Procedures

• BOTOX®: Botox® is designed to paralyze the injected muscle in order to minimize the appearance of facial lines, which are the hallmarks of aging. Generally, its effects last about 3 months, though this length will vary by individual. Before injection, do not take aspirin or ibuprophen-like medication, as it will increase the likelihood of bruising. Areas treated are commonly the forehead, the crow's feet (just lateral to the eyes), and between the eyebrows. It may take a few visits to fine tune an individual treatment for you. We keep record of where and how much you are treated. This helps us get more predictable results. We charge by the amount of Botox® injected (known as units). We schedule Botox® days to keep costs down, and to minimize wasting unused Botox®. Individuals with previous allergic reaction to Botox®, pregnant or planning to become pregnant, allergies to amino glycosides such as Gentamycin, sensitivity to albumin or eggs, or with neuromuscular disorders such as multiple sclerosis or muscular dystrophy should not be treated with Botox® for cosmetic reasons.

• INJECTABLES (such as RESTYLANE®, JUVEDERM®): Both these injectables are hyaluronic acids. They are injected into the skin to smoothen out wrinkles. Common areas treated are the nasolabial lines (the lines lateral to the nostrils and above the lips), marionette lines, and cheek lines. The lips can also be augmented or plumped up. These injections are generally done under local anesthetic block to minimize the discomfort of the injection. The effects last about 6 months, though sometimes longer by my clinical observations. If you are getting your lips treated and have a history of cold sores of the lips, you will need to be treated with anti-viral medications before and after treatment. The charge for the injectables is by the number of syringes used or requested. Expect some bruising and swelling after injection.

• MICRODERMABRASION: Microdermabrasion is a superficial skin peeling preformed with sodium bicarbonate crystals (similar to salt). No anesthesia is required. Peeling may be notice 1-2 days after treatment. A slight pinkness of the skin may be noticed for an hour or two after treatment. Generally, 5-6 treatments are done 1-2 weeks apart. The skin is left refreshed and softer with repeated treatments, and maintenance treatments. It helps exfoliate the skin. It is not meant to eliminate wrinkles or age spots as the level treated is the superficial skin.

• OTOPLASTY: This procedure is for correction of prominent ears. Otoplasty is commonly preformed on children. Children are often teased by their peers, which precipitate a consultation with the plastic surgeon. The ears are molded with sutures to hold them in a more natural position. Sometimes cartilage is also removed. This is done under general anesthesia and the patients are sent home afterwards. A headband is often needed to cover the ears for protection of the repair.

• BREAST ENLARGEMENT: One of the most popular procedures performed by Dr. Seballos is breast enlargement surgery. Often, patients have this surgery done so that they can fit better in clothing, have breasts that are more proportional to their bodies, to help them feel more confident, or to return fullness to the breasts after pregnancy or breast feeding. The procedure is done under general anesthesia. The implants are generally placed under the pectoralis muscle through either a breast crease incision, through the areolar margin, or the armpit. Dr. Seballos prefers smooth, round saline implants. Silicone gel implants have been re-introduced into the market for 22-year-old patients or older, but you will have to be enrolled in the post approval silicone study as mandated by the gel implant manufacturers. Recommendations are for an MRI to be done of the breasts 3 years post op and every two years afterwards for study enrollees. As of this time, it is not anticipated that insurance companies will pay for these MRI's. The consultation is critical is evaluating patients pre-op concerns and goals. Also, you will have an opportunity to try on implant sizers to roughly estimate the size you desire and order the implant size that you feel most comfortable with.

• BREAST LIFT: The breast lift or mastopexy is often requested because a woman's breasts have become "droopy" or "saggy". This is often seen after pregnancy/breast feeding completion, and with aging. The nipples are repositioned upward to their more natural position. One has to be aware that scarring is the natural result of incisions used to move the nipples upward. Some individuals scar acceptably, but others may scar poorly. This is often unpredictable despite meticulous surgical technique. This is also done under general anesthesia and with the patient sent home after the procedure. This can sometimes be combined with augmentation should someone request an increase in size as well. Dr. Seballos often stages or separates augmentation and breast lift procedures as two separate operations as he feels he has more control of final results by doing it this way. He may consider combining these two procedures if only a minor nipple elevation is needed.

• BREAST REDUCTION: Breast reduction surgery is popular for those individuals who have breasts too large or out of proportion to their bodies. These individuals often complain of back pain, neck pain, shoulder pain and shoulder grooving from the bra straps, inability to exercise well due to the excess weight of the breasts, rashes under the breasts, and generalized breast pain. Your insurance company may cover this procedure. Additional requirements of documented treatments for pain and estimated amount of tissues to be removed may be required prior to authorization of this procedure by your insurance company. This procedure is done under general anesthesia and drains are left in place under each reduced breast for 2-4 days. An overnight or extended recovery in the hospital or surgery center is the usual plan, with follow up in the office 2-4 days after discharge.

• NECK LIFT: The neck lift is a popular procedure used to tighten the loose skin of the neck and jaw line. The type of anesthesia used and post op course is similar to the facelift. A drain is often used. The neck lift is commonly a component of the facelift. Garments are used post op as well. Liposuction of the neck and tightening of the muscles of the neck may also be done when appropriate.

• COSMETIC EYELID SURGERY (BLEPHAROPLASTY): Cosmetic eyelid surgery when performed on its own is usually done under sedation anesthesia. Surgical candidates complain of heavy droopy eyelids and possibly even visual obstruction. They may also complain of bags under the eyes that make them look old and tired. These bags should not be confused with malar or cheek bags, which will not be improved with eyelid surgery. It may take about 1-2 weeks for most of the bruising to go away. This is also an outpatient procedure. The eyelids are left looking more youthful and refreshed. Some mild swelling may persist for months. Patients prone to having edema and swelling will also notice that this will persist even after surgery and will not be corrected.

• FACELIFT: There are a number of variations of the facelift procedure. Dr. Seballos will make incisions to make them less conspicuous starting from in front to the ear, around the earlobe, and the hairline behind the ear into the neck. The purpose of the facelift is to rejuvenate the face and to lessen the appearance of wrinkles and the jowls. This procedure can be done under general anesthesia or sedation anesthesia. An overnight stay at the hospital or surgery center may be required. Drains are left in place under the skin flaps and will be discontinued in a few days. Dr. Seballos will not perform this procedure on smokers. You should pay close attention to avoiding any and all medications, for the required time period, to decrease your risks of bleeding post op. A compressive dressing is applied post op. When this dressing is removed, a compressive garment is applied, and should be worn for the instructed period of time. Usually with the facelift, the neck is lifted as well. See NECK LIFT.

• BROW LIFT: This procedure is used to lift the eyebrows when they move downward as the results of aging. Prospective patients usually complain of looking angry or tired. This may be done in conjunction with cosmetic eyelid surgery (see below). This procedure is usually done under general or sedation anesthesia though small incisions in the hairline. There are numerous fixation techniques used to keep the brows up until it has healed sufficiently to stay in the desired position.

• BREAST RECONSTRUCTION: Breast reconstruction after mastectomy is a common procedure. For Dr. Seballos, the most common reconstructive procedure is using a tissue expander to stretch the skin, and then subsequent replacement with either a saline or silicone implant. The whole expansion and replacement process can take 6 or more months. This procedure can be done immediately after mastectomy, or after completion of chemotherapy or radiation. If radiation is anticipated, tissue expansion reconstruction is discouraged. Another option is using your own tissue such as a pedicled TRAM flap (skin, fat, and muscle from the abdomen still attached to the muscle and rotated into the breast defect), a latissimus flap (skin, fat, and muscle from the back) with or without an implant, or a free flap (tissue completely removed from one part of the body and whose blood supply is restored using micro vascular techniques). Dr. Seballos does not do free flaps and recommends that you have this done at a tertiary center such as the Cleveland Clinic Foundation, University Hospitals, or Metro. TRAM flap or latissimus flap reconstruction require longer recovery and longer hospital stays in general compared to tissue expander reconstruction. To obtain symmetry, the opposite non-cancerous breast can be reduced, lifted, or enlarged after completion of the breast reconstruction.

• GYNECOMASTIA SURGERY (BREAST REDUCTION FOR MEN): A large percentage of teenage boys have some form of gynecomastia during puberty. However, this is self-limited and resolves within 2 years. Men will seek reduction of breast tissue to improve the contour of the breast and improve their self-confidence. Often, this procedure involves excision of breast tissue directly through incisions around the areola plus liposuction if needed. If there is a lot of excess skin, additional skin removal may be done as well. This skin excision may be done at the same time, but often at a later date when the swelling from the first surgery has resolved. This is called a staged procedure when it is performed as two separate procedures separated by a number of months. Compression garments are needed post op. This is done as an outpatient procedure under general anesthesia.

• LIPOSUCTION: Liposuction is one of the most popular plastic surgical procedures performed. This is done under general anesthesia and as an outpatient procedure. Patients who undergo large volume liposuction may have to be kept overnight at the surgery center for observation and fluid management. The typical procedure involves ultrasound assisted and suction assisted liposuction. Garments are worn post op. Bruising is the norm and may take weeks to resolve. Swelling may persist for months. During surgery, intravenous fluid with lidocaine and epinephrine is injected into the fatty layer to be suctioned to reduce blood loss and provide some initial post-operative pain relief. Common areas suctioned are the neck, thighs, abdomen, chest and hips. Patients that are near or at their ideal body weight are the best candidates for liposuction. Weight gain after the procedure will negate the positive gains produced by the procedure. Cellulite or rippling, uneven skin over fatty deposits is not improved by liposuction.

• ABDOMINOPLASTY (TUMMY TUCK): An abdominoplasty or "tummy tuck" is a common surgical procedure desired by patients wanting to remove excess fat and skin from the abdomen. This helps to improve the contour of the abdomen. Contrary to what is often believed, this is not a weight loss procedure. Patients are encouraged to be near their ideal body weight as possible in order to achieve the best results possible. Overweight individuals are at higher risks for wound healing delay or surgical wound complications. Women who are no longer planning to be pregnant often want the loose skin and stretch marks removed. The abdominoplasty can achieve this. Also, patients who have had massive weight loss after bariatric surgery will often seek to have a tummy tuck. Insurance companies do not typically cover this procedure. The incision is from hip to hip and an incision is also around the belly button. A mini-abdominoplasty removes less skin and does not involve an incision around the belly button. This is best for women with only minor skin excess. The rectus muscle is also sutured during abdominoplasty to the midline (called plication of the rectus fascia) to further tighten the abdominal wall. Patients are of different shapes. So, if one's shape is more rounded due to familial tendency or excess intra-abdominal fat storage, one can expect that this pre-op contour to remain despite doing an abdominoplasty. This can be improved by pre-operative weight loss. Weight gain will eliminate the gains achieved by the abdominoplasty.

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