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Archive for the ‘consent for plastic surgery’ Category

Consent for Plastic Surgery: Braline Backlifts

Tuesday, February 12th, 2013

 

Every plastic surgery procedure has numerous issues that every patient who is undergoing a procedure should know. These explanations are always on a consent form that you should read in detail before surgery. This consent form, while many perceive as strictly a legal protection for the doctor, is actually more intended to improve the understanding of the braline backlift procedure. The following is what Dr. Eppley discusses with his patients for this procedure. This list includes many, but not all,of the different outcomes from surgery. It should generate both a better understanding of the procedure and should answer any remaining questions that one would have.

ALTERNATIVES

Alternatives for improving the appearance of braline back rolls instead of surgical  excision is liposuction.

GOALS

The goal of a braline backlift is to eliminate (flatten) the horizontal/oblique rolls of skin and fat that exist either above or below the braline and are accentuated by its wear.

LIMITATIONS

The limitations of the procedure are that only some much skin and fat can be removed and still obtain a competent wound closure. This may or may not completely flatten the back rolls.

EXPECTED OUTCOME

Expected outcomes include the following: temporary swelling and bruising around the incisions, temporary numbness of the surrounding back skin, permanent horizontal braline scars and up to one month after surgery to see the final back result.

RISKS

Significant complications from braline backlifts are extremely rare. More likely risks include infection, hematoma,  scars not completely within the braline, overcorrection or undercorrection of the back rolls, and asymmetry of scar placement. Any of these risks may require revisional surgery for improvement.

ADDITIONAL SURGERY

Should additional surgery be required for scar revision or further reduction of incompletely removed back rolls, this will generate additional costs.

Consent for Plastic Surgery: Temporal Implants

Wednesday, February 6th, 2013

 

Every plastic surgery procedure has numerous issues that every patient who is undergoing a procedure should know. These explanations are always on a consent form that you should read in detail before surgery. This consent form, while many perceive as strictly a legal protection for the doctor, is actually more intended to improve the understanding of temporal implant augmentation. The following is what Dr. Eppley discusses with his patients for this procedure. This list includes many, but not all,of the different outcomes from surgery. It should generate both a better understanding of the procedure and should answer any remaining questions that one would have.

ALTERNATIVES

Alternatives for improving the appearance of a depressed or hollowed temporal area include synthetic injectable fillers, fat injections, or augmentation using a variety of bone cements.

GOALS

The goal of temporal augmentation is to improve its appearance from a hollowed (concave) profile to a flatter one. In rare cases, the patient may even have a more convex profile if they desire.

LIMITATIONS

The limitations of temporal augmentation with implants is the size and shape of the implanted material. The thickness of the implant and its height and length determine how much augmentation is achieved.

EXPECTED OUTCOME

Expected outcomes include the following: temporary swelling and bruising around the temples and eyes, temporary numbness of the overlying temporal skin, and four to six weeks after surgery to see the final temporal shape.

RISKS

Significant complications from temporal implants are extremely rare. More likely risks include infection, permanent temporal hairline scars, overcorrection or undercorrection of the temporal profile, and implant/augmentation asymmetry. Any of these risks may require revisional surgery for improvement.

ADDITIONAL SURGERY

Should additional surgery be required for temporal implant revision and/or replacement, this will generate additional costs.

Consent for Plastic Surgery: Scar Revision

Wednesday, February 6th, 2013

 

Every plastic surgery procedure has numerous issues that every patient who is undergoing a procedure should know. These explanations are always on a consent form that you should read in detail before surgery. This consent form, while many perceive as strictly a legal protection for the doctor, is actually more intended to improve the understanding of surgical scar revision. The following is what Dr. Eppley discusses with his patients for this procedure. This list includes many, but not all,of the different outcomes from surgery. It should generate both a better understanding of the procedure and should answer any remaining questions that one would have.

ALTERNATIVES

Alternatives for improving the appearance of a scar could include more time for scar maturation, dermabrasion, laser resurfacing, injectable fillers, fat injections, collagen and stem cell injections and the use of make-up for camouflage.

GOALS

The goal of scar revision is to improve the appearance of the scar(s). This could include physical changes such as narrowing, correction of depressed or elevated surface contour, red or brown color reduction, or line of scar direction.

LIMITATIONS

The limitations of scar revision is in how much the appearance of the scar can be actually improved. Age of the scar, the scar pattern, where on the face or body the scar is located and the patient’s skin color and elasticity all play a factor in limiting how well the appearance of the scar can be improved.

EXPECTED OUTCOME

Expected outcomes include the following: temporary swelling and bruising around the scar revision site, temporary numbness of the surrounding skin, temporary increased redness or discoloration of the scar, elevation/firmness of the scar, and that it can take up to one year after scar revision to see the final result. It is important to understand that no scar can be completely removed and scar revision is about scar reduction not scar elimination.

RISKS

Significant complications from scar revision are very rare. More likely risks include infection, wound separation, suture reactions, worsening of the appearance of the scar, and failure of long-term scar improvement. Any of these risks may require revisional surgery for improvement.

ADDITIONAL SURGERY

Should additional surgery/therapies be required to do additional surgical scar revision, laser resurfacing, pulsed light treatments or topical scar therapies, these will generate additional costs

Consent for Plastic Surgery: Breast Lifts with Implants

Monday, February 4th, 2013

 

Every plastic surgery procedure has numerous issues that every patient who is undergoing a procedure should know. These explanations are always on a consent form that you should read in detail before surgery. This consent form, while many perceive as strictly a legal protection for the doctor, is actually more intended to improve the understanding of combining breast lifts with implants. (also known as mastopexy augmentation breast reshaping procedures) The following is what Dr. Eppley discusses with his patients for these procedures. This list includes many, but not all,of the different outcomes from surgery. It should generate both a better understanding of the procedure and should answer any remaining questions that one would have.

ALTERNATIVES

Alternatives could include using a breast implant by itself or doing only a breast lift without augmentation. Each of these choices have their own consequences for the resultant breast shape which would not be the same as a combined breast lift with a breast implant.

GOALS

The goal of combination breast lifting with implants is to give the breast more fullness (particularly in the upper pole) and lift a sagging breast to a better position on the chest wall. In addition, the nipple-areolar complex is moved upward to a more central position on the breast mound.

LIMITATIONS

The limitations of breast lifting with implants are those of the final breast size achieved and how much lifting of the sagging breast can be done on top of an expanded breast mound. How much excessive breast skin one has, the remaining amount of underlying breast tissue, the elasticity of the breast skin, the amount of breast sagging and the size and droop of the nipple-areolar complex all pose limitations on the final result that can be achieved.

EXPECTED OUTCOME

Expected outcomes include the following: temporary swelling and bruising of the breast mounds and nipples, breast skin numbness, nipple numbness, permanent breast scars and weeks to months for full scar healing to occur. The initial shape of the breast mounds may look too high, too full or non-round. It may take as long as six months to see the final shape and size of the breasts as both the implants and lifts settle. Scars may take up to one year to fully mature.

RISKS

Significant complications from combined breast lifting with implants are rare but could include implant infection or partial or complete loss of the nipple-areolar complex. More likely occurrences could include delayed incisional healing with some separation and suture reactions, breast implant malposition or asymmetry, breast mound or nipple-areolar asymmetry,  recurrent breast tissue sag over the implants, scar widening and no guarantee can be made as to the eventual breast cup size. It is important to understand that the combined breast lift with implants is the most technically challenging of all aesthetic breast reshaping procedures and has a high risk of the need for revisional surgery for optimal results. Any of these risks may require revisional surgery for improvement.

ADDITIONAL SURGERY

Should additional surgery be required to do additional breast lifting, reposition and/or replace the breast implants or perform any scar revisions, these will generate additional costs.

Consent for Plastic Surgery: Fat Grafting

Wednesday, January 30th, 2013

 

Every plastic surgery procedure has numerous issues that every patient who is undergoing a procedure should know. These explanations are always on a consent form that you should read in detail before surgery. This consent form, while many perceive as strictly a legal protection for the doctor, is actually more intended to improve the understanding of the various fat grafting procedures. The following is what Dr. Eppley discusses with his patients for these procedures. This list includes many, but not all,of the different outcomes from surgery. It should generate both a better understanding of the procedure and should answer any remaining questions that one would have.

ALTERNATIVES 

There are alternatives to fat grafting and they change based on the reason and the face or body site that needs more volume or contour. They could include synthetic injectable fillers, allogeneic (cadaver) and xenogeneic (animal) dermis, autogenous fascia and synthetic implants.

GOALS

The goal of fat grafting in every case is to either aesthetically add or restore lost or deficient soft tissue volume in the face or body. In some reconstructive procedures, the additional goal of fat grafting is to improve tissue quality and help prevent future wound healing problems.

LIMITATIONS

The limitations of fat grafting is based on several factors including the size and availability of fat from the donor site, how much volume the recipient site can take and, most importantly, how much fat survives after transplantation.

EXPECTED OUTCOME

Expected outcomes include the following: temporary swelling  and bruising from the donor and recipient sites, temporary skin numbness from the donor and recipient sites, and months of healing and fat graft settling until the final result is seen in terms of permanent volume and contour. Healing of any fat grafting procedure is a process and the minimal amount of time to judge the result is three months and may take as long as six months to see the final retained volume and shape of the grafted face or body site(s).

RISKS

Significant complications from fat grafting are very rare but could include infection. More likely occurrences could include small nick-type scars from the harvest and injection of concentrated fat aspirates and a longer scar for the harvest and insertion of solid dermal-fat grafts. Additional risks include partial or complete loss of the fat graft, irregularities and asymmetries of the harvested and grafted areas, overcorrection vs. undercorrection of the treated areas and the unpredictability of fat grafting volume retention. While estimates are provided for percent of fat grafting survival based on Dr. Eppley’s experience, no guarantee can ever be made on how much fat will survive in any one patient. Any of these risks may require revisional surgery for improvement.

ADDITIONAL SURGERY     

Should additional surgery be required to do additional fat grafting, perform contour adjustments or  revise any harvest or graft insertion scars, these will generate additional costs.

Consent for Plastic Surgery: Cranioplasty (Skull Reshaping)

Monday, January 28th, 2013

 

Every plastic surgery procedure has numerous issues that every patient who is undergoing a procedure should know. These explanations are always on a consent form that you should read in detail before surgery. This consent form, while many perceive as strictly a legal protection for the doctor, is actually more intended to improve the understanding of the various skull reshaping procedures. The following is what Dr. Eppley discusses with his patients for these procedures. This list includes many, but not all,of the different outcomes from surgery. It should generate both a better understanding of the procedure and should answer any remaining questions that one would have.

ALTERNATIVES

There are no alternatives to surgical skull reshaping. Some small skull defects may be treatable by a fat injections or bone cements placed through a minimal incision injection approach. High spots or skull reduction can not be reduced by a non-incisional approach.

GOALS

The goal of skull reshaping surgery is to create a more normal appearing skull contour. In some cases, this may require building up the bone, reducing raised areas or a combination of both reshaping techniques to get the optimal skull contour.

LIMITATIONS

The limitations of any cranioplasty procedure are how much of an incision can the patient tolerate (access and exposure), how much the skull can be built up based on the scalp’s ability to stretch and the thickness of the skull bone when reductions are being done.

EXPECTED OUTCOME

Expected outcomes include the following: temporary swelling of the scalp even extending down into the face, scalp skin numbness, a permanent scalp scar, the implantations of various biomaterials for augmentation/buildup including microcrew anchorage and months of healing and tissue settling until the final result is seen in all aspects. Healing of any cranioplasty procedure is a process and the minimal amount of time to judge the result is three months and may take as long as six months to see the very final result in many cases.

RISKS

Significant complications from skull reshaping surgery are very rare but could include infection. More likely but uncommon occurrences could include a wide scalp scar, potential hair loss along the incision, suture reactions along the incision edges causing local wound healing problems, edge demarcation/irregularities along any implant-bone interface, overcorrection of the skull contour, undercorrection of a skull contour, and asymmetries and irregularities of the skull contour. Any of these risks may require revisional surgery for improvement.

ADDITIONAL SURGERY     

Should additional surgery be required to revise a scalp scar, adjust a bone or implant contour or perform aesthetic adjustments of the initial skull reshaping will generate additional costs.

Consent for Plastic Surgery: Gynecomastia Reduction

Sunday, January 27th, 2013

 

Every plastic surgery procedure has numerous issues that every patient who is undergoing a procedure should know. These explanations are always on a consent form that you should read in detail before surgery. This consent form, while many perceive as strictly a legal protection for the doctor, is actually more intended to improve the understanding of the various lip enhancement procedures. The following is what Dr. Eppley discusses with his patients for these procedures. This list includes many, but not all,of the different outcomes from surgery. It should generate both a better understanding of the procedure and should answer any remaining questions that one would have.

ALTERNATIVES 

There are no effective alternatives to surgical gynecomastia reduction. There are no exercises, drugs or weight loss strategies that will work. In very young male teenagers, further physical development may cause some lessening of the size of the breasts in some individuals.

GOALS

The goal of gynecomastia reduction surgery is to decrease the size of the breast tissue to make the chest as flat as possible. This includes the overall shape of the chest as well as the projection of the nipple-areolar complex.

LIMITATIONS

The limits to the amount of gynecomastia reduction is how much chest skin exists and the size of the nipple-areolar complex. The shape of the chest will ultimately be determined by how well the overlying skin shrinks down and adapts to the reduced breast tissue. Excess chest skin, chest skin with stretch marks and a large nipple-areolar complex may fail to produce a completely flat chest based on his elasticity and the amount of skin retraction.

EXPECTED OUTCOME

Expected outcomes include the following: temporary bruising and swelling of the chest, temporary chest skin numbness, temporary vs permanent nipple numbness, permanent scars around the areola and at the side of the chest (if liposuction is used), undercorrection (residual gynecomastia), overcorrection (indentation of the nipple-areolar complex, chest skin irregularities and asymmetry if bilateral gynecomastia reduction is done. Healing of the scars and settling of any chest irregularities is a process that may take months (6 to 12) to see the very final result in many cases.

RISKS

Significant complications from gynecomastia reduction surgery are very rare but could include infection and bleeding. (hematoma) More likely complications could include aesthetic deformities such as asymmetry and irregularities of the chest skin, scar deformities of the areola and chest wall, too little breast tissue removed, too much breast tissue removed and nipple-areolar deformities.Any of these risks may require revisional surgery for improvement.

ADDITIONAL SURGERY     

Should additional surgery be required to adjust chest symmetry, remove further breast tissue, correct a nipple-areolar deformity or for scar revision will generate additional costs.

Consent for Plastic Surgery: Lip Lifts, Lip Advancements and Corner of Mouth Lifts

Sunday, January 27th, 2013

 

Every plastic surgery procedure has numerous issues that every patient who is undergoing a procedure should know. These explanations are always on a consent form that you should read in detail before surgery. This consent form, while many perceive as strictly a legal protection for the doctor, is actually more intended to improve the understanding of the various lip enhancement procedures. The following is what Dr. Eppley discusses with his patients for these procedures. This list includes many, but not all,of the different outcomes from surgery. It should generate both a better understanding of the procedure and should answer any remaining questions that one would have.

ALTERNATIVES

Enhancements of the lips can be done by a variety of synthetic or fat injectable fillers to increase the size of the pink part of the lip. (vermilion) Whether the results achieved by injection techniques is comparable to that of tissue excision and lifting should be thoroughly understood before surgery.

GOALS

The goal of lift lifts and advancements is to shorten the distance between the base of the noses and the upper lip and increase the amount of vermilion show. A lip lift will increase the central lip pout and vermilion show. A lip advancement will increase vermilion throughout the whole lip from one mouth corner to the other. The goal of a corner of the mouth lift is to lift up the sagging mouth corners and create a more horizontal smile or lip line.

LIMITATIONS

There are limits as to how much the lip can be lifted or advanced and how much the corners of the mouth can be changed. The limits to these changes are based on trying to keep the lips looking natural and not overdone and to not making excessive visible scarring.

EXPECTED OUTCOME

Expected outcomes include the following: temporary bruising and swelling around the lips and the corner of the mouth, temporary lip numbness, permanent scars at the junction of vermilion-skin junction (lip lifts and advancements) and away from the corner of the mouth. (corner of mouth lift) All excisional lip procedures may create some temporary stiffness on movement and mouth opening. Healing of the scars and settling any scar irregularities is a process that takes months (6 to 12) to see the final result in many cases.

RISKS

Significant complications from lip surgery are very rare but could include infection. More likely complications could include aesthetic deformities such as asymmetry and irregularities of the vermilion-skin junction (lip lines) asymmetry of lip (vermilion)sizes or mouth corners, suture reactions along the incision lines, and under vs. overcorrection of the desired lip sizes or corner of the mouth changes. Any of these risks may require revisional surgery for improvement.

ADDITIONAL SURGERY     

Should additional surgery be required to adjust the  shape of the lips or corner of the mouth, this will generate additional costs.

Consent for Plastic Surgery: Jaw Angle Implants

Friday, January 25th, 2013

 

Every plastic surgery procedure has numerous issues that every patient who is undergoing a procedure should know. These explanations are always on a consent form that you should read in detail before surgery. This consent form, while many perceive as strictly a legal protection for the doctor, is actually more intended to improve the understanding of the jaw angle implant procedure. The following is what Dr. Eppley discusses with his patients for this procedure. This list includes many, but not all,of the different outcomes from surgery. It should generate both a better understanding of the procedure and should answer any remaining questions that one would have.

ALTERNATIVES

Jaw angle augmentation can be done by temporary fillers although they do not produce the same angular and well defined effect as an actual implant. There are no bony moving alternatives to creating a jaw angle enhancement effect. Another alternative would be to not place an implant at all.

GOALS

The goals of jaw angle implant surgery is to create a more visually apparent L-shape to the back part of the lower jaw. This could be to simply widen the jaw angle one already has, to vertically lengthen the existing jaw angle, or some combination of both. Jaw angle implants are often part of an overall jawline enhancement effort.

LIMITATIONS

The amount that the shape of one’s jaw angles that can be changed is limited by the thickness of the skin covering the implant and the size and shape of the underlying jaw angle bone. While different sizes and styles of jaw angle implants exist, the final shape that the back part of the jaw will assume after augmentation is limited by the size and shape of the  underlying bone on which it sits as well as the thickness of the soft tissues over it.

EXPECTED OUTCOME

Expected outcomes include the following: temporary bruising and swelling around the jaw and neck, temporary  numbness of the inside of the cheek, and the skin over the jaw angle and a fine small scar inside the mouth through which the implant was placed. Jaw opening will be stiff for a few weeks after surgery. It often takes weeks to several months for the swelling from surgery to completely resolve and the final shape and contour of the jaw angles to be seen.

RISKS

Significant complications from jaw angle implant surgery are rare but  may include postoperative bleeding and infection. More likely but also uncommon complications include aesthetic deformities such as asymmetry and irregularities of the jaw angles due to either a natural asymmetry to the jaw angles or differences in implant placement between the two sides. The implants may also be either too big, too small or otherwise do not create the desired aesthetic effects. Any of these risks may require revisional surgery for improvement.

ADDITIONAL SURGERY     

Should additional surgery be required to adjust the position of the implant or change its size or shape, this will generate additional costs.

Consent for Plastic Surgery: Armlifts

Wednesday, January 16th, 2013

 

Every plastic surgery procedure has numerous issues that every patient who is undergoing a procedure should know. These explanations are always on a consent form that you should read in detail before surgery. This consent form, while many perceive as strictly a legal protection for the doctor, is actually more intended to improve the understanding of the armlift procedure. The following is what Dr. Eppley discusses with his patients for this procedure. This list includes many, but not all,of the different outcomes from surgery. It should generate both a better understanding of the procedure and should answer any remaining questions that one would have.

ALTERNATIVES

The alternatives to arm lift surgery are liposuction to remove fat only (and hope the skin tightens) and non-surgical devices to shrink fat and tighten skin.

GOALS

The goal of armlift surgery is to reshape the circumference of the arms, making them smaller and less flabby on the triceps or backside of the arm area.. This is done cutting out loose skin and fat on the back of the arms from below the elbow to the armpit and, in some cases, below the armpit area as well.

LIMITATIONS

The upper arms can only be downsized so much, which is limited by how much skin and fat can be removed and getting the excised area closed without too much tension.

EXPECTED OUTCOMES

The following are all likely to occur: temporary pain, swelling, and bruising of the arms, possible need for several days to a week of drain tubes after surgery, permanent scars along the inside or back of the arms, temporary or permanent numbness of the skin of the arms, and up to one month after surgery for complete healing.

RISKS

Complications may include bleeding, infection, fluid accumulation (seroma) after drain removal, skin irregularities, poor scarring, incision separation after surgery (particularly close to the armpit), spitting of sutures for months after surgery, tightness of the arms, scar banding across the armpits and residual loose skin that may need further surgery to remove.

ADDITIONAL SURGERY

Additional or revisional surgery may needed to close open wounds or improve undesired scarring. These risks are not rare in armlifts with the risk of the need for scar revision as most likely with a 5% to 10% likelihood. This may generate additional costs.

Dr. Barry Eppley

Indianapolis, Indiana


Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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