Nose Surgery (Rhinoplasty)

Nasal reconstruction was one of the first cosmetic procedures ever developed and is among those most frequently performed today. Rhinoplasty is a surgical procedure in which deformities of the nose are corrected by removing, rearranging or reshaping bone or cartilage.

chin augmentation

The chin is important to the overall balance of the face. A large or small chin may create a proportional imbalance with other facial features such as the neck, lips, nose and forehead. A chin that is too large in dimension can be reduced, and the chin that is too small can be augmented.

thread lifting

Ear surgery (otoplasty) is a procedure performed to reshape the ear and give it a more normal appearance. The surgery usually is done on ears that are too large or that protrude from the head.

otoplasty

An eyelid lift, or blepharoplasty, is designed to restore a more youthful appearance to your eyes. It may involve the upper lids, the lower lids, or both.

Blepharoplasty

Facelift surgery, or a rhytidectomy, is designed to restore a more youthful appearance by removing major wrinkles and sagging skin. It involves tightening of the facial and neck muscles as well as the removal of any excess skin.

Face Lift (Rhytidectomy)

The thread lifting is an inabsorbible, nonbiodegradable, biocompatible polypropylene thread and of strong resistance. We have to say, the thread lifting is not absorbed, does not produce allergic reaction, it is not rejected by the organism and it resists the great tensions. The thread lifting replaces the scalpel and therefore the surgeon does not leave you scar.

Nose Surgery (Rhinoplasty)

Dr. Salcedo and Dr. Ramirez perform rhinoplasties in order to reshape the nose but keeping its natural appearence. Appearance can be improved for those people who are unsatisfied with the shape and size of their nose. Nasal reconstruction was one of the first cosmetic procedures ever developed and its among the most frequent surgeries performed today. Rhinoplasty is a surgical procedure in which deformities of the nose are corrected by removing, rearranging or reshaping bone and cartilage.

Reasons for Surgery

Reasons include reducing the size of the nose, removal of bumps as well as improving the angle of a nose. Conditions in which the nose is deviated due to external trauma to the face can also be corrected with this procedure. This operation will also help patients who have respiratory problems. The operation can be performed on all age groups, including teens and the elderly.

Before Surgery

A medical history along with a careful examination are in order to evaluate your general health. We will discuss with you the way your nose might seem in relation to your facial features. Digital photographs and computer imaging allow Dr. Salcedo and Dr. Ramirez to evaluate the appropriate procedure to achieve the desired results. Pre-operative instructions may include the avoidance of certain drugs that contain aspirin in order to minimize the possibility of excess bleeding. Antibiotics may be prescribed before surgery to prevent infection.

Method of Surgery

Surgery is usually performed under IV sedation, which is both extremely comfortable, less swelling and bruising than general anesthesia. In most cases involving a reduction in shape or size of the nose, angle or removal of a hump, the skin of the nose is separated from the underlying skeleton of bone and cartilage. The bone and cartilage are then reshaped and the skin re-draped over the surface. Patients who have a deviated septum may benefit by correcting this problem. The incisions are placed inside the nose, unless the surgeon uses an open approach, in which case the incisions are made across the tissue between the nostrils. In cases where the nostrils flare, the surgeon may make an incision at the junction between the nose and the skin of the upper lip to narrow the flared appearance. It is not unusual to combine rhinoplasty with chin augmentation to improve the profile.

Post-Operative Information

The recovery time takes from one to two weeks. Most people return to their normal activities within a week or two. Following surgery, a lightweight splint is applied to maintain the new shape of the nose. The splint is removed within a week. Nasal splints may be inserted at the time of surgery to protect the septum. These are removed within a week. There is always some stuffiness, swelling, and sensitivity of the nose, especially when work has been done on the nasal septum. The final result will be seen between the third to sixth month after the operation.

Pain is minimal and is controlled with medications. Bruising occurs around the eyes, but begins to fade within a few days. Discoloration usually disappears in two weeks.

Insurance

Your insurance company may pay for all or part of the costs associated with your surgery if it is performed as a result of nasal obstruction. It is recommended that you check with your carrier to determine if there is coverage.

Chin Augmentation

The chin is important to the overall balance of the face. A large or small chin may create an unbalanced proportion with other facial features such as the neck, lips, nose and forehead. A chin too large in dimension can be reduced, and a chin that is too small can be augmented. These surgical procedures are often done in concert with other cosmetic procedures.

It is common for patients to seek chin augmentation. This is accomplished by placing an artificial implant or changing position of the chinbone. The type of procedure depends on the degree of chin recesion and the patient's individual wishes.

If the patient needs an artificial implant for a minor deficiency, a pocket is created by making an incision in the mouth or chin skin. An appropriately sized implant is placed. Following surgery, patients must wear chin dressing and eat soft foods for 2-3 weeks. Patients will experience a brief period of lower-lip discoloration and swelling.

Major chin deficiency will require bone surgery (osteotomy) in which the bone of the chin is moved forward. The procedure is performed through a mouth incision made behind the lower lip. Patients must follow a soft diet for 2-3 weeks. In addition, the lower-lip swelling, discoloration, and altered lip sensation may last longer than previously described.

For chin reductions, an incision is made behind the lower lip. Then using bone reduction instruments, the surgeon molds the chin according to your facial features giving a natural harmony to your face. Following surgery, patients must wear a chin dressing and eat soft foods for two to three weeks. Patients will experience a brief period of lower-lip swelling, discoloration, and numbness.

Thread lifting

The thread lifting is an inabsorbible, nonbiodegradable, biocompatible polypropylene, and very resistant. The thread lifting is not absorbed, does not produce allergic reaction, it is not rejected by the organism and it resists great tensions.

The effect of the thread lifting (pick up the skin of the face) is guaranteed by 3 factors:

1. Thread lifting is equipped with two segments claws that run in opposite senses and direction towards the center of the thread; when the threads are implanted in the deep fat, the claws take firmly in the tissue.
2. As the trajectory and traction exerted by the claws of the thread lifting, run in a backwards and upwards direction of the face, face comes up again.
3. The elevation action of flaccid weaves is still harnessed by the normal inmune reaction of the organism wanting to expel all strange body that is introduced. The fat weave firmly forms a protective coating around the thread creating an artificial ligament of sustentation giving a better aesthetic result with the time.

Indications.

Although is not minimum age, indications in use of thread lifting is indicated to:

• People with more than 30 years old.
• To refresh lifting surgical traditional.
• People who can not use the traditional lifting .
• Older than 80 years, diabetics and cardiologists.
• All kinds of skin: white, tan person and black, because the procedure does not leave scar.

Surgical procedure.

Preoperating examinations.

Hematic biometry and coagulation times as well as complementary examinations that the doctor indicates each individual patient are in order.

The procedure is painless thanks to the application of local anesthesia. The complete duration of lifting including neck takes of 9 to 11 threads and the procedure lasts maximum of 60 minutes.

The thread lifting is implanted in the deep fat of the face, this way the thread doesn't cause elevations or depressions in the face surface.

The procedure of the implantation of threads lifting does not correct flaccid eyelid or the eye bags on the eyes, although is very frequent that such surgical is corrected at the same time to get a better harmonization on the face.

The thread lifting replaces the scalpel and therefore, the surgeon does not leave you scar. The exit and entry points of the cannula guide in the skin are closed immediately, without having side effects like edema (swelling), hematomas (bruises) and scar. As well Dr. Salcedo and Dr. Ramirez do never touch any important nerve. You won´t have to suffer any risk.

The risk of infection is almost nonexistent because the aseptic methods used in the procedure. Combined with the use of antibiotics and anti inflammatory drugs for 5 days.

It is important to know that the threads lifting harmonically needs an average 30 days so that final results are shown.

Postoperative.

At the end of the procedure the face receives a mask of micropore tape to prevent excessive face movements during two days. If the patient needs to return to its normal duties, it can be done inmediatly avoiding laughing and speak too much.

In order to give uniformity to the texture and the coloration of the new skin it is recommended the used of exfoliants, clarify elements, and moisturizing.

otoplasty

Ear surgery (otoplasty) is a procedure performed to reshape the ears and give it a more natural appearance. The surgery usually is done on ears that are too large or protrude from the head. Many times, the problem is caused by an undeveloped middle fold of the ear. In addition to the lack of a fold, there may be other deformities. For this reason, it may be necessary to perform several procedures on the ear at the same time. In most cases, patients need surgery on both ears so that they will be similar. Rarely, only one ear may require surgery.

Otoplasty is done under general anesthesia in children, while adults may have the procedure under either general anesthesia or local anesthesia with intravenous sedation. The patient can return home the same day of surgery.

During the procedure, the surgeon makes an incision behind the ear and weakens the cartilage, which is folded into the proper position and held with sutures. Sometimes, the surgeon will remove cartilage and skin. Rarely, the surgeon will make the incision in the front of the ear. Upon healing, scarring barely shows. Following surgery, a head dressing is applied. After removal of the dressing, the patient must wear a headband at night for a few weeks to keep from pulling out the sutures during sleep. Swelling and discoloration will subside in a few weeks.

In most cases, the results of ear surgery are very pleasing. However, the ears may not be perfectly symmetrical since even normal ears are not exactly the same. In a small number of patients, the ear may return toward the old position and require a second operation. Rarely, one of the nondissolving sutures left in the ear will work its way to the surface and have to be removed.

Once the ears have healed, they are in a more harmonic position that complements the patient's overall appearance.

Blepharoplasty

Eyes are a prominent facial feature. It is the surrounding skin, rather than the eyes themselves, that conveys emotion. The tissue, muscle, fat, hair, and lashes all contribute to the wide number of expressions. Age, sun exposure, and hereditary factors all contribute to wrinkles, deep lines, and puffiness around the eyes.

The aging process can cause unwanted changes in expression, causing us to look permanently fatigued and older than we really are. These changes in appearance can cause emotional distress and sometimes even visual impairment. An eyelid lift, or blepharoplasty, is designed to restore a more youthful appearance to your eyes. It may involve the upper lids, the lower lids, or both.

New and Traditional Techniques

Traditional Blepharoplasty: An incision is made in the crease of the upper lid toward the temples. Once healed, it is not noticeable when the eye is open. On the lower lid, the incision is made along the lash line toward the temples and is hidden by lashes when healed.

The Transconjunctival Approach: This is a newer technique for lid blepharoplasty involving an incision inside the lower lid. Fat can be removed through this incision, but excess skin cannot be eliminated.

Laser resurfacing of the eyelids is a non-surgical alternative that may delay the need for a surgical blepharoplasty. It results in significant tightening of the skin around the eyes, but will not affect the fat around the eyes and may even accentuate it.

Please ask your doctor if you have any questions about which procedure is right for you.

The Surgery

Local anesthesia is given around the eyes. An intravenous line is started so that sedation may also be given. During the procedure you will be awake but comfortable and relaxed. General anesthesia is rarely used.

This procedure is performed on an outpatient basis at our surgical center. It is important to arrange for care after the surgery. Someone must drive you home and be available to care for you for the first 24 hours.

Complications are unlikely when performed by a surgeon with experience in blepharoplasty. These include: bleeding, swelling, delayed wound healing, infection, droping of eye upper or lower eyelid, asymmetry, double vision and dry eyes.

Recovery: What to Expect

The area surrounding the eyes will remain swollen in the days following the surgery. It should begin to subside after the first day. Some vision blurring is normal.

The stitches will be removed in 4-5 days. Swelling and bruising will persist for about 10 days, but you can begin wearing makeup to help conceal these concerns. You may expect to resume normal activity within a week to 10 days, and start enjoying your new look within approximately 10-14 days. It may take about 6 months for the scars to lose their redness.

Wrinkling will recur later in life, however it is unlikely that the "eye sacks" will, because the fat has been removed. Deeper wrinkles around the outer eye extended onto the temple are not greatly affected by the eyelid lift. These areas may be treated with laser resurfacing.

Face Lift (Rhytidectomy)

Facelift surgery, or "Rhytidectomy", is designed to give a youthful appearance by removing major wrinkles and sagging skin. It involves tightening of the facial and neck muscles as well as the removal of any excess skin.

The skin begins to wrinkle and sag as a result of age, sun exposure and genetic factors. Children and young adults have smooth, round faces due to evenly distributed fatty tissues in facial contours. Over time, the skin sags and folds are the chin, jawline and neck become prominent. A facelift not only improves facial appearance but also has a dramatic effect on the neck, enhancing its contour and profile.

A facelift can make a patient look 5 to 10 years younger.

As dramatic as the final results are in short amount time, this is not a simple procedure. It requires a week to 10 days of recovery.

Before Surgery

We will evaluate your medical history in order to determine your overall health.

Dr. Salcedo and Dr. Ramírez will discuss with you how your face can look and what you can expect from surgery. Our objective is to create a natural appearance that is pleasing to you. Before and After photographs will reveal what the surgery has accomplished.

Preoperative Instructions: Avoid drugs that contain aspirin several weeks prior to surgery to minimize excess bleeding. You might be required to take antibiotics to prevent infection, also to wash your hair with shampoo several times the night before surgery. A small amount of hair may be shaved around your ears and temples.

The Procedure

A facelift is frequently performed along with blepharoplasty (eyelid surgery), forehead lift, chin augmentation, and/or liposuction, to create an overall rejuvenation of the face.

The procedure takes place at our clinic as an ambulatory surgery, under the effects of local anesthesia and intravenous sedation. General anesthesia is generally not required but can be used if desired. After the surgery, the pacient is moved to the recovery room until he/she is confortable to leave.

The surgeon will make incisions inside the hairline at the temple, in front of the ear, then around the earlobe and behind the ear, ending at the scalp area. Excess skin is removed and sagging muscles and connective tissues are tightened. In some cases, fat deposits are removed from beneath the chin and neck. Incisions are closed with small sutures.

The procedure may take up to 5 hours depending on whether any other procedures are performed at the same time.

Post Operative Care

It is necessary to have someone drive you home and stay with you for the first 24 hours. Initially you will have a large dressing wrapped around your head. You may have surgical drains attached to bulbs hanging at your neck. These will be removed in approximately 24 hours. Stitches around the ears will be loosened or removed in a few days. The scalp sutures will be removed in 7-10 days.

To minimize scarring, the doctor may remove the sutures in stages. Scarring fades quickly. Swelling and discoloration decrease within two weeks. Tightness in your face will be present for several weeks and there may be slight changes in your hair pattern around the incision.

We recommend that you avoid the sun for several weeks after surgery.

Complications following facelift are rare. These include bleeding, infection, loss of skin behind the ears, facial nerve injury, discoloration of the skin, numbness, asymmetry and scarring. Infection is rare due to the large blood supply to the face. As mentioned, the risk of bleeding is greater if you take aspirin or blood thinners within 2 weeks of the surgery. The risk of wound complications increases in diabetics, persons with a history of radiation, autoimmune and collagen disease as well as in smokers.

By following pre- and post-operative instructions, you will minimize potential problems.

Recovery: What to Expect

In the weeks following surgery, the facial skin and area around the ear may be numb. There may also be some temporary discoloration as healing begins, which may take a few months to disappear. Occasionally, the facial nerve is bruised during surgery, resulting in temporary loss of function or sensation. However, actual permanent damage to the facial nerve is rare.

The healing process is gradual, so you will not notice final results for up to 6 months. A single procedure often achieves the desired results. Most patients who have had facelifts are pleased with their new, more youthful appearance.