Boris Volshteyn, MD Boris Volshteyn, MD, is a plastic and reconstructive surgeon with offices located at 9436 Double R Blvd., Suite A, Reno, and 904 N. Nevada St., Carson City. Please call 841-9090 for more information or to schedule a consultation.

By Boris Volshteyn, MD
First of a two-part series

Cosmetic surgery is the most frequently performed type of surgery in the United States, yet patients sometimes find it difficult to find comprehensive information about different procedures. The following overview explores major cosmetic surgery available today, with some of the procedures fulfilling true medical need.

It's important to understand the circumstances and experience of every individual will be unique. If you're considering cosmetic surgery, ask your physician for further information and what you should expect. In addition, please note that all surgery carries some uncertainty and risk, including the possibility of infection, bleeding, blood clots and adverse reactions to anesthesia. You can reduce your risks by choosing a qualified plastic surgeon and closely following his or her advice, before and after surgery.

Breast augmentation
Augmentation mammaplasty
Procedure: Enhance the size of breasts using inflatable implants filled with saline.
Length: One to two hours.
Anesthesia: Local with sedation, or general.
In/outpatient: Usually outpatient.
Side effects: Temporary soreness, swelling, change in nipple sensation, bruising. Breasts sensitive to stimulation for a few weeks.
Risks: Lack of implant permanence -- surgical removal or replacement of the implants may be required to treat problems, including deflation; the formation of scar tissue around the implant, which may cause the breasts to feel tight or hard; bleeding or infection. Increase or decrease in sensitivity of nipples or breast skin, occasionally permanent. Mammography requires a special technique. (Note: Some women have reported symptoms similar to those of immune disorders. Ask your doctor about these and other FDA concerns.)
Recovery: Back to work: a few days. Physical contact with breasts: three to four weeks. Fading of scars: several months to one year or more.
Duration of results: Variable. Implants may require removal or replacement.

Breast lift
Mastopexy
Procedure: Raise and reshape sagging breasts by removing excess skin and repositioning remaining tissue and nipples.
Length: One to three hours.
Anesthesia: Local with sedation, or general.
In/outpatient: Usually outpatient; sometimes inpatient.
Side effects: Temporary bruising, swelling, numbness, dry breast skin. Permanent scars.
Risks: Thick, wide scars; skin loss; infection. Unevenly positioned nipples. Permanent loss of feeling in nipples or breasts.
Recovery: Back to work: one week or more. Strenuous activities: one month. Fading of scars: several months to one year.
Duration of results: Variable: gravity, pregnancy, aging and weight changes may cause new sagging. Results may last longer or be enhanced when breast implants are inserted as part of the procedure.

Chemical peel
Phenol and trichloroacetic acid (TCA)
Procedure: Restore wrinkled, blemished, unevenly pigmented or sun-damaged facial skin using a chemical solution to peel away skin's top layers. Works best on fair, thin skin with superficial wrinkles.
Length: One to two hours for full face.
Anesthesia: None; sedation and EKG monitoring may be used.
In/outpatient: Usually outpatient. Full-face phenol peel may require admission for one to two days.
Side effects: Both: temporary throbbing, tingling, swelling, redness; acute sensitivity to sun. Phenol: permanent lightening of treated skin; permanent loss of ability to tan.
Risks: Both: tiny whiteheads (temporary), infection, scarring, flare-up of skin allergies, fever blisters, cold sores. Phenol: abnormal color changes (permanent); heart irregularities (rare).
Recovery: Phenol: formation of new skin: seven to 21 days. Normal activities: two to four weeks. Full healing and fading of redness: three to six months. TCA: new skin within five to 10 days.
Duration of results: Phenol: permanent, although new wrinkles may form as skin ages. TCA: variable (temporary).

Collagen/fat injections
Procedure: Plump up creased, furrowed or sunken facial skin; add fullness to lips and backs of hands. Works best on thin, dry, light-colored skin.
Length: 15 minutes to one hour per session.
Anesthesia: Collagen: usually none; local may be included with the injection. Fat: local.
In/outpatient: Outpatient.
Side effects: Temporary stinging, throbbing or burning sensation. Faint redness, swelling, excess fullness.
Risks: Collagen: allergic reaction including rash, hives, swelling or flu-like symptoms; possible triggering of connective-tissue or autoimmune diseases. (A skin test is required before collagen treatment to determine whether an allergy exists.) Both: contour irregularities, infection.
Duration of results: Variable; a few months to one year.

Dermabrasion
Procedure: Mechanical scraping of the top layers of skin using a high-speed rotary wheel. Softens sharp edges of surface irregularities, including acne and other scars and fine wrinkles, especially around the mouth.
Length: A few minutes to one hour. May require more than one session.
Anesthesia: Local, numbing spray or general.
In/outpatient: Usually outpatient.
Side effects: Temporary tingling, burning, itching, swelling, redness. Lightening of treated skin. Acute sensitivity to sun; loss of ability to make pigment (tan).
Risks: Abnormal color changes (permanent). Tiny whiteheads (temporary), infection; scarring, flare-up of skin allergies, fever blisters, cold sores.
Recovery: Back to work: two weeks. More strenuous activities: four to six weeks. Fading of redness: about three months. Return of pigmentation/sun exposure: Six to 12 months.
Duration of results: Permanent, although new wrinkles may form as skin ages.

Eyelid surgery
Blepharoplasty
Procedure: Correct drooping upper eyelids and puffy bags below the eyes by removing excess fat, skin and muscle. (Upper-eyelid surgery may be covered by insurance if used to correct visual field defects.)
Length: One to three hours.
Anesthesia: Usually locally with sedation or general.
In/outpatient: Usually outpatient.
Side effects: Temporary discomfort, tightness of lids, swelling, bruising. Temporary dryness, burning, itching of eyes. Excessive tearing, sensitivity to light for first few weeks.
Risks: Temporary blurred or double vision. Infection, bleeding. Swelling at the corners of the eyelids. Dry eyes. Formation of whiteheads. Slight asymmetry in healing or scarring. Difficulty in closing eyes completely (rarely permanent). Pulling down of the lower lids (may require further surgery). Blindness (extremely rare).
Recovery: Reading: two or three days. Back to work: seven to 10 days. Contact lenses: two weeks or more. Strenuous activities, alcohol: about three weeks. Bruising and swelling gone: several weeks.
Duration of results: Several years. Sometimes permanent.

Facelift
Rhytidectomy
Procedure: Improving sagging facial skin, jowls and loose neck skin by removing excess fat, tightening muscles, redraping skin.
Length: Several hours.
Anesthesia: Local with sedation or general.
In/outpatient: Usually outpatient. Some patients may require short inpatient stays.
Side effects: Temporary bruising, swelling, numbness and tenderness of skin; tight feeling, dry skin. For men, permanent need to shave behind ears where beard-growing skin is repositioned.
Risks: Injury to the nerves that control facial muscles or feeling (usually temporary but may be permanent). Infection, bleeding. Poor healing, excessive scarring. Asymmetry or change in hairline.
Recovery: Back to work: 10 to 14 days. More strenuous activity: two weeks or more. Bruising: two to three weeks. Must limit exposure to sun for several months.
Duration of results: Usually five to 10 years.

Forehead lift -- Browlift
Procedure: Minimize forehead creases, drooping eyebrows, hooding over eyes, furrowed forehead and frown lines by removing excess tissue, altering muscles and tightening the forehead skin. May be done using the traditional technique, with an incision across the top of the head just behind the hairline; or with the use of an endoscope, which requires three to five short incisions.
Length: One to two hours.
Anesthesia: Local with sedation, or general.
In/outpatient: Usually outpatient.
Side effects: Temporary swelling, numbness, headaches, bruising. Traditional method: possible itching and hair loss.
Risks: Injury to facial nerve, causing loss of motion, muscle weakness or asymmetrical look. Infection. Broad or excessive scarring.
Recovery: Back to work: seven to 10 days, usually sooner for endoscopic forehead lift. More strenuous activity: several weeks. Full recovery from bruising: two to three weeks. Limit sun exposure for several months.
Duration of results: Usually five to 10 years.

You can read the second part of this series in the summer issue of Living Well.

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