CENTER FOR COSMETIC FACIAL SURGERY
Pavilion
II
Drs.
Roger Crumley and Brian Wong
714-456-7017
Introduction
..2, 3
About
Our Facial
Plastic Surgeons
.4, 5
First Things First
..
6 - 10
What
Facial Plastic
Surgery Entails
.11 15
Rhinoplasty
.16
For
further Rhinoplasty information, doubleclick
Mentoplasty
.16
Malar Augmentaton ..
17
Protruding Ears
..17
Facial Sculpturing
..18
Facelift Surgery
..
18
DoubleClick Here for more Info on Face Lift Surgery
Forehead Lift
..19
Doubleclick for
More Info on Blepharoplasty
Chemical Peel
.20
Collagen Injections
21
Dermabrasion and
Scar Revision
..22
Excision
22
Laser Surgery
.23
Reconstruction
of Facial
Skin Defects
.23
Alternatives to
Baldness
.23
Conclusion
24
Introduction
To Our
Patients
Ask
for and expect a specialty plastic surgeon, who
focuses on one part of the body. (Facial Plastic Surgery)
.
This information is
designed to acquaint you with our services at
The
degree of success depends not entirely upon the surgeons technical skills and
analysis, but often upon the limitations inherent in each
patients
type of skin, bone structure, healing capacities and overall health
status. If any limitations exist in your
case, they will be pointed out and
explained
factually and honestly. Certain patients are simply not good candidates for
surgery, and may be understandably disappointed when
plastic
surgery is not recommended or is delayed until a more appropriate time when results will be better.
The goal of cosmetic surgery is to make you
look as good as it is possible for you to look.
Surgery cannot do more than that.
We always try to pro-
duce
natural facial features, thereby improving appearance and minimizing facial
abnormality. When we discuss the various
procedures in this booklet,
we
are speaking in terms of the average case; individual variations certainly
exist.
The
purpose of this booklet is exclusively to provide you with information and knowledge
upon which intelligent decisions may be made.
No portion should
be constructed as implying a warranty or guarantee of any specific surgical
result. Finally, cosmetic surgical
procedures have
been
performed successfully many thousands of times and are overwhelmingly
dependable when executed by experienced surgeons.
The
facial plastic surgeon is a highly trained, skilled and artistic physician, but
not a miracle worker. The degree of success depends
not
entirely upon the surgeons technical skills and analysis, but often upon the
limitations inherent in each patients type of skin, bone structure,
healing
capacities and overall health status. If
any limitations exist in your case, they will be pointed out and explained
factually and honestly.
Certain patients
are simply not good candidates for surgery, and may be understandably
disappointed when plastic surgery is not recommended
or
is delayed until a more appropriate time
when results will be better.
The goal of cosmetic surgery is to make you
look as good as it is possible for you to look.
Surgery cannot do more than that.
We always try to pro
duce
natural facial features, thereby improving appearance and minimizing facial
abnormality. When we discuss the various
procedures in this booklet,
we
are speaking in terms of the average case; individual variations certainly
exist.
FIRST
THINGS FIRST
Facial
plastic surgery is concerned with improvement in the appearance and function of
facial structures. It is well accepted in
the United States with more than one-half million people having such surgery
each year. However, many people still
know very little about this surgery. You
have chosen to learn more and to consider some form of facial plastic
surgery. This booklet is written to
provide you with basic information and make you a better informed patient.
A
REALISTIC ATTITUDE
Any plastic surgery should be regarded as a
way of making a deformity less conspicuous, thereby minimizing attention drawn
to the deformity. The improved
appearance often results in increased self-satisfaction and
self-confidence. Facial plastic surgery
can greatly help, for instance, in minimizing the psychological harm due to
physical deformities such as protruding ears, oversized noses, birthmarks, and
a host of facial blemishes, sags, wrinkles, and scars. Plastic surgery, however, will not serve as a
cure-all for the individual who blames his appearance for his lack of success
in life. Those patients who expect
miracles or magic from facial plastic surgery will be disappointed. From the perspective of aesthetic results, improvement is a more realistic goal
than is perfection. As stated earlier, in all plastic surgery,
results will depend not only on the skill and experience of the surgeon, but
also on the age, health, skin texture, bone structure, healing capacity, and
specific problem of the patient. Many
patients,
because
of these variables and because of physchological
considerations do not make appropriate candidates for plastic surgery. No surgical procedure should be taken
lightly. A slight but real risk is
involved in every surgical procedure.
The patient must receive medications prior to, during and after
surgery. While they are uncommon in
plastic surgery, reactions can, and do, occur.
Therefore, the patient should enter into surgery with the realization
that he or she is consulting a surgeon and not a beauty salon.
RISKS
OF FACIAL PLASTIC
SURGERY
All surgical procedures have
risks associated with them. Every
surgical procedure, even a simple tooth extraction, involves some degree of
risk. Risk is defined in terms of
possible complications or mild disappointments that surgical results may not
match ones expectations. Although quite
rare, other risks may include reactions to medications or anesthesia,
infection, poor healing, numbness, swelling, injuries to muscles or nerves,
discoloration of tissues, scarring, and even death. Every patient should be aware of these
possibilities and is encouraged to inquire about the realistic risks associated
with their contemplated procedure. Every
patient is also encouraged to discuss any concern or fear with the surgeon
before going into surgery.
To reduce some of the risks inherent in any
surgical procedure, the Facial Plastic Surgeons and staff in the Department of
Otolaryngology/Head and Neck Surgery work closely with qualified professionals
in all areas of expertise to assure that you will be exposed to a minimum
degree of risks. Our operating rooms and
recovery rooms are staffed by registered nurses. They are superbly trained and experienced in
all aspects of facial plastic and reconstructive surgery patient care from
pre-operative discussions to post-operative care. They continue to attend courses to keep their
skills and knowledge updated and are trained in
emergency care procedures. Anesthesia
services are provided by licensed anesthesiologists (physicians).0
The great majority of our
surgery is performed on an outpatient basis in our Outpatient Operative
Suite. This suite has been carefully
designed with the most modern and complete equipment, while providing a relaxed
and comfortable setting for our patients.
Cardiac monitoring and all possible emergency procedures are provided. We take great care to make sure that your
care in our suite will equal or exceed that found in any facility
elsewhere. Although medical students,
residents, and fellows (physicians in training) may often accompany your
surgeon to the operating room and on office visits, all of your operation will
be performed by your own surgeon. We are
available 24 hours a day at the phone numbers listed on the back cover of this
booklet. A physician from the Department
of Otolaryngology/Head and Neck Surgery will always be available to answer any
questions that arise.
MEDICAL
PHOTOGRAPHS
Medical photographs are
routinely obtained in order to help the surgeon plan the meticulous details of
each operation. You will be photographed
in the office as a part of your initial consultation. These pictures then become an integrated part
of your medical record in our office.
Your consent for us to take and use photographs for educational purposes
will be specifically requested if we would like to use your pictures for such
purposes. Education is a vital part of
our commitment to teaching younger surgeons and colleagues.
ANESTHESIA
It is our practice to use
twilight intravenous anesthesia for most of our procedures. However, with the availability of skilled,
board certified anesthesiologists on staff with us, the full range of
anesthetic services are available. This
includes general anesthesia if it is appropriate for you in order to treat your
condition or concern.
You may receive pre-operative
medications to help you relax before arriving in the operating room. Medications are then given intravenously to
produce twilight anesthesia, found by most patients to be pleasant and
comfortable. A local anesthetic is then
used to numb the area of surgery. Most
people have no memory of the entire operation but are usually alert upon
returning to their room. Our experience
with conscious sedation ensures that patients are up and around sooner and that
the likelihood of anesthetic complications is reduced. During all but the most minor procedures, a
physician and a nurse, both skilled in conscious sedation techniques are
actively involved in ensuring your comfort and
medical safety during the operation and in the post-operative recovery
period.
FEES and INSURANCE
We will discuss all
fees and provide a written estimate of the charges for your procedure during
your first consultation visit. We have
developed a fee schedule which itemizes both the surgeons fee and
the charges for the outpatient suite.
Our longstanding experience with the conscious sedation technique allows
us to pass on to you a cost savings in not requiring an anesthesiologist to be
present for most procedures. The Facial Plastic Surgery Centers pricing
schedule makes it very economical for patients to undergo facial plastic
surgery, particularly when more than one procedure is being considered. It is our office policy for surgical fees to
be paid one week in advance for elective cosmetic surgery. Since these procedures are not done on an
emergency basis, the patient has time to arrange his or her finances. As a general rule, insurance companies will
not pay claims for surgical procedures performed solely for cosmetic
purposes. Sometimes they will pay for
plastic surgery when cosmetic improvement is the by-product of a procedure
performed to improve function relieve symptoms,
correct a congenital deformity or repair the effects of injury. Since there are many different insurance
policies with variable allowances and coverage amounts, our office staff is in
no position to predict how your company will handle your individual case. Cosmetic surgery
fees need to be paid in advance of surgery. Because of the many changes occurring with
insurance plans, it is very important for you to find out if your policy
requires a second opinion or pre-certification for the procedure and/or for an
overnight stay. If there is a percentage of the procedure that is cosmetic, it
will be quoted separately and that portion will need to be paid for in advance
like all cosmetic surgery.
If your specific
procedure might possibly be covered by your particular insurance policy, our
staff will provide you with assistance in dealing with your insurance company
(third party). However, our office
cannot ethically, and will not, fill out forms in such a way as to make a cosmetic
procedure appear
to be done for non-cosmetic reasons
(insurable reasons) when in fact it is cosmetic. The patient must remember that health
insurance policies are contracts between the insurance company and the
patient. You, the patient, not the
insurance company, are responsible for the charges incurred. After the day of the surgery your
postoperative visits in the first 30 days related to that procedure are
included in (covered by) the surgical fee, when the surgical fee has been paid
in advance.
What Facial
Plastic Surgery
Entails
THE CONSULTATION
Prior to your
consultation visit, our office will have asked you to complete the medical
history questionnaire and bring it in with you.
Be sure to list and describe any medical condition(s) that you have had
in the past or have presently. Please
also list all allergies and all reactions you have had to foods, medicines,
synthetic products, latex rubber, soaps, ointments, surgical tape adhesives,
etc. In addition, carefully list all
medications, vitamins, aspirins, ibuprofens (Advil, Motrin, Feldene,
etc), antihistamines, decongestants, or any medications for skin conditions
that you currently take or use, and that you have taken within the last six
months. Be sure to include all dosages
of each medication and how often you take them.
During your visit we will
discuss your desires and the conditions you wish to have corrected or
improved. This will be followed by an
examination and an analysis of each condition.
We will give you an idea of what we believe can be accomplished in your
particular situation. The expected
improvements of each procedure will be discussed along with the limitations,
risks and alternatives. Please ask any
questions that may concern you about the proposed surgical procedure.
During that first visit, we will
usually take a set of medical photographs.
This is to help us accurately record the existing pre-operative
condition or problem.
Patients who have
time schedules to meet, such as returning to school or work, vacation, or other
commitments, should advise our scheduling staff. If you are interested in
surgery as soon as possible, we need to know so that a period of time can be
reserved in the surgery schedule for your procedure. Preliminary tests such as blood counts,
x-rays, EKGs, and consultations with other medical specialists may also be
necessary prior to surgery depending on your specific condition. Your surgeon will inform you of the need of
these tests during your consultation.
SUBSEQUENT
We may ask you to return to the
office at least once prior to surgery to further discuss the proposed surgical
improvements. This may be particularly
true if we have asked you to see another physician or obtain other medical
consultations. Should you desire an
additional visit before undergoing surgery, please contact our office staff and
schedule another office visit. If the
surgery is planned long after your initial visit, we may ask you to return to
the office prior to surgery to conduct a more recent evaluation, to update
laboratory and other tests, to review and refresh your memory, and to answer
any new questions that you may have.
PREPARING FOR SURGERY
We ask that you not take any aspirin,
ibuprofen, or any drugs containing aspirin compounds, or vitamin E over and
above what is already in a multivitamin, for two weeks prior to surgery. These medications can prolong bleeding and
increase the risk of post-operative hemorrhage.
Medicines that contain acetaminophen (i.e. Tylenol) can used safely in place of aspirin for pain. They are available without a
prescription. We also ask patients who
smoke to refrain from doing so for two weeks before and two weeks after the
surgery. The nicotine contained in the
tobacco causes constriction of the blood vessels which supply oxygen to the
skin and underlying tissues. Any
restriction of this blood flow will jeopardize the healing process and lead to
a less favorable outcome from the procedure.
Surgery can be stressful. Do not try to wedge in your procedure
between multiple trips and other commitments.
Give your body and yourself time to adequately prepare for, and recuperate
from, the efforts of surgery. It is
important and helpful for you to be well-rested and relaxed
pre-operatively. In this way, your body
will be better able to handle the stress of surgery.
DAY OF SURGERY
Do not eat or drink anything,
including water, after
For
your own safety and comfort, do not wear any facial or eye makeup the day of
surgery. Wash your face thoroughly with
a mild soap (Ivory or Neutrogena) and warm water. Do not wear contact lenses. If you wear dentures, keep them in. On the morning of your surgery you will be
admitted to the Day Surgery area. You
will exchange your street clothes for a hospital gown. An I.V. will be placed, through which you
will receive pre-operative medication. A
nurse from the Outpatient Surgical Suite will transport you to the operating
room. Your nurse will be with you during
the entire procedure and can answer any questions you may have. Medication given in the operating room
to
be pleasant and comfortable. A local
anesthetic is then used to numb the area of surgery. Most people have no memory of the entire
operation but are operating room. Medications
are then given intravenously to produce twilight anesthesia, found by most
patients usually alert upon returning to their room. Our experience with twilight anesthesia
ensures that patients are up and around sooner and that the likelihood of
anesthetic complications is reduced.
During all but the most minor procedures, a skilled physician
anesthesiologist is actively involved in ensuring your comfort and medical
safety during the operation and in the post-operative recovery period.
FINANCES
We will discuss all fees and
provide a written estimate of the charges for your procedure during your first
consultation visit. We have developed,
in conjunction with OHSU, a package price for our patients which includes the
surgeons fee, the charges for the outpatient suite, and anesthesia
coverage. This package price makes it
much more economical for patients to undergo facial plastic surgery,
particularly when more than one procedure is being considered. It is our office policy for surgical fees to
be paid two weeks in advance for electric cosmetic surgery. Since these procedures are not done on an
emergency basis, the patient has time to arrange his or her finances. As a general rule, insurance companies will
not pay claims for surgical procedures performed solely for cosmetic
purposes. Sometimes they will pay for
plastic surgery when cosmetic improvement is the by-product of a procedure
performed to improve function relieve symptoms,
correct a congenital deformity or repair the effects of injury. Since there are many different insurance
policies with variable allowances and coverage amounts, our office staff is in
no position to predict how your company will handle your individual case. If there is a percentage of the procedure that
is cosmetic, it will be quoted separately and that portion will be due from you
like all other cosmetic surgery.
The following section of the booklet discusses many of
the procedures performed by our facial plastic surgeons. Please proceed to the portions which are of
particular interest to you.
Rhinoplasty:
Creating the Nose
You Always Wanted
Rhinoplasty is the
surgical procedure for correcting structural deformities of the nose. It involves redesigning the nose either by removing
excess tissues or correcting insufficiencies to improve overall nasal contour
and function. Your surgeon can shorten a
long nose, narrow a wide one, reduce a wide tip, lower a high nose, and
straighten a crooked one. The incision
is usually hidden to avoid visible scarring.
Rhinoplasty is usually performed
on an outpatient basis. You may be
required to wear an external splint for a few days. During this time you can resume non-stressful
activities like bathing shampooing and walking.
After the splint is removed the nose may appear slightly swollen. Within two weeks after surgery, most patients
can return to full activities. Although
most of the swelling will be resolved after the first two weeks following
surgery, the final results may not be evident for several months due to the
normal healing process.
Mentoplasty:
Creating Facial Balance
through Chin Augmentation
Ideal facial balance starts with
an ideal bony structure. This can be
achieved through sculpturing and contouring your existing facial
framework. One of the most commonly
performed procedures to accomplish this is mentoplasty,
or chin augmentation.
A mentoplasty
can bring a receding
or weak
chin into better harmony with other facial features and creates a more pleasing
balance. Because mentoplasty
can improve the results of a rhinoplasty or facelift it is often done in
conjunction with these procedures.
After numbing with a local
anesthetic, an incision is placed usually underneath the chin in a preexisting
skin crease. An implant is placed
underneath the soft tissue at the point of the chin to enhance the chins
projection. Improvements are noticeable
immediately after surgery, although some swelling is to be expected. An external dressing is usually applied and
left in place for a few days to aid in stabilization during the healing
process.
MALAR
AUGMENTATION:
Highlighting the Cheeks
Another common way of contouring
facial framework to achieve greater beauty is through cheek augmentation. Traditionally, strong cheekbones have been
considered signs of beauty because they add to the definition of the face and
help improve facial harmony. In
addition, some malar implants may give even a more
youthful appearance to the face and can enhance the results of a facelift.
The surgery is done with a local
anesthesia and mild sedation or twilight anesthesia. The implant is placed through an incision in
the mouth hidden under the upper lip above the gum line. Dissolvable stitches are used and there is no
visible scar. There is minimal
discomfort associated with this surgery and swelling resolves rapidly. You can return to work and other activities
within two to four days.
Protruding
Ears:
Making Them Inconspicuous
The
ears are ideally positioned close to the side of the head. Anyone with protruding ears knows the hurtful
teasing which their ears may provoke.
This harassment is even more intense in primary school-age children.
Classroom teasing
can be avoided by having corrective surgery before the age of six - but it can
be done at any age, even adulthood.
Other outer ear deformities can be corrected by surgery as well. In young children a general anesthetic is used. In adults, a local anesthesia with IV
sedation is usually preferred. The surgery
is performed through incisions behind the ears so that there is no scaring
visible. A helmet-type bandage is worn
for several days after surgery. You can
return to your normal routine in one week.
Facial Sculpturing
This is a method of removing fat
from the neck to redefine the jawline. Sculpturing is performed either by direct fat
removal or with liposuction and is most often done together with facelift
surgery, although in some cases it may be done without a facelift.
The bandages are removed three
to five days after outpatient surgery and you are allowed to resume easy
activities. Within a week you can return
to work and commence full activities.
Facelift Surgery:
A
Younger Looking You
Facelift
surgery has become one of the
most popular and well-known forms of cosmetic surgery. More and more aging people want to look as
youthful as they feel physically and mentally.
The surgery is designed to
remove or reduce wrinkling caused by loose skin, and to lift and tighten
sagging tissues of the lower face and neck.
The incisions are placed in front of and behind the ear in the natural
creases of the skin and in areas which help hide the scars. The skin is separated from the underlying
tissues and gently smoothed back to relieve the redundant folds. We will often perform tightening of the
underlying muscles of the face in order to provide this smoother skin a solid
foundation to rest upon. The excess skin
is then removed and the remaining skin is brought back into position.
The degree of improvement
depends upon the amount of wrinkling and sagging of tissues present. The results can be dramatic if wrinkling is
marked, but may be more subtle if the patient is younger and has only early sagging. No operation, of course, can permanently
prevent aging, but with surgery you can be restored to a more youthful
appearance. As the years go by you may
wish to have additional rejuvenation procedures to lessen other signs of aging. The facelift does not speed the aging process
and actually serves to help slow the sagging.
The surgery is performed on an
outpatient basis. You can resume
non-stressful activities during the first week.
In about ten days you can wear makeup and resume most normal activities. Final healing can take several weeks. It is important to understand what a facelift
can and cannot do. It can smooth the
skin on the temples, face, check, and neck areas. However, it does not improve the eyelids,
eyebrows, horizontal forehead creases, or the small vertical creases about the
lips. Other procedures discussed here my be combined with a facelift to give a rejuvenated
appearance to the entire face.
Forehead
Lift:
An Upper Facelift
One of the earliest signs of
aging is the drooping of the eyebrows.
This causes the eyes to appear smaller or deeper set and accentuates crows feet, the wrinkles often found at the outer corners
of the eyes. In addition, furrows may
appear horizontally and vertically as the brow descends. These conditions can be dramatically improved
with a forehead lift. We will often
recommend this in conjunction with or in place of a facelift to help in facial
rejuvenation.
The incisions are made in such a
way so that they are hidden. The skin is
separated
and tightened. Some of the smaller muscles
in the forehead which cause the deep furrowing may be weakened to reduce the
severity of the frown lines. The
procedure is frequently combined with a blepharoplasty
in opening up and rejuvenating the eyes.
For the first week after
outpatient surgery you may engage in relaxed activities, and then begin to
resume normal activities the following week.
Final healing may take several weeks.
Blepharoplasty:
Creating Less Tired Eyes
Age brings changes to the eyes
much as with other facial features. The
muscles around the eyes often weaken, allowing fatty tissue to protrude through
them, producing the commonly seen bags or pouches. Although this is often associated with the
aging process, it may also be an inherited characteristic, or related to certain
diseases. In addition, as the eyebrows
descend, an accumulation of excess skin above the eyes can lead to a tired,
hooded appearance.
Blepharoplasty
(eyelift surgery) is designed to eliminate excess skin and fat in your upper
and lower eyelids.
Most commonly, both upper and
lower lid corrections are done during the same procedure. The incisions are hidden in the skin creases
or on the inside surface of the lower eyelids.
After the excess tissues are removed the wound is meticulously closed.
After outpatient surgery some
temporary swelling and bruising of the eyelids may develop. Minimal restrictions are placed on activity
for one week and you may resume normal activities the following week. Eye makeup may be worn after the first week.
Chemical
Peel:
Freshening Tired Skin
Aging skin develops fine lines
and wrinkles along with changes toward a more sallow com-
Dermabrasion and
Scar
Revisions
Different types of scars can be
improved by using a variety of techniques.
The overall goal of improvement is to minimize the appearance of the
scars. You must realized
that it is not ever possible to completely remove all traces of the scar since
the body can only heal by forming a new scar.
The goal of scar revision and dermabrasion is
to render a scar less conspicuous.
Scar revision and dermabrasion procedures are done either in the office
setting or in the outpatient surgery area.
Healing generally takes several days and there is usually minimal
restriction on activities. On occasion a
scar revision surgery is combined with dermabrasion
in a staged fashion to achieve the best results possible.
Dermabrasion
is an excellent means of providing overall improvement in acne scarring. The scarring cannot be completely removed,
but when combined with other minor procedures and, rarely, a complete facelift,
dermabrasion can provide excellent smoothing of
noticeable acne defects. The acne itself
must be quiescent or inactive prior to dermabrasion.
Excision:
Removing Skin Cancers,
Moles, Tattoos
If you have skin cancer,
blemishes, moles, or tattoos, surgical excision may be an option. Even though most moles are not dangerous, a
certain type of flat, deeply colored variety may precede a highly malignant
skin tumor.
There is usually a small scar
which results from this type of surgery, but these generally blend well with
the surrounding skin.
The great majority of our
surgery is performed on an outpatient basis in our Outpatient Operative
Suite. This suite has been carefully
designed with the most modern and complete equipment, while providing a relaxed
and comfortable setting for our patients.
Cardiac monitoring and all possible emergency procedures are provided. We take great care to make sure that your
care in our suite will equal or exceed that found in any facility
elsewhere. Although medical students,
residents, and fellows (physicians in training) may often accompany your
surgeon to the operating room and on office visits, all of your operation will
be performed by your own surgeon. We are
available 24 hours a day at the phone numbers listed on the back cover of this
booklet. A physician from the Department
of Otolaryngology/Head and Neck Surgery will always be available to answer any
questions that arise.
MEDICAL
PHOTOGRAPHS
Medical photographs are
routinely obtained in order to help the surgeon plan the meticulous details of
each operation. You will be photographed
in the office as a part of your initial consultation. These pictures then become an integrated part
of your medical record in our office.
Your consent for us to take and use photographs for educational purposes
will be specifically requested if we would like to use your pictures for such
purposes. Education is a vital part of
our commitment to teaching younger surgeons and colleagues.
ANESTHESIA
It is our practice to use
twilight intravenous anesthesia for most of our procedures. However, with the availability of skilled,
board certified anesthesiologists on staff with us, the full range of
anesthetic services are available. This
includes general anesthesia if it is appropriate for you in order to treat your
condition or concern.
You may receive pre-operative medications to
help you relax before arriving in the