Enhancing one’s chin with an implant is a common plastic surgery procedure. The simple placement of a synthetic implant on the front of the chin (mandibular symphysis) bone can make a dramatic difference in how the lower jaw looks and in the appearance of the lower face and neck. While chin augmentation is a very straightforward operation, there are some common side effects that will occur after surgery which will go away with time.
Despite the fact that a chin implant and the incision through which it is placed is small, it will definitely make the chin sore after surgery. This is because it is necessary to lift the chin muscle (mentalis) off of the bone to position the implant in place. The soreness will go away in a week or so as the muscle pain settles down but the chin will feel stiff for awhile. One may also notice some unusual muscle movements or ‘spasms’ as the chin muscle heals over the implant. This is the result of the muscle adapting to being stretched over the size of the implant.
Some moderate swelling of the chin is to be expected for a few weeks but bruising is rarely seen. If bruising occurs, it is mild and usually appears below the chin in the neck.
There almost always is some numbness after the chin implant procedure. The skin over the chin, and sometimes part of the lower lip, may feel numb for awhile after surgery. This occurs because the small branches of the mental nerve, which supplies feeling to the lower lip, front teeth, and chin, are stretched from the surgery. In some cases, the big end of this nerve where it comes out of the bone may be affected from placing the side wings of the chin implant. In either case, the feeling will return within a month after surgery.
Between the numbness and the muscle stretching in the chin, some patients will notice that their lower lip may appear or move a little differently after surgery. This effect can be disturbing but it is only temporary.
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis
Tummy tuck or abdominoplasty surgery is a dramatic operation that offers an unparalleled change in your waistline shape and contour. It can be so significant that I frequently refer to it as the ‘facelift’ of the body. Like all dramatic surgical changes, there will be some equally dramatic immediate after effects that all patients should be aware of with the understanding that these are normal but temporary inconveniences.
Most importantly, most tummy tucks are significant surgery. You should plan an adequate time for recovery with particular emphasis on how long it will take to return to the type of work you do. Don’t short change yourself. I can make one assumption for most patients…..they don’t have a good idea (why would they?) as to what a tummy tuck operation is like after. Most of us are not as tough as we think. Plan accordingly!
Without question, pain is a common immediate feeling after a tummy tuck. Whether the pain is significant or surprisingly moderate is determined by whether your abdominal fascia (covering of the rectus abdominal muscles) has been tightened down the middle. This is what gives tummy tucks their pain afterwards. Not all tummy tucks are done with muscle tightening. Some can be simple skin and fat cutouts (simple abdominoplasty or panniculectomy) which do not have much discomfort at all. If your plastic surgeon is going to tighten the muscles (which you should know and discuss beforehand), then ask if there will be some type of pain relief offered after surgery such as a 24 or 48 hour pain pump. Pain does get better within a few days but the first week can be a rough one for some patients.
Tummy tucks do not usually have a much swelling and rarely any bruising. If you have a lot of bruising across the abdomen after surgery, call your plastic surgeon. This might be the development of a hematoma. (bleeding) This is of particular concern in the first day or two after surgery. Small insignificant amounts of bruising may appear later but these are not of any concern.
The skin over the stomach area will feel very numb. This numbness will persist for many months and the feeling may take up to a year to come back, particularly down close to the incision area. This occurs as the tiny skin nerves that give feeling to the skin are cut (they can’t be seen) as the upper abdominal skin is raised and stretched down to meet the lower incision. The numbness gradually gets smaller as the feeling comes in from the side, closer to the center and down near the incision. Some patients may have a small area in the center of the incision just above it which may always be numb.
Difficulty standing straight after a tummy tuck is common…if the muscles have been tightened. In those abdominal procedures where muscles are not tightened, then standing straight is not a problem. If the muscles have been tightened and you can stand straight right away…that is a good sign. That will get better by the end of the first week after surgery. This means they have been tightened enough to make a real difference.
Almost all tummy tucks require a drain after surgery. Some plastic surgeons use one drain, others use two. Either way, they will need to stay in place for 7 to 10 days until their fluid output drops considerably. They help immensely in decreasing the risk of a fluid-build-up after surgery under the skin. They are necessary evils of the procedure.
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
Clarian North Medical Center, Carmel, Indiana]
Clarian West Medical Center, Avon, Indiana
Indianapolis
Rhinoplasty or nose reshaping is one of the most popular facial plastic surgery procedures. Because the nose occupies such a prominent place on the face, the desire to change one’s nose is a big decision. In addition to the uncertainty of how one will ultimately look after surgery, concerns about how one will appear and feel during the recovery process are also important. While rhinoplasty surgery is done differently for each and every patient, what will happen after surgery is fairly standard.
Every rhinoplasty patient will have a dressing on the nose after surgery. This consists of tapes and a splint on top of them covering most of the nose except the nostrils. The sole purpose of this type of nasal dressing is to keep the swelling on the nose down and help the skin to stick back down to the reshaped cartilage and bone framework. While it will not get eliminate all the swelling, it helps considerably. It will be removed in a week but it is very important to have the ‘visible sign of having a nose job’ in place after surgery. When it is removed, you should see some of the positive changes but far from the final results which takes many months.
Bruising after a rhinoplasty will depend on whether the nasal bones (i.e., nasal osteotomies) were broken as part of the procedure. Most full rhinoplasties will have reshaped bone and cartilage and the bone cutting and narrowing will result in bruising developing under the eyes. (raccoon eyes). Usually, it takes several days for the bruising to be fully seen and ten to fourteen days until it goes away completely. If no bone cutting is done, bruising will not usually develop.
Numbness over the nose, particularly on the skin of the tip of the nose, is common. Raising up the skin to work on the tip of the nose cuts the tiny little nerves to the skin making it numb for several months. The feeling will eventually come back as these nerves regrow back into the skin but it will be at least 3 months or more until it all comes back.
The tip of the nose will usually feel very stiff after surgery. This is expected and desired for best long-term results. Even though the tip of the nose may have been reshaped, it is strengthened through cartilage grafts and suture techniques to prevent weakening over time as the nose heals. This support method makes the nose feel very stiff initially. The ‘springiness’ in the nose will usually come back, or at least get softer, by one year after surgery.
Stuffiness in the nose, or difficulty in breathing, may not occur after all rhinoplasties. When the inside of the nose is worked on (septoplasty, turbinate reductions), considerable stuffiness will exist after surgery. Blood clots in the nose and impaired nasal breathing will be present for several weeks before it starts to improve. It can take up to four to six weeks after surgery until real nasal breathing improvement is felt. If the rhinoplasty work is restricted just to the visible portions of the nose, congestion and breathing difficulties will not occur.
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis
I stumbled across recently the website entitled www.about.com and discovered that they had a lot of health-related videos (297 to be exact). These videos are short ( a few minutes) but are of excellent quality with outstanding 3-D animations. They specifically have 10 that are for plastic surgery on the following topics.
Breast Augmentation
Breast Lift
Breast Reduction
Breast Reconstruction
Browlift
Chin (Neck) Liposuction
Facelift
Micodermabrasion
Micropeel
Tummy Tuck
The best thing about these videos is that they convey a 3-D image of how the procedures are done…which is really what you want a video for. They are worth a look for patients about to undergo these plastic surgery procedures. Hopefully there will be more plastic surgery video topics in the future.
These plastic surgery videos can be found at http://video.about.com/health.htm
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis
Liposuction remains one of the most popular of all plastic surgery procedures. If you count all the different body areas from which fat is removed , liposuction is the #1 plastic surgery procedure performed in the United States. While liposuction continues to evolve with newer methods of fat emulsification (e.g., ultrasonic, laser), the basic concepts of liposuction and what to expect after the procedure remain the same.
While liposuction does not use any significant incisions to be done (small cannulas are introduced through several minute incisions), what occurs under the skin is quite traumatic to the tissues. While it may not look like much from the outside, a lot has taken place underneath which will account for a host of symptoms which will be evident in the following weeks of recovery.
First and foremost, liposuction causes a fair amount of discomfort. No matter what method of liposuction is used, it is painful after. Certain body areas are more uncomfortable after than others, such as the abdomen, back, and flanks, but saying liposuction causes some ‘mild discomfort’ is certainly an understatement. You can’t cause that much tissue trauma without associated pain.
Liposuction, even with a small amount of fat removal, is associated with swelling and bruising. These can vary greatly between patients, but all will have both. Between the swelling from the procedure, and the fluid that is infused during the procedure, the swelling may not make the results evident for weeks. Remember….if you have bruising, you still have swelling. A great liposuction result will happen when you take off the garments for the first time to shower and you can already see a significant improvement even in the face of swelling. However, just because the treated areas may not look any different right after doesn’t mean good improvement won’t be there a month after surgery. Liposuction is a procedure which takes time to see the results. I never judge the success of any liposuction procedure for at least 6 weeks after surgery. The final elimination of swelling and the fine-tuning of body contours takes up to 3 months after surgery.
It is common to feel hard areas or knots under the skin of liposuctioned areas for several months. These area areas of blood, fluid, and scar that are typical. These areas will eventually soften and go away as fluid and blood are reabsorbed and scarred areas soften as healing progresses.
Expect numbness of the skin overlying any area treated by liposuction. The sweeping of the cannula under the skin cuts the tiny little nerves to the skin which makes it numb. Feeling will eventually return but it will take a month or two to do so. As the feeling comes back, you will experience some strange sensation in the skin such as burning, electrical shocks, and itching. This is a normal part of nerves recovering. It is annoying but it will go away.
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis
Gluteal Implants or Fat Injections for Buttock Enlargement Surgery
Author: barryeppleyEnlargement of the buttocks or buttock enhancement is a plastic surgery procedure that has become more commonly requested and performed in the past several years than ever before. Ten years ago, this was a procedure that was unheard of and rarely done. Due to cultural influences and a changing population mix, the shape and size of the buttocks has become an aesthetic issue of importance.
The buttocks is a three-dimensional structure of which its size and shape are both important. For some patients, their buttocks is too flat and lacks any definition, for other patients it is an issue of size more than shape. As a result, when it comes to buttock recontouring, one has to consider what procedures can increase size as well as shape. It often takes a combination of procedures to create the best buttock result.
When it comes to increasing buttock size, it is a choice between natural fat injections or the use of synthetic implant. Both work and are capable of adding volume to the buttocks, but they are different in the results achieved and their associated potential risks and complications.
Buttock implants remain the gold standard for buttock enlargement. They have a long-standing history of success and their primary advantage is that the volume they add to the buttocks is both stable and permanent. The implants will not change in size over time as the material of which it is made (silicone rubber) does not degrade in the body. While implants do have traditional risks of malpositioning, infection, and seroma (fluid) development, improved surgical techniques with intramuscular placement has gone a long way in decreasing these issues. Nonetheless, these potential risks still exist and a patient must be willing to accept that a small percentage of buttock implants will develop these problems.
Fat injections, using the patients own fat, is a ‘newer’ buttock implant approach that has only become popular in the past few years. Its recent popularity is linked to the emergence of fat grafting in plastic surgery in general and as an easier alternative than traditional implant placement. Fat injections into the buttocks is less invasive and has a quicker recovery than an implant. It also uses the patient’s own fat which, if one is having liposuction anyway uses the discard, or if done by itself offers an aesthetic contouring benefit from the donor site. The primary disadvantage to fat injections is their unpredictability and that only a modest gain in buttock size can be achieved with one surgical treatment. It is far to say that fat injections can not create the same volume size that an implant can……in one surgical session. Multiple fat injections sessions, however, can create the same volume but at the disadvantage of considerable more expense and effort.
Which is better for any buttock enlargement patient….fat injections vs implant? If one is opposed to the thought and risks of an implant, then fat injections are the way to go with the understanding of the limitations in size that can be obtained. Or if one is having liposuction anyway, then fat injections are worth trying since enlargement of the buttocks may not be the sole objective of the surgery. But if considerable buttock size is wanted and one wants the most predictable result, buttock implants are the best choice…..if one can accept their risks.
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis
Breast augmentation is one of the most common plastic surgery procedures performed in the United States and also one of the most euphoric cosmetic procedures due to the instantaneous results. In one hour of surgery, an immediate increase in breast size is achieved. Despite the successful nature of breast augmentation surgery and the immediate results, there are an expected number of temporary events after surgery that patients have to tolerate before truly having the final result.
Swelling of the breasts after surgery always occurs. What can be confusing for patients is that the swelling does not occur immediately. The first day after surgery some swelling is present but it takes two to three days to see the maximal swelling of the breasts. They will continue to get larger and tighter for the first few days before they start to go down.
Because of the combination of swelling and the immediate and dramatic expansion of the skin, the breasts will feel abnormally stiff and tight. They will feel like ‘two’ rocks’ sitting on your chest. They will have that feeling for several weeks until the swelling goes down and the skin starts to relax and get used to the implants underneath. It usually takes about 4 to 6 weeks until the breasts relax enough to feel more normal.
It is also common for some patients to hear fluids or something swishing around inside during the first week after surgery. In the case of saline breast implants, in particular, this is not the implant deflating or water running out of it. It exists for both saline and silicone gel implants. Rather it is the irrigation or fluid that your surgeon used to wash out the breast pocket prior to inserting the implants. This fluid will be absorbed naturally in a week or so and that feeling or sound will go away.
Numbness of the skin, particularly on the lower half of the breast, will occur and may be present for a long time. This is because this skin is lifted up the most of any part of the breast during the surgery and the tiny skin nerves get disrupted. Most patients will get back the feeling back on this part of the breast but not all patients will get all of the feeling completely back.
While the risk of losing feeling in the nipple permanently is one of the risks of breast augmentation surgery, it is not common. However, temporary changes in nipple sensation right after surgery is. Usually it is too much feeling or hypersensitivity that occurs. This will settle down and return to normal in a few weeks. Less commonly, the nipple may actually be numb for awhile but returns to normal in a month or so after surgery.
Finally, the final size and shape of the breast can not be fully realized until about 6 weeks after surgery. The breast implants may initially seem too high but will usually settle as the skin relaxes. Don’t be too critical of the breast shape and symmetry between the breasts for some time after surgery. While the change in breast size is immediate, the final shape and contour of the breasts take some time to be realized.
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
Clarian North Medical Center, Carmel,l Indian
Clarian West Medical Center, Avon, Indiana
Indianapolis
Facelift surgery brings dramatic changes to the neck and jowl area and helps to completely reverse the effects of aging and gravity on this visible facial area. While the euphoria of the final result is what many patients understandably think about, there are some expected after surgery events that happen that can be disturbing if one is not aware. These are frequent sources of phone calls and questions and, while only temporary, are part of the process to get to the final result.
Pain after a facelift is usually quite minimal. The little pain that it creates is directly around the ears, where most of the incisions are made. The combination of the ear incisions and a pressure dressing the night after surgery makes for the ear discomfort. It gets better once the head dressing is removed the next day. When neck muscle work (platysmal tightening) is done with a facelift, there may be some soreness in the center of the neck and a slight temporary feeling of ‘difficulty’ with swallowing.
The reason there is so little pain after a facelift is that much of the skin will be numb. Undermining of the skin, which is a fundamental part of a facelift, makes the skin numb as the tiny little nerves to the skin will be cut in this process. Those skin nerves will grow back and normal feeling will return, but it will take months to do so. The feeling gradually returns from the sides of the face and neck towards the ears.
Tightness of the face and neck is to be expected right after facelift surgery. I tell my patients that if it doesn’t feel tight right after, you won’t have a good long-term result. The tightness will be felt on the side of the face and neck and may make turning your head side to side a little difficult. Eventually that tight feeling will go away after a few weeks.
Some bruising and swelling always occurs but it does vary a great deal between different patients. Most of the bruising will settle low in the neck due to gravity and may take a few days to see fully. Often it takes a good 10 to 14 days to go away completely. The swelling will occur mainly in the sides of the face and will make one’s face a little round or full initially. This will go down significantly in a week or so.
Many facelift patients suffer a little ‘depression’ in the first week after surgery. It can be quite a shock to see your face, the one you have known all your life, to be bruised, swollen, and look different. Such an appearance creates some initial uncertainty about whether you should have done the surgery. This will pass as one starts to improve by the second week after surgery.
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis
The thighs suffer loose and hanging skin after extreme weight loss and often look like ‘wax melting on a candle’. Thigh lifts or thighplasty is the plastic surgery procedure that can address some of these issues. Thigh liftsconsist of a variety of procedures that differ based on the location and extent of the procedure. There are inner and outer thigh lifts and vertical and extended vertical thigh lifts, all based on the nature of the excess skin on your thighs.
The outer thigh lift is done as either part of the circumferential body lift or as an isolated procedure. When the circumferential skin cutout of the body lift crosses the outer waistline (actually lower so it is an upper or outer thigh lift), the saddlebag area of the thighs is lifted. The final scar will cross or be just above the hip bone so this area can be quite tight when closed at the time of surgery. Some plastic surgeons choose to anchor the underside of the thigh skin to the tough lining of the hip bone (iliac crest) and this maneuver can be a good one to prevent scar widening later. In the extreme weight loss patient, the extended nature of the sagging ski n around the waistline makes the body lift a logical choice to get a tummy tuck, outer thigh lift, and buttock lift all in one procedure. Isolated outer thighs in extreme weight loss patients is unusual because if one has sagging thighs there will be other areas that sag as well.
Inner thighs lifts consist of two basic types, simplistically those that are oriented horizontally and those that are more oriented vertically. In either type of thigh lift, I don’t recommend doing them until after the tummy tuck or body lift is first completed. This is because these procedures will provide a mild thigh lift effect which may change the amount of thigh skin removed or the incision (cutout) pattern. Either inner thigh lift approach is a compromise. A horizontal inner thigh lift removes a crescent of skin and fat along the groin crease and this is where the final scar will be. A groin crease scar can be long, extending back into the buttock crease, but it is placed in a natural skin crease that is not that visible. A vertical thigh lift usually includes a horizontal excision of skin along the groin crease but also has a long vertical cut out, a T excision pattern. This is a very effective thigh reshaping procedure but results in a long visible scar down the inner thigh. Most extreme weight patients are usually better off with the combined horizontal/vertical inner thigh lift, if the scar is acceptable.
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis
Breast augmentation is an operation that works exclusively because of the implant. Like joint replacement surgery, the operation is completely dependent on a medical device for its result. Like all medical devices, breast implants will eventually fail for some patients at some point in their lives. Because of this concern, I not infrequently hear questions from breast augmentation patients asking….is it time for me to replace my breast implants?
As a general statement, you do not need to replace breast implants until they develop a problem, known as failure. They is no known benefit to replacing them just because they are ‘old after ten years, for example, or some other length of time. You replace them when the device fails.
The presentation of failure will differ depending upon what type of breast implant is used. Saline implant failure is usually quite obvious as it develops a leak and the breast size begins to change. In other words, you develop a ‘flat tire’. Whether the leak is slow or fast, your breast gradually gets smaller. This is tantamount to a cosmetic emergency and there will be no question as to whether it needs to be done. Silicone gel implants, however, fail differently. Because the gel is not a liquid, it will not come running out and cause a dramatic change in breast size. Rather silicone gel implant failure may not be obvious at all as the breast will not change size. Its failure is ’silent’ and often will only be picked up by mammogram or MRI. If the breast looks good and is pain-free, one can have the debate if it should be replaced at all since it will cause no harm to your body (because of the tear) and the breast size has not changed. Certainly there is no urgency to replace it like in saline implants. One has a lot of time to decide if replacing it needs to be done now or later.
Dr. Barry Eppley
http://www.eplpeyplasticsurgery.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis