Author: Morgan Cosmetic Surgery

Cosmetic  Question:  I had Botox around my eyes. Now my cheek lines look worse. Am I imagining things?

Cosmetic  Answer:

Probably not.  If Botox or any other neurotoxin (Xeomin, Dysport) is injected around the eyes, it can be injected too far out or too far down on the face. In some people, this can relax other facial muscles that were not necessarily the ones to be treated. This creates new lines. Contact the doctor that injected you and let them know what has happened.

If you were not injected by a physician, I suggest in the future that you find an experienced physician such as a Board Certified Plastic Surgeon or ENT specialist to inject your Botox. In many states, inexperienced physicians, physician assistants, registered nurses and dentists can legally administer Botox injections. Often the results turn out fine, but it is best to go to someone who is experienced and had the proper training.  A trained professional will analyze your face, have a knowledge of the anatomy of the face and know how to deal with tiny side effects, to get the best results. This allows tailoring of your treatment to your specific needs.

 

Cosmetic  Question :  If I have buttock implants, is it better to have 1 or 2 incisions. Which one is more noticeable after you have healed?

Cosmetic Answer:

The trend today is to use two incisions for buttock implants. They are placed one on either side of the buttock crease. Using 2 incisions helps your healing in several ways.

Healing is better because:

• There is less pulling on the incision
• The tissues are looser and fit more easily over the implants.
• 2 incisions do not show any more than the 1 incision made in the crease.
• Occasionally an incision in the crease will distort the shape of the buttock crease.

There is not a right or wrong. Some surgeons use 1 incision and some use 2 incisions. It depends on the patient’s tissues and what the patient prefers. I think the better approach for most patients is 2 incisions, given it heals better.

 

 

Cosmetic Question:  How can I make sure I get implants that fill a D cup Bra?

Cosmetic  Answer:

Implants are not made in bra cup sizes. These days bra cup sizes make little sense because all brands are sized differently. Do not worry about cup size, a D cup size means you want to look larger than normal.

Choosing the right implant is so important in breast augmentation surgery. It  should be taken seriously and a patient must have the right guidance.

This is how I make sure my breast augmentation patients get the implant that will give them the look they want:

1. At the consultation, I have the patient bring a snug-fitting tank top and a bra that they would like to fit into, as well as a trusted friend or relative to give their opinion.
2. I discuss the look they want, take measurements and look at any “Wish Photos” they may bring.
3. The patient then will try sizers. These are test implants of various sizes placed into the bra that they bring to their appointment.
4. The snug tank top is placed over the bra with the sizers in place. This allows the patient to see what they look like and if this is the size that gives them the look they want.
5. With this information, I will see what style and size implant will fit the patient’s chest.
6. Depending on a patient’s height, weight and frame, a D cup might be a 450 cc implant or a 250 cc implant. Implant size definitely depends on a person’s build.

 

Cosmetic  Question:  How long will I be swollen after a face lift?

Cosmetic  Answer: 

 Swelling after a face lift varies from patient to patient.

Typically it goes this way:

• First week – you are swollen but too tired to care.
• Second week –the swelling persists and you may feel depressed.
• Third week –the swelling is much less, bruising gone and you feel better.
• Sixth week – most of the swelling is gone.
• Six months – final result.

However, in some people swelling lasts much longer. Swelling can be prolonged if you have fat injections, you have a reaction to sutures or if you are of a certain skin type. Facial swelling takes time to subside. It is very frustrating, but not much can be done to speed it up. This is our natural healing process and will require patience.

 

Cosmetic  Question:  Why is it important to protect new scars from the sun?

Cosmetic Answer:

The sun can have adverse effects on new scars in 3 ways:

1. The sun disrupts collagen in the skin. This will make a scar thinner and wider.
2. The sun causes damage to the veins in our skin. Therefore, red scars that have have lots of tiny veins while they are healing, must be protected from the sun. If not, the veins may not disappear and the scar may widen.
3. Hyperpigmentation or darkening of a scar can occur if overexposed to the sun. We want patients who tend to have brownish scars to protect it from the sun or the brown will not fade and may even get darker. This is because the UV rays of the sun will increase the activity of the melanocytes, cells that produce color in the skin.

 

The easiest way to protect scars from the sun is to apply a zinc oxide/titanium dioxide sun block over any recent scars that are going to be exposed to sunlight. The sun block should be applied consistently from spring through fall.

Since the sun can reach scars that are even covered by clothing, especially white and light colored clothes, it is a good idea to apply the sun block under your clothes. This is very important if you go to the beach or on a cruise where you will be in the sun for hours at a time.

 

Cosmetic Question:  I had a mid-face lift through an eyelid incision. Now one eyelid is pulled down. How long does it take for this to go away?

Cosmetic  Answer:

The mid-face lift is an excellent operation, but distortion of the lower lid is one of its complications.

You may have a problem called ectropion.   Ectropion is the pulling down of the eyelid by a scar. When this surgery is done, a scar is left in the middle layer of the eyelid (middle lamella). This is where the eyelid meets the muscle. Ectropion occurs because the eyelid is weak and the pull of the scar is strong.

Mild ectropion after surgery often corrects itself. You should see improvement no later than 3 months after surgery and continued improvement for another 6 months. However, until the ectropion is gone the eye will be over-exposed and this can result in dry eye. The eyelid may need support with tape until the ectropion subsides. The dry eye may need to be treated with Natural Tears preservative free eye drops every 2 hours during the day and at night Lacrilube preservative free eye ointment applied before bed.

Ectropion can be severe and require the affected eye to be patched.  If it is severe, a surgery that involves a wide release of the scar and possibly a small graft would need to be done.

If the surgeon who did your mid-face lift is not concerned, you should get a second opinion at once to have the problem treated. Informed and experienced plastic surgeons always take ectropion seriously.

 

Cosmetic  Question:  How do I choose the right size implant for a breast augmentation?

Cosmetic  Answer:

 Every woman worries she will choose the wrong implant size and regret it. What if I go too big and look ridiculous? What if I go too small? Will it be the cup size that I want?

Our job is to help you find the best possible size for you. First, we start with discussing your goals as well as the different implant shapes, textures and where it will be placed. We will remind you that implants look smaller once placed inside. We suggest about 30 ccs larger than what looks right if the implant goes under the muscle and about 15 ccs more if it goes over the muscle.

Next, we consider the look you want, determining whether you want something natural, something dramatic or something minimal. If your goal is dramatic, we discuss how to get the maximum volume for you, discussing the trade-offs involved. We also consider your height, weight, chest circumference, chest measurements, skin looseness and how much breast tissue you have.

For a natural look, when you have little or no breast tissue, the size may be smaller than your ideal. We will discuss whether natural is really your goal. Or perhaps maybe a shaped implant over the muscle would be best.

Then, there is the always the difficult question of “ What bra size will I be?” This is a problem because bra sizes have no predictable meaning.  You might wear a B, C or D cup bra, depending on bra style and manufacturer.  However, an A is smaller than average, a B is on the small-side of average, a C is average, a D is larger than average, and a DD much larger than average. That is a more helpful guide. For a D cup, depending on all the other variables, the implant might be 275 cc or 500!  We will help you figure that out. Then you will try on various sizes of implants to see how they look under a top.

By the time you leave, you will be confident you have the implant range that is right for you. The final choice often depends on if you would rather end up a little larger or a little smaller than your ideal. Most patients almost always call or come back to consider this again.

It is well worth it to take your time, because choosing the right size is essential to your being happy with your new implants! Our goal is your happiness, and we will help you along the way.

Cosmetic  Question:  Can Botox be injected to narrow my face?

Cosmetic  Answer:

Yes. Botox can be injected into the masseter muscles which attach to the side of the jaw  and this can narrow your face.  If you have TMJ or grind your teeth, these muscles will get large. They make the jaw look square.

Botox injections into the muscles will shrink them, returning an oval look to the face. It is important that the injections be done correctly or the Botox can also change your smile (see our Blog “Can Botox Change My Smile”).

Injections are needed every 3 months to maintain the improvement. Many people say the injections relieve the pain of TMJ. They can also protect teeth from being ground down excessively by tooth grinding.

For more information from Dr. Morgan about cosmetic surgery and treatments, call us for an appointment, search our blog or go to www.realself.com – where Dr. Morgan regularly posts answers.

I am 55 and considering a breast augmentation. I have never been able to do this until now. Is 55 too old?

Answer:

At 55 these days, assuming you are healthy, you are young! You are definitely not “too old” for cosmetic surgery. Many women of your age find that it is the first time they can do something for themselves that they have always wanted to do. Go right ahead with your breast surgery and enjoy your result.

You are never too old for cosmetic surgery if you are in good health. I have done cosmetic surgery on men and women in their 70’s and 80’s with outstanding results and very happy patients. As we live longer, soon I am likely to be operating on people in their 90’s.

Cosmetic surgery is popular for a reason. Being in control of our bodies is essential to happiness. So, choosing to have or to not have cosmetic surgery is one way we may exert this control. There is no question that for most people who get cosmetic surgery, it can change their lives for the better. This is great at any age.

Cosmetic Question:   I really need a tummy tuck with muscle repair. What is the best way to deal with the pain after surgery?

Answer:

Tummy tuck pain is from muscle spasm, ‘ the world’s worst charley horse’.   Every time you try to sit up, cough or breathe deeply, you have horrible pain. Today you can have a low-pain tummy tuck thanks to Exparel. This is a long- lasting local anesthetic, bupivacane, that has been packaged into lisosome packets that release slowly over several days. It can give you up to 3 days of pain relief after surgery.

With Exparel, a number of things change. First, you have much less pain so you can get up and walk, stretching the muscle, which helps the muscle get out of spasm. Being able to walk from the start lowers the risk of blood clots. You need less narcotics and sedatives so you breathe better. Exparel stops the body from getting into a pain cycle, in which severe pain becomes harder and harder to control.

Although Exparel adds to the cost, I strongly recommend it for tummy tucks, for comfort and to reduce your risk of blood clots. How effective is it? The plastic surgery nurses at my main hospital all had Exparel for their tummy tucks once it came out. They became immediate fans.

Exparel cannot be used in obstetric paracervical blocks, in people with liver disease or in people with allergies to amide local anesthetics. It is ideal for cosmetic patients having surgeries that cause days of severe muscle pain, such as tummy tucks, under-the-muscle breast implants and calf implants.

Exparel helps you get up and moving from the start. It makes a riskier, high-pain, miserable recovery into a lower risk, easier one. If I were having a tummy tuck, I would have Exparel and I recommend it to all my patients. However, because of the extra cost not everyone chooses to have it, but I consider it well worth it.