Gynecomastia correction
Blepharoplasty
Face Lift
Liposuction
Gynecomastia comes from the Greek terms “gyne” which means woman and “mastos” which means breast. In medical terms, gynecomastia means abnormally large breasts in men. Commonly found in young teenagers, gynecomastia typically resolves in the majority of cases. For the 10% of cases that do not disappear naturally, severe psychological consequences can follow such as feelings of embarrassment, shame, and anxiety. Causes of gynecomastia can include steroids, obesity, tumors, drug abuse, certain syndromes, liver disease, and many medications. Most of the time workups are negative and no known cause can be found. If gynecomastia persists and fails to resolve after a long period of time, surgery may be indicated. As most physicians consider this condition cosmetic, don’t count on getting insurance to cover the cost of the surgery.
Surgical correction of gynecomastia involves first performing an aggressive liposuction of the entire breast. This allows for removal of large amounts of fat and breast tissue and also stimulates the skin to shrink up. The next step is to make an incision around the areola and remove the abnormal breast tissue which lies beneath the nipple and areola. In the majority of cases no skin removal will be necessary as the skin will contract and not sag. In severe cases with major breast ptosis (sagging), skin removal will be needed. This can be performed by removing skin from around the areola or by performing a formal breast reduction. Sometimes these procedures will be staged (performed at separate times). Most surgical corrections take less than 2 hours and are performed as outpatient procedures. A garment is worn for 2-3 weeks and all sutures dissolve and do not need to be removed. Drains may or may not be used to remove excess fluid. Complications can include seromas, bleeding, nipple loss, infection, and scarring. Occasionally ultrasound or steroid injections will be needed to encourage healing. Remember that when having surgical correction of gynecomastia, it will take 3-6 months to see the final results so be patient.
Our main goal in treating gynecomastia is to limit scarring and produce a normal appearing breast. Make sure you understand what type of procedure will be performed and where the scars will be located.
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Has anyone ever said “you look tired” or “you must have been up all night” when in fact you feel great? The fact is changes around the eyelids can lead to an aged, tired appearance. Youthful eyes have no excess fat, smooth skin, no lid laxity, and an almond shape. Undesirable changes in the upper lids include excess skin and fat as well as ptosis (droopy eyelid) which can obscure your vision. Undesirable changes in the lower lids include excess fat and skin and ectropion (laxity) leading to a dry eye. Surgical procedures to rejuvenate the eyelids involve removing excess skin and fat and tightening of lax eyelids. Blepharoplasty will not correct crow’s feet nor correct excess skin in the eyebrow area. Botox will be needed to correct crow’s feet and a brow lift will be needed to correct brow ptosis. Most eyelid surgeries are performed in office under local anesthesia with minimal discomfort and recovery. Below is a discussion of the common methods of rejuvenation of the eyelids.
Upper blepharoplasty – Excess skin in the upper lid is carefully measured and marked after being cleaned with an antiseptic solution. Local anesthesia is injected to numb the area and to limit bleeding. A strip of skin is removed along with a strip of eyelid muscle. In some patients the eyelid muscle is preserved for a more natural look. Fat pockets are then dissected and excess fat removed. If the eyelid is droopy (ptosis), a repair can be completed at this time. Following a short healing period of 3 days the sutures are removed. After a few weeks of healing the scars become imperceptible. Complications are rare and can include over tightening of the lid skin, bleeding, and incomplete removal of fat.
Lower blepharoplasty – Preoperative evaluation includes amount of skin and fat as well as evaluating the elasticity of the lower lid by performing a “snap back” test. For laxity of the lower lid a canthopexy or canthoplasty may be needed. Following cleansing with an antiseptic, local anesthesia is injected. An incision is made 2-3 mm from the lash line and a flap is developed. Excess skin is removed followed by removal of fat from all 3 pockets. Sometimes fat is preserved and rolled under the nasojugal groove. Following the surgery one should keep their head elevated and ice the lower lids for the first day. Sutures are removed after 2-3 days and recovery is very quick.
Transpalpebral lower blepharoplasty – For patients with fatty lower eyelids and minimal skin, a lower eyelid lift with an incision inside the eyelid may be used. This has the advantage of no external scar but may require a peel of the lower lid skin.
Ptosis repair – Ptosis of the upper eyelid occurs when the eyelid drops down toward the pupil. The cause of ptosis is multifactorial but advanced age is one of the most common causes. Repair involves suturing the levator aponeurosis (a ligament) which elevates the lid to a more normal position. This procedure may be covered by insurance.
TCA peel – Excess wrinkling of eyelid skin can be improved by chemical peeling. Chemical peeling requires 2-5 days of recovery and has minimal complications.
Orbicularis lift – For patients with lax lower lids or festoons an orbicularis lift may be indicated. This involves pulling the muscle of the lower lid upward and suturing it into place. Suspension of this muscle supports the lower lid leading to a more youthful look.
Canthopexy/Canthoplasty – These procedures tighten the lax lower lid by repositioning the lateral canthus (corner of the eye) or by shortening the lower lid. Laxity of the lower lid can lead to ectropion (outward bowing of the lower lid) which can cause dry eye syndrome. Ectropion can also lead to an aged appearance. The elasticity of the lower lid is evaluated by performing a snap back test. The eyelid is pulled down by the surgeon and the degree of “snapback” is measured. Inability of the eyelid to return to a normal position or an excessive distance of pull down may indicate the need for a canthopexy. Your surgeon will decide which type of canthopexy or canthoplasty is indicated to achieve a normal appearance.
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Which facelift is right for you? The “mini facelift? How about the MACS Facelift? Maybe the endoscopic assisted biplanar facelift. Or my favorite “The exclusive Kurtis W. Martin lift”. You get the picture. Choosing the right procedure for the best result can be very difficult. The problem is keeping up with all the technology and separating the facts from the hype. The most important factor when considering a facelift is to choose a surgeon who can achieve consistent, predictable results with minimal complications. During your consultation with your surgeon look at before/after pictures of facelift patients and see if you like what you see. You must understand that not all surgeons perform all the techniques available. Most surgeons choose a limited number of techniques which produce excellent results with limited complications. Let’s look at an example. Surgeon A performs many facelifts a year and uses very quick, simple techniques that are well received and have minimal recovery. His patients are very satisfied. Surgeon B performs very long procedures using the latest and most invasive techniques available. His patients take longer to recover but are also very happy. Which surgeon is performing the “best” facelift? The answer is both surgeons are able to achieve consistent, high quality results using different approaches. So don’t base your opinion of a surgeon on which procedures he performs. Let’s look at some of the common questions regarding facelift surgery.
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When should I have a facelift? You should consider facelift surgery when you want improvement in your facial situation. You are never too young (well maybe) nor too old to have a facelift. The aging process of the face is determined by genetic factors as well as environmental factors. You have no control over genetics but you can control environmental factors (smoking, sun exposure, skin care regimen, etc.) Younger patients will usually require less invasive procedures for facial rejuvenation. Some evidence exists that having a facelift at a younger age will result in a longer lasting facelift.
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Am I too old for a facelift? As stated above, you are never too old for a facelift as long as you are healthy. My oldest facelift patient is 85 years old.
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Will I look “pulled” or “windblown” after my facelift? Absolutely not! Most people want to look like themselves only younger. Few people want a windblown look. A tight, pulled look is very unnatural. Some people believe the tighter the pull the longer the facelift will last. This is not true. A tight, pulled look results from over tightening the skin without any pull on the underlying structures (SMAS). Pulling the skin in the wrong direction (abnormal vectoring) can also result in an abnormal appearance with lines going in the wrong direction. A secondary facelift can sometimes correct a pulled or vectored look.
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How long will my facelift last? The results of a facelift can last forever but you will continue to age and the skin on your face will continue to sag. Some patients with poor elasticity will require a secondary facelift (minor tightening) in as little as 6-12 months following the first facelift. A secondary facelift generally involves simply tightening the skin with minimal alteration to the SMAS.
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Is a “mini facelift” effective. Yes, a mini facelift can be effective but less so then a major facelift. The problem is agreement on what constitutes a mini facelift. Some consider a mini facelift to consist of skin excision only with short incisions. Others consider a mini facelift a secondary lift. One caveat to remember is that some non certified doctors promote the mini lift because they don’t know how to perform a more invasive facelift.
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Where will the facelift incisions be made? Standard facelift incisions start just above the ear at the sideburn, continue down in front of the ear, and circle back under the earlobe and behind the ear. I usually make the post auricular incision straight up the ear without crossing into the hairline. This allows for the incision to hide completely behind the ear and not be seen when one wears their hair short. Be sure to ask if your incision will show when wearing short hair. This is a very common complaint from facelift patients.
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Will a facelift remove wrinkles? Yes and no. A facelift can stretch the skin allowing for the wrinkles to look less prominent. The only wrinkles that are actually removed are the wrinkles adjacent to the skin that is excised. Most facial wrinkles require soft tissue augmentation (Radiesse, Restylane, Fat, ect.) and or wrinkle reduction (chemical peels, laser, ect.)
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Will a facelift improve nasolabial folds or marionette lines? Yes and no. Most standard facelifts do not affect the nasolabial fold or marionette lines. Some special techniques and a particular type of facelift known as a mid facelift can improve these areas. Usually these areas respond best to soft tissue augmentation.
Most facelifts involve common principals of repositioning deeper structures, removing excess fat, and excising loose skin. Many can be performed under local anesthesia while the patient is awake. The face is infiltrated with anesthetic solution which numbs the face and reduces bleeding allowing for more precise dissection. Incisions are made under the chin and around the ear followed by dissecting the skin away from the deeper structures. The SMAS is then plicated (sutured up) to reposition the jowls and cheek tissue. The skin is then carefully removed and sutured back in place. Excess fat is removed from the neck, followed by tightening of the neck muscles (platysma). All sutures are removed in 5-7 days and recovery takes 1-2 weeks. Pain is minimal. Complications can include bleeding, infection, seroma, tissue loss, and nerve damage. Other tell-tale signs of a facelift which should be avoided include pulling of the external auditory canal, a pixie ear, disappearing sideburn, abnormal vectoring, and abnormal scarring.
Caveats
- It is very difficult even for a plastic surgeon to determine which techniques work the best without performing a large number of that specific procedure. Ask your surgeon how many facelifts he has performed using specific techniques.
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If you smoke, you may be a poor candidate for a facelift. Even if you quit smoking, you are still at high risk for tissue breakdown and scarring.
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Some patients develop recurrent laxity of the facial skin following a facelift. This may occur as early as 2-6 months following the procedure. Don’t blame your surgeon for not pulling the skin tight enough! Recurrent laxity is more related to your genetic makeup and there is very little you can do to improve the elasticity of your skin.
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Never leave your sutures in more than 5-7 days. With time sutures cut through the skin leaving small cuts which heal as “railroad track” scars. These can be very noticeable.
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One serious complication is a hematoma which can lead to tissue necrosis and unacceptable scarring. The most common causes are aspirin, advil, alcohol, and herbal products all of which inhibit platelet function. Don’t take any of these products before or after your surgery. Ask your surgeon which other products to avoid.
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Never place a heating pad on your face following your facelift. The skin lacks normal sensation and the heating pad can burn your skin.
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Be sure to ask where your incisions will be located behind your ear. An incision that crosses into the hairline may leave scars which are easily seen if you wear your hair short. Ask about placing your incision totally behind your ear without crossing into the hairline.
If you are considering a facelift in Cincinnati or Dayton, choose a surgeon with the skill and experience needed to achieve natural, consistent results. Ask about computer imaging to preview expected results and ask to see before/after photos of actual patients. If you have undergone a facelift and are unhappy with the results, please schedule a consult to see what options are available for correction.
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Diet and exercise are the best means for achieving overall weight loss, but despite healthy eating and high activity levels, some areas of the body tend to retain fat pockets that can detract from a person's appearance. Liposuction at our Cincinnati location can help our patients remove stubborn fat deposits, creating a better proportioned and more attractive appearance. Many areas of the body, including the hips, thighs, buttocks, abdomen, back, legs, arms, and neck, can be treated using liposuction. In the procedure, the area to be treated is first injected with fluid. Then a special slim tube called a cannula is inserted through a small incision and used to siphon away excess fat. Dr. Martin is very experienced in performing liposuction. In Cincinnati, his reputation has grown, due to his extensive training and expertise, combined with the personal attention he gives to each patient.
