Cosmetic Surgery

Although cosmetic surgery is increasingly common, it still carries risks. In order to reduce those risks as much as possible, you should choose an experienced plastic surgeon to perform your cosmetic surgery. Although any doctor can legally perform cosmetic surgery, the board-certified surgeons at the Cedars-Sinai the Center for Plastic and Reconstructive Surgery have extensive training and experience.

Patients considering cosmetic surgery can be seeking to correct a disfigurement or improve their physical appearance. In either case, the Center for Plastic and Reconstructive Surgery is an excellent choice. Besides being treated and cared for by the dedicated physicians and nurses at the center, patients have access to all of the world-class support services at Cedars-Sinai.

Cosmetic procedures available through the Center for Plastic and Reconstructive Surgery at Cedars-Sinai include:

Abdominoplasty (tummy tuck) is a common surgical procedure designed to improve the appearance of the abdomen for both men and women by removing excess skin and fat from the abdomen (middle or lower) and tightening the abdominal wall muscles. Individuals considering abdominoplasty should:
  • Contemplate whether having excessive fat deposits around the abdominal area or loose abdominal skin (regardless of diet and exercise) is bothersome
  • Set realistic expectations before and after surgery
  • Understand the complications that can occur after surgery, including infections, blood clots, pain, swelling and delayed healing

The Center for Plastic and Reconstructive Surgery offers comprehensive surgical procedures for abdominoplasty. Surgeons use leading-edge technology and world-class surgical techniques.

Surgical Procedure

Depending on the needs of each patient, abdominoplasty can take between two and four hours. During surgery, surgeons:

  • Apply anesthesia (general, epidural or intravenous)
  • Make a long incision from hipbone to hipbone
  • Make another incision to free the navel from surrounding tissue
  • Separate the skin from the abdominal wall, revealing vertical muscles
  • Tighten abdominal muscles
  • Stretch the skin flap and remove extra skin
  • Cut a new hole for the navel and stretch it into place
Surgical Procedure for Partial Abdominoplasty

Partial abdominoplasty can take an hour or two to complete. It is mostly used for patients who have limited excess skin around their abdomen. Surgeons:

  • Apply anesthesia (general, epidural or intravenous)
  • Make shorter incisions (navel may not be removed) than for a full abdominoplasty
  • Separate the skin between the incision line and the navel
  • Stretch the skin flap down, remove excess skin and stitch it back into place
After Surgery

Following surgery, the abdomen can swell, which can result in pain and discomfort. Surgeons prescribe medication or use other methods to resolve these issues. Patients may be released from the hospital within a few hours or remain hospitalized for a few days depending on the case.

Eyelid surgery, or blepharoplasty, is a surgical procedure to remove excess fat, skin and muscle from the upper and lower eyelids to correct drooping upper lids, puffy bags or loose skin below the eyes. This procedure is not intended to remove wrinkles, dark circles around the eyes, crow's feet or saggy eyebrows.

The Center for Plastic and Reconstructive Surgery offers comprehensive surgical procedures for eyelid surgery. Surgeons use leading-edge technology and world-class surgical techniques.

Upper Eyelid Lift Surgery (Upper Blepharoplasty)

As we age, the skin, fatty tissues and muscles above the eye begin to sag or droop. This can give a person a tired, aged look.

Eyelid surgery, or blepharoplasty, is a surgical procedure to remove excess fat, skin and muscle from either the upper, the lower or both eyelids. The surgery corrects drooping upper lids or puffy bags or loose skin below the eyes. The procedure is not intended to remove wrinkles, dark circles around the eyes, crow's feet or saggy eyebrows.

Depending on the patient's needs and the surgeon's technique, eyelid surgery can take one to two hours to complete.

In the procedure for lifting the upper portion of the eye and incision is made in the creases of the upper lids. The underlying fatty tissue and muscle area is then separated to allow surgeons to remove excess fat, saggy skin and muscle.

Lower Eyelid Surgical Procedure

Aging can also lead to excess fat, skin and muscle under the eye. When this happens, puffy bags or loose skin develops under the eye. This may make a person look older or tired.

Lower blepharoplasty is a surgical procedure to remove the excess fat, skin and muscles from under the eye. It will not remove wrinkles, dark circles under the eyes or crow's feet. The procedure takes one to two hours, depending on the patient's needs and the surgeon's technique.

In lower eyelid surgery, an incision is made just below the lashes of the lower lid. The fatty tissue and muscle under the skin are separated. This allows surgeons to remove the excess fat, skin and muscle.

Often a person will have both lower and upper eyelid surgery done.

After Surgery

Following surgery, patients may experience blurred vision, swelling and some pain and discomfort around the eyelids. Surgeons prescribe medication or use other methods to ease these complications. To reduce swelling and bruising, patients are advised to keep their head elevated for several days and to use cold compresses. Stitches are usually removed two days to a week after surgery. Patients begin to look and feel better two weeks after the procedure.

Over time, aging causes a person's face and neck area to sag, fold, crease and wrinkle as skin develops less tolerance towards sunlight, stress and gravity. A facelift or rhytidectomy is a surgical procedure to reposition or remove muscle, skin and fatty areas around the lower parts of the face and neck to give the face a younger, fresher appearance. Men and women have facelifts, and most are over 40, still have skin elasticity and have well-defined and strong bone structure.

The Center for Plastic and Reconstructive Surgery offers patients a range of options for facelifts. Surgeons use leading-edge technology and world-class surgical techniques.

Surgical Procedure

Most facelift incisions start above the hairline at the temples and extend in a natural line in front of the ear and continue behind the earlobe. The exact placement of incisions depends on the patient's facial structure and the surgeon's preference. After the incisions have been made, surgeons:

  • Separate the skin from the fat and muscle beneath it
  • Trim or suction around the neck and chin to improve the contour of the face
  • Tighten the underlying muscle and membrane
  • Pull the skin back and remove excess skin
  • Stitch layers of tissue and close the incisions
After Surgery

Facelift complications occur infrequently, but may include hematoma (collection of blood under the skin), nerve injury (temporary), infection and possible reactions to the anesthesia. Surgeons prescribe medication or use other methods to ease these complications. Most stitches and bandages are removed within five days after surgery. Patients should also expect their faces to look pale, puffy and bruised. This is quite normal and should go away several weeks after surgery.

As we age, our face begins to develop laugh lines, crow's feet, facial creases and sunken cheeks due to the effects of sunlight, gravity and facial movement.

The Center for Plastic and Reconstructive Surgery offers injectable treatment options to help patients temporarily counteract the negative effects of aging and improve the appearance of a their facial skin texture.

Injected Collagen

Collagen (naturally occurring protein that provides support to the human skin, joints, bones and ligaments) is used to fill lines, wrinkles and scars on the face, and can sometimes be used for the chest, neck and back. Patients are required to take a skin test before they can receive collagen injections to make sure they are not allergic to it. The injection is usually made along the outer edges of the treatment site using a fine needle.

After receiving collagen treatment, patients may experience some minor discomfort and a stinging sensations. This is normal and should go away within a couple of days.

Injected Restylane

Restylane® is a natural cosmetic filler used to treat and correct wrinkles, enhance lips, correct lines around the eyes and mouth, and shape facial contours in the cheeks and chin to correct deep skin folds. The fat-injection procedure involves extracting fat cells from the patient's abdomen, thighs or buttocks and re-injecting them under the skin on the face. The fat cells are extracted using a syringe that has a large hollow needle attached to a suction device.

Complications

Both injected collagen and Restylane provide temporary results, anywhere from six to 12 months. Complications that can occur include hematoma (collection of blood under the skin), infection and facial nerve injury. Surgeons either prescribe medication or use other measures to ease these complications.

Collagen is a naturally occurring protein that provides support to various parts of the human body, including the skin, joints, bones and ligaments. It is used primarily to fill wrinkles, lines and scars on the face and sometimes the neck, back and chest.

Injectable collagen is derived from bovine collagen that undergoes a purification process to create a product similar to human collagen. Injectable collagen received approval from the Food and Drug Administration in 1981. It is produced in various degrees of thickness to meet individual patient needs.

The Procedure

Treatment with collagen can begin after a skin test determines that you are not allergic to the substance. The collagen is injected using a fine needle inserted at several points along the edge of the treatment site. If local anesthesia has not been used, you may feel some minor stinging or burning as the injections are administered.

Since part of the substance is salt water that will be absorbed by the body within a few days, your doctor will slightly overfill the area. You may be asked to hold a hand mirror during the procedure to help your doctor decide when you have had enough.

After Treatment

Immediately following treatment, you may notice some minor discomfort, stinging or throbbing in the injected area. Occasionally, some bruising or swelling will occur, but it is usually minor. Any redness that appears in the injected site usually disappears within 24 hours. However, in some individuals (particularly fair-skinned patients) this redness may persist for a week or more. Tiny scabs may also form over the needle-stick areas, but these generally heal quickly.

No bandaging is needed, and you are free to eat, drink and wear makeup with sunblock protection shortly thereafter. There may be some temporary swelling and redness in the treated area, which should dissipate within a few days. If these symptoms persist, contact your surgeon.

Results

Collagen's longevity depends on the patient's lifestyle and physical characteristics, as well as the part of the body treated. In general, the injected material is likely to disappear faster in areas that are more affected by muscle movement. Your doctor can help you determine how long you can go between treatments to best maintain your results.

Risks Related to Injectables

When injectables are administered by a qualified plastic surgeon, complications are infrequent and usually minor in nature. Still, individuals vary greatly in their anatomy, physical reactions and healing abilities. The outcome of treatment with injectables is never completely predictable.

Allergic reaction is the primary risk of collagen. To help determine if you are allergic to the substance, your surgeon will perform an allergy skin test about a month before the procedure. After the test is performed, the test site should be watched carefully for three or four weeks or as long as your surgeon advises. Any sign of redness, itching, swelling or other occurrences at the test site should be reported to your surgeon.

Risks not necessarily related to allergies include infection, abscesses, open sores, skin peeling, scarring and lumpiness, which may persist over the treated area. Reports of these problems are very rare.

Fat injection (also known as autologous fat transplantation or microlipoinjection) involves extracting fat cells from the patient's abdomen, thighs, buttocks or elsewhere and re-injecting them beneath the facial skin. Fat is most often used to fill in "sunken" cheeks or laugh lines between the nose and mouth, to correct skin depressions or indentations, to minimize forehead wrinkles and to enhance the lips.

The Center for Plastic and Reconstructive Surgery offers fat injections.

The Procedure

After both the donor and recipient sites are cleansed and treated with local anesthesia, the fat is withdrawn using a syringe with a large-bore needle or a cannula (the same instrument used in liposuction) attached to a suction device. The fat is then prepared and injected into the recipient site with a needle. Sometimes an adhesive bandage is applied over the injection site.

As with collagen, overfilling is necessary to allow for fat absorption in the weeks following treatment. When fat is used to fill sunken cheeks or to correct areas on the face other than lines, this over-correction of newly injected fat may temporarily make the face appear abnormally puffed or swollen.

After Treatment

If a larger area is treated, you may be advised to curtail your activity for a brief time. However, many patients are able to resume normal activity immediately. You can expect some swelling, bruising or redness in both the donor and recipient sites. The severity of these symptoms depends upon the size and location of the treated area. You should stay out of the sun until the redness and bruising subsides (usually about 48 hours). In the meantime, you may use makeup with sunblock protection to help conceal your condition. The swelling and puffiness in the recipient site may last several weeks, especially if a large area was filled.

Results

The duration of the fat injections varies significantly from patient to patient. Though some patients have reported results lasting a year or more, the majority of patients find that at least half of the injected fullness disappears within three to six months. Therefore, repeated injections may be necessary. Your doctor will advise you on how to maintain your results with repeat treatments.

Risks Related to Injectables

When injectables are administered by a qualified plastic surgeon, complications are infrequent and usually minor in nature. Still, individuals vary greatly in their anatomy, physical reactions and healing abilities. The outcome of treatment with injectables is never completely predictable.

Allergic reaction is not a factor for fat because it is harvested from a patient's own body. However, there is still a small risk of infection and other infrequent complications.

Liposuction (lipoplasty) is a surgical procedure to remove unwanted fat deposits in certain areas of the body, such as the buttocks, thighs, neck, face, cheeks, arms, hips or abdomen.

The Center for Plastic and Reconstructive Surgery offers liposuction treatment for patients wanting to reshape one or more parts of their body to a desired shape or size.

Surgical Procedure

The time necessary to perform liposuction surgery depends on the size of the area where the fat is to be extracted, the anesthesia used and the surgeon's technique. Surgeons usually make a tiny incision and insert a suction tube beneath the skin to extract the fatty tissue. Several methods and techniques can be used to achieve this, including:

  • The tumescent technique: surgeons inject a medicated solution into the fatty area. This solution of intravenous salt, lidocaine and epinephrine is used to help reduce blood loss and remove fat more easily, and it acts as an anesthetic.
  • The super-wet technique: a fluid injection technique requiring less volume of medicated solution, usually equivalent to the amount of fatty deposits to be removed. The super-wet technique often requires general anesthesia.
  • Ultrasound-assisted lipoplasty: a tube is used to produce ultrasonic energy. Once this energy passes through the fatty area, a tiny explosion occurs in the walls of the fatty cells to help liquefy the fat.
After Surgery

Following surgery, patients may experience some pain and discomfort around the incision site. Surgeons prescribe medication to ease these complications or use other methods to resolve these issues. To prevent fluid buildup and to control swelling, surgeons insert a small drainage tube beneath the skin for two days.

Recovering

When patients are able to, they are asked to walk around to prevent blood clots from forming in their legs. Patients are also advised to avoid any strenuous physical activity the first month following surgery or until their body has fully recovered.

Rhinoplasty is a common surgical procedure to improve the appearance of the nose, correct breathing problems, birth defects or repair an injury. Potential candidates are thoroughly evaluated, which involves analyzing the patient's medical history and nose structure, such as underlying nasal bones and cartilage, overlying skin and other facial features.

The Center for Plastic and Reconstructive Surgery offers patients a range of options for rhinoplasty to best suit each patient's needs and medical requirements. Surgeons use leading-edge technology and world-class surgical techniques.

Surgical Procedure

Rhinoplasty is performed under local or general anesthesia and is usually an outpatient procedure. Surgeons make incisions inside the nostrils to access the bone and cartilage. Depending on the desired outcome, bone and cartilage may be added or removed.

After the nose has been reshaped, a splint is used to support the new shape and allow the nose to heal. Nasal packing also may be used to provide additional support.

After Surgery

Following surgery, bed rest with the head higher than the chest is recommended to reduce swelling and bleeding. There may be bruising around the eyes and nose, which is usually treated using cold compresses.

Additional risks and complications may include:

  • Bleeding
  • Skin problems (such as breakdown of skin tissue and irritation from bandaging)
  • Infections (treatable with antibiotics)
  • Serious nasal blockage from swelling inside the nose
  • Complications from anesthesia

Surgeons may prescribe medication or use other methods to ease these complications. It takes about 10 to 14 days for the swelling and bruising to subside and several weeks before the patient can return to normal physical activities.