Plastic Surgery Advice

admin asked:

Lower lid blepharoplasty

The lower eyelid is a common area for patients to notice aging changes. This article describes the anatomy of the lower eyelid and the reasons for aging. It concentrates on the various operative principles and variations in practice including complications and adjunctive procedures

Introduction

The alterations caused by aging are noticeable first around the eyes and then on the neck and lower face. Periorbital rejuvenation continues to evolve with a more detailed understanding of eyelid anatomy and its subsequent affect on the anatomy with aging. Procedures have developed with time, with surgeons striving for a more youthful appearance.

Anatomy of the lower eyelid

The anterior lamella consists of the skin and orbicularis muscle. The middle lamella consists of the orbital septum, which originates from the arcus marginalis and inserts into the inferior tarsal margin. The posterior lamella includes the conjunctiva and lower eyelid retractors.

The orbicularis oculi muscle is immediately deep to the skin of the lower lid and extends from close to the ciliary margin past the infraorbital rim to the cheek. It has both pretarsal and preseptal components. Pretarsally, the orbicularis is tightly adherent to the underlying tarsus. The preorbital portion of the orbicularis oculi has cephalad attachments to the orbital rim along the orbicularis retaining ligament and along its caudal margin to the fascia enveloping the origin of the elevators of the upper lip (zygomaticus muscles). The retaining ligaments that support the orbicularis oculi to the underlying orbital rim and cheek serve to fixate this muscle tightly against the underlying facial framework.

The orbital septum lies deep to the orbicularis. A plane of loose connective tissue, the suborbicularis fascia, lies between the orbicularis and orbital septum. The suborbicularis oculi fat (SOOF) lies in this plane and is the continuum of the malar fat pad14. The triangular malar fat pad has its base at the nasolabial fold and its apex at the malar eminence, and is situated between the skin and the superficial musculoaponeurotic system (SMAS). It is loosely connected to the SMAS and firmly attached to the skin.

The orbital septum fuses superiorly with the tarsal plate and inferiorly with the periosteum of the infraorbital rim; this inferior attachment of the septum is termed the arcus marginalis. The arcus marginalis attaches medially to the anterior lacrimal crest and thins as it extends laterally attaching approximately 2 mm inferior to the rim on the facial aspect of the zygomatic bone. The orbital septum serves to retain orbital fat within the orbit. The fat mass as it encircles the extraocular muscles causes it to be divided into three pads; medial, central and lateral.

Aging of the lower eyelid-cheek complex

The pathogenesis of herniation of lower orbital fat has been debated for decades. Whether excess fat appeared in older age or whether this was shifting of intraorbital contents was unclear. The concepts of Manson et al and Camirand et al attributed lower fat extrusion to a weakening of Lockwood’s suspensory ligament with the presence of intraorbital septation within the fat compartments limiting the degree of protrusion. De la Plaza and Arroyo first proposed the theory that fat protrusion is related to the weakness of the support system of the globe, allowing it to descend and causing enopthalmos and lower lid pseudoherniation (bags).

The most poorly supported part of the orbicularis oculi is the preseptal portion and it is this portion of the orbicularis that shows the greatest tendency toward descent. As the retaining ligaments relax with aging, the herniated lower lid fat becomes situated not only anteriorly but also inferiorly below the orbital rim. This is most apparent along the central fat pad but may be noted medially as well. It is uncommon to note a lateral fat pad inferior to the infraorbital rim. In youth there is no herniation of orbital fat, the lateral orbicularis oculi blends with the malar pad. Malar bags are rarely apparent and there is a smooth contour between the preseptal and preorbital orbicularis. In youth, there is relatively more SOOF in the lower lid and more subcutaneous cheek fat. This helps to make the lower lid appear soft and smooth without the sharp demarcation between eyelid and cheek that become obvious with aging.

Hamra noted that in the youth the eyelid-cheek complex is a single mildly convex line on profile, running from the tarsus inferiorly over the young cheek. Aging causes descent of the globe and subsequent pseudoherniation of intraorbital fat. The inferior and lateral descent of these structures produces an orbit that appears deeper with a wider diameter. This progressive ptosis and an attenuation of soft tissue coverage produce skeletonization of the entire orbital area and reveal the topographical contours of the inferior bony orbital rim. A youthful midface is characterized by a malar fat pad seated over the zygomatic arch, its upper border covering the orbital part of the orbicularis oculi and its inferior border located along the nasolabial fold. With advancing age, the malar fat pad along with the SOOF slides an inferonasal direction and anteriorly over the SMAS. It bulges against the fixed nasolabial crease and exacerbates the appearance of the nasolabial fold.

The combination of descent of the orbicularis oculi, SOOF and malar fat with aging transforms the youthful single convexity to an aging double convex pattern.

Historical correction of lower lid aging

Historically lower lid blepharoplasty was viewed as an operation to remove skin and fat in the lower eyelid. The traditional open blepharoplasty redraped the skin or the skin-muscle flap between the infraorbital rim and the subciliary incision. Orbital fat that appeared excessive was removed, but the “malar crescent” or inferior border of the orbicularis muscle remained undisturbed from its position over the malar eminence.

Postoperatively, the appearance of the lower eyelid became smoother and usually deeper, particularly in patients with a negative vector. The appearance of the “malar crescent” or inferior orbicularis border if present before surgery remained unchanged. Removal of orbital fat caused eventual collapse of the existing skin cover, which created more wrinkling than before. With continuing aging, ptosis and attenuation of the orbicularis oculi led to a typical sunken appearance with possible scleral show.

Repositioning of the orbicularis muscle

The use of the orbicularis muscle as a flap in surgery of the lower eyelid was first described by Adamson et al, Courtiss, Furnas and was first used to treat malar bags/festoons by Furnas advocating lateral tension placed on the orbicularis muscle.

Hamra noted that by elevating the orbicularis muscle off the malar eminence, in a suborbicularis oculi plane, and repositioning it, the axis of the muscle from the medial orbital rim to the lateral raphe could be changed and the muscular ring around the bony orbit could be tightened. Hamra postulated that to negate the vector of aging in the orbicularis oculi, an inferolateral direction off the malar eminence, that the vector of repair should be superomedial. This superomedial vector could either be obtained by either a composite rhytidectomy or by using a lateral based orbicularis muscle flap. The laterally based orbicularis muscle flap was turned superiorly under the raphe and sutured under extreme tension to the periosteum of the lateral orbital rim.

Hamra noticed limitations of this procedure, which included occasional prolonged malar odema and an inability to exert sufficient tension on this skin muscle flap owing to the fear of lower eyelid retraction. He thus adapted the plane of dissection to continue the suborbicularis dissection under the medial portions of the zygomaticus minor and major muscles while maintaining an adequate soft-tissue cover over the periosteum. With this level of dissection he found no need to disrupt the origins of the zygomaticus musculature but could still reposition the orbicularis with even more tension than before. This zygorbicular (zygomaticus-orbicularis) plane offered many advantages. Hamra believes that this zygorbicular dissection plane is preferable to the subperiosteal plane as introduced by Tessier and recommended by Hester.

Following dissection of the zygoorbicular flap he used a 4-0 nylon suture through the longitudinal axis of the lateral canthal tendon and sutured it to the inner wall of the lateral orbital periosteum. This suture stabilized the lower eyelid in yet a higher position ensuring stability of the eyelid when suturing the septum with adequate tension over the orbital rim. He called this a “transcanthal” canthopexy, which required neither detachment of the lateral canthal tendon nor a canthotomy.

Preservation of Orbital Fat/Septal reset

Loeb was first to describe the technique of mobilizing intraorbital fat across the medial infraorbital rim. He used it to fill and thus camouflage the nasojugal groove. Hamra expanded this concept by advocating complete release of the arcus marginalis allowing the subseptal fat to be elevated to the level of the orbital rim. He extended Loeb’s concept to include advancement of all of the lower lid fat pads in an effort to conceal the infraorbital rim and to recreate the youthful fullness of the lower lid. As originally described, the arcus marginalis was incised and the orbital fat alone was advanced and sutured to the preperiosteal fat of the upper cheek. Subsequently, Hamra refined his technique leaving the septum orbitale that he once excised intact and resetting the inferior border of the septum after arcus marginalis release over the orbital rim. The septal flap included orbital fat creating a smoother transition of soft tissue covering the bony rim and a firm smooth convex surface for the redraped overlying skin-muscle flap thus diminishing the rhytids. Hamra termed this procedure a septal reset. Hamra observed a marked improvement with the repositioned orbicularis now resting on a firm undersurface of septum, rather than on the concavity created by fat removal, or the soft fullness of fat only.

Surgical Technique

Perioperatievly the dermis of the subciliary incision line is injected with local anaesthesia along with percutaneous injections of a few drops of local anaesthesia with adrenalin layered over the periosteum of the maxilla and zygoma.

Subciliary skin incision is followed by a skin flap dissection to the junction of the preseptal portion with the periorbital portion of the orbicularis oculi muscle. The preseptal orbicularis is opened, leaving the pretarsal muscle undisturbed. After dissecting down to the orbital rim over the septum orbitale, the suborbicularis dissection is continued under the zygomaticus muscles. The origins of the zygomaticus major and minor muscles are left intact and an adequate layer of soft tissue is left overlying the periosteum. Dissection is started with cutting cautery, continued with scissors, or occasionally a “Kitner.” This blunt dissection prevents potential nerve injury, and pushes the dissection boundary under the midportion of the zygomaticus minor and major and laterally to the zygomatic arch and a zygoorbicular dissection performed. The arcus marginalis is released by incising the junction of the septum orbitale and the periosteum of the inferior orbital rim with cutting cautery after the zygorbicular dissection has been accomplished. Decisions regarding fat removal and repositioning over the orbital rim are determined preoperatively

Some medial and central fat may be resected whereas lateral fat is in most cases used for repositioning. Before the septal reset is completed, a transcanthal canthopexy, with a 4.0 nylon, is accomplished fixing the lower eyelid position so that the septal reset can then be completed without tension. The inferior edge of the septum is then reset over the orbital rim with multiple 5-0 Vicryl sutures. Usually 5-0 eight to 12 sutures are required for the septal reset to create a smooth transition, with the tension being enough to create a firm undersurface for the orbicularis to rest upon.

After the reset is completed, the zygorbicular midface flap is advanced. Several 3-0 Vicryl sutures are placed between the zygorbicular flap and the preperiosteal tissue to reduce dead space and serum collection. A laterally based orbicularis pedicle is created from the lateral “dog leg” of the blepharoplasty incision. This pedicle is passed under the skin and muscle raphe to be secured with two sutures of 4-0 Monocryl to the periosteum of the lateral orbital rim. The very last manoeuvre is the trimming of skin, in the event that an adjustment needs to be made.

Fat Removal

Before surgery, the surgeon must decide whether fat must be resected or not, and if so, how much. This is a preoperative judgement dictated by the anatomy of each individual patient, which is difficult to assess when the patient is anaesthetized. Positive and negative vector eyelids refer to the axis dropped from the most anterior point of the globe to the cheek. The positive vector eyelid is usually the easiest for achieving a good result when using conventional blepharoplasty, and the negative vector eyelid presents a challenge when using conventional blepharoplasty. In the case of a positive vector eye with no excess fat, the septal reset takes a small amount of fat with the reset. In the case of a negative vector eye, most of the fat is necessary to adequately fill in the depression between the subciliary line and the cheek mound to create the contour of youth. Patients with a negative vector may also present with a congenital excess of fat. In these cases conservative fat removal may be appropriate. In the hollow lower eyelid, whether iatrogenic or natural, all possible fat is recruited from the subseptal space to effectively achieve a correction.

Transcutaneous versus transconjunctival.

The transcutaneous method of lower lid blepharoplasty has been generally met with some resistance. Proponents of the transconjuctival method recommend it as it addresses the lower eyelid fullness attributable to prominent orbital fat with a much lower risk of lid retraction, without visible incisions and can be safely combined with resurfacing techniques. The concerns surrounding transconjunctival blepharoplasty are related to middle lamellar contraction/shortening, lateral rounding, scleral show and ectropion. The causative factors attributed being violation of the orbicularis resulting in denervation of the orbicularis oculi. Hamra admits that with the composite lift combining and repositioning of the orbicularis that partial denervation of the orbicularis can occur. Although this is likely to result in partial denervation long lasting effects have been postulated. Clinical studies however have shown a mixed innervation of the muscle both medially from the buccal branches and laterally from the temporal branch of the facial nerve. Reinnervation to functional normality following surgery has been demonstrated. Even studies of orbicularis myomectomies for the treatment of blepharospasm have not produced any long-term denervation or loss of tone.

Honrado review of 4395 cases showed that patients who may benefit from transconjunctival blepharoplasty include the younger patient with smooth skin, moderate fat pseudoherniation and no muscle swag.

It is generally accepted that the transcutaneous method is required for orbicularis hypertrophy, excessive skin, sagging lower eyelids or where canthopexy is required, although the transconjunctival methods have been further adapted to address these issues. A transconjunctival excision of the excess fat may be followed by a transcutaneous approach leaving the orbicularis/septum complex and removing excess skin. Canthoplasty may also be combined as may adjuvant resurfacing procedures where required. Transconjunctival orbicularis septum tightening using CO2 laser in combination with periocular skin resurfacing has also been postulated. It is proposed that leaving the orbicular/septum complex prevents the problems of middle lamellar tightening. Hester et al have questioned that if so many lid supporting procedures need to be performed via the transconjunctival approach whether the morbidity can be any less than a transcutaneous procedure.

Hamra suggests however that the transconjunctival approach results in a sub optimal result.

Reproducibility

Hamra advocates addressing the lid/cheek complex as part of a composite face-lift. The isolated Hamra lower lid blepharoplasty technique has not been adopted widely although its concepts have proved to be reliable and reproducible by others. Barton et al describe its use in the group of patients they label as the “tear trough triad”.

These patients exhibit “fat herniation, prominent orbital rim depression and malar rim retrusion with negative vector”. They performed the technique in 71 patients showing no middle lamella shortening or contracture. They added that the more extensive infraorbital dissection disrupts more lymphatic channels draining into the cheek resulting occasionally in prolonged oedema. In order to avoid this they used an irrigation solution of triamcinolone into the suborbicularis space before closure and advocate manual lid stretching exercises.

Orbicularis repositioning/transcanthal canthopexy/zygoorbicular dissection plane

The plane of dissection has been debated, Hester recommending a subperiosteal plane based on the work of Tessier. For patients with pseudoherniation of orbital fat with minimal skin/muscle excess and patients with minimal descent of the lid/cheek junction and malar prominence Hester recommends that a preperiosteal cheek dissection is sufficient. This is based on their extensive review of complications in 757 cases of transblepharoplasty approach recommending that it prevents both oedema and downward retraction on the lower lid. They also recommend minimal lower lid skin excision.

Although Hester performed a subperiosteal flap dissection they utilized the arcus marginalis release, transcanthal canthopexy and laterally based orbicularis pedicle flap passed under the lateral raphe. They found improvement on their original canthotomy and canthoplasty technique. Hamra sees this change in practice as the turning point in the author’s quest for a natural look.

Although techniques incorporating orbicularis repositioning provide a vertical lift they generally result in lateral dog-ear formation, especially in patients with excess skin. Maximal skin removal to address the lateral dog-ear as recommended by Hester is required which is tolerated well with minimal complaints.

Fat repositioning and mobilization

Although fat conservation is an increasing trend debate still centers on fat repositioning versus fat mobilization. Repositioning of the subseptal fat into a subperiosteal pocket is advocated by Goldberg. Repositioning is also advocated by Moelleken rather than a septal reset because of the risk of middle lamellar contracture. Rohrich concludes that Hamras technique is useful in the central and outer portion of the lower eyelid but falls short in the medial portion, which requires either autologous fat transfer from the central and lateral compartment or autologous fat injection in the suborbicularis plane to soften the medial portion of the nasojugal groove.

Adjuvant resurfacing procedures

Adjuvant therapies such as laser resurfacing have been used for transcutaneous blepharoplasty including TCA injections/peels laser resurfacing or fat injections. Hester used TCA or laser resurfacing in over 60 percent of cases without complications and also proposed fat injection volume restoration in the nasojugal groove. Hamra postulates that improved results would be the same 1-2 years later with or without adjuvant therapies.

Complications

Complications following lower blepharoplasty techniques include lateral orbital fullness, canthal webbing, minor scleral show, ectropion, lower lid malposition, prolonged oedema, lateral dog ears and recurrence of the nasojugal groove.

For significant scleral show/ectropion Hester recommends canthoplasty. For recalcitrant lower lid malposition usually with dry eye symptoms not corrected by repeated canthoplasty and re-elevation of the lower lid Hester et al recommended the use of lower lid spacers such as ear cartilage and hard palate mucosa. Hamra recommends alloderm as an alternative.

Consultation

For anyone considering blephaoplasty it is important to consult with a surgeon who has experience in all the above techniques. For further information www.garylross.com

(c) copyright garyross 2009

About Author

Mr Gary Ross is an NHS consultant plastic surgeon, on the GMC specialist register for plastic surgery, member of BAAPS and BAPRAS. He has trained in Australia, United Kingdom and Canada and has become a leading figure in the highly competitive field of Plastic Surgery. His private practice in Cheshire reflects his interest in head and neck and breast aesthetics. He has been appointed as an honorary senior lecturer at the University of Manchester and has published over 50 peer reviewed articles and a number of book chapters (including face lifts, brow lifts, blepharoplasty). He has presented worldwide over 200 times many as a key note lecturer and moderator. He has organized a number of international conferences and instructional courses and offers non surgical options including laser, botox, fillers and peels. He offers the full range of cosmetic surgery procedures specialising in facial aesthetics, breast surgery and body contouring. Further information available on www.garylross.com

admin asked:

Plastic surgery is a tool many people use to improve their body image. However, not all people are good candidates for cosmetic surgery. The American Society of Plastic Surgeons recognizes this and cautions surgeons from taking on certain types of patients. That being said, some people can benefit greatly from cosmetic surgery, provided they have realistic expectations and a good understanding of their motivation.

Who Are Bad Candidates for Cosmetic Surgery?

So who does the American Society of Plastic Surgeons say is a bad candidate for cosmetic surgery? First, the Society cautions surgeons against performing surgery on patients with unrealistic expectations about the procedure’s results. Patients need to know what to expect after a procedure, and their view of “perfection”is likely not going to be the result.

Also, patients who are suffering from a severe crisis or trauma in their lives should wait to have surgery. A divorce or serious financial crisis can sometimes make people start seeking a way to change their outer image in an attempt to deal with the inner turmoil they are experiencing. Working through the crisis first is essential. If, afterwards, the patient still feels surgery would be a benefit, then options can be pursued.

Doctors are cautioned against performing surgery on people who are seeking perfection. These patients notice every possible flaw on their bodies and want it fixed. Often, they are unhappy with their results and seek another physician’s opinion or another surgery to fix the first one. These are poor candidates for cosmetic procedures, because there is often an underlying problem causing the individual to continue to seek surgical treatment.

Many people suffer from body image complexes, thinking that they look far worse than they really do. Some turn to cosmetic surgery in an attempt to fix these perceived flaws. People with a severe body image complex, a condition known as Body Dysmorphic Disorder, should not look to cosmetic surgery to fix their perceived flaws. This is a serious psychological condition that needs counseling, not surgery, to fix.

Good Candidates for Cosmetic Surgery

While many people seek cosmetic surgery as a “fix”for problems it was not designed to fix, there are some patients who stand to benefit greatly from a cosmetic procedure. There are also those patients who have realistic expectations about a procedure and can enjoy a better body image after surgery without the psychological problems others experience.

People who are good candidates for plastic surgery are those who understand what the risks and the possible outcomes are. They are not obsessed with achieving “perfection,”but perhaps have a flaw or two that they would like to improve. They understand that they are going to still look like themselves, with slight improvement, after the procedure.

Cosmetic surgery is also a great option for people with birth defects, such as a cleft palate. There are also many procedures that can be done to improve the appearance of scars after an accident or fire. A skilled plastic surgeon can reconstruct an appearance lost after a traumatic event, thus allowing the patient to return to a fairly normal appearance. People in these situations are good candidates for cosmetic surgery.

There are also some lifestyle and physical features that how whether or not someone is a good candidate for cosmetic surgery. People who are at a healthy weight, exercise regularly, and do not smoke are good candidates. It is very important for a patient to be emotionally stable, and the patient must be able to accept the risks and potential disadvantages of having a cosmetic procedure done.

If you feel like you are a good candidate for cosmetic surgery, have weighed the risks, and still wish to have a procedure done, look around carefully for the right doctor. Once you have found one, set up some support to lean on after the procedure while you heal. Cosmetic surgery is major surgery, no matter how low risk it is, so make sure you have the help you need in place prior to the surgery.

jewellery asked:

A tummy tuck cosmetic surgery procedure will take about two to five hours, depending on the nature of the job. If you are only receiving a partial abdominoplasty it will probably only take between one to two hours.

A complete abdominoplasty (tummy tuck) procedure is performed by creating a small incision from one hip to the next (just above the pubic area). After this, another cut is made to free the surrounding skin away from the navel. The skin is detached from the abdomen wall which will reveal the muscles. The skin is then reattached and a new hole for the navel is created and stitched into place.

Other people who often benefit from a tummy tuck are those who have lost a great deal of weight. Because of their great weight loss, they are usually left with great folds of hanging skin on their abdomen. This can be depressing for the person who has lost the weight; therefore a tummy tuck can be just the boost they need to ensure they don’t slip back into bad habits and regain their lost weight.

An abdominoplasty procedure, generally known as a tummy tuck, is a surgical process that allows the removal of the extra skin and fat from your abdomen. This surgery will lead to tighter collection of muscles in the abdominal wall thus giving you a flatter stomach.

Tummy tuck treatment varies depending on your conditions and requirements. Some people go for both abdominiplasty treatment and liposuction because they have that need. Others go for one or the other only.

Men and women who have lost large amounts of weight by any means, including those who have dieted or have lost it through “Gastric Bypass” — also known as “Stomach Stapling” or “Bariatric Surgery” — are often left with folds of skin that hang like an apron. This is not only demoralizing for those who have gone to the effort of achieving a significant weight loss, but it also makes personal hygiene, exercising and wearing normal clothes difficult.

Anesthesia. For most mini tummy tucks, plastic surgeons use local anesthesia. This means that you are semi-conscious during the operation. This brings the cost of anesthesia way down. Anesthesia that puts you totally out during the operation is more expensive.

Many times when receiving a quote they will only inform you of the surgeons fees without telling you that is all they are actually quoting you. when in reality the surgeon’s fee is roughly only 60-80% of the cost for the entire procedure. This is to get you to make an appointment to see the doctor which is when they will tell you the true total cost.

Tummy tuck or abdominoplasty is a major surgical procedure which needs the direct monitoring of doctors even after the procedure. The actual operation involves the removal of excess fats from the abdomen tissues and muscles. After the removal of fat through liposuction, the excess sagging skin which makes up the flabby stomach can now be removed.

Tummy tuck, medically known as abdominoplasty, is a major surgical procedure which involves the removal of excess fats around the abdomen tissue and muscle area. After the removal of fats through liposuction, the “tucking in” or the removal of flabby and sagging skin follow next. Abdominoplasty is a major operation so extra and professional care and advice must be taken before, during, and after the procedure.

admin asked:

Desperate people can do desperate things when consumers become more savvy and sophisticated as they shop around for the very best deals offered on websites promoting surgical procedures.

That’s right folks; you can offer a bid for that eye lift or tummy tuck on Bidforsurgery.com, just like you would bid on a piece of jewelry or camera equipment on eBay. If you select to pursue a bid, you are entitled to a free in-person consultation with the physician of your choice. This forum is designed to save the consumer time, money and effort thus saving the doctors administrative and marketing costs.

Insurance companies do not typically reimburse plastic surgery fees leaving the consumer to fend for the best deal with their hard earned cash. Prudent consumers can be thrifty and conservative when spending after tax dollars for a temporary face lift or other risky procedure that will undoubtedly need repeating in a few short years.

Another new wrinkle – no pun intended – was developed for the jet setting consumer who believes that they can enjoy a quiet surgical tweak in a foreign clinic where their dollar may go further because of low-cost, high-quality procedures. Sites like MedRetreat.com and PlanetHospital.com will book your appointment with a doctor then take care of the travel requirements such as passport and visas, airline tickets and hotel.

Life altering choices coupled with risk is a high price to pay for beauty especially when unrealistic claims and unqualified practitioners induce patients to make uneducated decisions. Even certain medical professionals are policing themselves and re-thinking their position on cutting into a healthy face for the sake of beauty.

Safety needs to be highly regarded for every surgical procedure and The British Association of Aesthetic Plastic Surgeons has published a checklist for those considering plastic surgery; it is the acronym entitled ‘S.U.R.E.’ We have seen similar admonitions from our US health officials and these are reminders of those warnings:

S: Surgeon’s credentials and qualifications.

U: Understand fully the procedure, risk, location, downtime and care requirements.

R: Recovery process, how long, implications, after care options

E: Expectations can be over the top so be informed about what actually can be achieved.

All in all, warnings such as these are not needed when you use natural means to correct the cause of aging.

Some aging in the face is from outside influences such as over exposure to the sun and elements, smoking, drinking, poor eating habits, lack of water in the diet, too many adult beverages night after night, and the list can go on and on.

Some aging presents itself like sagging and this is caused because the muscles underneath your skin are elongating due to atrophy/disuse. The facial muscles, although small compared to say muscles in the forearm or leg, can cause noticeable aging when they begin to lose those their shape and tone so by the time you reach 40, apparent aging has begun in your face.

Rather than opt for risky, temporary procedures such as injections and surgical treatments that tax your wallet, why not consider facial exercise to lift your face? You won’t have to book an expensive trip or run the risk of contracting Montezuma’s revenge or interview countless physicians hoping one of them can work with your budget and health constraints.

Exercises that use resistance and isometrics work for your body and the same principles can be applied to the face. It makes sense. Imagine seeing the face you had years ago returning day by day when you exercise your face.

The key to a younger, healthier looking face is prevention using a natural, safe method such as facial exercise to lift the sagging, droopy muscles without injections, harmful chemicals or cutting. Start now for a better looking face almost instantly!

Cynthia Rowland is widely recognized as an expert in all natural facial fitness with over thirty years experience in health & beauty related fields. She has appeared on The View, Fit TV, HGTV and other popular shows. This author, speaker and television personality is leading the crusade to keep men and women looking vibrantly younger through natural techniques without spending their children’s inheritance.

admin asked:

Good looks are the norm these days. People are ready to go to any extent to get the perfect look so much so that getting under the knife is no longer an issue. Earlier plastic surgery was done to rectify the functional issues. A plastic surgeon was skilled enough to correct the person’s appearance in case of damage due to a mishap. Plastic and reconstructive surgery would help the patient get back to leading a normal life. Reconstructive surgery is an essential part of plastic surgery. Visiting a good plastic surgery clinic for your needs is absolutely imperative. California is known for its competent plastic surgeons and a plastic surgery clinic California would be a good place to find a good surgeon. From plastic surgery there came another branch known as cosmetic surgery. A cosmetic surgeon would correct minor problems only for aesthetic and cosmetic reasons. Almost anything is possible with cosmetic surgery today, from acne scar removal in which different methods including laser is used as acne scarring treatment methods to body contouring where various surgical procedures are used on different parts of the body to give the body a well formed look.

Plastic surgery can be done for various reasons. Brow lift plastic surgery actually smoothes the lines on the forehead and lifts the eyebrow to make the face better defined. Brow lift surgery lasts only for about 2 hours and is usually done on local anesthesia. Another surgical option for brow lift is the endoscopic brow lift surgery where the surgery is less invasive and is best suited for those who require very less skin removal. A brow lift surgery is at times combined with a blepharoplasty surgery which is an eyelid lift surgery where the upper or lower eyelid is reshaped. Also known as eyelid tuck, the surgery removes the fat or skin on the eyelids and makes your eyes looking younger. Although blepharoplasty is a part of ophthalmology, blepharoplasty is mainly for cosmetic purposes. Choosing a blepharoplasty surgeon carefully is essential since it is not just the appearance that is at stake here but a small mistake can cost you your vision which would be a very high price to pay.

Over the years our skin tends to sag. Some people look far older than their age due to the stress and pressures in life. Anti-ageing treatment would be best suited for such patients. Alma skin tightening laser treatment is another new option that is being adopted by many today. It uses radio frequency and is a non-surgical process. Laser treatment for acne along with other laser skin treatment has produced very encouraging results. Laser skin tightening methods have a loyal clientele. Botox injection which is a derivative of Clostridium Botulinum bacterium is also a popular method of treating age related facial lines. Bovine collagen is similar to Botox and is an injection meant to get rid of wrinkles and scars. It is basically a cow skin extract that is purified and sterilized before administering to the patient. The non-surgical injection is quite sought after by patients looking for alternative treatment options.

admin asked:

When patients undergo surgical procedures, whether they are medically necessary or elective surgeries, they are typically aware of the inherent risks and complications associated with the procedure, such as anesthesia reactions, blood clots, infection, cardiovascular complications or healing complications. Sometimes, though, the inherent complications of surgery are worsened by a mistake made by a doctor or nurse during the procedure. Unfortunately, medical errors are the fifth-leading cause of deaths in the United States, causing up to 98,000 deaths annually, according to the Institute of Medicine.

Surgical errors account for thousands of patient injuries or deaths every year. Examples of surgical errors related to medical negligence include:

· Use of unsanitary surgical utensils

· Surgical instruments or sponges left inside a patient

· Improper surgical technique

· Organ, nerve or artery puncture or perforation

· Surgery on wrong organ, wrong site surgery or wrong side surgery

· Delayed or prolonged surgery

· Anesthesia mistakes or over-sedation

· Unnecessary surgery

· Medication overdoses

· Use of wrong blood type

· Failure to diagnose and treat post-operative infection

If you were a victim of any of these surgical errors, you can file a medical malpractice lawsuit. An experienced attorney can help you determine if a doctor or other staff member neglected to provide proper care or neglected to demonstrate an appropriate level of medical skill.

What types of surgeries are prone to surgical errors?

Any type of surgery carries the risk of surgical error. The most common surgeries with this risk include:

· Gastric Bypass

· Childbirth

· Cardiac Surgery

· Thoracic Surgery

· Laparoscopic Intestinal Surgery

· Plastic Surgery/Cosmetic Surgery

When can surgical errors happen?

Surgical errors can occur before, during or even after a surgery. Pre-operative evaluation and planning is crucial in understanding the patient’s current health and medical history, medications, lifestyle and family history. Surgeons should only operate when it is certain that the procedure is in the best interest of the patient, safe and appropriate.

Errors that occur during a surgical procedure are widespread. Negligent, careless or inexperienced medical professionals can make anesthesia mistakes, make incorrect or sloppy incisions, use un-sterile tools, etc. Reasons for these errors could include:

· Sleep-deprived, overworked surgeons

· Poor communication between physicians and other healthcare providers

· Drug or alcohol addictions among surgeons, the surgical team or anesthesiologists

· Surgical teams not properly trained to use operating room equipment and technologies

· Surgeons, anesthesiologist or nursing staff not properly monitoring the patient

Post-operative surgical errors can lead to infection, septic shock, delayed healing, hemorrhage, pneumonia and other respiratory complications, pain and other life threatening medical consequences. These complications can occur immediately after the surgery or weeks or months later.

Surgical errors can leave a patient with lifelong complications, including permanent disability, chronic pain/suffering and shorter life spans.

jewellery asked:

The term plastic surgery derives from Greek word ‘Plastikus’, which means to mould or to shape. Plastic surgery is not just for celebrities any more. There is great variety of plastic surgery procedures that a plastic surgeon can offer. When looking at the trends of plastic surgery, it becomes clear that certain procedures are much more popular than the other ones.

Plastic surgery is a surgical specialty, which changes the way a person’s body looks and feels. There are two main types of plastic surgery. Reconstructive surgery is the surgical reconstruction of body defects due to trauma, burns, disease and birth defects. Cosmetic surgery is used to enhance a person’s appearance for purely aesthetic reasons.

Reconstructive plastic surgery is performed on abnormal body parts resulting from infections, tumors, illnesses and other traumas. While cosmetic plastic surgery is performed on normal body parts to improve a patient’s self esteem and perception of attractiveness. In cosmetic surgery, skin, fat and muscle are reshaped, tightened and repositioned to enhance and improve the patient’s physical appearance. Typical surgeries include breast augmentations, rhinoplasty and face lifts. Cosmetic surgery can be subtle or extreme.

One of the main reasons people decide to get plastic surgery is to enhance their physical appearance. Every person has that one body part that they grow up feeling insecure about. For some it may be an oversized nose and for others it may be disproportionate breast size or shape. Whatever it may be, it will nag at them, pull at them, and make them feel insecure, embarrassed and in some cases ashamed. However, with the advances in today’s plastic surgery industry, people can turn to their plastic surgeons for help with their insecurities and problem areas. It is always essential for the patient to research and screen the surgeons before deciding on them. It helps to take the advice from previous patients and to discuss about their experiences.

Dr. Sawan, one of the leading plastic surgeons in Oklahoma City offers affordable plastic surgery in Oklahoma to change your body’s appearance. The professional staff will work hard to accommodate your schedule and make your visit as pleasant and efficient as possible.

To know more about Dr. Sawan, please visit the site http://www.juveniss.com

 

admin asked:

e of you, Indonesian, still remember the accident, which happened to a woman severely burned by her husband out of jealousy. The accident took place a couple of years ago in Jakarta. The news suddenly becomes major headlines in all media, printed and electronic. The public opinion is all stirred to sympathy towards the woman and curse for the husband. Because the woman, who used to be a very beautiful, after the accident became unrecognizable. The husband did his action based on his suspicion that his wife might have an affair with other man. So to prevent that from progressing even further, the husband took the precaution step by burning his wife, alive. Luckily the woman managed to escape and sought help although she had burn wound.

Although her wound could be well treated, still her face won’t be the same again. There would be major changes in her face and skin. This phenomenon intriguing some psychologist when they began to question whether the patient was mentally stable enough to handle the stressful, high-risk procedure. People around her might not be able to recognize her again.

Experts have begun to discuss how any analyst could fully know if an individual were “ready” for such a novel procedure. Some psychological readiness criteria exist for patients who seek elective plastic surgery, but there is little literature about the mental

attributes that make someone a good candidate for reconstructive surgery, much less a highly visible transplant.

Critic of the operation say that in addition to needing the mettle to follow post surgical procedures and stick with anti-tissue-rejection medication and side effects, the woman will have to withstand intense public scrutiny, and they wonder if she is up to it. But Elaine Walker, professor of psychology and neuroscience at Emory University, notes the patient’s perspective, “the stresses may not trump the stress of living with the original disfigurement.”

Walker points out that the patient essentially had to choose between three psychologically challenging options: live with a terrible disfigurement that would very likely instill in her significant social anxiety, attempt a protracted series of reconstructive surgeries that doctors said might not succeed, or undergo the risky face transplant. “None of the alternatives would be free of psychological stress,” observes.

In the end, life is full of options. For each option, there would be consequences regardless the stress that would come along. And the patient, like every human being must choose one with consequences he/she can handle best.

admin asked:

Plastic surgery or cosmetic surgery is quite a topic that has gotten so much attention over the years. Perhaps more attention due to the controversy involved in having some work done. More and more people have gotten plastic surgery over the last few years and more and more people have spun conceptions either for or against it. Although there is nothing illegal about undergoing an operation to enhance certain things, many people seem to rally against it.

My body my choice

Perhaps one of the main reasons why people go against plastic surgery is because it is not natural.  It is still considered taboo to have certain parts of your body surgically altered to become better of course on the person’s perspective. There is still a pretty conservative school of thought that tries to convince people to be happy with what they have and be comfortable in their own skin, which is not a bad argument at the very least. Also there has been a growing concern as to how many people have gone under the knife especially since a large amount of these people are very young. It then shifts the argument from what is proper from taboo to how much freedom a person can actually exercise in making decisions affecting their bodies.

Crucial plastic surgery

Although unpopular in most public forums there are a significant amount of cases where plastic surgery is a necessity for a patient to become able to live normal lives. In the areas of prosthetics and reconstructive surgery, plastic surgery is far from taboo as it becomes a solution for people who have lost limbs or suffered disfiguring ailments to lead normal lives. People who suffered from accidents depend on these medical solutions to overcome the problems brought about by the aftermath of their accidents. There are thousands of testimonies that support how much of a life changing experience plastic surgery has become.

The middle ground

There are some undeniable reasons why people should get plastic surgery as there are reasons for people not to. Of course for those who unfortunately encountered accidents the choice is pretty obvious and anyone in the said situation wouldn’t think twice about getting it. The argument for or against surgery lies on the end user; it is whether that person really needs the enhancement or not. Although there is no way to censor someone from deciding to get plastic surgery, it must be stressed that a significant amount of thought is put into it before committing. Consultations with doctors and family members can help people decide the best way to go about decision making and it is strongly advised to do so.

There are also dangers of getting shady plastic surgeons who may case more harm than good so it is important that credentials are checked before going through any type of surgery. Get the best surgeon you can find as your life would be in his hand. People may choose to get plastic surgery for either necessity or luxury, both are legal and both respect an individuals right to live their lives the way they want it is just important to set aside some time for proper thought before making major decisions such as this.

admin asked:

So, you have decided to look into cosmetic surgery to improve some aspect of your body. Maybe you think that your breasts are too small…maybe they are too big or just too droopy. Perhaps you don’t like the shape of your nose or perhaps your ears stick out too much. Maybe you don’t like the effect that the ageing process has had on your face and you think that you could do with a bit of a lift or have those eye bags looked at. It might even be that you cant shift that last bit of fat around the stomach or love handles, despite sweating your guts out at the gym 3 times a week and following a healthy eating plan to the letter and you fancy having a bit of liposuction. It could be that you have an excess of skin around the tummy following childbirth or weight loss and would like a nice flat tummy again so that you feel more confident about yourself. Maybe you are very overweight and have tried every diet under the sun and are so despondent that you are considering the possibility of weight loss surgery. OK, so now what do you do? After all, there are all those horror stories that you read in magazines and see on television about surgery that has gone wrong. Who do you trust with your body…? It might not be the body of a catwalk model but it’s the only one you’ve got and you don’t want to end up worse than when you started, right?

Well, there are many sources of information that can provide you with details about cosmetic surgery. The obvious one is the medium that you are using now to read this. There are hundreds, if not thousands of pages about plastic and cosmetic surgery as well as weight loss surgery on the Internet. Lots of different companies, all offering their services with flashy websites and tempting testimonials from their many past “delighted” patients. Some based in the UK and some that are trying to tempt you to go abroad with massive savings. Perhaps one of your friends or co-workers may also have shared their cosmetic surgery experiences with you. Television and magazines offer story upon story, some good, some bad about new techniques and advances in cosmetic surgery. But the most valuable time you will spend is during the consultation with your surgeon. During this consultation, you will gain specific information about the surgery, the surgeon, the recovery and the results. Equally importantly, you will get a sense of your comfort level with the surgeon, his or her skills, and bedside manner. This is one of the many reasons why it is important to meet the actual surgeon straight away and not just a “patient advisor” or “nurse councillor”, who are often simply glorified sales people. You can normally expect to pay for the time of a good consultant plastic surgeon, which is usually between