among patients has yet to be identified.
If you’ve had short-lived results from fat injections, you shouldn’t necessarily assume that collagen injections will work better for you. And, conversely, if you’ve had disappointing results from collagen, don’t assume that injected fat is the answer. Although it’s true that some individuals’ bodies are more receptive to one substance than the other, others may find that neither substance produces long-lasting results. Sometimes one substance may work better than the other for a specific problem.
When injectables are administered by a qualified plastic surgeon, complications are infrequent and usually minor in nature. Still, individuals vary greatly in their anatomy, their physical reactions and their healing abilities. The outcome of treatment with injectables is never completely predictable.
Collagen: Allergic reaction is the primary risk of collagen. To help determine if you are allergic to the substance, your surgeon will perform an allergy skin test about a month before the procedure. After the test is performed, the test site should be watched carefully for three or four weeks, or as long as your surgeon advises. Any sign of redness, itching, swelling or other occurrences at the test site should be reported to your surgeon.
Risks not necessarily related to allergies include infection, abscesses, open sores, skin peeling, scarring and lumpiness, which may persist over the treated area. Reports of these problems are very rare.
Fat: Allergic reaction is not a factor for fat because it’s harvested from a patient’s own body. However, there is still a small risk of infection and other infrequent complications.
Facial rejuvenation is very individualized. That’s why it’s important to discuss your hopes and expectations with a board-certified plastic surgeon who has experience with many different types of surgical and non-surgical facial procedures.
In your initial consultation, your plastic surgeon will evaluate your face – the skin, the muscles and the underlying bone – and discuss your goals for the surgery. Your doctor will help you select a treatment option based on your goals and concerns, your anatomy and your lifestyle.
Your surgeon will ask you about your medical history, drug allergies, and check for conditions that could cause problems, such as active skin infections or non-healed sores from injuries. Collagen injections are generally off limits for pregnant women, individuals who are allergic to beef or bovine products, patients who suffer from autoimmune diseases, and those who are allergic to lidocaine (the anesthetic agent contained in the syringe with the collagen material). For more specific information about the contraindications and risks of collagen use, ask your doctor for the manufacturer’s brochure for patients.
Insurance usually doesn’t cover cosmetic procedures. However, if your injectable treatment is being performed to treat a scar or indentation from an accident or injury, you may be reimbursed for a portion of the cost. Check with your insurance carrier to be sure.
Injectables are usually administered in a surgeon’s office-based facility. If, however, you are being hospitalized for a facelift, necklift, browlift, or any other procedure, your injections may be administered in the hospital as well.
Collagen: Because the anesthetic agent lidocaine is mixed in with collagen, additional anesthetic is usually not used. However, if you are especially sensitive to pain, your doctor may use a topical cream anesthetic or a freon spray to numb the injected area. Or, you may elect to have an injected local anesthetic or sedative drugs.
Fat: Both the donor and recipient sites are numbed with local anesthesia. Sedation can be used as well. If you elect to use sedation, be sure to arrange for a ride home after your treatment.
Collagen is a naturally occurring protein that provides support to various parts of the human body: the skin, the joints, the bones and the ligaments. Injectable collagen, patented by the Collagen Corporation under the trade names Zyderm and Zyplast, is derived from purified bovine collagen. The purification process creates a product similar to human collagen. Injectable collagen received approval from the Food and Drug Administration in1981. It is produced in various thicknesses to meet individual patient needs.
Collagen is used primarily to fill wrinkles, lines and scars on the face and sometimes the neck, back and chest.
The procedure: Treatment with collagen can begin after a skin test determines that you’re not allergic to the subsstance. The collagen is injected using a fine needle inserted at several points along the edge of the treatment site. If a local anesthesia has not been used, you may feel some minor stinging or burning as the injections are administered.
Since part of the substance is salt water that will be absorbed by the body within a few days, your doctor will slightly overfill the area. You may be asked to hold a hand mirror during the procedure to help your doctor decide when you’ve had enough.
After treatment: Immediately following treatment, you may notice some minor discomfort, stinging or throbbing in the injected area. Occasionally some bruising or swelling will occur, but it is usually minor. Any redness that appears in the injected site usually disappears within 24 hours. However, in some individuals, particularly fair-skinned patients, this redness may persist for a week or more. Tiny scabs may also form over the needle-stick areas; these generally heal quickly.
No bandaging is needed and you are free to eat, drink, and wear makeup with sunblock protection shortly thereafter. There may be some temporary swelling and redness in the treated area which should dissipate within a few days. If these symptoms persist, contact your surgeon.
Results: As stated earlier, the duration of results from collagen injections is variable. Collagen’s longevity depends on the patient’s lifestyle and physical characteristics as well as the part of the body treated. In general, the injected material is likely to disappear faster in areas that are more affected by muscle movement.
Your doctor can help you determine how long you can go between treatments to best maintain your results.
In the medical world, the fat-injection procedure is known as autologous fat transplantation or microlipoinjection. It involves extracting fat cells from the patient’s abdomen, thighs, buttocks or elsewhere and reinjecting them beneath the facial skin. Fat is most often used to fill in “sunken” cheeks or laugh lines between the nose and mouth, to correct skin depressions or indentations, to minimize forehead wrinkles and to enhance the lips.
The procedure: After both the donor and recipient sites are cleansed and treated with a local anesthesia, the fat is withdrawn using a syringe with a large-bore needle or a cannula (the same instrument used in liposuction) attached to a suction device. The fat is then prepared and injected into the recipient site with a needle. Sometimes an adhesive bandage is applied over the injection site.
As with collagen, “overfilling” is necessary to allow for fat absorption in the weeks following treatment. When fat is used to fill sunken cheeks or to correct areas on the face other than lines, this overcorrection of newly injected fat may temporarily make the face appear abnormally puffed out or swollen.
After treatment: If a larger area was treated, you may be advised to curtail your activity for a brief time. However, many patients are able to resume normal activity immediately. You can expect some swelling, bruising or redness in both the donor and recipient sites. The severity of these symptoms depends upon the size and location of the treated area. You should stay out of the sun until the redness and bruising subsides – usually about 48 hours. In the meantime, you may use makeup with sunblock protection to help conceal your condition.
The swelling and puffiness in the recipient site may last several weeks, especially if a large area was filled.
Results: The duration of the fat injections varies significantly from patient to patient. Though some patients have reported results lasting a year or more, the majority of patients find that at least half of the injected fullness disappears within 3-6 months. Therefore, repeated injections may be necessary. Your doctor will advise you on how to maintain your results with repeat treatments.
If you’re like most patients, you’ll be very satisfied with the results of your injectable treatments. You may be surprised at the pleasing results that can be gained from this procedure.