Frequently Asked Questions

Is fat from other body areas a better choice than breast implants for augmentation?

Currently, it is felt that only up to 50-65% of transplanted fat successfully survives in its new location. The remainder doesn’t go elsewhere. It is just resorbed by the body. Fat injections to the breasts may be useful in making small modifications and correcting asymmetries, but many plastic surgeons feel this procedure should currently be regarded as experimental. Long term results do not yet exist. The results are not totally predictable and are very inconsistent. Breast augmentation with fat tends to be a lengthier procedure, generally more expensive than an augmentation with an implant and may require additional sessions of fat injection. There are a wealth of unanswered concerns: the extent of resorption of the fat, the large volume of fat that is required to produce an improvement, the limitation of the amount of augmentation that is possible, and specifically the issue about long term safety with regard to tumor stimulation, which all need to be further investigated with valid scientific studies before fat injection for breast augmentation should be utilized by any surgeon or have it performed on any patient.

Will a certain number of “c.c.s” in a breast implant produce a certain cup size?

The size of the augmented breast will depend on the amount of breast tissue that you start with before surgery in addition to the implant. Cup size is not standardized in the bra industry. A 32C and a 38C are totally different. What is a C cup in one bra company may not be a C from another bra manufacturer. Cup size even varies within a company from style to style

Will a large enough implant correct droopy breasts?

If you have sagging breasts, with your nipples located at or below the fold under your breasts, implants alone will not correct the problem. Implants will increase the size of your breasts, but the nipples will still remain too low and the breast will not look youthful. You will need a lift procedure along with your breast augmentation to achieve well- shaped attractive breasts. The type of lift needed will depend on the amount of drooping. Patients who are satisfied with the size of their breasts, but have lost shape and sagged due to pregnancy or weight loss, will find that a lift alone, without an implant may solve their problem.

Will breast implants make breasts sag earlier?

A natural breast of the same size and weight will gradually sag just as much as a breast with an implant. With or without breast implants, a patient’s own body genetics and its reaction to gravity, weight fluctuation, and loss of elasticity as your skin ages all contribute to breast sagging A good supportive bra is helpful in avoiding sagging, whether you have implants or not.

Will I be able to breastfeed after a breast augmentation?

Some women, who never had breast surgery, are naturally unable to breastfeed, and some variations of breast augmentation may make it more likely that you are unable to breastfeed, but most women with breast augmentations are able to successfully breastfeed. Breast implants pose no medical risk to your baby.

What if the implant ruptures?

Both silicone and saline breast implants can rupture or leak. If this should occur, treatment may require surgical removal of the implant and possible replacement. When a saline (salt water) breast implant leaks, it will usually deflate very quickly similar to what occurs when a balloon loses its air. Your breast will change in size or shape. It is less common for saline to leak slowly, although it can happen. When the saline leaks, the body absorbs it.

A rupture or leak of a silicone breast implants may occur very slowly, produce no symptoms or problems (called a silent rupture), and go unnoticed, because the gel is contained within the normally occurring fibrous tissue that forms around an implant. Sometimes the rupture is discovered only with on mammogram or an MRI or when an implant is replaced. It is possible, however, for the fibrous tissue to become inflamed or form additional internal scar tissue which can lead to:

• Pain, soreness or swelling in the affected breast
• Change in breast size or shape
• Lumps in the affected breast
• Softening or hardening of the affected breast

Implants have been thoroughly evaluated by the FDA and ruptured silicone breast implants aren’t thought to cause breast cancer, reproductive problems or connective tissue disease, such as rheumatoid arthritis.

Can breast implants rupture during a mammogram?

While an implant can rupture during mammography the risk of this is very low. It may occur when the pressure on the breast weakens the implant shell. The older the breast implant, the more susceptible it is to trauma. This is not a reason to avoid mammograms, since the benefits of a mammogram well out weigh any potential downside. Let the mammography technician that you have breast implants, and he or she will take additional views and special care not to cause a rupture.

What are the risks involved with breast augmentation surgery?

As with any surgery, there are risks associated with breast enlargement. Unfavorable scarring, asymmetry, changes in breast/nipple sensation, implant displacement, and rippling are all possible side effects. More serious complications which occur infrequently include: reactions to anesthesia, bleeding, and infection. Long term, potential problems include deflation or implant leakage requiring implant removal and possible replacement surgery as well as capsular contracture which occurs when the scar or capsule, which naturally forms around the breast implant begins to tighten, squeezing the implant and causing the breast to feel harder.

Will I have to change my lifestyle or activities after an augmentation?

Immediately after surgery, you will have a restriction on exercise and activity until you are healed. Once healing has taken place you may resume all of your usual activities, including sports, and not have to alter your normal lifestyle.

Is breast and nipple sensitivity affected by a breast augmentation?

Breast sensitivity may be increased, decreased or the same after surgery. Sensitivity varies greatly from person to person. After breast augmentation, you may find the nipples have decreased sensation, which generally returns. When it returns, the nipple complex may be hypersensitive before it returns to normal. In most patients, it takes 6-12 months before achieving the final level of sensitivity which may not totally return in some patients, no matter where the incision was made to insert the implant.

When can I exercise?

Strenuous sports such as golf, tennis, swimming, bowling, jogging, aerobics, jazzercise, or bicycling may be resumed after three weeks with a “sport” bra for support. Refrain from any activity, which significantly raises your body temperature, and/or blood pressure for three weeks after surgery. This includes hot tubbing, sexual relations, and brisk walking.

How long is the recovery period after breast enlargement surgery?

You should “take it easy” the day of your operation and the following days. Increase your activity as instructed. Depending on the kind of work you do, you may return to your job as soon as you are comfortable. If your work is fairly sedentary, you may go back to work in three to four days after surgery. Do not lift anything over ten pounds for three weeks. Exercise can typically be resumed three to four weeks following breast enlargement surgery.

Will a breast augmentation hurt?

You will be asleep during the procedure and feel no pain. After surgery, pain and discomfort can be easily relieved with prescribed medication and usually subsides in a matter of days. The greatest period of discomfort usually lasts about twenty four to forty eight hours. Thereafter, you should have less discomfort and less need for medication. Occasionally, it lasts a little longer. Implants placed in the submuscular position initially produce more discomfort than those placed in front of the muscle.

What are my breast augmentation incision site options?

There are four potential incision sites:

• Peri-areolar: This incision site is typically the most concealed and favored by many plastic surgeons and patients.
• Inframammary: This is a frequently used incision and is made below the breast fold. This incision is generally less concealedthan the peri-areolar incision.
• Transaxillary: This incision is made under the arm and is used primarily to place unfilled saline breast implants under the muscle.
• Transumbilical: The transumbilical incision is made in the belly button or umbilical channel. This incision site is not used by most plastic surgeons because of increased complications and problems with implant malposition.

Who is NOT a Good Candidate for a breast augmentation?

• A woman who has an active infection anywhere in the body.
• A woman with existing cancer or pre-cancer and has not received adequate treatment for those conditions or has other ongoing health issues
• A woman who is currently pregnant or breast-feeding.
• A woman who is unrealistic about the procedure.
• A woman who is having the procedure at someone else’s urging.

Who is a good candidate for a breast augmentation?

• Small breasted women, women with breasts that are unequal in size, women whose breasts are markedly smaller after pregnancy, and women whose breasts are sagging due to aging all may benefit from breast enlargement surgery.
• A healthy women over the age 18 (for Saline Implants)
• A healthy women over the age 22 (for Silicone Gel Implants)

What anesthesia will be used?

General anesthesia is commonly used in order to make the intra-operative portion of the procedure pain-free and as comfortable and pleasant experience as possible.

How long does the breast implant procedure take?

Cases may differ, but on average the surgery lasts one to two hours.

Where is the breast augmentation surgery performed?

Breast augmentation is most frequently performed on an outpatient basis in the Singer Surgery Centre, our office-based surgical facility which is accredited at the highest level by the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF), the “gold standard “in national ambulatory surgical accrediting organizations. The other option is as an outpatient or an inpatient at the highly acclaimed Scripps Memorial Hospital – La Jolla, which is immediately adjacent to our office.

Is a breast augmentation a one-time procedure?

The majority of patients having breast augmentations are very pleased with their results. No one should enter into that procedure with the idea that the implants will last forever or that they may never need another breast surgery. There are a variety of reasons why a woman would have a secondary procedure: to alter the size of the implants as the patient ages and the size and shape of the breast naturally change, to correct the effects of pregnancy on the breasts, weight fluctuation, the implant can form a capsular contraction around it which produces a hardening, or the implant may leak. No one can guarantee the life cycle of an implant.

Will breast implants interfere with annual mammograms?

Breast implants may affect how your annual mammogram is performed. You should have your mammogram performed at a radiology center where the technicians are trained to perform mammograms on patients with breast implants. Additional x-rays taken from various angles are beneficial to ensure an accurate reading. Most radiologists feel that there is less difficulty in reading the mammogram when the implants are behind the muscle.

Will all breast implants have to be replaced after 10-12 years?

No one can guarantee the lifecycle of an implant and no one should enter into the procedure with the idea that the implants will last forever or that they may never need another breast surgery. Implants do not need to be replaced unless a problem occurs. There is no expiration date on breast implants. I have personally seen patients who have had implants in for over thirty years and the implants are still intact. However, if you do replace your implants, your recovery from a replacement surgery will usually be much easier than the first surgery. Most of the discomfort women experience during recovery from breast implant surgery comes from creating the initial pocket that the implant is placed into. Performing a second surgery is often much easier, and the recovery faster. Implant rupture or leak is not the most frequent reason that a patient elects to have the implant replaced, more often it is because of a desire to improve the breast appearance which may change from aging, internal scar formation that can cause the implant to feel harder or appear misshapen, gravity, weight loss or weight gain.

How long do breast implants last?

There is a myth that implants will last 10 years. There is no data to support that statement. We have seen patients with implants that are over 30 years old and still intact. You should realize that no one can guarantee the life cycle of an implant, that it may not last forever and it may not be a one time surgery. The implant manufacturers have limited warranties on the implants.

Are “gummy bear” implants better?

There are a number of new implants referred to as “gummy bear”, “jelly bean”, “form stable”, or “highly cohesive gel” implants that are available, but there are no long term results to show that they are significantly better or will last any longer than the current implants. They do feel firmer.

Can saline-filled breast implants harden?

Capsular contracture, which occurs when scar tissue forms around the implant, can occur with both saline-filled and silicone-gel-filled breast implants. Most plastic surgeons feel that the rate of capsular contraction is less with a saline implant.

How many cubic centimeters make a cup size?

It is very easy to be confused by a cup size measuring system. Cup sizes are only used as estimates for clothing. The cup is determined by many variables including: size of the chest, the shape of the rib cage, body build, implant type, and breast dimensions.It is very easy to be confused by this measuring system. Cup sizes are only used as estimates for clothing. Although the measuring technique for determining cup size is precise, the results of these measurements are not. Let me give you an example; weight is a very accurate measurement. However two patients that weigh 120 lbs are not likely to look alike. The same is true with two patients that… Show more It is not an exact science if you are trying to figure out what breast implant size you want to obtain. For example, it will take a lot more for someone who has a 36 band to go from an A cup to a C cup than someone who wears a 32 band bra. The following are estimates:

34 Band Bra Size -175cc’s to increase 1 cup size.

36 Band Bra Size-200cc’s to increase 1 cup size.

38 Band Bra Size-225cc’s to increase 1 cup size.

The better way to choose an implant size is to try on try on sizers in the office while wearing a tight t-shirt, bathing suit or leotard.

How do I choose the right size implant?

It depends on multiple factors: Individual anatomy, existing breast volume, breast dimensions of height, width and projection, ribcage width, chest shape, tissue thickness, desired outcome, and realistic expectations. There is no standardization of cup size. A 32 C and a 36 C are very different. Cup sizes vary from bra manufacturer to bra manufacturer. Even different styles from a manufacturer will vary in what they label a cup size. The best way to choose an implant size is to try on try on sizers in the office while wearing a tight t-shirt, bathing suit or leotard.

What are the options for breast implant placement?

There are two choices for breast implant placement: sub-glandular (under the breast tissue and in front of the chest muscle – the pectoralis muscle) or sub-muscular (under or partially under the chest muscle). The best location depends on many factors including: tissue thickness, weight, desired outcome, and individual anatomy. Each position has advantages and disadvantages:

Subglandular implant benefits:

• A shorter recovery time.
• Less discomfort initially.
• No distortion of the breast when the pectoralis muscle flexes.
• Mild preoperative sagging can be improved, especially if no breast lifting procedure is performed.
• Easier surgical procedure.
• Larger implants can be placed.

Subglandular implant disadvantages:

• The implant may be more visible.
• More visible rippling, especially in patients with a small amount of natural breast tissue.
• Generally, saline implants do not produce a good result in front of the muscle.
• Higher incidence of capsular contraction.
• “Bottoming out” in some patients.
• Some radiologists have more problems reading a mammogram with an implant in front of the muscle.

Submuscular implant benefits:

• Usually results in a better appearance for naturally small breasted women
• Less tendency for seeing ripples of the implant.
• A more natural feel to the breast especially in slender women who don’t have much of their own breast tissue.
• Less interference with mammograms, although most radiologists take additional views no matter where the implants are placed.
• Lower rate of capsular contraction.
• Less of a chance of “bottoming out” where the implant bulges at the lower aspect of the breast and the nipple and areolas tend to appear excessively elevated.

Submuscular implant disadvantages:

• Recovery usually takes a little longer and is more uncomfortable initially.
• There may be an “animation deformity”, which is a temporary distortion of the breasts when the pectoralis muscle is flexed. Body builders and weight lifters generally prefer implants in front of the muscle.
• It is harder to achieve cleavage in women who have widely spaced breasts.
• The implants often ride higher on the chest.

Actually, most patients who have breast augmentations today have breast implants placed in a combination or “dual plane” position. This approach has the same benefits and disadvantages of a total “submuscular implant”, but with a lesser tendency to ride high on the chest wall. The disadvantage as compared to a total “submuscular implant” is a higher tendency for bottoming out.

The ideal placement in any particular patient depends on their particular anatomy and understanding of the pros and cons of each approach. Your concerns should be discussed at the consultation.

Are saline implants as good as or better than silicone implants?

There are advantages and disadvantages of each type of implant. Both are utilized by surgeons across the country with satisfactory results. They are both approved for usage by the FDA. The best way to determine what the best implant is for you is to discuss the advantages and disadvantages of the various types of implants along with your concerns and personal preferences at a consultation.

What are the differences between smooth and textured mammary implants?

The surface of the outer shell of breast implants can be either smooth or textured. There are pros and cons of each. Smooth implants usually have thinner shells and move more freely in their pocket than their textured counterparts. Many plastic surgeons believe that the thinner shell allows smooth implants to feel more natural. Implants with smooth surfaces are also less likely to ripple. Textured implants were designed to lower the risk of capsular contracture, but whether it achieves that is open to debate. The textured implants may have a greater chance of leakage or deflation. One type of implant shape, known as the anatomical or tear-shaped implant, is only available with a textured surface, because this surface helps keep these contoured implants in position and diminishes the risk of rotation and distortion. Some of the differences of the implant surface characteristics depend on whether the fill material is saline or silicone gel.

How much do implants weigh?

Obviously the larger the size of the implants, the more they will weigh. Every 100cc of silicone implant weighs 0.23lbs. Every 100cc of saline implant weighs 0.21lbs. For example, a typical 300cc silicone implant weighs 0.69 pounds and a pair of them together weighs 1.38 pounds. 300cc saline implants weigh 0.63lb each or 1.26lbs for both of them. Essentially implants weigh about the same as an equal amount of breast tissue would weigh. There might be a slight weight variation from manufacturer to manufacturer, which is insignificant. The slight difference between the weight of similar size saline and silicone implants is negligible.

What are the breast implants options?

The Food and Drug Administration (FDA) has approved both saline filled breast implants (for women 18 years and older) and silicone gel filled implants (for women 22 years and older). Both are basically shaped silicone envelopes that are filled with silicone gel or sterile salt water (saline). Silicone breast implants are filled either with cohesive gel or with “highly” cohesive gel, which are sometimes referred to as “gummy bear” implants due to their consistency. The outer surface may be smooth or textured.

What is a breast implant made of?

Breast implants are made of medical silicone a soft rubbery material, filled with either salt-water or silicone gel. Women without implants who are considering breast enlargement in the USA are eligible for the salt-water-filled implants if they are 18 or older, and for silicone-gel implants if they are 22 or older

What are the alternatives to a breast augmentation?

• Accept your breasts as they are.
• Wear a padded bra or an external prosthesis.
• There are no creams or ‘magic formulas” that are marketed to produce non-surgical breast enlargement that have ever been proven to work.

Are breast implants safe?

Breast implants are among the most tested of medical devices. No other medical device has been studied to the extent that breast implants have. Extensive studies of tens of thousands of women with breast implants have shown that both saline and silicone implants are safe. They do not produce a higher rate of cancer or autoimmune disease. After vigorous evaluation by the FDA, both are approved for cosmetic and reconstructive usage.

Can a breast lift be combined with other procedures?

A breast lift is often performed in conjunction with other procedures, such as breast augmentation, breast reduction, body contouring.

Can I breastfeed after a breast lift?

There is no way of determining if you will be able to breastfeed after a breast lift. Some women cannot breastfeed regardless of whether or not they had breast surgery.

Can I undergo more than one breast lift procedure?

While a breast lift provides an effective lifting and firming of the breasts that may last for many years, certain factors, such as aging, weight gain/loss, pregnancy, and gravity can cause the tissues to weaken and the breasts to sag again, at which time you may choose to undergo another breast lift.

What risks and side effects are associated with mastopexy?

As with any surgical procedure, complications from a breast lift may occur, but are unlikely. Some of the risks and side effects associated with breast lift surgery include infection, negative reaction to anesthesia, delayed healing, bleeding, prominent scarring, uneven nipples, decreased breast sensation, and breast asymmetry. Every effort is made to make the procedure as safe as possible and limit the risks of problems and complications. Choosing a certified and experienced plastic surgeon like Dr. Singer and following all instructions will increase the likelihood of having a safe and successful procedure.

Is there noticeable scarring?

Unfortunately you cannot achieve a breast lift without an incision. Any time you make an incision, there is a scar. Scarring is noticeable with breast lift surgery, but fades with time. Dr. Singer will use the shortest incisions that will accomplish the desired result. The incisions are placed in areas that can be concealed while wearing a bra or bathing suit. Most patients report that the results of cosmetically improved breast shape and position are well worth the scars.

Can exercise alone tighten and lift the breasts?

In general, exercise is good for the mind and body and can increase muscle bulk, which can make skin look a little tighter, but exercise cannot actually tighten the breast skin or lift the breasts. Currently, only surgery can effectively and reliably accomplish that.

How long does the procedure take?

The procedure can take one to three hours to complete, depending on the method being used.

Where will the surgery be performed?

Usually the procedure is performed as an outpatient in the Singer Surgical Centre, an American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) fully accredited office-base surgical facility.

What is the recovery period like?

Recovery time depends on the individual and the extent of the procedure, but usually follows a general pattern. The first few days are the most uncomfortable, but pain and discomfort can easily be controlled with prescribed medications and will soon decrease. Bruising and swelling may persist for several weeks. The results will continue to improve for up to one year. The discomfort is initially greater if an implant is placed behind the chest muscle (pectoralis) at the time of the breast lift.

When can I return to work and strenuous activity?

While most patients can begin their return to daily activities (such as driving, light housework, a desk job, and shopping) within 1-2 weeks, you should refrain from exercise, strenuous activity, and heavy lifting for the first 3 weeks.

How long do the results last?

The results of a breast lift vary depending on each individual patient. Most patients enjoy firmer, more youthful breasts for years, but certain factors, such as aging, weight gain/loss, pregnancy, and gravity can cause the tissues to weaken and the breasts to sag again.

Does a breast lift surgery enlarge your breasts?

By lifting and firming up the breasts, a breast lift (mastopexy) may make them look firmer, but generally not larger. In patients who desire fuller breasts, implants can be inserted at the same time, which will make them larger.

What should I expect during breast lift surgery?

At the Singer Surgical Centre, breast lifts are usually performed under general anesthesia, which is administered and monitored by a board certified anesthesiologist. This means that you are asleep and comfortable through the entire procedure. There are variations as to how this procedure can be performed. Typically the procedure includes: Excess breast skin is removed, the areola is repositioned to a higher position, the underlying loose tissue is contoured, and the incisions are meticulously closed in layers with sutures. If breast volume has decreased, breast implants may be placed to enhance the size and shape of the breasts.

What are the breast lift variations that are available?

Based on your concerns, preferred outcome, and individual anatomy (breast size, shape, and extent of tissue elasticity), Dr. Singer will use the shortest incisions that will help accomplish the desired result. Utilizing a minimal incision when there is significant amount of laxity is fraught with significant problems. The following are the options for improvement, which may be performed alone or in conjunction with a breast implant augmentation:

• “Crescent Lift”: For very mild degrees of descent of the areola or to improve a small amount of nipple/areolar position asymmetry, only a crescent shaped incision placed at the top of the pigmented portion may be all that is necessary. This is often done in conjunction with the insertion of a breast implant.
• “Doughnut Mastopexy”: A modest amount of laxity requires a greater amount of lifting which in some patients may be nicely improved with a circular incision around the areola (leaving the nipple attached to the underlying tissue).
• ”Lollipop Mastopexy”: If greater lifting is required and more loose skin has to be removed, then there will also be a need for a vertical scar extending downward from the nipple-areola resulting in a scar that will be a circle around the edge of the areola with a line downward to the infra-mammary fold.
• “Anchor Mastopexy”: When the breast relaxation is more severe, there may also be a horizontal scar from side-to-side under the breast, so the scar will be a circle with a line down and then a curved line under the breast.

What is a breast lift?

A breast lift is a surgical procedure that elevates the position of the breasts. This surgery is designed to lift sagging breasts to a more youthful, aesthetic position upon the chest.

Who is a good candidate for a mastopexy?

Women best suited for a breast lift procedure:

• Sagging or loss of volume in the breasts
• Stable weight
• Good overall health
• Realistic expectations
• Non-smoker

Will I still look like “me” after eyelid lift surgery?

The general comments from friends and associates after returning to normal activities “are:” Gee you look great. Did you change your hairstyle?” “New makeup? Or “Have you been on vacation?” Retaining your uniqueness is the sign of a successful procedure. Although the change may be significant to you, it’s not uncommon that friends and family don’t really notice the specific changes unless patients request dramatic changes. Eyelid or forehead surgery performed meticulously, in the hands of a skilled, experienced, board certified plastic surgeon should not result in an unnatural over-operated appearance. Most patients want to look natural and like themselves, yet refreshed. This is achieved by the artistic combination of repositioning and removing the lax excess tissue and adding micro fat grafts or fillers where the tissue is deficient.

What if I want to dramatically change the appearance of my eyelids?

Some of the characteristics of a good board certified aesthetic (cosmetic) plastic surgeon are: willingness to listen to patients, an ability to tell the difference between realistic and unrealistic expectations, being truthful about meeting each patient’s desires, and the ethics to tell a patient why something should not be done. Our biggest referral source is from satisfied patients – ones who have had realistic expectations and were satisfied with the results.

What happens during a consultation for eyelid or forehead surgery?

La Jolla (San Diego) board certified plastic surgeon Dr. Robert Singer will personally meet with you during the consultation. He will ask about the areas that concern you, what is your desired outcome, and take a detailed medical history. He will examine and evaluate you. He will then explain the options that are available and the pros and cons of each alternative. This explanation will include what treatment option/options he will recommend, where the surgery will be performed, what type of anesthesia, a step-by-step explanation of what the recovery will be like, what is expected of you as a patient, as well as the potential problems that may occur. Dr. Singer will answer all of your questions. You will then meet with the patient care coordinator, who will show you pre and post-op photos of the various options, explain the scheduling details, the costs involved, and answer any additional questions that you may have.

What if I have a history of bad scars?

Scars on the rest of the body typically are not an indication for how patients heal following facial plastic surgery, since the facial area usually heals with better scars. At the time of your consultation, it’s important to show Dr. Singer any previous scars that are of concern to you so he can give you a realistic assessment of your healing potential following facial plastic surgery. Healing is variable from patient to patient, and somewhat unpredictable, although most patients heal with scars that generally blend in extremely well with time. Scars continue to improve in appearance for up to 1 year. The eyelid area generally heals with excellent scars.

Will a blepharoplasty take away the crow’s feet and all the fine wrinkles?

Nothing will remove all of the fine lines and crow’s feet. Botox or Dysport help diminish the crow’s feet. Skin care and light resurfacing with gentle peels or lasers can further improve the fine lines. It is natural to have lines when you smile.

Is eyelid surgery performed under general anesthesia or will I be awake?

You will not be awake. At the Singer Surgical Centre, eyelid and or forehead surgery is typically performed under local anesthesia with intravenous sedation. Sometimes, depending on the patient, a general anesthesia is an option. To maximize safety, in either case, anesthesia is administered by a board certified anesthesiologist and patients are asleep, comfortable, and unaware of any pain during the procedure.

Where is eyelid surgery performed?

Dr. Singer usually performs eyelid procedures in the Singer Surgery Centre, our fully accredited state of the art office based outpatient surgical facility, which has earned the highest level of accreditation by the American Association for Accreditation of Ambulatory Surgical Facilities (AAAASF).

Eyelid and forehead procedures are typically performed under local anesthesia with intravenous sedation. Sometimes, depending on the patient, a general anesthesia is an option. In either case, to maximize safety, in either case, anesthesia is always administered by a board certified anesthesiologist and patients are asleep, comfortable, and unaware of any pain during the procedure.

Can I combine eyelid surgery with other facial surgery?

Yes, it’s generally preferred to combine procedures. It is financially beneficial because you only undergo 1 anesthesia and minimize the cost of the operating room and surgical supplies. In addition you minimize downtime by having to go through the recovery process following surgery only once. Commonly combined procedures with face lift surgery include the following:

• Brow lift
• Micro fat transfer
• Laser or dermabrasion
• BOTOX® Cosmetic or Dysport
• Face or neck lifts
• Chin implant
• Rhinoplasty (nasal surgery)

How much pain will I have?

Most patients who have eyelid surgery say how surprised they are at how mild the discomfort is that they experience. Patients more typically complain of tightness from swelling or a pulling sensation. Understandably, after any surgical procedure, some discomfort can be expected and pain tolerance varies from patient to patient. All patients are provided with prescriptions for pain medication. Many patients use the prescription medication 2-5 days after surgery and then switch to Extra Strength Tylenol. It is uncommon for patients to report extreme pain after surgery.

How long does eyelid lift surgery take?

The length of eyelid lift surgery depends on several factors including the extent of tissue laxity and the anatomy of each person’s eyelids, but generally takes 1-2 hours. Many patients who have previously had a blepharoplasty are referred to the Singer Surgical Centre for revision eyelid lift surgery. Revision blepharoplasty can take a little longer because of corrections that need to be made as a result of the initial eyelid surgery. If additional procedures like forehead surgery, micro fat injections, laser treatments or facial lifting are performed in conjunction with the eyelid surgery, it will naturally take longer.

Can I go home after eyelid surgery?

Most eyelid or forehead surgeries are performed on an outpatient basis. Because you will be receiving sedation, you will need to make arrangements for a responsible adult to drive you home, to stay with you overnight and to drive you to our office for your first postoperative appointment the next day. Our patient coordinator can arrange for an experienced individual to help with your post-op care, if you do not have someone to take care of you after surgery. Patients having surgery must stay in the immediate La Jolla area overnight within 60 minutes of our facility.

Some patients who feel more comfortable in a hospital after surgery and those who would benefit from closer monitoring are admitted to Scripps Memorial Hospital – La Jolla for 1 to nights after surgery. The Singer Surgical Centre is on the campus of the hospital and immediately adjacent to the main hospital building.

Will I need someone to help me out at home after the eyelid procedure?

It’s a good idea for patients to prearrange for post-surgery support from family members or friends before undergoing surgery. Our patient coordinator can arrange for an experienced individual to help with your post-op care at your home or a nearby hotel if you do not have someone to take care of you after surgery.

How long will bruising and swelling last after eyelid surgery?

Postoperative bruising and swelling begins to resolve at the end of the first week. Full resolution of bruising or swelling may take 2-3 weeks. Bruising is variable and many patients can camouflage bruises fairly easily at seven to ten days with a concealer. Our aestheticians at the Singer Skin Care Center are available to help patients with this during their recovery period.

When can I go back to work after eyelid surgery?

It depends on the type of work you perform. Restrictions from work are generally 7 days to two weeks after eyelid surgery. Because some bruising and swelling may still be present, an occasional patient will take three weeks off to be safe.

When can I return to the gym or “work out?”

Aerobic activities should be avoided for three weeks following surgery. Any activity that potentially increases blood pressure will increase the amount of time it takes for postoperative swelling to resolve.

Why do I have to stop smoking before eyelid surgery?

Healing depends on blood supply and smoking adversely affects your recovery by diminishing the blood supply to the skin. Smoking causes the blood vessels that supply oxygen and nutrients to the tissues to constrict and prevent the necessary healing of the operated areas. Patients who smoke have a greater chance of delayed or non-healing of incisions, which can result in additional scarring or pigment change of the skin, as well as lung problems with anesthesia. Patients must stop smoking for a minimum of two weeks prior to surgery to decrease the risk of these complications, and continue smoking cessation after the procedure.

How long will the results of eyelid surgery last?

The results of eyelid surgery may be considered permanent in that you will continue to look younger years later than you would have without undergoing the eyelid improvement. However, eyelid or forehead surgery cannot stop the aging process and you will continue to age. You will, however, always look younger and better than a twin, if you undergo the correction and the twin does not.

The results will vary from person-to-person. Most patients can expect their results to last between eight and twelve years. The length of time that patients enjoy a satisfactory improvement after an eyelid surgery depends on many factors including the quality of their skin, which is influenced by the degree of sun damage or loss of elasticity. Smokers typically have poorer quality skin. Older patients will see an earlier return of laxity, while younger patients will see a more long-lasting improvement.

Heredity is important. If your parents aged slowly, you probably will, too. Your diet, general health, time spent in the sun, smoking, weight gains and losses, emotional traumas, and type of skin will all play a role in determining how long the improvement will last.

Is there anything I can do to improve my eyes without surgery?

Botox or Dysport, a filler like Restylane, light skin peels, and a supervised ongoing skin care program may be options for patients who want some improvement, but are not ready or unwilling to undergo eyelid surgery (blepharoplasty).These options may offer some benefit, depending on your individual anatomy and concerns, but in most patients are not a replacement for surgical correction.

I had eyelid somewhere else and I don’t like my result. Can it be “fixed”?

It’s not uncommon for patients who have previously had eyelid surgery to be referred to the Singer Surgical Centre for revision surgery. Although patients may want immediate adjustments to the original surgery, patients generally should wait 6 months to a full year before undergoing revision eyelid surgery. The final results of a blepharoplasty are not achieved until one full year postoperatively, since it takes that period of time for postoperative healing to be complete. Changes, however subtle, continue throughout the 12-month course following eyelid surgery. As time goes by, the eyes gradually improve and features refine as the swelling resolves. These refinements sometimes are enough for a result to be considered acceptable by a patient. A revision blepharoplasty can be more complex, may take longer than the initial eyelid lift surgery, and may take a slightly longer time to heal.

A thorough consultation is necessary to evaluate whether the areas that concern you can be realistically improved.

What do I do to prepare for surgery?

Although the preparation for surgery is pretty simple, it is an essential element in a successful outcome. To prepare for surgery, a preoperative appointment will be scheduled before surgery. It is important that you ask all of your questions at that time and follow all of the instructions in order to get the best possible result.

What happens at the preoperative appointment?

This visit will be scheduled approximately two weeks before surgery. It will give you an opportunity to ask questions you might not have asked previously. We will review your medical history, give you a preoperative examination, arrange for laboratory tests, and discuss what to expect during surgery. If you are over forty years of age, or have a history of heart abnormalities, we may arrange for an electrocardiogram and chest x ray. We will also take preoperative photographs, which become a permanent part of your medical record, and remain strictly confidential. Your operative consent will be read and signed, preoperative instructions reviewed, and prescriptions for the medications that you will need will be given to you at this visit. Your fee will be due at this time.

Arrangements to facilitate admission will be made if you are scheduled for hospital surgery, or for an overnight hospital stay. Hospital and anesthesia charges are separate from those of our office.

What are the risks or complications associated with eyelid and forehead surgery?

No surgical procedure is without risk. Most complications associated with eyelid and forehead surgery, however, are minor. Here are some possible problems:

• Collection of blood under the skin (hematoma). This can be removed.
• Temporary crusting which forms on the incisions.
• Loss of sensation in the scalp (with forehead lifts). If this occurs, feeling will usually return in time. Numbness behind the scalp incision may last six months or more.
• Soreness and itching around the incisions. If these sensations occur, they will soon disappear.
• Depression. With aesthetic surgery, as with other surgical procedures, this sometimes occurs postoperatively. This is generally attributed to the normal response of the body to surgery and anesthesia.
• Dryness and irritation of the eyes. This is usually temporary, and is relieved by “artificial tears.”
• Asymmetry. No patient is identical from side to side. Small differences exist in all patients. In the occasional patient with a major difference, this can usually be improved with a secondary procedure.

Potential but unlikely complications:

• Infection.
• Poor healing of skin.
• Loss of small areas of skin (necrosis).
• Widening or thickening of a scar. If this happens, it can be revised at a later date in a simple office procedure. Incisions can never be guaranteed to “heal” in a certain way.
• Hair loss around the incision after forehead lift. If this occurs, the hair generally grows back in a few months.
• Pulling down of the lower eyelid. This is usually temporary, and gradually improves as the muscle regains its tone in the first few days, or weeks.
• Injury to the forehead branch of the facial nerve (with forehead procedures). This is usually temporary and corrects itself in the first few days or weeks.

Complications of a severe nature, which could be life threatening, or cause loss of vision on one side.

YOU MUST ENTER INTO YOUR SURGERY FULLY UNDERSTANDING NOT ONLY THE BENEFITS, BUT ALSO THE POSSIBLE PROBLEMS. ON OCCASION, A MINOR REVISION MAY BE NECESSARY TO ENHANCE THE FINAL RESULTS.

What does informed consent mean?

Informed consent means you understand the benefits of surgery as well as any risks, and all the preoperative and postoperative information. You are making an “informed” decision as to whether surgery is right for you.

What are the benefits and risks of eyelid or forehead surgery?

As part of your initial consultation, Dr. Singer and our staff will review your expectations for surgery. At that time, we will provide a realistic picture of what surgery can and cannot accomplish. Depending on which procedures you are interested in, we will provide you with a list of risks reported in the medical literature associated with all of the procedures you are considering. Although risks from cosmetic surgery are uncommon, every patient should be fully informed of any the risks associated with surgery.

What are some of the other things to do to prepare for surgery?

We review your health history and any daily medications you may be taking at the time of the pre-operative visit. Because tobacco abuse impedes wound healing, you will be asked to stop for two weeks before surgery and two weeks following surgery. We will be happy to discuss over-the-counter aids to help you with this.

What about my daily medications before surgery?

You will have a preoperative appointment well in advance of your surgery when our experienced staff will review all medications with you. If you are on medications that effect blood coagulation, you will be asked to stop them approximately 8 days prior to surgery. We also ask that you avoid certain over-the-counter, drugs, supplements and herbal medications. We will provide a list of medications and supplements to avoid prior to surgery.

Do vitamins and supplements need to be stopped before eyelid or forehead surgery?

Most vitamins and supplements have few side effects. However, there are some, such as vitamin E, fish oils and ginkgo-biloba that affect bleeding during surgery. Also, because there are now so many supplements available, we do not know how your particular supplements would interact with anesthesia, so we ask you to stop them 8 days before surgery. We will provide a list of medications and supplements of products to avoid prior to surgery.

Do I need any special prescriptions before surgery?

Most patients do not need any special prescriptions before surgery, except a medication to diminish anxiety the night before and the morning of surgery, which will be provided for you at the pre-operative visit. Please let us know of any special medical concerns you may have. (We will address prescriptions needed after surgery below.) You will also be instructed not to eat or drink anything after midnight the night before surgery.

Why will I be asked not to eat or drink anything?

Anesthesia medications can cause stomach upset. The best way to prevent problems from anesthesia will be to avoid food or drink from midnight the night before surgery. For patients with special concerns, such as a patient with diabetes, we will be happy to address special arrangements with you ahead of time.

I am concerned about my privacy?

We honor the privacy of all of our patients.

What happens when I check in for surgery?

Our nurses will help you get ready for surgery. Please let our nurses know of any special needs you may have. Also, be assured that you have plenty of time for any last minute questions with Dr. Singer. Before surgery begins, you will be asked to change into a surgical gown and then will be taken into a private operating room.

Does someone have to stay at the Singer Surgical Centre while I have my surgery?

No one needs to stay at the Singer Surgical Centre during your surgery. However, we ask that you have someone available by telephone at all times during your surgery.

What to Expect During Eyelid or Forehead Surgery

Eyelid, forehead, or brow surgery is usually performed at the Singer Surgical Centre on an outpatient basis under twilight sleep sedation anesthesia. A Board certified anesthesiologist will be present to make you comfortable and unaware throughout the procedure.

Before the surgery begins, you will be asked to change into a surgical gown and will be taken into a private operating room. An intravenous line will be inserted into a vein in your arm. This will make it possible for the anesthesiologist to administer fluids, and to deliver the necessary medications to make you comfortable. Monitoring devices will be connected to you, to assure your safety.

Dr. Singer will talk with you before you are sedated and use a surgical marking pen to draw several lines on your face. These will guide him during the operation. For the eyelid surgery, an elliptical incision is made in the upper lid in the natural crease of the lid. Excess skin, muscle, and fat are removed, and the skin is sutured. An incision is then made in the lower lid, just beneath the lashes. This incision extends slightly beyond the outside corner of the eye. Extra skin and fat are removed, sagging muscles are tightened, and the incision is sutured. If the incision is on the inside if the lid, fat, but no skin is removed, the skin can be tightened with the use of a laser.

For a forehead lift, the incision is generally made across the scalp, just behind the hairline. The skin of the forehead is loosened down to the brows, the necessary muscles are cut and the skin is pulled upward, redraping and trimming as needed. The incision, which is concealed by the hair, is closed with surgical clips, and a drain placed. For persons with a high forehead, this incision would not be satisfactory, since it would make the forehead even higher. In such cases the incision is made directly in front of the hairline, preserving the hairline’s original position.

When a forehead lift is performed on a man with a receding hairline, the incision can be placed in the mid forehead crease. There are instances when a supraorbital brow lift, instead of a forehead lift, will be recommended. In this procedure, the incision is made just above the eyebrows, and the skin is trimmed and pulled up.

Some patients may benefit from a recent breakthrough in technology that achieves correction of the forehead through a minimally invasive endoscopic approach to the muscles through several small incisions behind the hairline.

Eyelid, forehead, or brow lift surgery usually takes one and a half to two hours. If performed in conjunction with other procedures, surgery will naturally take longer.

What happens after surgery?

After surgery, you will be transferred to a recovery room adjacent to the surgical suite, where you will be continuously monitored as you recuperate from the effects of the surgery and anesthetic. You will be allowed to go home after a recovery period of one to two hours, or transferred by our nurses to an after-care facility or the adjacent hospital for a planned overnight stay. You should feel fine, although it is not unusual to expect some minor discomfort.

If you have a forehead lift, you will have a bandage around your forehead and scalp. If you have eyelid surgery, you will not have any bandages, but will have small tapes over the incisions. Cold compresses will be applied to minimize swelling.

If you are going home, the person taking care of you must stay with you for 24 hours and will be given instructions about your after care before you leave, or we can arrange for postoperative care in an aftercare facility.

NOTE: If you live out of town, you must make arrangements to stay within a sixty minute drive of the Centre for the first twenty four hours after surgery.

What do I look like when I wake up from eyelid or forehead surgery?

You will have some bruising and swelling of your eyelids, with steri-strips over the incisions and moisturizing ointment in your eyes. There will be no bandages covering your eyes, except iced eye pads which are kept on in the recovery room. If you had forehead surgery, there will be a soft dressing around your head that also goes under your chin and a small drain that is connected to a bulb that collects fluid. You may have eyelid swelling and bruising and will have moisturizing ointment in your eyes.

You will have some bruising and swelling of your eyelids, with steri-strips over the incisions and moisturizing ointment in your eyes. There will be no bandages covering your eyes, except iced eye pads which are kept on in the recovery room.

If you had forehead surgery, there will be a soft dressing around your head that also goes under your chin and a small drain that is connected to a bulb that collects fluid. You may have eyelid swelling and bruising and will have moisturizing ointment in your eyes.

What Are the Blepharoplasty and Forehead Surgery Postoperative Instructions?

You should expect:

• Moderate swelling, bruising, and bloodshot eyes which last for about two weeks.
• Drainage or crusting of your eyelids. This is not infection. Simply draw it away with a Q Tip dipped in tap water. If your eyelashes are stuck together use the same technique to tease them apart.
• A sensation of tightness, itching, and occasionally, tearing. This subsides over several weeks. If you have had a forehead lift, there may be a sensation of tightness in the forehead that subsides in one to two weeks.

Call: (858) 455 0290 if you have:

• Severe pain that doesn’t respond to medication.
• Significant swelling, and/or unrelenting pain which occurs more on one side than the other.
• Significant changes in vision, (mild blurring is normal).
• Any other problems or questions.

Activity: You should “take it easy” the day of your operation and the following days. Sleep on your back for two weeks, elevating your upper body on two or three pillows. By keeping your head elevated above your heart, swelling can be minimized. Because of your medications, you may need assistance getting to and from the bathroom for the first day.

Medications: Take the medications we’ve prescribed according to the instructions on the bottle. You may feel a little drowsy, so have someone help you. If you need a refill, call the office and give us the telephone number of your drugstore or pharmacy. Do not take aspirin for five days after your surgery.

Pain: Most patients feel that the discomfort from this surgery is minimal. The greatest period of discomfort usually lasts about twenty four to forty eight hours. Thereafter, you should have less discomfort and less need for medication. Occasionally, it lasts a little longer.

Smoking: Do not smoke for five days after surgery.

Alcohol: Do not drink alcohol for five days after surgery.

Driving: You may drive after four days.

Diet: Start with liquids the first day and then progress to your regular diet as you desire, restricting salt and artificial sweeteners.

Hair: You may wash your hair three days after surgery, or the day the dressing is removed. This should be done in the face up position. Do not bend your head forward. You may blow dry your hair with a warm hand dryer, or sit under a cool dryer, but do not use a hot dryer, electrical rollers, or curling irons for three weeks. (For forehead lift).

Compresses and ice packs: Apply continuous cold water compresses to your eyes for two days after surgery and then intermittently. This will decrease discomfort, swelling, and bruising. Our staff will explain how to make simple, effective ice packs that should be placed on the forehead for two days following surgery (if you have a forehead lift).

Reading and television: You may read and watch television at any time, but you may have blurred vision for a few days after surgery. This is normal.

Eyelid makeup: You will be instructed when you can resume application of makeup. This is usually about 10 14 days after surgery.

Contact lenses: You may wear your contacts two to three weeks after surgery. Occasionally, it will take longer until they fit properly.

Sun: Do not sit in the sun at all for three weeks after surgery. If the incisions are exposed, apply sunscreen for six months, and wear sunglasses.

Sports: Strenuous sports such as golf, tennis, swimming, bowling, jogging, aerobics, jazzercize, or bicycling may be resumed after three weeks. Refrain from any activity that significantly raises your body temperature and/or blood pressure for three weeks after surgery. This includes hot tubbing, sexual relations and brisk walking.

Work: Depending on the kind of work you do, you may return to your job as soon as you are comfortable.

Postoperative visits: The day after surgery: You will be seen at our Centre. If you are hospitalized, you will be seen there. You will be examined at this time. Subsequent visits: They will be determined by your progress. Sutures will be removed four to five days after surgery and the tapes replaced. This does not hurt. The forehead lift surgical clips will be removed about two weeks after surgery.

You will feel more comfortable using the private postoperative waiting room for your initial post operative visits.

Please feel free to call us at any time during your healing period.

THE OUTCOME OF YOUR SURGERY IS IN YOUR HANDS AS WELL AS THE DOCTOR’S. IT IS YOUR RESPONSIBILITY TO FOLLOW ALL INSTRUCTIONS GIVEN TO YOU.

Can I do anything to prevent bruising?

Most patients will have some bruising. You can minimize bruising by following instructions and using Arnica 1-2 days before and after surgery.

What to expect from a facelift?

A facelift is one of the most sought after and satisfying aesthetic surgical procedures. It can remove many, but usually not all wrinkles. It can remove much of the sagging skin of the face and neck. Excess fat can be removed or sculpted as needed. The facelift will give you a more youthful fresher natural appearance, but your expectations must be realistic. There are limitations to what it can accomplish. Magazines and non medical articles may lead you to believe a facelift is a simple procedure: in fact, it is real surgery. It requires complex incisions that are placed to make them inconspicuous, dissection of the skin, contouring of the fat, and tightening of the underlying muscles. It should be performed only by a qualified, capable, and experienced plastic surgeon.

A facelift can turn back the clock, but will not stop the process of aging. The length of time the improvement is acceptable before any additional surgery may be considered varies with each person. However, most people can expect their results to last between eight and twelve years.

Heredity is important. If your parents aged slowly, you probably will, too. Your diet, general health, time spent in the sun, smoking, weight gains and losses, emotional traumas, and type of skin will all play a role in determining how long the improvement will last. For many men and women, a rhinoplasty can improve the shape of the nose, while eyelid surgery, forehead lift, dermabrasion, micro-fat grafts, skin rejuvenation, or cheek and chin implantation can enhance the results achieved by the facelift.

Most of the women and men who would benefit from facelifting are between 40 and 70 years old. However, there are exceptions. Some people age prematurely and may consider improvement at an earlier age, while others age more slowly and can successfully undergo the surgery in their seventies or eighties.

In some cases, a partial limited incision facelift (mini-lift) or a neck lift may be all that is required to restore a natural more elegant and youthful contour to the face.

What is a facelift?

Technically known as rhytidectomy, a facelift is a surgical procedure that smoothes loose skin on the face and neck, tightens underlying tissues and muscles, and removes excess fat.

Are there alternatives to a facelift?

There are a variety of procedures which claim to replace a facelift, but in reality do not. Fillers, Dysport or Botox, peels, laser treatments, and radio-frequency all may improve appearance in some patients. We incorporate some of them at the Singer Surgical Centre in our options of treatments, but they do not produce the same long standing result of a well performed natural appearing facelift. They provide a lesser degree of improvement, the results are usually temporary, and in the long run may be more expensive.

Many of the claims of alternatives to a facelift are scientifically unsubstantiated. There are no “facelifts in a bottle”. If it sounds too good to be true, it probably is!

Am I too young (or old) for a facelift?

Most patients who seek a facelift are 40+ years old. However, if a patient has substantial loose skin of the face and or neck at a younger age, they can undergo a more limited variation of this procedure. Unfortunately, if a patient’s skin elasticity has diminished too much during the aging process, he or she may get a significant improvement, but not an ideal result, nor will it be as long lasting as in the patient with better elasticity.

When should I have a facelift?

You should consider a facelift when what you see in the mirror does not match what you feel on the inside, when you have a support structure in place to facilitate a comfortable recovery, when you are confident you are doing this for yourself and not to please others. There is no “correct” age, and if you are not physically or emotionally ready for a facelift, there are non-invasive and less-invasive procedures to rejuvenate your face such as supervised skin care, chemical peels, injectable fillers, microdermabrasion, lasers, and Dysport or Botox.

Who is a good candidate for a facelift?

The best candidate for a facelift is a person whose facial and neck skin has started to sag but whose skin retains some elasticity. Additionally, a good candidate will have a strong, well-defined bone structure. It is important for patients to be physically and psychologically healthy, have realistic expectations of their surgery, understand the risks and benefits of a facelift, and desire improvement rather than perfection.

Most of the women and men who would benefit from facelifting are between 40 and 70 years old. However, there are exceptions. Some people age prematurely and may consider improvement at an earlier age, while others age more slowly and can successfully undergo the surgery in their seventies or eighties.

What happens during a consultation for a facelift?

La Jolla (San Diego) board certified plastic surgeon Dr. Robert Singer will personally meet with you during the consultation. He will ask about the areas that concern you, what is your desired outcome, and take a detailed medical history. He will examine and evaluate you. He will then explain the options that are available and the pros and cons of each alternative. This explanation will include what treatment option/options he will recommend, where the surgery will be performed, what type of anesthesia, a step-by-step explanation of what the recovery will be like, what is expected of you as a patient, as well as the potential problems that may occur. Dr. Singer will answer all of your questions. You will then meet with the patient care coordinator, who will show you pre and post-op photos of the various options, explain the scheduling details, the costs involved, and answer any additional questions that you may have.

Is there a common technique for facelift procedures?

Techniques for facelifts vary depending on the surgeon, your individual anatomy, desired outcome, and extent of the procedure. Generally, the skin of the cheeks and neck is meticulously separated from the underlying layers of muscle and fat. The underlying facial muscles and tissues are tightened. Fat is repositioned and any excess is removed. The skin is shifted to a more desirable position and the excess removed.

What types of facelift surgeries are available?

The types of face lift surgery available include the traditional (contemporary) face lift, mini or limited lift, mid -face lift, lower face or neck lift.

How long will it last?

The results of a facelift may be considered permanent in that you will continue to look younger years later than you would have without undergoing the facelift. However, a facelift cannot stop the aging process and the face will continue to age. You will, however, always look younger and better than a twin, if you undergo a facelift and your twin does not.

The results will vary from person-to-person. Most patients can expect their results to last between eight and twelve years. The length of time that patients enjoy a satisfactory improvement after a facelift depends on many factors including the quality of their skin, which is influenced by the degree of sun damage or loss of elasticity. Smokers typically have poorer quality skin. Older patients will see an earlier return of laxity, while younger patients will see a more long-lasting improvement.

Heredity is important. If your parents aged slowly, you probably will, too. Your diet, general health, time spent in the sun, smoking, weight gains and losses, emotional traumas, and type of skin will all play a role in determining how long the improvement will last.

Where is facelift surgery performed?

Dr. Singer usually performs the facelift procedure in the Singer Surgery Centre, our fully accredited state of the art office based outpatient surgical facility, which has earned the highest level of accreditation by the American Association for Accreditation of Ambulatory Surgical Facilities (AAAASF).

Facelifts are typically performed under local anesthesia with intravenous sedation. Sometimes, depending on the patient, a general anesthesia is an option. In either case, to maximize safety, anesthesia is always administered by a board certified anesthesiologist and patients are asleep, comfortable, and unaware of any pain during the procedure.

How long is the surgical time for a facelift?

It depends on the extent of the procedure. It generally takes around 3 hours. If additional procedures like eyelid surgery (blepharoplasty), forehead improvement, micro- fat injections, laser or dermabrasion treatments are performed in conjunction with the facelift, it will naturally take longer.

Can I combine a cosmetic facelift with other facial surgery?

Yes, it’s generally preferred to combine procedures. It is financially beneficial because you only undergo 1 anesthesia and minimize the cost of the operating room and surgical supplies. In addition you minimize downtime by having to go through the recovery process following surgery only once. Commonly combined procedures with face lift surgery include the following:

• Eyelid surgery
• Brow lift
• Micro-fat transfer
• Laser or dermabrasion
• BOTOX® Cosmetic or Dysport
• Chin implant
• Rhinoplasty (nasal surgery)

Will a facelift address a drooping brow?

A facelift alone will not correct a drooping brow or forehead. A brow lift is often combined with a facelift to address drooping brows and excess upper lid skin. The resultant brow position should appear natural and not overly elevated.

What is a mid-facelift?

A mid-facelift essentially lifts the cheeks, blending the junction between the lower eyelids and the middle of the face, while improving the deep folds in the middle of the face.

What does a lower facelift do?

Lower facelifts address signs of aging in the neck such as lax neck skin, jowling at the jaw line, and drooping cheeks.

The rest of my face appears youthful but I have loose aging skin on my neck with a double chin; what can be done for this?

A neck lift works well to correct the effects of an aging neck. This is done in conjunction with contouring of the excess neck fat. The scars from the neck lift are hidden behind the ears and sometimes there is an additional short scar in a natural crease under the chin. Other methods that claim to correct the neck, like “skin-tightening” radio frequency, lasers and peels have been proven to not be effective.

What can be done about the lines around my mouth, which causes my lipstick to run?

These lines can be resurfaced, e.g. with dermabrasion, laser, or they may be filled out, for example, with fat or fillers. They can be softened, but usually not totally erased.

Is a facelift performed under general anesthesia?

Not necessarily. At the Singer Surgical Centre, facelifts are typically performed under local anesthesia with intravenous sedation. Sometimes, depending on the patient, a general anesthesia is an option. To maximize safety, in either case, anesthesia is administered by a board certified anesthesiologist and patients are asleep, comfortable, and unaware of any pain during the procedure.

Is a facelift performed under general anesthesia?

Not necessarily. At the Singer Surgical Centre, facelifts are typically performed under local anesthesia with intravenous sedation. Sometimes, depending on the patient, a general anesthesia is an option. To maximize safety, in either case, anesthesia is administered by a board certified anesthesiologist and patients are asleep, comfortable, and unaware of any pain during the procedure.

Why do I have to stop smoking before a facelift?

Healing depends on blood supply and smoking adversely affects your recovery by diminishing the blood supply to the skin. Smoking causes the blood vessels that supply oxygen and nutrients to the tissues to constrict and prevent the necessary healing of the operated areas. Patients who smoke have a greater chance of delayed or non-healing of incisions, which can result in additional scarring or pigment change of the skin, as well as lung problems with anesthesia. Patients must stop smoking for a minimum of two weeks prior to surgery to decrease the risk of these complications, and continue smoking cessation after the procedure.

Why does it look like I have lost a lot of fat in my face as I have aged?

Part of aging of the face is the loss and shifting of facial fat. The fat deficit can be restored by micro- fat injections, while the shifting of the fat is corrected by repositioning of the tissues during the facelift, resulting in a softer, more youthful appearance, while avoiding an over-operated or over-filled look.

“If I have a facelift will I look pulled or too tight?”

A common question is “Will I still look like ‘me’ after cosmetic surgery?” : The general comments from friends and associates after returning to normal activities are:” You look great. Did you change your hairstyle?” “New makeup? “Have you been on vacation?” Retaining your uniqueness is the sign of a successful procedure. Although the change may be significant to you, it’s not uncommon that friends and family don’t really notice the specific changes unless patients request dramatic changes.

A facelift, performed meticulously, in the hands of a skilled, experienced, board certified plastic surgeon should not result in a pulled look. Most patients want to look natural and like themselves, yet refreshed. This is achieved by the artistic combination of repositioning and removing the lax excess tissue and adding micro- fat grafts or fillers where the tissue is deficient.

What if I want to dramatically change the appearance of my face?

Some of the characteristics of a good board certified aesthetic (cosmetic) plastic surgeon are: willingness to listen to patients, an ability to tell the difference between realistic and unrealistic expectations, being truthful about meeting each patient’s desires, and the ethics to tell a patient why something should not be done. Our biggest referral source is from satisfied patients – ones who have had realistic expectations and were satisfied with the results.

What are the elements of a natural appearing facelift?

The elements of a natural face lift include smooth, toned skin that does not look pulled, cheeks and temples with restored volume, a sharp jaw line, a well-defined neck, soft nasolabial folds, preservation of the normal facial landmarks (e.g. hairline, ear position, sideburn), well placed fairly inconspicuous scars, and absence of deep furrows and lines. Ideally, it is a face whose features are in balance.

Where are the incisions, and will I need to have sutures removed?

Incisions are typically hidden in the hair behind the ear and along the hairline or in the hair above the ear to maintain as much sideburn as possible. Facelift incisions go around the ear and dip inside the ear in the front to help hide the suture lines. Some patients require a short incision beneath the chin to allow access to the neck area to tighten up the muscles in front. Some of the stitches in front of the ear are removed after 4 or 5 days. The rest of the stitches and the skin clips in the scalp above the ear are removed in approximately 10-14 days.

Will I still be able to wear my hair up and not have scars show?

For patients who wear their hair up, the facelift scars can placed where they can be well hidden and still allow you to wear your hair up.

How long before I can resume normal activities after my facelift?

This will depend on the individual. Most people are able to return to work between 10 and 14 days after their surgery even though some residual swelling and bruising may take up to three weeks to disappear. You should refrain from any strenuous activities for at least three weeks. Strenuous activities or exercise before that time will increase the risk of bleeding, swelling, and bruising. Sun exposure should also be avoided during that time. Your return to your normal activities is more determined by swelling and bruising and by your personal feelings about how you want to look as you resume social activities. A lot of the swelling will be resolved within eight to ten days, which is when most patients resume more normal limited activities. Bruising generally resolves in 2-3 weeks but it can be fairly easily covered with make-up prior to total resolution. Many patients prefer to wait until the bruising has disappeared before attending any major social events, or if they want to look their best before being seen by their friends.

Will my friends notice I have had a facelift?

The ultimate goal is that you look like yourself, just more youthful or rested. Patients often report to Dr. Singer that their friends tell them that they look rested or rejuvenated, not different. The extent of improved change in your appearance after facial surgery depends on how aged your face and skin are prior to the surgery.

Are there any differences with men having facelifts?

At the time of facelift surgery in La Jolla (San Diego) we take into account a number of anatomic differences between women and men to assure the best result. Due to the vascularity of the beard, men are at slight increased risk for bleeding, but they also seem to heal a bit more quickly, often with less bruising and quicker resolution of swelling. Facelift incisions need to be placed slightly differently to minimize and make the scars as inconspicuous as possible. There are issues regarding shaving after facelift surgery due to mobilization and repositioning of the hair-bearing cheek and neck skin. These issues are emphasized during Dr. Singer’s consultations with men who desire the improvements facial cosmetic surgery can offer.

Do you tighten the muscles?

The relaxed muscles and tissues under the skin are “tightened” and the excess skin is removed. Tightening the muscles improves the “turkey wattle” of the neck and results in an appearance, that makes you look younger, better and thinner. Because of the elasticity of skin, if only the excess skin was removed, without tightening the underlying tissue (the SMAS and the Platysma muscle) the benefits of a facelift would usually be very short-lived. Successful and longer lasting facial improvement involves treating both muscles and skin.

Will a facelift help the dark circles and bags under my eyes?

A facelift will not meet the expectations of most patients whose primary concern is the bags under or dark circles around the eyes. It is common that patients with these two concerns have a combination of procedures which may include a facelift, blepharoplasty (eye lid surgery), and skin care. Keep in mind that a facelift does not address the surface or textural changes, such as fine wrinkles of the skin.

Do I need a chin implant?

Balance and harmony of the facial features are key to having an attractive appearance, whether you are a female or a male. If your chin is retruded or weak from the profile view, you may benefit from a natural appearing chin implant, which can be inserted at the time of the facelift. On the other hand, if your chin appears balanced with the forehead and face, you do not need to consider a chin implant.

What can be done for a droopy double chin and jowls?

Most patients undergo neck fat contouring at the same time as a facelift. This has several advantages. Removing the excess fat under the chin and neck results in a more defined neck line, which generally makes you look younger, thinner and better. Tightening the muscles as well as the skin diminishes the jowls, resulting in a more clearly defined jaw line.

Will a facelift get rid of all my wrinkles?

As we age, our skin loses its elasticity. A facelift is most often performed to “lift” and remove sagging skin and as a result eliminate some wrinkles. Some of the deepest lines (such as the frown lines between the eyes that are improved with a Brow Lift or Dysport or Botox may not completely resolve but they will be significantly improved. Further improvement can be achieved with aggressive skin care and skin resurfacing with fractionated lasers. Fillers and micro-fat Injections can improve wrinkles and are particularly effective on laugh lines or smile lines. Patients who are not ready to have surgery visit the Singer Skin Care Center to consider non-invasive or minimally invasive procedures like Botox or Dysport, fillers, microdermabrasion, skin care or several other conservative procedures – many of which can be performed during the lunch hour.

I had a facelift somewhere else and I don’t like my result. Can it be “fixed”?

It’s not uncommon for patients who have previously had facelifts to be referred to the Singer Surgical Centre for revision surgery. Although patients may want immediate adjustments to the original facelift, patients generally should wait one full year before undergoing revision facelift, since the final results of facelift are not achieved until then. It takes that period of time for postoperative healing to be complete. Changes, however subtle, continue throughout the 12-month course following a facelift. As time goes by, the face gradually improves and features refine as the swelling resolves. These refinements sometimes are enough for a result to be considered acceptable by a patient. A thorough consultation is necessary to evaluate whether the areas that concern you can be realistically improved.

Why is a revision facelift often more difficult for the surgeon than a first-time facelift?

Many reasons, including: After any surgery, scar formation creates a thick, firm layer that is more difficult to work with than the unoperated tissue, the original location of (anatomical) landmarks have been altered, and revision facelifts can take a little longer because of corrections or modifications that need to be made as a result of the initial surgery.. The overall skill level required to perform a successful revision facelift is greater. It is best to have a realistic picture of exactly what can be accomplished prior to undergoing another surgery.

How much pain will I have?

Most patients who have facelift surgery say they are surprised at how mild the discomfort is that they experience. Patients more typically complain of tightness from swelling or a pulling sensation under the chin or in the temple area. Understandably, after any surgical procedure, some discomfort can be expected and pain tolerance varies from patient to patient. Patients are provided with prescriptions for pain medication. Many patients use the prescription medication 2-5days after surgery and then switch to Extra Strength Tylenol. It is uncommon for patients to report extreme pain after surgery.

Is it normal to have facial skin numbness after a facelift?

Numbness, especially near the incision lines and over the cheeks, is most noticeable in the immediate postoperative period. Many patients report resolution of most of the numbness within about six weeks following a facelift, although patients should expect it to last up to12 months or rarely longer.

Will I need someone to help me out at home after the facelift procedure?

It’s a good idea for patients to prearrange for post-surgery support from family members or friends before undergoing surgery. Our patient coordinator can arrange for an experienced individual to help with your post-op care at your home or a nearby hotel if you do not have someone to take care of you after surgery.

What happens when I check in for surgery?

Our nurses will help you get ready for surgery. Please let our nurses know of any special needs you may have. Also, be assured that you have plenty of time for any last minute questions with Dr. Singer. Before surgery begins, you will be asked to change into a surgical gown and then will be taken into a private operating room.

Does someone have to stay at the Singer Surgical Centre while I have my surgery?

No one needs to stay at the Singer Surgical Centre during your surgery. However, we ask that you have someone available by telephone at all times during your surgery.

What Happens After Surgery?

When the bandages are in place, you will be transferred to a recovery room adjacent to the surgical suite, where you will be continuously monitored as you recuperate from the effects of the surgery and anesthesia. You will be allowed to go home after a recovery period of one to two hours, accompanied by a responsible adult, or transferred by our nurses to an after-care facility or the adjacent hospital for a planned overnight stay. You should feel fine, although it is not unusual to expect some minor discomfort.

If you are going home, you must arrange for a responsible person to spend the first night and the next day with you. We will give them instructions for your care before you leave. This is absolutely necessary. You will not be able to care for yourself immediately following surgery. They will be required to wake you frequently throughout the night.

NOTE: If you live out of town, you must make arrangements to stay within a sixty-minute drive of the Centre for the first forty eight hours after surgery.

What do I feel like when I wake up from surgery?

Most patients report only mild to moderate discomfort associated with some tightness or pulling. This pulling sensation, most noticeable under the chin, subsides after 1-3 weeks. We will give you medication to avoid being nauseated. Our nurses and anesthesiologist will be right there with you as you wake up from surgery to give you special attention.

What Are the Facelift Postoperative Instructions?

You should expect:

• Moderate swelling, bruising, and bloodshot eyes that may last for about two to three weeks. Don’t be concerned if blood appears on your bandage, especially behind the ears.
• Sensations of tightness, which subside slowly over several days to weeks.
• Intermittent sensations of tingling, burning, and itching behind or on your ears. These also subside over several weeks. Numbness of the cheeks and neck that gradually improves over several months.

Call: (858) 455 0290 if you have:

• Severe pain that doesn’t respond to medication.
• Significant swelling, and/or unrelenting pain which occurs more on one side than the other.
• Bandages that become too tight.
• Any other problems or questions.

Activity: You should “take it easy” the day of your operation and the following days. Sleep on your back for two weeks, elevating your upper body on two or three pillows. By keeping your head elevated above your heart, swelling can be minimized. Because of your medications, you may need assistance getting to and from the bathroom for the first day.

Medications: Take the medications we’ve prescribed according to the instructions on the bottle. You may feel a little drowsy, so have someone help you. If you need a refill, call the office and give us the telephone number of your drugstore or pharmacy. Do not take aspirin for five days after your surgery.

Pain: Most patients feel that the discomfort from this surgery is minimal. The greatest period of discomfort usually lasts about twenty four to forty eight hours. Thereafter, you should have less discomfort and less need for medication. Occasionally, it lasts a little longer.

Smoking: Do not smoke for five days after surgery.

Alcohol: Do not drink alcohol for five days after surgery

Driving: You may drive after five days.

Diet: Start with liquids (fruit juice, milk shakes with Carnation Instant Breakfast, etc.) the first day then for the remainder of the first week progress to soft foods (pudding, macaroni and cheese, mashed potatoes, oatmeal, pasta) that do not require much chewing, restricting salt and artificial sweeteners.. To prevent dehydration, please drink as much juices and nutritional fluid as possible.

Hair: You may wash your hair after the dressing is removed. We suggest that you wash it in a shower with ordinary shampoo. You may dry it with a towel, or blow dry it with a cool dryer. Do not use a hot hair dryer, electric rollers, or curling irons for three weeks following surgery. Do not color or bleach your hair for three weeks after surgery, or until you are completely healed.

Makeup: You may apply makeup when the bandages are removed, keeping the makeup away from the incisions for two weeks.

Sun: Do not sit in the sun at all for three weeks after surgery. If the incisions are exposed, apply sunscreen for six months.

Sports: Strenuous sports such as golf, tennis, swimming, bowling, jogging, aerobics, jazzercise, or bicycling may be resumed after three weeks. Refrain from any activity that significantly raises your body temperature, and/or blood pressure for three weeks after surgery. This includes hot tubbing, sexual relations, and brisk walking.

Work: Depending on the kind of work you do, you may return to your job as soon as you are comfortable.

Postoperative visits: The day after surgery: If the procedure is to be performed as an outpatient, you will be seen at our Centre. If you are hospitalized, you will be seen there. You will be examined at this time.

Subsequent visits: They will be determined by your progress. The drains are removed one to two days after surgery. The dressing is removed three to five days after. Some of the stitches will be removed four or five days after surgery, the remainder at about two weeks. This does not hurt. A consultation will be provided by our cosmetologist at no charge to you.

You will feel more comfortable using the private waiting room for your initial postoperative visits.

Please feel free to call us at any time during your healing period.

THE OUTCOME OF YOUR SURGERY IS IN YOUR HANDS AS WELL AS THE DOCTOR’S. IT IS YOUR RESPONSIBILITY TO FOLLOW ALL INSTRUCTIONS GIVEN TO YOU.

What do I look like when I wake up from surgery?

Following the procedure, you will have a soft head wrap around your head and under your chin. This helps minimize swelling. You will also have a tube with a ball on the end of it – called a drain – just behind each ear. We will teach you and whoever is taking care of you postoperatively how to empty these drains overnight. The drains will generally be removed in the office in 1-2 days. The headwrap will be freshened in the office and generally removed at 3-5 days. You may have some bruising and swelling, which typically is more pronounced 24-48 hours after the procedure.

Can I do anything to prevent bruising?

Most patents will have some bruising. You can minimize bruising by following instructions and using Arnica 1-2 days before and after surgery.

Will I need any special prescriptions following surgery?

Postoperative prescriptions are provided at the pre-operative appointment well in advance of surgery, so you arrive home completely prepared. Postoperative prescriptions and over-the-counter medications for facelift patients include the following:

A) An antibiotic to take after surgery to prevent infection.
B) Pain medication to minimize any discomfort.
C) A specific prescription anti-inflammatory to minimize discomfort and swelling.
D) An anti-viral pill if you have a history of cold sores.
E) Eye drops and lubricating ointment if you are having your eyes done.
F) Over-the-counter Arnica to minimize bruising.

Does it hurt to get the drains removed?

Most patients tell us that there is a momentary pulling or stinging sensation when the drains are removed. It is described more as a discomfort than pain.

Are there any instructions about regular daily activities?

Sleep with head of the bed elevated or use two to three pillows for one week. Facial fullness, mild headaches and disrupted sleep are very normal postoperative symptoms and will decrease as the healing process occurs. Absolutely no bending, lifting or straining.

When will I look normal?

You will be presentable at two to three weeks. You will look better at six weeks and even better at six months as things settle and expressions become more natural. At three weeks you know you are well on the way to recovery and most patients resume routine activities around two to three weeks following surgery. Final results are generally achieved at one year.

How long does healing take?

Most patients look reasonably good at 2-3 weeks, but subtlety improve over months. It takes a year to see the final results.

What will you see in the mirror?

It will be difficult to evaluate your facelift during the first several days after surgery. Discoloration and swelling will be most noticeable on the second or third day, but will gradually diminish. As the swelling goes down, a number of fine wrinkles which were not evident with postoperative swelling may reappear. This is because your surgery was planned to give you a rested, more youthful, natural appearance, and not to tighten the skin so much that your face seems mask like.

Surgical scars will be permanent, but will fade in time. Every effort is made to conceal them, and to make them inconspicuous. For most of our patients, the results of facelift surgery are so favorable that the scars become a minimal consideration.

How can I maintain the results of my face lift in La Jolla (San Diego)?

At the Singer Surgical Centre, we believe that surgery for a natural face lift result is only part of the process. The icing on the cake is ongoing skin care to keep the skin looking as fresh and vibrant as possible, which is why most of our facelift patients continue to see our licensed aestheticians on a regular basis as part of their total facial aesthetic care. We will develop an individualized management protocol, including options of skin care and non-invasive techniques to maintain a youthful look. After surgery, you should minimize sun exposure, use sun block liberally, and follow Dr. Singer’s recommendations to maintain the best result.

How can I maintain the results of my face lift in La Jolla (San Diego)?

At the Singer Surgical Centre, we believe that surgery for a natural face lift result is only part of the process. The icing on the cake is ongoing skin care to keep the skin looking as fresh and vibrant as possible, which is why most of our facelift patients continue to see our licensed aestheticians on a regular basis as part of their total facial aesthetic care. We will develop an individualized management protocol, including options of skin care and non-invasive techniques to maintain a youthful look. After surgery, you should minimize sun exposure, use sun block liberally, and follow Dr. Singer’s recommendations to maintain the best result.

What will you see in the mirror?

It will be difficult to evaluate your facelift during the first several days after surgery. Discoloration and swelling will be most noticeable on the second or third day, but will gradually diminish. As the swelling goes down, a number of fine wrinkles which were not evident with postoperative swelling may reappear. This is because your surgery was planned to give you a rested, more youthful, natural appearance, and not to tighten the skin so much that your face seems mask like.
Surgical scars will be permanent, but will fade in time. Every effort is made to conceal them, and to make them inconspicuous. For most of our patients, the results of facelift surgery are so favorable that the scars become a minimal consideration.

How long does healing take?

Most patients look reasonably good at 2-3 weeks, but subtlely improve over months. It takes a year to see the final results.

When will I look normal?

You will be presentable at two to three weeks. You will look better at six weeks and even better at six months as things settle and expressions become more natural. At three weeks you know you are well on the way to recovery and most patients resume routine activities around two to three weeks following surgery. Final results are generally achieved at one year.

Are there any instructions about regular daily activities?

Sleep with head of the bed elevated or use two to three pillows for one week. Facial fullness, mild headaches and disrupted sleep are very normal postoperative symptoms and will decrease as the healing process occurs. Absolutely no bending, lifting or straining.

Does it hurt to get the drains removed?

Most patients tell us that there is a momentary pulling or stinging sensation when the drain is removed. It is described more as a discomfort than pain.

Will I need any special prescriptions following surgery?

Postoperative prescriptions are provided at the pre-operative appointment well in advance of surgery, so you arrive home completely prepared. Postoperative prescriptions and over-the-counter medications for facelift patients include the following:

A) An antibiotic to take after surgery to prevent infection.
B) Pain medication to minimize any discomfort.
C) A specific prescription anti-inflammatory to minimize discomfort and swelling.

D) An anti-viral pill if you have a history of cold sores.

E) Eye drops and lubricating ointment if you are having your eyes done.
F) Over-the-counter Arnica to minimize bruising.

Can I do anything to prevent bruising?

Most patents will have some bruising. You can minimize bruising by following instructions and using Arnica 1-2 days before and after surgery.

What Are the Facelift Postoperative Instructions?

You should expect:

• Moderate swelling, bruising, and bloodshot eyes that may last for about two to three weeks. Don’t be concerned if blood appears on your bandage, especially behind the ears.
• Sensations of tightness, which subside slowly over several days to weeks.
• Intermittent sensations of tingling, burning, and itching behind or on your ears. These also subside over several weeks. Numbness of the cheeks and neck that gradually improves over several months.

Call: (858) 455 0290 if you have:

• Severe pain that doesn’t respond to medication.
• Significant swelling, and/or unrelenting pain which occurs more on one side than the other.
• Bandages that become too tight.
• Any other problems or questions.

Activity: You should “take it easy” the day of your operation and the following days. Sleep on your back for two weeks, elevating your upper body on two or three pillows. By keeping your head elevated above your heart, swelling can be minimized. Because of your medications, you may need assistance getting to and from the bathroom for the first day.

Medications: Take the medications we’ve prescribed according to the instructions on the bottle. You may feel a little drowsy, so have someone help you. If you need a refill, call the office and give us the telephone number of your drugstore or pharmacy. Do not take aspirin for five days after your surgery.

Pain: Most patients feel that the discomfort from this surgery is minimal. The greatest period of discomfort usually lasts about twenty four to forty eight hours. Thereafter, you should have less discomfort and less need for medication. Occasionally, it lasts a little longer.

Smoking: Do not smoke for five days after surgery.

Alcohol: Do not drink alcohol for five days after surgery

Driving: You may drive after five days.

Diet: Start with liquids (fruit juice, milk shakes with Carnation Instant Breakfast, etc.) the first day then for the remainder of the first week progress to soft foods (pudding, macaroni and cheese, mashed potatoes, oatmeal, pasta) that do not require much chewing, restricting salt and artificial sweeteners.. To prevent dehydration, please drink as much juices and nutritional fluid as possible.

Hair: You may wash your hair after the dressing is removed. We suggest that you wash it in a shower with ordinary shampoo. You may dry it with a towel, or blow dry it with a cool dryer. Do not use a hot hair dryer, electric rollers, or curling irons for three weeks following surgery. Do not color or bleach your hair for three weeks after surgery, or until you are completely healed.

Makeup: You may apply makeup when the bandages are removed, keeping the makeup away from the incisions for two weeks.

Sun: Do not sit in the sun at all for three weeks after surgery. If the incisions are exposed, apply sunscreen for six months.

Sports: Strenuous sports such as golf, tennis, swimming, bowling, jogging, aerobics, jazzercise, or bicycling may be resumed after three weeks. Refrain from any activity that significantly raises your body temperature, and/or blood pressure for three weeks after surgery. This includes hot tubbing, sexual relations, and brisk walking.

Work: Depending on the kind of work you do, you may return to your job as soon as you are comfortable.

Postoperative visits: The day after surgery: If the procedure is to be performed as an outpatient, you will be seen at our Centre. If you are hospitalized, you will be seen there. You will be examined at this time. Subsequent visits: They will be determined by your progress. The drains are removed one to two days after surgery. The dressing is removed three to five days after. Some of the stitches will be removed four or five days after surgery, the remainder at about two weeks.

This does not hurt. A consultation will be provided by our cosmetologist at no charge to you.

You will feel more comfortable using the private waiting room for your initial postoperative visits.

Please feel free to call us at any time during your healing period. THE OUTCOME OF YOUR SURGERY IS IN YOUR HANDS AS WELL AS THE DOCTOR’S. IT IS YOUR RESPONSIBILITY TO FOLLOW ALL INSTRUCTIONS GIVEN TO YOU.

What do I look like when I wake up from surgery?

Following the procedure, you will have a soft head wrap around your head and under your chin. This helps minimize swelling. You will also have a tube with a ball on the end of it – called a drain – just behind each ear. We will teach you and whoever is taking care of you postoperatively how to empty these drains overnight. The drains will generally be removed in the office in 1-2 days. The headwrap will be freshened in the office and generally removed at 3-5 days. You may have some bruising and swelling, which typically is more pronounced 24-48 hours after the procedure.

What do I feel like when I wake up from surgery?

Most patients report only mild to moderate discomfort associated with some tightness or pulling. This pulling sensation, most noticeable under the chin, subsides after 1-3 weeks. We will give you medication to avoid being nauseated. Our nurses and anesthesiologist will be right there with you as you wake up from surgery to give you special attention.

What Happens After Surgery?

When the bandages are in place, you will be transferred to a recovery room adjacent to the surgical suite, where you will be continuously monitored as you recuperate from the effects of the surgery and anesthesia. You will be allowed to go home after a recovery period of one to two hours, accompanied by a responsible adult, or transferred by our nurses to an after-care facility or the adjacent hospital for a planned overnight stay. You should feel fine, although it is not unusual to expect some minor discomfort.

If you are going home, you must arrange for a responsible person to spend the first night and the next day with you. We will give them instructions for your care before you leave. This is absolutely necessary. You will not be able to care for yourself immediately following surgery. They will be required to wake you frequently throughout the night.
NOTE: If you live out of town, you must make arrangements to stay within a sixty-minute drive of the Centre for the first forty‑eight hours after surgery.

Does someone have to stay at the Singer Surgical Centre while I have my surgery?

No one needs to stay at the Singer Surgical Centre during your surgery. However, we ask that you have someone available by telephone at all times during your surgery.

What happens when I check in for surgery?

Our nurses will help you get ready for surgery. Please let our nurses know of any special needs you may have. Also, be assured that you have plenty of time for any last minute questions with Dr. Singer. Before surgery begins, you will be asked to change into a surgical gown and then will be taken into a private operating room

I am concerned about my privacy?

We honor the privacy of all of our patients.

Why will I be asked not to eat or drink anything?

Anesthesia medications can cause stomach upset. The best way to prevent problems from anesthesia will be to avoid food or drink from midnight the night before surgery. For patients with special concerns, such as a patient with diabetes, we will address special arrangements with you ahead of time.

Do I need any special prescriptions before surgery?

Most patients do not need any special prescriptions before surgery, except a medication to diminish anxiety the night before and the morning of surgery, which will be provided for you at the pre-operative visit. Please let us know of any special medical concerns you may have. (We will address prescriptions needed after surgery below.) You will also be instructed not to eat or drink anything after midnight the night before surgery.

Do vitamins and supplements need to be stopped before surgery?

Most vitamins and supplements have few side effects. However, there are some, such as vitamin E, fish oils and ginkgo-biloba that affect bleeding during surgery. Also, because there are now so many supplements available, we do not know how your particular supplements would interact with anesthesia, so we ask you to stop them 8 days before surgery. We will provide a list of medications and supplements to avoid prior to surgery.

What about my daily medications before surgery?

You will have a preoperative appointment well in advance of your surgery when our experienced staff will review all mediations with you. If you are on medications that affect blood coagulation, you will be asked to stop them approximately 8 days prior to surgery. We also ask that you avoid certain over-the-counter drugs, supplements and herbal medications. We will provide a list of medications and supplements to avoid prior to surgery.

What are some of the other things to do to prepare for surgery?

We review your health history and any daily medications you may be taking at the time of the pre-operative visit. Because tobacco abuse impedes wound healing, you will be asked to stop for two weeks before surgery and two weeks following surgery. We will be happy to discuss over-the-counter aids to help you with this.

What if I want more filling later?

We are careful not to make you look unnatural and not overinflated. Most patients are pleased after their first procedure, but some patients may feel that they would like additional enhancement after approximately 6 to 12 months from the initial procedure. That would entail a separate procedure with a separate fee.

What is the cost of the procedure?

Pricing depends on the patient’s anatomy, the extent of the procedure and the donor sites or areas.

When will I see the final result?

Most of the swelling and bruising are gone in 1 week. Generally the fat that is present at 6 months will be permanent and remain.

How long will the results of fat grafting last?

The fat grafts that “take” become a permanent part of your facial soft tissues. Like the fat tissue that is naturally present there, it is also subject to natural factors such as significant weight changes and continued aging.

When will I be able to resume work after my fat transfer procedure?

The time to return to work and other activities is variable and mostly dependent upon the individual. For the first week, most patients feel that they look too swollen to be in a typical work environment. However, patients that can work from home frequently return to their work the very next day.

What is recovery like after the fat injection procedure?

It depends on the areas and the size to be treated and where the fat is harvested from. In lip grafting you feel fine right away; you just look swollen for days to 2 weeks. Recovery after fat transfer is relatively fast and easy compared to other cosmetic surgery procedures and discomfort is minimal. Patients may experience some minor discomfort after the fat transfer procedure, though this tends to resolve quickly. Redness, bruising, swelling are variable but are greatly improved within one week. In general, the recovery is relatively minor and most patients report that the results are absolutely worth it.

Is the fat transfer procedure painful?

The discomfort from fat grafting should be minimal in most cases. Discomfort should be only short term and can be managed with oral pain medication

What anesthesia is the fat transfer procedure performed with?

Fat transfer may be performed with intravenous sedation plus local anesthesia. With a limited minimal procedure, patients may occasionally opt for a light sedation which can be achieved with an oral pill in addition to local anesthesia.

How long does the procedure take?

It depends on the areas to harvest and to graft. If it is a small area like the lips, it can take as little as one hour. If it is a larger area other than the face, like the buttocks with liposuction, the procedure may take 3-4 hours.

Why should I choose fat injections over other dermal fillers?

There is no chance of causing an allergic reaction with a patient’s own fat. While rare, anytime a foreign substance (dermal fillers) is introduced into the body, there is the possibility an allergic reaction or rejection of that material. Fat transfers avoid this problem, since the body recognizes the tissue as its own, even in its new location. In many patients, it may be far more economical in the long term than synthetic fillers, which must typically be re-injected at least once per year to maintain the effect.

What is the difference between autologous fat transfer, fat grafting, micro-lipoinjection, and micro-fat grafting?

They are all different names for the same procedure of removing fat from one area of the body, purifying the fat, and then injecting it back into another area of the body that needs a little smoothing or augmentation. The fat transfer procedure is individualized to fill in facial creases and contour deficits caused by age, trauma, or genetics. The amount of fat taken out of the donor area for facial fat injection is significantly less than that removed in standard liposuction surgery.

How much fat will be needed for fat grafting?

Only the amount needed for the fat grafting is removed, unless the patient is having additional elective liposuction. Over-treating or injecting extra fat is not ideal, as this creates a mass of fat that is too big for the blood supply and doesn’t survive. In addition, the goal is a natural result, avoiding an overdone appearance. Sometimes, it is better to do it in stages.

What should a patient weigh before fat grafting?

There is no minimum weight. Patients just need to have enough reserve fat to harvest and graft.

How many procedures are needed to achieve the desired results?

Most patients reach the desired goal with just one procedure, but a second may be required to further enhance the results.

Is fat grafting permanent?

Fat grafting is usually successful, but not totally predictable since the results vary from patient to patient. In most patients, ultimately about 30-60 percent of the transferred injected fat survives long term.

How is the fat injected?

Fat is injected and transplanted using a micro-grafting technique using very small narrow hollow cannulas to create thin tunnels under the skin which are formed by passage of the cannulas through the tissue. The fat is then placed in small syringes and injected into the desired regions of the face using separate small access points in the skin. Fine blunt-tipped cannulas are used to minimize the chance of injuring neighboring blood vessels or nerves. The fat is placed in a three-dimensional latticework that provides structural support and maximizes the in-growth of blood vessels which are necessary for fat survival.

How is the fat prepared?

The fat is carefully and gently washed with sterile normal saline. The healthy fat cells are then separated from any other material by centrifuging.

How do you harvest the fat?

With small cannulas so that only small fat parcels will be harvested. This will allow the best opportunity for new blood supply to grow into the grafts. It is harvested using very light suction with a syringe so that the fat cells will not be destroyed.

What factors determine the outcome of fat grafting?

The anatomy and contour of the area to be treated, how much fat is available as a source for transplantation, the amount of fat that is available to graft once it is harvested and prepared, and how much fat actually survives once it is transplanted. It also depends on general medical health, realistic expectations, and a thorough understanding of the pros and cons of the procedure.

What is the science and theory behind fat grafting?

Fat cells are very delicate and fragile and need a blood supply to survive. The cells are meticulously harvested with a syringe and small needle or cannula, prepared by sterilely washing and centrifuging the fat, and then injected into the treatment site in many small crisscrossed tunnels (micro-fat grafting). This method maximizes the probability of developing the new required blood supply for the fat cells to survive and keep their volume.

Do you freeze fat and re-use it later?

The reliability of frozen fat is totally unpredictable. There is a greater risk of infection and other complications. Most facilities that freeze and store fat generally do not have the special FDA license for a tissue banking facility that is required to be in compliance with the law.

Do all areas respond to fat grafting equally well?

Unfortunately, no. Areas of frequent motion like the lips and laugh lines are more unpredictable and may take more than one session to get a good lasting improvement. All other areas of the face and body do reasonably well, and in many patients the fat survives and gives a very nice result in one session.

What are the best sources for fat harvesting?

Areas like the hips, flanks, abdomen where you have an excess of fat that has generally not been liposuctioned before. It should also be an area where there is not a lot of fibrous tissue, like the male chest.

In what areas can be fat be grafted in the body?

Any area where fat exists in the subcutaneous space and there is deficient volume.

Who is a candidate for fat grafting?

Individuals who are looking to gain or restore a healthy, youthful appearance of the face that cannot be achieved with traditional facial procedures are excellent candidates for fat grafting. As with other cosmetic procedures, patients should be healthy and have realistic expectations of their potential results.

What is fat transfer?

Fat transfer, also known as fat injection, is a cosmetic procedure in which fat is removed from one area of the body (usually the hips, flanks abdomen, or legs) and then injected into very specific areas of the face in order to restore the volume that gives the youthful glow that we all lose with age or with athletic activity. It is also beneficial in patients with a congenital thin or gaunt face in order to improve the contours and balance of the face.

Why do people have dermal fillers?

People have injections of fillers to look younger and to: restore loss of cheek volume, smooth wrinkles, soften deep facial lines, improve thin lips subtly improve a recessed chin, diminish hollows under the eyes, and correct minor depressions of the nose.

How common are dermal filler treatments?

Hyaluronic based dermal fillers are the second most common cosmetic procedure after injections of Botox or Dysport. Last year there were almost 2,500,000 hyaluronic filler treatments in a survey from The Aesthetic Society. They have become extremely popular because of minimal side effects and effectiveness of treatment in the appropriately chosen patient.

Are all dermal fillers basically the same?

Dermal fillers are not all the same. They are all gels that are injected under the surface of the skin in various layers to add volume, but they use different active ingredients and come in different formulations so the various areas of the face can be more appropriately treated.

How do dermal fillers work?

We lose some of the skin’s “building blocks” such as elastin, collagen, and fat as we age which causes the skin to become lax and sag causing fine lines and wrinkles. Different fillers with different characteristics are carefully injected into various layers of the skin in different areas to reverse those changes.

What are the best dermal fillers areas?

As we age the face loses volume and contour, the bones and soft tissue resorb and contribute to the appearance of sagging and aging. Dermal fillers can be used in places to restore volume and replace structural support resulting in a more youthful appearance. The aim is to make the face more harmonious and rejuvenate it. Nasolabial (laugh lines), lip border (lipstick lines), the lines between the chin and the cheek (marionette lines), sunken cheeks, Under eyelid hollows, thin lips, corners of the mouth, jowl areas, temporal hollows, crow’s feet, and ear lobes. Often some of these areas these are treated in combination with Dysport® or Botox®.

Who should perform the dermal filler injections?

If a member of my family was going to have a dermal filler, it would be injected by a Board-Certified Plastic Surgeon, ideally a member of The Aesthetic Society. Dr. Singer does all of the injections of fillers and Dysport® or Botox® in his office. He does not delegate that to anyone with lesser training.

What does a dermal filler procedure involve?

After careful evaluation by Dr. Singer and development of an individual plan, a topical anesthetic cream is applied and cold packs. This maximizes comfort. The injections are performed meticulously. The entire treatment generally takes around 30-45 minutes.

What will a woman’s face look like after dermal fillers?

Makeup can be applied immediately after the procedure and you can go straight back to work. The results of fillers are seen immediately as compared to Botox®, Dysport® which generally take 5-7 days to work. Optimal results can be maintained over a long period of time through regular, maintained treatments. The frequency of the procedure will vary from person to person depending on your individual anatomy, genetics, severity of the wrinkles, and the particular type of filler that is used.

What are the key benefits of having the treatments at Singer Surgical Centre?

• We only use FDA approved dermal fillers.
• The consultation and treatment are personally performed by Dr. Robert Singer who is an international acclaimed plastic surgeon and who has been a trainer in advanced surgical procedures.
• Multiple fillers are available since the treatment plan is individualized.
• Topical anesthetics are used on the area being treated to increased patient comfort.
• Robert Singer is well known for his methods of achieving beautiful, yet natural cosmetic results with minimal pain, bruising, and downtime.
• We provide excellent post treatment care.

Can I combine a dermal filler treatment with other procedures?

Certainly. At Singer Surgical Centre, we recommend a combination approach to help patients improve their individual aesthetic concerns. It is perfectly safe to mix and match dermal fillers in conjunction with Dysport® or Botox®. The combined procedures are often referred to as a “liquid facelift”.

What is a “liquid facelift”?

It is a non-surgical facial rejuvenation technique that uses a combination of Dysport® or Botox® and dermal fillers to improve the wrinkles and rejuvenate the lost volume in the face. While it can improve the appearance, it does not produce the same result as a facelift.

What is the difference between Botox®, Dysport® and dermal fillers?

Dermal fillers and Dysport® or Botox® are all injectable treatments that are used to reduce the appearance of wrinkles. They work in different ways. Fillers use a gel ingredient to physically fill in wrinkles and elevate them from below the skin’s surface which improves the appearance. Dysport® or Botox® uses a purified form of botulinum toxin to temporarily reduce the muscles that cause dynamic wrinkles. When used appropriately, Dysport® or Botox® and dermal fillers can create significantly improved outcomes and are often used in combination to produce better cosmetic results.

What if I don’t like the results of my dermal fillers?

Hyaluronic acid fillers can be reversed by dissolving them with hyaluronidase.

New Year’s Eve Is Only Days Away. Are You Ready to Party?

Do you want to know the secret to the best New Year’s Eve party? We suggest friends, fun, and a little fabulous. We can’t supply the party, but we can help you look and feel great when you do show up. Come into Singer Plastic Surgery for last minute rejuvenation. We’ll help you look amazing as you ring in the New Year.

New Year’s Eve is just a couple of days away. These treatments are the perfect choice if you need improvement in a rush. All require no downtime and provide near-instant results. Come in today!

“Freeze” Wrinkles Away in 10 Minutes

If you’re short on time but want big aesthetic results, ask us about Botox and Dysport. These two injectable treatments are sometimes called “freezers” because they stop or “freeze” muscle activity that causes certain types of wrinkles. What you get are natural looking and lasting results. Best of all, treatment takes just 10 minutes. Get in, get treatment, and get right back to your life. No downtime is needed!

It does take some time for results to appear so, if you want to see changes by New Year’s Day, you’ll need to hurry in. The results happen gradually over about a week. In some patients Dysport works a little more quickly than Botox, so this treatment may be the better choice if you’re in a hurry to see results.

Start the New Year with smoother skin and fewer crow’s feet. Botox and Dysport to the rescue!

Dermal Fillers Provide Instant Results

If you need instant gratification, opt for a dermal filler. Hyaluronic acid fillers are especially suited to last-minute treatments since they provide instant results with no downtime. You should see improvement immediately. If you have any redness, cover it with makeup. Side effects are minimal and fade quickly.

Juvederm is another excellent choice for last-minute treatments. This dermal filler is versatile and can be used to fill in moderate to severe wrinkles on the cheeks. We often use it to treat nasolabial folds (lines from the nose to the mouth). It can also be used for lip augmentation to create a pouty, full lip. Dr. Singer is a skilled injector and is known for his natural looking results using dermal fillers.

Hurry In—New Year’s Eve Is Almost Here

These last minute treatments will have you looking great in just days but, if you want to see results by New Year’s Eve, you’d better hurry in. The sooner you get treatment the better you’ll look by party time. Call today!

How long do dermal fillers last?

It varies depending on the filler and location of the injection, but typically most fillers last 6-9 months. Some of the fillers like Voluma can last up to two years. Patients do respond individually to fillers as their body breaks down the fillers which occurs faster in some people than in others.

What is the chemical makeup of a dermal filler?

Most popular fillers like Restylane®, Perlane®, Juvederm®, and Voluma® are made from a natural complex sugar called hyaluronic acid. Hyaluronic acid exists within your own tissue including skin. Radiesse® is a less frequently used calcium based filler. It not only replaces facial volume, but stimulates your own production of Collagen.

What are the possible side effects that can result from dermal fillers?

Potential side effects include tenderness, swelling, pinkness, rare lumpiness or contour irregularities, temporary numbness, mild bruising, discomfort, infection or very rare allergic reaction and visual disturbance. Today’s dermal fillers have significantly improved since the first generation of collagen injections. Injection techniques have been modified and coupled with use of micro cannulas (blunt needles) and improved product safety. Significant side effects are extremely uncommon. These risks are higher when the treatment is performed in a non-sterile environment such as beauty clinics, salons, or in-home environments by inexperienced or underqualified individuals.

Can I be allergic to dermal fillers?

Allergies to hyaluronics have been described, but are very rare.

Is there an age limit for cosmetic dermal fillers?

For cosmetic purposes, dermal fillers should be administered to patients older than 18.

Can dermal fillers be used in patients with skin of color?

Hyaluronic fillers can be used in patients with skin colors since these are colorless gels that don’t alter the skin color and are not visible.

What are the risks associated with cosmetic dermal fillers?

Temporary bruising, and very rarely infection or scarring. We don’t use synthetic permanent fillers because they may cause clumping or granulomas which may require additional treatments.

Are dermal fillers safe?

The FDA approved dermal fillers are safe. It is important that they are administered by an appropriately qualified and trained individual and injected in a medical setting.

Is there anything I should do to prepare for fillers?

Medications that could increase bruising such as anti-inflammatory drugs, vitamin E, fish oil, herbal medications, supplements and aspirin should be discontinued 7-8 days before any injection to diminish the risk of bruising.

Do dermal injection fillers hurt?

Dermal injection fillers can cause discomfort. Using a combination of numbing cream and ice makes it much more comfortable. Most of the dermal fillers that are injected at the Singer Surgical Centre include a local anesthetic.

How much downtime can I expect after having a dermal filler?

Most patients do not have any downtime following filler injections and they return to normal activities and work right after treatment. In the patients who do experience some swelling, redness or bruising, it generally only lasts a couple of days and can usually be covered with makeup.

What is the best dermal filler, wrinkle filler or face filler?

The best dermal filler is one that is individualized for your specific facial rejuvenation. Different fillers are used in different areas to get the best cosmetic result. Commonly used fillers are Restylane, Restylane Lyft, Juvederm, Restylane Silk, and Voluma. At the Singer Surgical Centre, we only use FDA approved products which ensure that they have undergone rigorous testing for safety and efficacy. All of the injections are performed by Dr. Singer, not lesser trained individuals.

What will the face look like after the dermal filler injection?

You will see the result right away. There may be some slight swelling, pinkness, or occasional mild bruising. Most people can return to work immediately after having fillers.

Who should not have a dermal filler injection?

Women who are pregnant or patients with a compromised immune system should not have a dermal injection or if you are allergic to any ingredient in the filler, have a skin infection or inflammation near the area of potential injection.

What happens to the dermal filler ingredients as they wear off?

Hyaluronic dermal fillers are not meant to be permanent. Depending on the type of filler and location of the filler, the results of treatment can last between several months and up to two years. The ingredients in the fillers gradually go through metabolic breakdown and are filtered out of the body through normal metabolic processes.

What is a wrinkle filler also referred to as a face filler or dermal filler?

It is an FDA approved injectable gel which is used to temporarily plump or add volume to the aging face and improve wrinkles and deep facial lines. The most popular dermal fillers being used today consist of hyaluronic acid based products which are naturally occurring substances that are found in your own body tissues. They are not permanent, meaning they are resorbed into the body over a period of time. Hyaluronic acid has been used in a variety of medical procedures for several decades.

What is the difference between the various lipo procedures?

Some practices use different names which mean the same thing: “lipoplasty” “liposuction” or “suction lipectomy”, “micro-liposuction”, “lipo-contouring, “micro-lipo”” — they are marketing name variations of basically the same procedure.

Is there an advantage of Laserlipo, ultrasoninc lipo, water jet lipo?

While some surgeons utilize these procedures, most of the promises of improved results, less bruising, faster recovery, skin tightening are purely unsubstantiated marketing claims. Most of the scientific studies show no appreciable improvement over standard liposuction. In fact, ultrasonic and laser lipo may produce other complications, including burns and greater scarring.

What is important: individualization, narrow instrument to remove the fat (cannula), wetting solution (tumescence), proper safety precautions, experience and training of individual at the end of the instrument, how much you leave, not just what you take, an appropriate surgical facility that is accredited by a national organization, like AAAASF – not just an office treatment room that may never be examined for standards, and a fully trained anesthesia provider . No matter which technology is used, you need to be realistic about your outcome. It is not a replacement for diet and exercise nor does it replace other surgical procedures for loose sagging skin.

Is liposuction a weight reduction treatment?

No, liposuction is used to get rid of isolated areas of fat which are diet resistant to exercise and diet. It is not a treatment for weight loss.

Who is a good candidate for liposuction?

The best candidates for liposuction are people at their normal weight who have isolated areas of fat. Firm, elastic skin allows for a better outcome. The patient’s age is not a factor, however, older patients have less skin elasticity and may not achieve the same results as younger patients.

How long do I need to be off of work?

It is suggested that you take off of work for 3-5 days after surgery but continue to avoid strenuous activity for 3 weeks after surgery.

When can I get back to my normal routine?

The recovery time differs with each La Jolla – San Diego liposuction Surgery patient. The recovery time will vary depending on how much liposuction was performed and how many areas were treated. Most patients are able to return to work 2-7 days after surgery depending on the areas treated.

When can I resume exercising?

Depending on the areas treated, most patients are able to resume exercise 2-3weeks after the procedure.

Will the fat return to the area that was treated?

If you maintain your weight after the liposuction, your result will be long standing. However, if after liposuction surgery one does not eat healthy and exercise regularly, the fat cells that remain in the treated area and those in other areas will grow. The fat cells that have been removed are gone forever. Liposuction is not meant to be used as a weight loss program.

Can I do multiple areas at the same time?

Yes. Dr. Singer will discuss which procedures may be performed at the same time while still being safe. Many patients will opt to have liposuction and breast augmentation surgery or liposuction and tummy tuck surgery at the same time. Combination surgeries can give dramatic results. In some patients, it is prudent to do several procedures in sequence, rather than all at the same time, to assure the safest outcome.

Will I be wearing any special garments after the surgery?

Yes. When you wake up after the procedure, a garment will be on the treated areas. This compressive garment is there to assist in the healing process and to decrease the amount of swelling. Dr. Singer will discuss the amount of time you will need to wear the garment – depending on what areas are treated.

What areas of the body can be treated with liposuction?

Liposuction provides excellent results when used on areas in patients where there is skin good elasticity, such as the neck, face, arms abdomen, hips, flanks, thighs.

Do patients ever need another midface lift?

Results are more permanent than those offered by injectables. Your face will always look younger and more refreshed after surgery than it would have if you didn’t undergo the procedure, but you will continue to age. Some, but not most, patients will choose to have additional facial rejuvenation years later.

Is a midface lift/cheek lift safe?

The risk of potential complications is low, but any surgical procedure carries the possibility of complications which include: bleeding, delayed healing, and asymmetries. In any surgery of the face, there is a remote possibility of a temporary bruising of a branch of the facial nerve which can result in temporary weakness of one of the branches.

How long does the procedure take?

Midface lifts take about 1 ½-3 hours to complete.

Can I have other procedures done at the same time as a midface lift?

Patients frequently opt to have other rejuvenating procedures done at the same surgery. These can include: Eyelid lifting (blepharoplasty), brow lifting, micro-fat grafts, and neck contouring. Having multiple procedures on the same day may lengthen the recovery time, but it allows the patient to accomplish many goals with one surgery and have one recovery period.

Are the results of a midface lift natural appearing?

In the hands of an experienced artistic plastic surgeon, the results of a midface lift are very natural, and generate a young, healthy appearance.

Are there injections that can improve my cheeks?

If injected correctly, several products can replace soft tissue in the cheeks or appear to minimally lift them. Temporary fillers such as Restylane or Juvaderm are effective, but need to be re-injected in 6-12 months. Voluma lasts up to 2 years. Micro-fat grafts produce a long lasting result. In general 30-50% remains permanently. These fillers only improve cheek fullness; they do not lift soft tissue that has fallen with time. They are often performed in conjunction with a midface lift to further enhance the results.

Are there other ways to improve my smile lines?

Aside from midface lift surgery, the best treatment for smile lines (or “nasolabial folds”) is the injection of a hyaluronic acid (Restylane, Juvaderm). These products give an effective, but temporary, remedy for deep smile lines. Micro-fat grafts produce a similar but long lasting result. In general 30-50% of the injected fat remains permanently. They are often performed in conjunction with a midface lift to further enhance the results. Remember that filling the nasolabial folds will not elevate or replace soft tissue in the cheek.

Do I need anesthesia for the midface lift?

It is generally performed with intravenous sedation plus local anesthesia or with general anesthesia, both of which are administered by a board-certified M.D. anesthesiologist.

Where is the midface lift procedure performed?

It is performed at the Singer Surgical Centre, an outpatient office-based surgery center, which is fully accredited, by the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF). Most patients go home the same day as the surgery.

What’s involved with a midfacelift?

Preoperative and postoperative mid facelift instructions are the same as for a facelift.

When can I return to work after my midfacelift procedure?

Patients typically return to work and activities anywhere from seven to ten days although restrictions limiting exercising, heavy lifting, bending and straining along with aerobic activity remain for three weeks following the procedure.

Is the healing time less with a midfacelift?

In general, yes, but healing is very individual. Midface lifts involve less dissection and muscle tightening so there is less bruising. Patients typically return to work and activities in about seven to ten days although restrictions limiting exercising, heavy lifting, bending and straining along with aerobic activity remain for three weeks following the mid facelift procedure.

Where are the incisions for a midfacelift?

The scars of a midface lift are well hidden in the hair of the temple above your ears (your hair will not be cut or shaved), and possibly in a natural crease just below the lower eyelid lashes. Depending on individual anatomy, a small component of the incision may be placed in front of the upper portion of the ear. The incision is much less than required in a full facelift. As with all procedures, Dr. Singer will use the smallest incisions possible for your midface lift.

What is the difference between a full facelift and a midface lift?

The traditional facelift focuses on the central and lower face and neck, while the midface lift focuses on the central third of the face, or the cheeks between the eyes and the upper lip. The changes that occur with aging in this area include deepening of the fold between the cheek and upper lip (also called the naso-labial fold). Although part of the reason that this fold deepens can be attributed to age-related volume loss, sagging skin and underlying tissues also contribute to the tired, sad look associated with these lines. Although the goal of the midface lift, like the traditional facelift, is to rejuvenate the face, the techniques are different and the area that is improved is more limited.

How do I know if I need a midfacelift or a full facelift?

A large number of factors, including your age, your genetic disposition, the amount of sun exposure, your skin type, general medical history, and your history of tobacco use can all affect facial aging. When aging has occurred in the central face, lower face and neck, the traditional facelift is a better option for rejuvenation. The midface lift is used for rejuvenation in the middle third of the face, between the eyes and the upper lip. The best way to know for certain what is best for you is to ask your questions at a consultation with Dr. Singer.

Am I a candidate for a midface lift?

A mid-face lift like any procedure should be individualized to achieve a natural appearing result. Ideal candidates for the midface lift do not have medical conditions that can impair healing or increase risk of surgery, are not active smokers, are realistic about the potential results, properly motivated, and have deep hollows beneath their eyes (and eye bags), deep smile lines, and sagging of the midface area (the cheeks between the eyes and upper lip). This starts in some patients in their mid-thirties and becomes more prominent during the decade between 40 and 50 years of age. In order to counter the effects of this aging, the midface lift restores the padding of the bony rim beneath the lower eyelid, allows for more skin removal (the wrinkled, lined skin of the lower eyelid) without eyelid changes, and softens the smile lines by raising the cheeks to their more youthful position. It can be performed together with an endoscopic brow lift to rejuvenate the forehead and brow at the same time.

What is a midfacelift?

The midface lift, also called a cheek lift, addresses the middle third of the face, between the eyes and the upper lip. It is performed when a more subtle, but still significant, improvement is needed. A cheek lift elevates the fat pad in the cheek (called the malar fat pad), providing fullness to the eyes and cheeks – leading to a refreshed, rejuvenated look. Although the goal of the midface lift, like the traditional facelift, is to rejuvenate the face, the techniques are different. Both techniques are used to address drooping or sagging skin, wrinkles, and other signs of premature aging, but the midface lift is performed with minimal incisions that are hidden from view within the hair and possibly under the lower eyelid lashes. In addition, many patients who qualify for the midface lift do not require significant skin redraping, may need less muscle tightening and therefore may have less swelling and bruising immediately after the procedure.

What is a mini cheek or facelift?

It is a term that describes a modified facelift. There are variations and it means something different to each surgeon. Some call it an “S Lift”, “J Lift’, Short Scar Facelift, or a number of “trade-marked” names that are variations of the procedure and are used as marketing tools.

Who would benefit from a mini lift?

It is appropriate for patients who have early jowling and minimal neck aging. It is best for patients in their mid-40’s-50.

What is the downtime versus a standard facelift?

The procedure is a smaller procedure with less dissection and usually less downtime than a traditional facelift, but it varies from patient to patient.

Am I candidate for a mini cheek or facelift?

The procedure may be beneficial for younger patients or those requesting a touch up versus a full facelift. If there is an excess amount of skin or tissue laxity, it is not an adequate replacement for a facelift.

Where is a mini or a face or cheek lift performed?

It can be performed at Singer Surgical Centre which is an AAAASF accredited full surgical facility.

What type of anesthesia is used for a mini cheek or face lift?

It is usually performed with MAC anesthesia (Monitored Anesthesia Care) plus local anesthesia administered by a board certified Anesthesiologist.

Where are the incisions for a modified face or neck lift?

Incisions are generally shorter than that for a traditional face lift and are located within the hairline and inside of the ear. In some patients, an additional incision under the lash line of the lower lids is performed.

What are the risks associated with a modified or mini face or cheek lift?

The risk of potential complications is low, but any surgical procedure carries the possibility of complications which include: bleeding, delayed healing, and asymmetries. In any surgery of the face, there is a remote possibility of a temporary bruising of a branch of the facial nerve which can result in temporary weakness of one of the branches.

What is the recovery like after a modified face or cheek lift?

Every patient heals differently and most patients look reasonable after 7-12 days. Swelling and bruising are usually less than in patients with a greater amount of laxity requiring a full facelift.

Are there scars from a mini or modified face or cheek lift?

Anytime you make an incision, there is a scar. They are meticulously placed in order to minimize the scars which are usually well concealed and generally blend in with time.

Is a mini or modified face or cheek lift painful?

Pain tolerance varies from patient to patient but most say that it is more of a discomfort than a painful feeling. Patients are given a low dose pain medication to relieve the discomfort.

What is involved in a mini or modified facelift?

Ideally, to get the best cosmetic result, it should be individualized based on the patient’s anatomy. It generally involves an incision in the temporal hairline which extends inside the ear and occasionally extending for a short distance behind the ear in the normal crease. The SMAS layer which is beneath the skin and overlying the underlying muscles and parotid gland is elevated and tightened as is the loose platysma muscle of the neck. These tissues are sutured into an elevated position which produces a more longstanding result than just tightening the skin. Doing this also improves the quality of the scar by minimizing the tension placed on the skin closure. The skin is then re-draped and the excess portion is removed. The incision is closed in layers with sutures. A small drain is often placed behind the ear and a compression dressing is applied.

When can I resume exercising after a modified or mini facelift?

Generally, we recommend waiting three weeks after surgery before resuming strenuous activities and exercise.

What are the limitations to what a mini face or cheek lift can achieve?

The procedure is directed towards improving the central lower face and upper neck. It will not improve the forehead, brows or eyelids. Additional procedures of those areas can add to the result.

Who is a good candidate for a mini facelift?

Ideally patients should not have any significant underlying medical problems or have a history of bleeding disorders or active smokers. A mini facelift is not for those looking for a dramatic result, but for those who want a subtle refreshed look.

What is a rhinoplasty?

Rhinoplasty (“nose job”) is a frequently performed surgery of the nose that may be cosmetic or reconstructive in nature for improving the appearance and/or function of the nose.

How many years has Dr. Singer been performing rhinoplasty surgery?

Dr. Robert Singer has been Board-Certified by the American Board of Plastic Surgery since 1977. He has continued to be involved in training other plastic surgeons and holds the position of Clinical Professor of Surgery (Plastic) at University of California San Diego while being in a full time private practice on the campus of Scripps Memorial Hospital, La Jolla.

Dr. Singer is an extremely experienced rhinoplasty surgeon, having performed around 2000 rhinoplasties in his practice.

Who is the best rhinoplasty surgeon for me?

There are several factors you want in a rhinoplasty surgeon:

• Training: Since rhinoplasties are among the most difficult cosmetic procedure, they require the greatest amount of formal training as well as finesse.
• Experience: The procedure requires a significant amount of anatomical knowledge and expertise.
• Artistry: A good natural appearing rhinoplasty depends on artistry.
• Safe surgical facility: Surgery should be performed only in a surgical facility accredited by a national organization like the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) or a state licensed facility with anesthesia provided by an appropriate anesthesia provided, preferably a board certified anesthesiologist or CRNA.
• Board certified by the American Board of Plastic Surgery or facial plastic surgery: A straightforward surgeon that meets with you personally and discusses what is realistic -not only the benefits, but also the potential problems and the fact that even in the best of hands, the nose is rarely absolutely symmetrical and may require secondary revision procedures.

Can computer imaging be used to predict the appearance of the nose?

Computer imaging is an excellent communication tool to show the direction one wants to go in improving the appearance of the nose. However, you have to be realistic that it is only a computer drawing and you may not get that exact result, because it does not show the unpredictable aspects of healing.

Where is a rhinoplasty performed?

Most are performed in Dr. Singer’s office-based surgical facility that is fully accredited by American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) or at Scripps Memorial Hospital La Jolla.

No matter where it is performed, anesthesia should be delivered by an appropriate anesthesia provider, a board certified anesthesiologist. Safety should always be the primary consideration.

How long does the surgery take?

It depends on the complexity of the procedure. Surgery usually takes 1-3 hours.

What is recovery like?

Most patients are urged to take at least 1 week off from work, school, and social activities for recovery. Bruising and swelling around the eyes are to be expected and are quite variable. It usually starts to subside after 48-72 hours following the surgery. In most patients the bruising will have disappeared or can easily be concealed at 10-14 days, when the splint comes off. The tip of the nose may feel numb for 4-12 months. Most patients look socially acceptable at 10-14 days, but swelling continues to diminish over months. Patients may temporarily feel self-conscious about their appearance, but it is generally not noticeable to others after a couple of weeks. It may take up to one year for the nose to achieve its ultimate appearance.

How painful is it?

Patient’s pain tolerance varies significantly. It is far less uncomfortable today than procedures performed in the past, when a lot of internal gauze (packing) was used. Most patients are pleasantly surprised that there is discomfort, but generally not a lot of pain. There is bruising and swelling. All of this depends on the extent of the procedure and the individual. Most take mild oral pain medications for a few days.

When can I exercise after nasal surgery?

Patients are urged to avoid strenuous exercise that raises their pulse rate, including: jogging, aerobics, swimming, working-out, brisk walking, and sex for a minimum of 3 weeks after surgery. You need to be involved in your care and follow all of the instructions in order to help diminish post-operative problems like bleeding. Once exercise is resumed, it is common for patients to experience temporary throbbing of the nose and swelling which may last for a few hours.
It is recommended to avoid contact sports for 4-6 weeks.

Is it common to do a rhinoplasty with a Septoplasty?

An external rhinoplasty and an internal correction of the airway, including a septoplasty, are frequently performed together by good experienced rhinoplasty surgeons. The best nasal surgeons deal not only with the external aesthetics, but also the internal function. Every insurance company’s approach to reimbursement is different. Many will pay for a portion of the septal surgery, but not the cosmetic aspect of a rhinoplasty. A full consultation with an experienced expert rhinoplasty surgeon is the first place to start and a prior authorization letter can help delineate what may or may not be covered. That can minimize the number of surprises you get with regard to reimbursement.

Can a rhinoplasty be performed with other surgical procedures?

Yes. There are a multitude of other cosmetic (aesthetic) procedures of the face or body that can be combined with a rhinoplasty. The most important consideration should always be safety. Some of the factors to be considered include the complexity of the nasal surgery, an individual’s general medical condition, and the anticipated length of the combined procedures. The advantages of combining procedures include: 1 trip to the operating room, savings on operating room costs, reduction of the number of anesthetics, and 1 recovery period.

Are board certified plastic surgeons or ENT doctors a good choice for rhinoplasty?

Rhinoplasty surgery is a combination of art and science. It ideally encompasses an aesthetic approach to the external appearance with a functional concern for the nasal airway. Good rhinoplasty surgeons are knowledgeable in both aspects. There are excellent nasal surgeons who come from both disciplines: Plastic surgeons certified by The American Board of Plastic Surgery who are ideally members of The Aesthetic Society and ear, nose and throat doctors who are certified by the American Board of Otolaryngology and additionally by the American Board of Facial Plastic and Reconstructive Surgery. Beyond the appropriate training, what is key is a sense of artistry and experience. Ask the surgeon how often he or she performs the procedure and discuss both the desired outcome and what is realistic.

What is the appropriate age to have a rhinoplasty?

Generally, any time after 14 years of age for a female and 15 for a male and when it bothers you enough to do something about it and you are mature enough to understand the procedure and accept possible outcomes.

Is there a difference between a male and a female rhinoplasty?

The basic procedure is similar, but there should be subtle variations in a male rhinoplasty to make it look masculine and blend with the other facial features and not appear feminized. The bridge of the nose should be a little higher and the angle between the nose and the lip not as high as in the female.

Who is a good candidate?

A reasonable candidate is an individual who is interested in changing the shape of the nose to improve facial balance as long as her or his goal is realistic, is in good medical condition, and understands and accepts the tradeoffs and possible problems that may occur with the surgery.

How much does a rhinoplasty cost?

Fees vary significantly depending on the surgeon’s experience, reputation, geographic location, the extent and complexity of the surgery, and the length of time required to perform the rhinoplasty. Don’t shop for bargains – you have only 1 nose and face.

What are the potential complications or risks?

Rhinoplasty, like any surgery, has potential risks: bleeding which may require packing, infection, asymmetric healing, and partial restriction of nasal breathing which are infrequent and treatable. There are other less frequent complications that may occur in any surgery which should be discussed at the consultation with your surgeon. You should be aware of not only the benefits of surgery, but also the limitations and potential downside.

What is a revision or a secondary rhinoplasty?

It is additional surgery that is performed to further improve the overall result or correct a problem from the prior surgery, which may be cosmetic or functional, related to breathing problems. While the revision may be quite simple, it may require significant expertise, since the corrective techniques may be more complicated than the initial surgery.

How often is a revision rhinoplasty required?

Noses are never absolutely identical from side to side. Even in the best of hands, revision or secondary rhinoplasty may be beneficial, since healing is individual and not totally controllable. Patients who start with significant asymmetries have a higher rate of requiring additional procedures. The rates of revision rhinoplasty vary significantly from surgeon to surgeon. Dr. Singer’s personal rate of revision rhinoplasty on patients on whom he performed the original nasal surgery on is quite low; 2-3%.

Dr. Singer performs many reconstructive or secondary nasal surgeries that were initially operated on by other surgeons.

Is fixing a deviated septum more complicated after a primary rhinoplasty?

It is usually not, but it depends on your particular anatomy and what was done surgically on your nose previously. The best way to approach this is to have a consultation with a fully trained surgeon certified by the American Board of Plastic Surgery who is ideally a member of The Aesthetic Society or an ENT doctor certified by the Board of Otolaryngology. The surgeon should have extensive experience in performing secondary nasal surgery.

Can I have a “non-surgical nose job”, if I’m thinking of getting a rhinoplasty later?

“Non-surgical nose jobs” or “liquid nose jobs” are essentially injections of filler alone or sometimes with Dysport or Botox. They may be beneficial in selected patients and make a slight temporary improvement of minor defects. They are not a replacement for a rhinoplasty. You should avoid any non-surgical rhinoplasty before undergoing traditional cosmetic nasal surgery. Nasal injections may have complications or side-effects that may interfere with and compromise future nasal surgery. Scar tissue may form and nasal cartilage may be altered with any procedure, even a “non-surgical nose-job”. Some residual injected material may still be present in the nasal tissue long after the initial treatment, which may interfere with rhinoplasty surgery and cause problems with healing.

Is it possible to fix a crooked nose placing fat?

What is paramount is seeking an experience rhinoplasty surgeon for any additional revisions.

Evaluation to determine the best option for correction should start with a full nasal exam by an experienced expert who is certified by he American Board of Plastic Surgery who is ideally a member of The Aesthetic Society or an ENT doctor certified by the Board of Otolaryngology. It may be useful to bring in prior photos as well as fully discussing your desired outcome and what is realistic. There are many options available and fat has a role as a filler for mild depressions. It is generally thought that 50-70% of the fat remains permanently. Fat, however, is not adequate if you need additional structural support which would require cartilage or bone grafts. If a cartilage graft was placed and is too big or displaced, it may require a revision or trimming of that graft rather than just placement of fat which may make the nose look larger. Healing may take longer to occur in a revision rhinoplasty.

There are permanent synthetic fillers, but they have significant greater long term problems and I would not suggest using them in the nose.

Artefill in the nose?

The correction of what you describe may be simple or complicated depending on the extent of the raised bumps and their location. Occasionally, these can be treated with a small injection, but often they require a more extensive surgical excision which may or may not remove all of the Artefill. Artefill is a permanent filler that is comprised of polymethyl methacrylate (PMMA) and bovine collagen. Most experienced knowledgeable rhinoplasty surgeons would not suggest using synthetic permanent fillers in the nose because of the long term problems that can develop, even years after these injections.

What are Botox® and Dysport®?

Botox® and Dysport® are trademarks of medications that are injected to temporarily decrease wrinkles and creases by interfering with the nerve impulse that causes the underlying muscle to contract and cause the wrinkle.

Where is abdominoplasty (tummy tuck) surgery performed?

Often, the tummy tuck can be performed as an outpatient procedure in the operating room at our Singer Surgical Centre, which is an AAAASF fully accredited office-based surgical facility. Depending on the extent of the procedure and individual circumstances, Dr. Singer may wish to have you transferred after surgery to the adjacent Scripps Memorial Hospital – La Jolla for a planned overnight stay. If extensive correction is necessary, the operation may be performed in the hospital.

Can exercise tighten loose skin without an abdominoplasty?

Unfortunately, exercise cannot tighten this loose skin. Although exercise is good for the mind and body, can tone muscles and increase metabolism assisting in weight loss it cannot tighten loose abdominal skin. To date, only surgery can reliably accomplish that.

Will a mini tummy tuck remove “love handles”?

A mini tummy tuck procedure does not affect the “love handle” area. However, there
are other procedures that can be recommended for treatment, for example: liposuction or
extended tummy tuck.

How long does the surgery take?

It depends on your anatomy, extent of the procedure, and what other procedures that may
be performed, but an abdominoplasty typically takes between two to three hours.

Are the results permanent?

With a healthy lifestyle consisting of regular exercise, a healthy diet, no significant weight gain, and no further pregnancies the results achieved from an abdominoplasty should remain. Significant weight gain or pregnancy could cause the abdominal muscles to stretch apart again, and reverse the results of the initial procedure. Patients should remember that cosmetic surgery is not a permanent fix, and the body will continue to age with some some relaxation of the tissues. It is important to follow all of the instructions, since you are a participant in your own care and be honest with your Doctor.

Can I repair my abdominal muscles with exercise alone?

When the abdominal muscles become significantly weakened and separate, exercise will not repair the abdomen. The separation that develops will need to be surgically repaired to return the muscles to their natural position. Following this repair, patients will be able to return to exercising and rebuilding their core strength.

Can an abdominoplasty help me lose weight?

An abdominoplasty is not a weight loss surgery. Patients should not undergo abdominoplasty to lose weight. Rather, they should have already lost the weight through diet, exercise, or weight loss surgery and desire to improve the contour of their midsection.

When will I be able to see the results?

Patients will notice a dramatic improvement in the contours of their abdomen immediately after surgery. As swelling subsides over the next several weeks, the results of an abdominoplasty will gradually improve. Subtle further improvements will continue for 6 months to a year following a tummy tuck.

Is there much pain associated with an abdominoplasty?

Since everyone has a different pain tolerance, the extent of pain with an abdominoplasty is quite variable. For most patients, the pain is not severe, may last several days, and is usually well-controlled with a prescription pain medication during this time. Most patients are ready to return to work and resume their daily activities within 1–2 weeks.

What should I expect postoperatively?

Some swelling and bruising are normal, but the amount varies from person to person. Recovery from tummy tuck surgery will vary depending on the person and the extent of the surgery. You are usually able to walk the first day after abdominoplasty surgery and you will be encouraged to do so. You should take a short walk three or four times a day for a few minutes each time. You will most likely not be able to stand completely straight and you may be a bit hunched over for several days. The skin of your abdomen may feel tight. If drains have been inserted, they are usually removed 4-10 days after tummy tuck surgery. You should take it easy for at least 2 weeks after surgery. You will wear an abdominal pressure garment for 3 weeks after your surgery to aid in the healing.

At what age is abdominoplasty usually performed?

There is no “normal” age or time in one’s life to have an abdominoplasty, but it is most often done after a woman has given birth and does not plan to have more children, or after someone has lost all the weight he or she intends to lose.

When can I start working out after a tummy tuck?

I generally recommend waiting three weeks to gradually return to limited exercise after surgery, but no impact or weight activities until 4-6 weeks after the operation, in order to limit the risks of complications and to avoid undoing the muscle repair.

When can I go back to work after a tummy tuck?

It depends on your type of work. Following a tummy tuck, most patients are able to work at home during the first week and resume returning to work at a sedentary job in 1-2 weeks. However, in a patient with a strenuous job requiring heavy lifting, I would recommend waiting 4-6 weeks.

Does a male tummy tuck differ from a female tummy tuck?

While the steps are similar, there are subtle differences in contouring of the tissue to get the best cosmetic results.

Can I combine a tummy tuck with breast surgery?

It is actually fairly common to combine a tummy tuck with some sort of breast enhancement operation. This combination is frequently referred to as a “Mommy Makeover”. Children predictably affect both the breasts and abdomen, so it makes sense that women considering abdominal improvement would also desire breast enhancement. Any of the breast operations (Breast Augmentation, Breast Lift, or Breast Reduction) can be combined with a tummy tuck.

Can a tummy tuck be done at the same time as a hysterectomy?

Although it has been performed together, most plastic surgeons feel that this is a bad combination of surgical procedures to undergo at the same time. There is an increased risk of bleeding, infection, deep venous thrombosis (DVT) and subsequent pulmonary embolism with this specific combination of elective surgery.

Does a tummy tuck remove stretch marks from pregnancy?

A tummy tuck will remove a significant amount of stretch marks on your abdomen. In most cases the majority of stretch marks below the belly button can be removed. The stretch marks that are above your belly button will still be present, but will be moved down to the lower portion of your abdomen and be less apparent.

Do you need a formal tummy tuck to fix a diastasis recti?

Bringing the rectus muscles back together is a major component of a full tummy tuck (the other component being removal of excess skin, the diastasis can be repaired through a mini tummy tuck scar. This version of the operation results in a scar the length of a c-section scar, but does not allow for the removal of much skin. As such, it is only appropriate for patients who really have abdominal wall laxity but not significant skin excess.

Does a tummy tuck leave scars?

The scar resulting from tummy tuck surgery usually runs from hip to hip. However, the incision is made low on the stomach and is usually easily covered by undergarments and bikini bottoms. The scar will fade over time. In patients with greater skin laxity, an additional small incision around the navel may be necessary. The position and length of the incisions depends on the amount of excess skin to be removed and your individual anatomy, while the appearance of the scar depends on how you heal as an individual as well as the surgeon. Much of healing is genetically determined. The scar is usually preferable to the appearance of a sagging abdomen.

What is the length of time of a tummy tuck surgery?

It depends on the extent of the surgical correction, varying from 1 1/2 to 3 hours.

What if I plan to have additional children?

Pregnancy following tummy tuck surgery is possible and is not dangerous, but if you plan on future pregnancies, you should wait to have surgery until you are done having children, since pregnancy will stretch out the skin and abdominal muscles again, usually undoing the repairs that were achieved with the abdominoplasty.

What if I plan to lose a lot of weight?

If you intend to lose a lot of weight, wait until after your weight loss and you are within 10-15 pounds of your desired weight before you undergo an abdominoplasty.

What are the limitations of a tummy tuck?

The tummy tuck will remove most of the stretch marks of your lower abdomen but not all of the stretch marks of your mid or upper abdomen. It will shift the higher stretch marks to a lower position on your abdomen and usually make them less noticeable.

What are the criteria of an ideal candidate for tummy tuck surgery?

• Close to their ideal body weight (within 10-15 pounds)
• Wants to remove specific areas of loose skin or fat that is resistant to diet and exercise
• Weight has been stable for 6 months or more
• Emotionally stable
• Understands the risks of abdominoplasty surgery and scarring
• Has realistic expectations
• Has a support system at home to assist in the recovery
• In good health with no serious pre-existing medical conditions or disease.
• If you do not meet all of these criteria, but meet most of them, you may still be a good candidate for a tummy tuck. You are at increased risk of complications if you have uncontrolled diabetes, poor circulation, heart, lung, or liver disease, smoke, have a personal or family history of blood clots, take certain medications, or if you are obese.

How do I know if I need a mini or full tummy tuck?

If you have a lot of loose skin and significant muscle weakness, then you may benefit from a full tummy tuck. It will remove the excess skin and fatty tissue as well as contour the shape of your abdomen by tightening the covering of your abdominal muscles. If your excess skin and fat, as well as your abdominal muscle weakness, is minimal or moderate, then a mini tummy tuck may be sufficient. The best way to find out which procedure is right for you is to have a full examination and consultation with Dr. Singer.

What are the types of tummy tucks?

There are a variety of surgical procedures or combinations that can produce good results in patients with abdominal laxity, depending on multiple factors including their anatomy and degree of desired improvement. The extent of the improvement will depend on the type of the procedure performed. Each type of tummy tuck (abdominoplasty) can be performed with or without liposuction:

• Full (Standard) Abdominoplasty: This allows for the greatest amount of tightening of the muscles and skin of the abdomen. A full tummy tuck, or abdominoplasty, addresses the 3 defective components (skin, fat, and muscle) so it benefits most patients who want the greatest improvement possible. Results, especially when combined with liposuction of the flanks and flanks can be dramatic. An incision is usually placed below the top of the bikini line, just above the pubic area . Every effort is made to hide the scars in the bikini area. The length depends on the extent of skin laxity and may go from hip to hip, although the shortest incision is used to achieve the desired outcome. A second incision is made around the belly button. The skin and fat are separated from the abdominal wall and lifted exposing the rectus muscles fascia, the sheath that covers the muscles and functions as an internal natural girdle.

The fascia is then sutured in order to tighten loose or stretched out muscles This creates a tighter abdominal wall and a thinner contoured waist. The skin is stretched down and the excess skin and fat are removed. A new opening is made in the skin for the belly button, which is kept in its pre-operative position. The incisions are then closed, and a dressing is placed on the abdomen. Liposuction to remove excess fat from areas of the abdomen, hips and flanks is often performed in conjunction with the tummy tuck to further enhance the cosmetic result.

• Mini Abdominoplasty: A mini tummy tuck or partial abdominoplasty is best suited for patients who have a bulging below the belly button who do not have significant stretch marks, an excess of saggy skin, or loose skin above the belly button. While a full tummy tuck involves an incision around the belly button and across the lower abdomen, a mini tummy tuck leaves the belly button intact and requires a smaller incision similar to that from a C-section (6-8 inches). The excess skin and fat are removed and tightening of the muscles is performed. Liposuction is frequently employed with this procedure to remove excess fat above and below the belly button as well as from the hips and love handles to enhance body contour.
• Umbilical Float Abdominoplasty (Modified Tummy Tuck): This version of a tummy tuck allows for tightening of the muscles on the whole abdomen, but does not tighten the skin as much as a standard abdominoplasty. It can produce a very nice significant result in many patients but the result depends on the extent of looseness of the tissue above the umbilicus, since there is a limitation of how much tightness you can get with this procedure and still maintain a normal appearing position of the navel, which is slightly lowered without placing an incision around it. The incision is usually smaller than in a full tummy tuck. The excess skin and fat are removed and tightening of the muscles is performed. Liposuction is frequently employed with this procedure to remove excess fat above and below the belly button as well as the hips and love handles to enhance body contour.

• Extended Abdominoplasty: The scar from this tummy tuck runs from behind the back hipbone, around the front, and to the back hipbone on the other side. This allows for tightening of the abdominal muscles, the abdominal skin, and the flank and lateral thigh.
• Circumferential Abdominoplasty – (Body Lift, Belt Lipectomy): The scar runs all

the way around the torso. It does everything an extended abdominoplasty does, but

additionally performs a Buttock Lift.

• Dermolipectomy: A dermolipectomy is a procedure that removes skin and fat from the abdomen but does not tighten the muscles. It is indicated for slender women who have wrinkly or excess skin and those for women or men following massive weight loss, but having good muscle tone. The scar, which depends on the extent of tissue laxity, is usually the same as in a full tummy tuck or a mini, depending on the extent of the laxity of the tissue.
• Reverse Abdominoplasty: Instead of the scar being at the level of the bikini line as in a full standard abdominoplasty, it is placed at the fold beneath the breast and usually continuing across the midline in an inverted “V”. The excess tissue is pulled up rather than down and removed. This operation really only makes sense for patients who have a tight fairly smooth lower abdomen with lax skin above the umbilicus (belly button).
• Vertical Scar Abdominoplasty (Fleur-de-lis tummy tuck): This technique combines an incision across the lower abdomen with a vertical incision up the center of the abdomen. It is usually reserved for people who have undergone massive weight loss and need substantial amounts of skin removed as well as a lot of tightening around the waist.

Liposuction versus a tummy tuck- What is the difference?

Liposuction is ideal to contour the abdomen for those who have good skin tone, tight muscle and excess fat that is resistant to diet and exercise. It does not address the muscle, minimally tightens the skin (no matter which type of liposuction), and removes no excess skin.. If skin tone is poor with laxity and stretch marks, the results of liposuction alone will usually be disappointing. The tummy tuck is a better procedure for women who have lost the contour of their abdomen following pregnancy and for men and women following significant weight loss, since it addresses the three areas: skin, fat and muscle.

What is a tummy tuck (abdominoplasty)?

A tummy tuck (abdominoplasty) is the operative procedure that reverses the changes caused by childbearing, weight loss or aging by contouring excess fat, removing the loose wrinkled skin, and usually tightening the stretched underlying muscles of the abdomen resulting in a flatter stomach and an improved waist.

What causes abdominal wall deformities?

Sagging abdominal skin, fat, and muscle can be the result of pregnancy, substantial weight gain and loss, aging, or an inherited tendency. Regardless of the cause, it is a source of unhappiness for many men and women. For some, the weight of the excess skin and fat can cause back or posture problems. For a woman, pregnancy, weight gain and weight loss can have a distressing impact on her abdomen. Rarely will dieting and exercise alone fully restore the abdomen wall to its desirable shape and appearance after the muscles and skin have been stretched to their limit. After losing significant weight, men can also have difficulties regaining their youthful flatter abdomen.

What are the components of abdominal wall deformities?

• Wrinkly or loose skin with stretch marks. This is usually the result of pregnancy, aging, or marked weight loss, but may be caused by heredity
• Excess fat tissue, usually more prominent in the central and lower abdomen, hips and flanks (love handles)
• Diastasis recti: The muscles of the anterior abdominal have separated causing a bulging which does not respond to exercise. It is like a rubber band that has been over-stretched.

Dr. Singer has the respect of his peers and patients across San Diego and the surrounding Southern California area. He has helped thousands of San Diego residents with an eye for balance and beauty and the skills of an artist. Dr. Singer has been engaged in private practice in the La Jolla area of San Diego since 1976 and is now an internationally recognized plastic surgeon. You are in the best of hands with Board Certified Plastic Surgeon (American Board of Plastic Surgery) Dr. Singer.

Please learn more about Dr. Singer’s affiliations, memberships, awards, honors, and accomplishments. The full list and Dr. Singer’s curriculum vitae are available upon request.