FAQs: Preparing for your Procedure

It’s important to do you research before you select a surgeon. The most important factor is that the surgeon is Board Certified either by the American Board of Plastic Surgery or by the American Board of Facial Plastic Surgery. This provides assurance that the surgeon has spent dedicated years training in the specialty of plastic surgery and has been rigorously examined both in written examinations and in person oral examinations to confirm their competence and expertise in plastic surgery. It is also important to look at before and after photos to ensure that you are happy with the surgeon’s outcomes on other patients and overall aesthetics. Make sure you read reviews and testimonials to see how other patients’ experiences have been with that surgeon. The consultation is a very important time to ensure that you feel comfortable and listened to by the surgeon and his or her staff. Being able to communicate well and understand each other is critical for the patient-doctor relationship! You should have ample time to ask all of your questions and understand your options and what to expect from your procedure before you select your surgeon. It’s often very helpful to have more than one consultation with different surgeons in order to understand different approaches and make sure you are picking the surgeon you feel the most comfortable with.

Many patients wonder if they are making the right choice by considering plastic surgery and if they are good candidates for a certain procedure. From a physical standpoint, the ideal candidates for any surgery are in good overall health and not actively smoking. If you do have any medical issues such as high blood pressure or diabetes, it is important to work with your primary care physician to make sure these are well controlled and stable before considering surgery. It is also very important to consider your motivations for and expectation about surgery. Plastic surgery is intended to improve your self-image, or the way you feel about yourself. You may be doing it for reconstructive purposes, either because of congenital defect or something that developed as a result of trauma or injury. Or, you may be doing it to slow the aging process or reverse changes that happened as a result of pregnancy and childbirth. Cosmetic surgery is a significant investment in time, effort, and emotion. It is important to be honest with yourself about your motivations for surgery and expectations of the outcome. It is unwise to expect that cosmetic surgery can cure a troubled marriage, significantly improve one’s success in the job market, or reinstate one’s youth. Instead, you should set your expectations on the way you feel about yourself and the impact that a physical change could have on that feeling.

Board Certification in Plastic Surgery or Facial Plastic Surgery is the most critical factor in choosing your surgeon Certification by the board means members are held to the highest standards of knowledge, skills, judgement, safety and ethics. Board Certification provides assurance that the surgeon has spent dedicated years training in the specialty of plastic surgery and has been rigorously examined both in written examinations and in-person oral examinations to confirm their competence and expertise in plastic surgery. There is a big difference between a “Cosmetic Surgeon” and a Board Certified Plastic Surgeon. A doctor of any specialty (including Ob-Gyn, Family Medicine, Internal Medicine, or any other medical specialty) can call themselves a “Cosmetic Surgeon” and perform cosmetic surgery procedures just by obtaining a medical license. They may have taken a brief course to learn a particular procedure but are not trained to assess and handle the nuances of individual anatomy or to handle complications that may arise.

Plastic surgery encompasses both cosmetic surgery and reconstructive surgery and seeks to maximize both appearance and function, regardless of the initial presentation. Often a significant amount of overlap exists between the two, which is why many surgeons consider themselves both cosmetic and reconstructive surgeons. Reconstructive surgery is performed on abnormal structures of the body, caused by congential defects, developmental abnormalities, trauma, infection, tumors or disease. It is generally performed to improve function, but is often also be done to approximate or improve a normal appearance. Reconstructive surgery is generally covered by most health insurance policies although coverage for specific procedures and levels of coverage may vary greatly depending on the quality of the insurance. Cosmetic surgery is performed to reshape normal structures of the body, usually to improve form and appearance. Cosmetic surgery typically is not covered by health insurance. There are a number of “gray areas” in coverage for plastic surgery that sometimes require special consideration by an insurance carrier. These areas usually involved surgical operations which may be reconstructive or cosmetic, depending on each patient’s situation. For example, eyelid surgery (blepharoplasty) – a procedure normally performed to achieve cosmetic improvement may be covered if the eyelids are drooping severely and obscuring a patient’s vision.

The first time you come to the Sandel Duggal Center, you will meet with several people in addition to the surgeon. You will most often have an opportunity to fill out your registration and health history paper work online before the consultation but if this wasn’t possible you can arrive a few minutes early to fill this out. It is important for us to have an understanding of your medical history, previous surgeries, medications or allergies, and any other pertinent information to give you the best advice regarding procedures you are interested in. You will be brought to a consultation room by one of our nurses or medical assistants and they may ask to confirm the reason for your consultation and any particular questions you have. If you are coming to discuss a face, neck, or skin question you will often have photographs taken prior to meeting with Dr. Sandel or Dr. Duggal so that those photos will be available to refer to during your consultation. For patients coming to discuss breast or body questions, photographs will be taken later in the consultation. None of these photographs would ever be used for anything other than your private medical file without your explicit consent. Your meeting with Dr. Sandel or Dr. Duggal will usually last anywhere from 45 minutes to an hour depending on the procedure you are considering and what questions arise from the discussion. You should feel very comfortable asking any question you have regarding the different options to address your concerns, the risks and benefits of different procedures, the expected recovery time, and the anticipated outcome of the surgery. You will have an opportunity to look at before and after pictures in the office with the surgeon. For certain procedures such as breast augmentation or rhinoplasty, you will have an opportunity to view your own personal projected outcome with our 3-dimensional Vectra photography system. After your consultation, you will meet with one of our patient care coordinators who can let you know the cost of your surgical or non-surgical plan as well as the next steps if you wanted to schedule a procedure. Our patient care coordinators will be in close touch with you with any questions you have about the possible procedures and the scheduling process. Often patients will return for a second consultation and may bring a family member or friend with them to ask additional questions and better prepare for the procedure.

It is very common for patients to be considering more than one plastic surgery procedure. These can be on related areas, for example a facelift combined with upper and lower blepharoplasty and a browlift, or on unrelated areas such as a breast lift and facelift. There are advantages to combining surgeries such as a single recovery period and the convenience of one surgery, and there can also be a financial advantage to combining anesthesia and operating room time. It is important for patients considering more than one procedure to discuss the safety of doing this with their surgeon. If the procedures you are considering combining would keep you in the operating room longer than 6 or so hours, your surgeon may recommend staying overnight to ensure you are comfortable, well hydrated, and monitored by a nurse for the first hours of your recovery.

There is a growing world of non-surgical procedures for the breast and body which patients are often very interested in. These range from fat reduction devices such as Sculpsure to injectable medications for facial rejuventation such as Botox and dermal fillers. Non-surgical treatments typically have little to no down-time or recovery involved and can be done in an office setting either with no anesthesia or with a topical numbing cream. Patients often wonder if they are good candidates for a non-surgical approach. The best answer to this is to discuss all options during your consultation. The answer depends very much on your individual anatomy, your personal goals and expectations, and your currently life situation. For many patients surgery many not be an ideal option at the current time due to job or family constraints. Non-invasive treatments can be the perfect option for improving an area which bothers you without the commitment of surgery. It is important, however, to understand the limitations of non-surgical treatments and the difference in outcome which would be expected between a treatment vs a surgical procedure for that area. This way you can make the most educated and informed decision about how to invest your time and money. Beware of locations and practices which only offer non-invasive options as they will likely not be able to guide you as to all the options and which one is truly right for you.

Unfortunately bruising and swelling can be common side effects after everything from in-office injectable treatments to surgical procedures. As surgeons we do everything possible from a technical standpoint to reduce these, but patients often wonder what they are able to do at home to reduce their chances of bruising. One important factor is limiting or stopping your intake of blood thinning medications for at least a week prior to any procedure. These include Aspirin, non-steroidal anti-inflammatory medications (Ibuprofen, Motrin, Alleive), and any prescription blood thinners. The use of Arnica, a homeopathic medication aimed at reducing swelling and bruising, may help some patients. Alcohol, especially red wine, can have a blood thinning effect and can be avoided if you want to reduce the chances of bruising. For surgical procedures, ice and elevation of the area for the first 24-48 hours is critical to reducing swelling. Unfortunately, there is always the chance of bruising from even an in-office injection. If you ever have any questions about the degree of bruising or swelling, it is important to get in touch with us to see if there is anything which can be done, including a light laser treatment of the bruise to improve its appearance or a medical grade cover-up makeup.

Plastic surgery is a significant commitment of your time, emotion, and money. It is important to understand the possible risks of any procedure before you undergo it, and to weigh the relative risks with the benefits. Each procedure and surgery carry their own individual risks and Dr. Sandel and Dr. Duggal can answer any questions you have regarding these risks prior to having your procedure. Most surgical procedures have a very low risk of serious complications and a slightly higher risk of temporary or minor setbacks during the recovery period. Understanding and anticipating these can make the recovery much less stressful. Overall, plastic surgery done by an experienced and board certified surgeon in an accredited operating room with a board certified anesthesiologist is a very safe and rewarding experience.

Rhinoplasty FAQs

Rhinoplasty is a term given to the surgical procedure intended to improve the shape, size, and function of the nose. A complete procedure will address every aspect of its appearance. This typically involves reducing a hump, straightening the nose, making the nose smaller, improving the definition and symmetry of the tip, and raising the tip into a more pleasing position. Other details can also be addressed, including narrowing the nostrils or nasal base and supporting a nose that has lost its structure.

A rhinoplasty may also be performed to improve breathing. This is usually done at the same time that the outside appearance is improved. Techniques that help breathing include septoplasty, or straightening the structure inside the nasal airway, placing supporting grafts that open the nasal valves, and improving the support of flaccid nostrils. This portion of a rhinoplasty is usually covered by insurance.

In general there are two types or surgical approaches to a rhinoplasty. The first is the endonasal technique. This is the classic technique where incisions are placed completely inside the nose. Although this is an excellent option for patients with a minimal deformity or a simple cosmetic concern, it is limited by the amount of exposure the surgeon can achieve. The more common technique is an external technique that utilizes a small incision placed between the nostrils. This provides the surgeon with excellent exposure allowing for the precise placement of grafts and detailed refinement of the nasal tip. The small incision is placed in such a way that it is virtually imperceptible even a few weeks after the procedure. During your consultation, each of these methods will be discussed in detail and the best option for you will be decided.

Although all insurance companies are different, most will provide coverage for patients who have a functional breathing problem or a severe nasal deformity resulting from trauma or medical condition. Insurance companies will not cover a rhinoplasty performed for cosmetic purposes.

Many patients with breathing problems also elect to undergo a cosmetic procedure at the same time. By doing so, insurance will assist in paying for that portion of the procedure, operating room costs and anesthesia fees that is associated with correction of the function of the nose.

Younger patients can consider surgery after they have reached puberty and the nose has completed growth. This is usually around the age of15 in girls and 16 in boys. Otherwise, a rhinoplasty can be performed at any age in adults.

The typical length of time required to perform a rhinoplasty averages about 2 hrs. This depends on the severity of the deformity and the surgical technique chosen. Revision surgery generally requires a longer operating time.

A primary rhinoplasty is performed on patients who have never had nose surgery before. The nose will not have scar tissue or complex abnormalities seen in revision rhinoplasty patients.

Revision rhinoplasty is performed on patients who have already had a rhinoplasty by another surgeon. The revision surgery is performed to correct a problem that was not addressed during the previous surgery or for those who have developed scarring or breathing difficulties.

During your consultation, Dr. Sandel will discuss in detail your expectations regarding the procedure. A complete medical history and nasal examination will be performed. You will also have your pictures taken and digital computer imaging will be done. This will allow you to see the results in your appearance after changing the shape of the nose and improve communication between you and our physicians regarding your cosmetic goals.

Rhinoplasty may take place in an outpatient surgical center, or a hospital.

The type of anesthesia commonly used is either local anesthesia with sedation or general anesthesia.

Sharp pain is uncommon after the procedure. The patient should expect a dull ache during the first few days. This can be controlled with a light prescription pain medication that can be quickly replaced by over-the-counter medications.

Dr. Sandel does not routinely pack the nose after nasal procedures. He uses a technique that prevents bleeding without the use of packs.

After your procedure, a splint will be applied to the nose. You will also have a small drip pad under the nose to catch drainage that will occur. On the first day after surgery, you will be seen in the office and the drip pad will be removed. You will be asked to apply cold compresses to the nose and face over the next several days. After this point you may continue to have swelling that will gradually subside with time.

Patients may wish to take one week off from work, although some may wish to return sooner with the nasal splint in place.

Patients may be able to return to light exercise after one week. Full strenuous activity or exercise should be avoided until 2-3 weeks.

Complications after surgery are rare but may include bleeding, infection, and incomplete correction of the nose. There are risks associated with having anesthesia that will be discussed by your anesthesiologist at the time of the surgery. There is also the potential that you may require additional surgery or a second procedure.

Rhinoplasty is one of the most difficult and complex cosmetic procedures to perform. It requires a level of skill and attention to detail that are only achieved after extensive training specifically in nasal surgery. It is of the utmost importance that you do your homework and carefully choose the surgeon to perform your procedure. Your surgeon should have a background in Otolaryngology, Head and Neck Surgery. Unlike any other specialty, surgeons board certified by the American Academy of Otolaryngology have undergone years of training in the surgical treatment of diseases of the nose, both inside and out. Their surgical training is exclusive to the face, head and neck, which encompass some of the most difficult anatomy in the human body.

In addition, he or she must also have fellowship level training in cosmetic surgery certified by the American Board of Facial Plastic and Reconstructive Surgery. A facial plastic surgery fellowship goes one step beyond the traditional residency training to give that person experience in state of the art procedures in cosmetic surgery. This level of training usually puts them at the forefront of the specialty and makes them leaders of the field of facial plastic surgery.

Forehead Lift FAQs

In some patients, a part of rejuvenating the eyes involves repositioning the eyebrows and softening the forehead lines. Low-lying eyebrows can affect the amount and redundancy of the upper eyelid skin. This sagging of the forehead pushes excess skin onto the upper eyelid. If a patient simply had surgery of the upper eyelid without addressing the forehead, the low-lying position of the eyebrow will be accentuated, resulting in a tired appearance. The goal of refreshing the eyes is to open them, making you look less tired. A forehead lift can play a large role in this.

If the forehead lift is done properly, the eyebrows will simply be elevated into a more natural position. This lift will soften the horizontal lines of the forehead and open the outer portion of the eyes.

Facelift FAQs

There are several different types or techniques used to perform facelifts. Although each patient is different, the most common facelift technique used is called the SMAS flap technique combined with a corset platysmaplasty. This provides patients with a long lasting lift without giving them an unnatural or pulled appearance. The muscle layer just beneath the skin is called the SMAS (superficial musculoaponeurotic system). This is the layer that is lifted. The skin is simply re-draped over the lift in a very natural way.

The corset platysmaplasty is a term used to describe the treatment of the neck and the angle beneath the chin and jawline. This is the key to defining the chin-neck angle, getting rid of the bands of skin, and supporting the facelift. Only a very small incision beneath the chin is required.

Facelift incisions are made so that they can be hidden as completely as possible. The most noticeable scarring can occur in front of the ear. Because of this, Dr. Sandel and Dr. Duggal designs this incision to hug the earlobe in a natural skin crease, extending inside the front of the ear, and curving around into the hairline. In men, this incision is left in front of the ear to avoid facial hair growth on the ear. The incision behind the ear is placed just above the ear crease to prevent scar bands. It is then gently extended into the hairline high enough to not be noticeable.

There is also a small incision placed just beneath the chin in order to effectively treat the neck. The incision is placed in the lower chin crease and is virtually invisible after it heals.

Dr. Sandel and Dr. Duggal wants patients to be to able to style their hair any way they like after the procedure. Thus, it is crucial to keep scarring minimized and well hidden.

Dr. Sandel and Dr. Duggal suggests that patients expect to be off work or in a restful environment for the first week after the surgery. Many patients will have mild to moderate swelling and bruising in the lower face and neck during this time period. The second day after surgery, we encourage our patients to shower and wash their hair. You may be taking a mild prescription pain medication during the first few days. This can be quickly exchanged for an over the counter pain reliever as the patient is able.

After the first week, all sutures are removed. You will be asked to continue to keep your incision sites clean with peroxide and moist with Aquaphor on a daily basis. On the tenth day, we have our patients undergo a complementary make up sessions. At this point, you will feel like yourself and be interested in returning to work. Although you may have some residual swelling, most people around you will not notice. The healing process will continue for the next few months, and we will follow your progress for one full year.

Although some patients are candidates for cheek lifts, neck lifts, or treatment of the jowls it is almost impossible to obtain a full facelift result with a one-hour minimal procedure. Many of these types of “minimum” facelifts are skin-only lifts or suture lifts. These procedures do little to address the neck and jowls. They also have a much greater tendency to break down after a short period of time and thus not give lasting results. If it sounds too good to be true, it probably is.

Our physicians’ philosophy is to only offer treatments that have proven results. Their goal is to provide results that last. In the long run, it can be much more expensive to undergo multiple small or “minimal” procedures rather than have your cosmetic concerns addressed appropriately the first time.

Although very rare, there are risks associated with any procedure. The risks specific to facelifts include bleeding or hematoma formation, infection, skin breakdown (especially in smokers), mild loss of sensation, and the possibility of a repeat operation. Dr. Sandel and Dr. Duggal takes great care to minimize these risks throughout your surgery and during your time of healing. They will go through these in detail at the time of your consultation.

Midface Lift FAQs

A facelift usually addresses the lower 1/3 of the face and the upper 1/2 of the neck. A midface lift is more of a cheek lift (middle 1/3 of the face). Many times the midface lift is performed in conjunction with a lower eyelid blepharoplasty.

Candidates for a midface lift are those who desire an improved appearance in the tone, firmness, and youthfulness to the midface and cheeks. These patients generally have cheeks that droop below the cheekbone. This pulls on the lower eyelid making it appear elongated. A hollowness can also be found beneath the eyelid (where the cheek should be).

Eyelid Surgery (Blepharoplasty) FAQs

Blepharoplasty, also known as eyelid surgery, is a surgical procedure which involves the removal of excess fat, skin and muscle of the eyelids. It is performed in order to correct droopiness of the upper eyelids and puffiness or bags of the lower eyelids. The surgery can be perfomed in many different ways depending on the problem that needs to be corrected. Discuss your concerns with our physicians and he can explain the differences of each technique. This procedure is commonly performed on both the upper and lower eyelids but may be performed independently.

Good candidates for blepharoplasty include men and women who are interested in improving the appearance of their eyes. Your eyes can say a lot about you, your health, and your well being. Commonly patients wish to look less tired. Patients with excessive upper eyelid fullness and/or skin are excellent candidates. Also, those with puffiness of the lower eyelids, redundant folds of skin, and hollowness of the tear trough are also excellent candidates. All patients should be physically healthy and have realistic goals and expectations.

You will meet with Dr. Sandel or Dr. Duggal for the consultation. During the consultation for blepharoplasty, they will discuss your goals and expectations, take a thorough medical history. We will also explain all details of the surgery including the technique, the anesthesia, the facility, the costs and the risks.

Blepharoplasty is usually performed in an outpatient surgery center under mild sedation. It can also be performed in the office under local anesthesia in certain circumstances.

Blepharoplasty may be performed with either local anesthesia and sedation or with general anesthesia.

There are many techniques for upper and lower eyelid blepharoplasty. The upper lid is relatively straightforward. Skin is removed after measuring the proper location of the upper eyelid crease. It is important to be conservative and not take too much skin. The fat pockets are then identified and removed. If you have a drooping upper eyelid border (not skin) then the muscle that pulls the eyelid open may need to be tightened.

The lower eyelid is a little more complicated. Under rare circumstances an incision is made behind the eyelid and fat is taken out of the eyelid. With this technique the skin and muscle are not lifted. This is not appropriate for someone with extensive lower eyelid bads or festoons.

Most of the time a small incision is made just beneath the lower eyelid lash line. This allows fat to be removed in a very precise manner. Also, if there is hollowness between the eyelid and the nose, this fat may be transposed into this location. This is an excellent technique to take fat out of the eyelid and fill the groove sometimes called the tear trough. It can also make the upper cheek look more full. Next, the skin and muscle layer are tightened and supported. Excess skin is removed and redundant fat is excised. Very small sutures are used to close the incision.

Blepharoplasty typically takes between one and two hours to complete.

The incisions made during blepharoplasty will result in minimal scars, though they tend to be well-concealed. They are made in the fold of the upper eyelid or in the inside of the lower eyelid. While the scars may appear slightly pink at first, they will fade to a thin, nearly invisible white line within a few months.

Some tightness and soreness of the eyelids can occur, but pain medication can be prescribed to help control any discomfort that patients experience.

Patients may experience some tightness or soreness of the eyelids right after surgery which can be controlled with prescription medication. In addition, some dryness, itchiness, burning, excessive tearing, sensitivity to light, and blurred or double vision can occur during the first week. To help reduce swelling and bruising, it’s best to keep the head elevated as much as possible and to use cold compresses during the first few days. Bruising may take anywhere from ten days to two weeks to fully fade. Patients who wear contact lenses may do so after two or more weeks. Patients can typically return to work within seven to ten days, though more strenuous activities and alcohol consumption should be avoided for about two to three weeks.

It’s best to make preparations for someone to drive you home after your surgery.

It’s best to make preparations for someone to help you out for the first day or two after surgery.

Most patients find that they can return to work and most other normal activities within seven to ten days.

Vigorous exercise, strenuous activities and alcohol consumption should be postponed for about three weeks.

Some of the potential complications associated with blepharoplasty are as follows: bleeding, difficulty in completely closing the eyes, dry eyes, infection, pulling down of the lower lids, slight asymmetry in healing or scarring, swelling at the corners of the eyelids, temporary blurred or double vision, and whiteheads.

Blepharoplasty procedure performed solely for cosmetic purposes are typically not covered by insurance. However, some degree of coverage may be available in cases where drooping of the upper lids interferes with vision.

Financing is available for many plastic surgery procedures.

Botox Cosmetic FAQs

BOTOX® Cosmetic® Cosmetic is a purified protein produced by a bacterium called Clostridium botulinum. The protein is taken up by the motor end plate (where a nerve contacts a muscle). It then inhibits the release of a neurotransmitter into the nerve terminal. This prevents the nerve signal from reaching the muscle therefore preventing muscle contraction.

BOTOX® has been used around the world in millions of people for both cosmetic purposes as well as medical treatments. There have been no reports of side effects or complications during routine use. It has been approved by the FDA since 2002.

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