THIS SECTION

FACIAL ESTHETICS

BLEPHAROPLASTY (PLASTIC SURGERY OF THE EYELIDS)

Blepharoplasty is the correction of excess skin and/or fat of the eyelids. The surgery can be done on the upper eyelid (above the eyes) or on the lower eyelid (below the eyes). This kind of surgery can be esthetic or reparatory (due to accidental causes, deformities at birth or difficulty with vision).
Generally the surgery is performed on patients over 40 years old, however, in some cases, where family genetic interaction occurs, this surgery can be completed before.

A photographic study should be done before and after the surgical procedure, as much for scientific documentation as to show the patient the changes carried out. Evaluation of an Ophthalmologist is important.

The kind of anesthesia chosen is local anesthesia with sedation, reducing the anesthetic risks and bringing greater comfort to the patient.
Blepharoplasty should be performed in a hospital or specialized clinics. Discharge happens on the same day as surgery.

The time of surgery varies from 1 to 3 hours, depending on the number of eyelids (upper and lower) Depending on the patient’s problem various techniques can be used. We can use an incision in the skin (slightly apparent) or on the inside of the conjunctiva (imperceptible).
Blepharoplasty can be associated with others kinds of surgery, for example to lift the eyebrow or the cheekbone. Blepharoplasty also can be done on the wrinkles of oriental eyelids to become more occidentalized.

Some procedures, such as filling or the use of Botulinum Toxin, can improve the result even more.
Blepharoplasty can improve the appearance and self-confidence, but will not be different just because of surgery. Plastic surgery can help you to feel much better and younger.
The expectations should be realistic, and it is up to the surgeon to say if the expected result is or is not possible.

The doctor should be careful, when suggesting Blepharoplasty with regards to ophthalmological illnesses which can affect the final result.

Some complications can occur if the surgeon is not experienced and well trained. This can include difficulty to close the eyes when sleeping, ectropion (eyelid remains weak and falls), small lack of symmetry (differences) and non-esthetic surgical scar.

The surgeon should not just be chosen for reasons of price or payment facilities, but mainly due to mutual confidence of the patient for the doctor and the doctor for the patient. Getting to know the surgeon in a practical consultation is very important for good results.

The post-operative period involves little pain, but does have swelling close to the eyes. Depending on the technique, the stitches should be removed between 5 and 7 days. The patient should avoid physical exercise and the sun for the first couple of weeks.

Return to the work can take between 7 to 10 days, depending on the recuperation of the patient.

FRONTOPLASTY (TO RAISE THE EYEBROW)

Frontoplasty is surgery performed to elevate the eyebrow (region between the eyebrows and the eyelids) in people that have a small excess of skin in the upper eyelid, forehead with wrinkles and a fallen eyebrow.

In the pre-operative consultation the surgeon will evaluate the face of the patient discussing which technique will be used and if any additional procedure is necessary. A photographic study is essential for any facial plastic surgery.

The anesthesia used is local anesthesia with sedation, bringing greater comfort to the patient and reducing the anesthetic risks.

The surgery takes between 1 to 2 hours and discharge happens the same day. This surgery should be performed in a hospital environment or specialized clinics.

The surgery is performed with small cuts in the scalp, 2 cm from the hair line, as the scars remain hidden by the hair. An endoscope (micro-camera) is used to facilitate the surgery and is less invasive.  In some cases the muscles can be removed that are causing the eyebrow to "fall", improving even more the final result.

After surgery the patient will be discharged and will have swelling in the forehead and above the eyes. Medication will be prescribed by the surgeon and should be followed rigorously.

The stitches are removed between 10 and 14 days. Physical activity should be avoided in the first weeks, as well as the exposure to the sun.

Complications with this surgery are rare, but can happen. These include infections, corneal exposure (eyes very open), unexpected esthetic result etc.

FACELIFT (Plastic surgery of the face)

Ageing occurs in all of the tissues of the human body. In the face, muscular flaccidity, reduction of the bone tissue and excess of skin occurs. These changes result in the face looking more aged.
The objective of the facelift is to reposition these tissues and rejuvenate the face. The facelift or plastic surgery of the face is done on older people who have an excess of skin in the face (jaw line) and neck.

This procedure improves the jaw line (lower third of the face), giving a small improvement in the neck and center of the face.

Additional procedures may be included with this surgery, such as: Blepharoplasty, Rhinoplasty, Otoplasty, Frontoplasty, the application of Botulinum Toxin and facial fillers.

It is in the pre-operative consultation that the doctor and patient will decide which additional procedures are appropriate. A photographic study is of vital importance with this kind of patient.

Local anesthesia with sedation is used and admission and discharge are on the same day.

The surgery takes around 2 to 4 hours, depending on the technique used and the additional procedures that are necessary.

The incision used in this kind of surgery goes from the front to behind the ear, close to the hair, with time this scar is practically invisible. The muscle is held by suture threads and the excess of skin is removed. A drain can be used to avoid hematomas.

Postoperative, the patient can have swelling and bruising (purple marks) and the face remains sore for a little. The medical prescription should be followed completely, as well as post-surgical advice.

The bandage may remain for 2 to 5 days and the stitches are removed after 7 days. Physical activity should be avoided in the first weeks, as well as the exposure to the sun.

OTOPLASTY (CORRECTION OF MALFORMED EARS)

Otoplasty is plastic surgery to correct the size of the ear in relation to the head, which causes an important change that affects mainly the youths or adolescents.

All the information about the surgery should be given to the patient so that he feels safe and capable of accepting the modifications of the surgery.

The patient should feel confidence and empathy for the surgeon, because of this the choice of the surgeon should be careful, made in good time and should not be decided based on price or payments.

The surgery is indicated for all patients who feel uncomfortable with their ears in relation to the head.

The minimum age for this surgery is from 6 years old, when the ear has already reached its most significant growth. This surgery should be done as soon as possible to avoid scholastic and psychological problems.

In the case of a child with malformed ear, the parents must be aware of the feelings of the child regarding the ears. However, the parents cannot force child to have the operation, they should comment about the problem to the parents. This way it is easier to accept the surgery and the child collaborates more in the medical consultation and the pre-anesthesia period. In adult patients the indication is much clearer.

The consultation with your surgeon is very important. From this consultation you can learn more about the surgery, all of the risks, results and expectations. The surgeon must also be aware of the esthetic result expected by the patient. Ideally it should be the same and the result expected by the doctor and patient should be as close as possible.

During the consultation the patient is informed about the technique to be used, where the surgical scar will be, the type of anesthesia, the time to remove the stitches, the admission time and the recuperation after surgery.

The anesthetic risks are small, since the surgery can be done with local anesthetics. If the patient is a child, general anesthesia should be used.

The surgery is done by making a cut behind the ear, thus "concealing" the scar with the ear and hair. The surgery takes around 1 to 2 hours. After that, the patient remains under observation in the surgical center for approximately 1 hour. After they go to the room, where they remain until discharge.

The surgery of Otoplasty should be performed in hospitals or specialized clinics, however it is a procedure that the patient has on the same day as discharge.

The post-operative care includes analgesic medicines, a bandage around the ears that will be removed after 3 to 5 days. Physical exercises should be avoided in the first weeks, as well as the sun and trauma in the area of the surgery. A band can be used to hold the ears for a period of a month.

Generally this type of surgery does not have major complications when completed by a qualified and experienced surgeon. However, they can happen and the patient should be aware. The surgeon is obligated to warn the patient about the undesired effects.

Hematoma (pocket of blood inside the ear) is one of these complications, which should be corrected immediately, through the drainage of the blood.

Infections can occur with the ear cartilage, making scarring worse. These infections are cured using specific antibiotics.

RHINOPLASTY

Rhinoplasty is the most used plastic surgery procedure. It consists of changing of the form of the nose, be it the tip, the back or the size of the nose.

It can be performed together with surgery to correct a deviated septum in order to improve breathing (Septoplasty).

The choice of the surgeon should be taken with care and attention, choosing a qualified professional, so that the patient feels secure and willing to complete the procedure. The surgeon should maintain the characteristics of the patient, not changing the structure of the face too much. The result should be natural and at the same time satisfactory.

During the consultation with the surgeon any doubts should be resolved entirely, as much with regards to the actual procedure as to the post-operative period, anesthesia and medicines.
Rhinoplasty can be indicated for all people who are not satisfied with the shape of their nose. This change can bring more self-confidence and improve the life of the patient. However the surgery should not be performed to conceal or hide some behavioral or psychological change, or family problems.

The expectations of the patient and of the surgeon should be discussed in the pre-operative consultation. This expectation should be reached with the surgery, and have a natural esthetic and satisfactory result. The doctor will discuss with the patient the possibilities that medicine can offer, with the hope that the expectations meet the result that can be achieved.

Surgery can be performed on girls from 15 years old and on boys from 16, as this is when primordial growth of the nose has been reached.

The surgery is performed with local anesthesia and sedation and the incisions are made on the inside of the nose so there is no visible scarring. Hospital Discharge will be on the same day.

Rhinoplasty takes 60 to 90 minutes, after which there is a period of recuperation in the surgical center. During the surgery, the skin of the nose is separated from the structure of bone and cartilage, which is then changed by the surgeon to the desired shape and then the skin is repositioned on this new structure.

With the improvement of surgical techniques and the experience of the surgeons the use of the plug (gauze inside the nose) has been eliminated without any complications, which provides much more comfort for the patient.

Occasionally a finishing touch on the initial surgery is necessary in order to correct small imperfections, not due to error, but an additional procedure to obtain a better result still.
In the post-operative period chilled compresses and the use of painkillers are necessary. The patient will use a plastic mold on top of the nose in order to do the shaping, which is removed between 5 and 7 days.

The eyes may stay swollen and bruised for between 7 and 10 days. Slight nose bleeds are possible, which is normal. Also a small nasal obstruction can happen, formed by swelling inside the nose, which improves between 5 to 7 days.

Return to the work can be after 2 to 3 days, however physical exercises only after 30 days. Exposure to the sun should be avoided for 90 days. The final scarring of the nose lasts 6 months, however after 30 days the result can already be observed.

Types of Rhinoplasty performed:


Revision Rhinoplasty
Revision Rhinoplasty occurs after a trauma and can be performed 6 months after this injury.

Functional Rhinoplasty
Functional Rhinoplasty occurs normally when the patient has respiratory difficulty due problems in the nasal valve. The nasal valve is the area of the nose that the air enters and is the area that causes the biggest difficulty for air to enter into the nose, and because of this, small problems in this region can cause a lot respiratory discomfort for the patient.

Esthetic Rhinoplasty
Esthetic Rhinoplasty, or plastic surgery of the nose, is the repair of changes to the nasal structure that the patient is not happy with. Rhinoplasty has numerous techniques, including:

Augmentation Rhinoplasty, in cases of a very small nose;
Reduction Rhinoplasty, which can occur in the profile, leaving it smaller or, in the front view, leaving it narrower;
Rhinoplasty of the nasal tip, to make it thinner, "raise" or reduce it;
Rhinoplasty to correct a nose deviated from the middle line, or as it were a “crooked” nose, leaving it closer to the central line of the face;

Or a combination of all the techniques in order to obtain more perfect harmony between the nose and the whole face of the patient.

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