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

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.

In the last issue of Living Well, we explored some of the most frequently performed cosmetic surgery procedures, including breast augmentation, breast lift, chemical peel, collagen/fat injections, dermabrasion, eyelid surgery, facelift and browlift. The following article describes additional procedures that are among the most requested in the United States.

In all cases, individuals considering cosmetic surgery should feel comfortable enough with their physicians to ask questions regarding risks and what to expect. Negative outcomes are a risk of all surgeries, 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.

Ear surgery
Otoplasty
Procedure: Set prominent ears back closer to the head, or reduce the size of large ears. Most often done on children between the ages of four and 14 years. (Occasionally covered by insurance.)
Length: Two to three hours.
Anesthesia: Young children: usually general. Older children or adults: general or local, with sedation.
In/outpatient: Usually outpatient.
Side effects: Temporary throbbing, aching, swelling, redness, numbness.
Risks: Infection of cartilage. Excessive scarring. Blood clot that may need to be drained. Mismatched or artificial-looking ears. Recurrence of the protrusion, requiring repeat surgery.
Recovery: Back to work or school: five to seven days. Strenuous activity, contact sports: one to two months.
Duration of results: Usually permanent.

Facial implants
Procedure: Change the basic shape and balance of the face using carefully shaped implants to build up a receding chin, add prominence to cheekbones or reshape the jawline.
Length: 30 minutes to two hours.
Anesthesia: Local with sedation, or general.
In/outpatient: Usually outpatient. Occasionally overnight hospital stay.
Side effects: Temporary discomfort, swelling, bruising, numbness and/or stiffness. In jaw surgery, inability to open mouth fully for several weeks.
Risks: Shifting or imprecise positioning of implant or infection around it, requiring a second operation or removal. Excess tightening and hardening of scar tissue around an artificial implant (capsular contracture), causing unnatural shape.
Recovery: Back to work: about one week. Normal appearance: two to four weeks. Activity that could jar or bump face: six weeks or more.
Duration of results: Permanent.

Hair replacement surgery
Procedure: Fill in balding areas with a patient's own hair using a variety of techniques, including scalp reduction, tissue expansion, strip grafts, scalp flaps or clusters of punch grafts (plugs, miniplugs and microplugs). Works best on men with male pattern baldness after hair loss has stopped.
Length: One to three hours. Some techniques may require multiple procedures over 18 months or more.
Anesthesia: Usually local with sedation. Flaps and tissue expansion may be done with general anesthesia.
In/outpatient: Usually outpatient.
Side effects: Temporary achy, tight scalp. Unnatural look in early stages.
Risks: Unnatural look. Infection. Excessive scarring. Failure to "take." Loss of scalp tissue and/or transplanted hair.
Recovery: Back to work: usually two to five days. More strenuous activities: 10 days to three weeks. Final look: may be 18 months or more, depending on procedure.
Duration of results: Permanent.

Laser facial resurfacing
Procedure: Smooth the face and smooth fine wrinkles using a carbon dioxide (CO2) laser device that treats layers of damaged skin. Softens lines around the eyes and mouth and minimizes facial scars and unevenly pigmented areas.
Length: A few minutes to an hour. May require more than one session.
Anesthesia: Local with sedation or general.
In/outpatient: Usually outpatient, unless combined with other surgical procedures that require hospitalization.
Side effects: Temporary swelling, discomfort. Lightening of treated skin. Acute sun sensitivity. Increased sensitivity to makeup. Pinkness or redness in skin that may persist for up to six months.
Risks: Burns or injuries caused by laser heat. Scarring. Abnormal changes in skin color. Flare-up of viral infections (cold sores) and other infections (rare).
Recovery: Back to work: two weeks. More strenuous activities: four to six weeks. Complete fading of redness: six months or less. Return of pigmentation/light sun exposure: six to 12 months.
Duration of results: Long-lasting, but does not stop aging. New wrinkles, expression lines may form as skin ages.

Liposuction
Suction-assisted lipectomy
Procedure: Improve body shape by removing exercise-resistant fat deposits with a tube and vacuum device. Can be performed using the tumescent technique, in which targeted fat cells are infused with a saline-containing solution with local anesthetic before liposuction to reduce postoperative bruising and swelling. Common locations for liposuction include chin, cheeks, neck, upper arms, above breasts, abdomen, buttocks, hips, thighs, knees, calves, ankles. For larger volumes of fat or for fibrous body areas, ultrasound-assisted lipoplasty (UAL) may be used. UAL is a new technique in which an ultrasound probe is inserted beneath the skin to "liquefy" the fat before it is suctioned.
Length: One to two hours or more. UAL: 20 percent to 40 percent longer than traditional liposuction.
Anesthesia: Local, epidural or general.
In/outpatient: Usually outpatient. Extensive procedures may require short inpatient stay.
Side effects: Temporary bruising, swelling, numbness, soreness, burning sensation. Tumescent: Temporary fluid drainage from incision sites. UAL: Larger incisions for liposuction tubing.
Risks: Asymmetry. Rippling or bagginess of skin. Pigmentation changes. Skin injury. Fluid retention. Excessive fluid loss leading to shock. Infection. UAL: thermal burn injury caused by the heat from the ultrasound device.
Recovery: Back to work: one to two weeks. More strenuous activity: two to four weeks. Full recovery from swelling and bruising: one to six months or more. Use of tumescent technique or UAL may decrease postoperative bruising and swelling.
Duration of results: Permanent, with sensible diet and exercise.

Male breast reduction
Gynecomastia
Procedure: Reduce enlarged, female-like breasts in men using liposuction and/or cutting out excess glandular tissue. (Sometimes covered by medical insurance.)
Length: One hour or more.
Anesthesia: General or local.
In/outpatient: Usually outpatient.
Side effects: Temporary bruising, swelling, numbness, soreness, burning sensation.
Risks: Infection. Fluid accumulation. Injury to the skin. Rippling or bagginess of skin. Asymmetry. Pigmentation changes (may become permanent if exposed to sun). Excessive scarring if tissue was cut away. Need for second procedure to remove additional tissue.
Recovery: Back to work: three to seven days. More strenuous activity: two to three weeks. Swelling and bruising: three to six months.
Duration of results: Permanent.

Nose surgery
Rhinoplasty
Procedure: Reshape nose by reducing or increasing size, removing hump, changing shape of tip or bridge, narrowing span of nostrils or changing angle between nose and upper lip. Also may relieve some breathing problems. (May be covered by insurance.)
Length: One to two hours or more.
Anesthesia: Local with sedation or general.
In/outpatient: Usually outpatient.
Side effects: Temporary swelling, bruising around eyes and nose and headaches. Some bleeding and stiffness.
Risks: Infection. Small burst blood vessels resulting in tiny, permanent red spots. Incomplete improvement, requiring additional surgery.
Recovery: Back to work: one to two weeks. More strenuous activities: two to three weeks. Avoid hitting nose or sunburn: eight weeks. Final appearance: one year or more.
Duration of results: Permanent.

Tummy tuck
Abdominoplasty
Procedure: Flatten abdomen by removing excess fat and skin and tightening muscles of abdominal wall.
Length: Two to five hours.
Anesthesia: General or local with sedation. In/outpatient: Either, depending on individual circumstances and extent of surgery.
Side effects: Temporary pain. Swelling, soreness, numbness of abdominal skin, bruising, tiredness for several weeks or months.
Risks: Blood clots. Infection. Bleeding under the skin flap. Poor healing resulting in conspicuous scarring or skin loss. Need for a second operation.
Recovery: Back to work: two to four weeks. More strenuous activity: four to six weeks or more. Fading and flattening of scars: three months to two years.
Duration of results: Two to 15 years, depending on weight loss/gain, hormonal changes and other factors.

You can read the first part of this series by visiting www.IchooseNNMC.com and clicking on Northern Nevada's Living Well in the right column. Then click on Past Issues and Spring 2007.

Northern Nevada Medical Center 2375 E. Prater Way, Sparks, NV 89434 775-331-7000