1) How does hair transplantation work?

Hair transplantation is really about relocating (transplanting) the bald resistant hair follicles fromthe back of the head to the balding areas on the top of the head. This process works for a lifetime because the hair follicles taken from the back of the head are genetically resistant to baldness, regardless of where they are relocated to

2) Will my hair transplant results look completely natural?

3) How long does a hair transplant procedure take?
A typical session of between 1,500 to 3,000 grafts normally involves a full day of surgery on an out patient basis. Most patients will arrive in the morning and will have their procedure completed by late afternoon.

4) Does the hair transplant procedure hurt?
Patients are given local anesthesia in the donor and recipient areas. Most patients find that once the anesthesia is given that they feel no pain or discomfort during the surgery. Following surgery patients will typically feel some amount of soreness and numbness, with some mild discomfort. Most patients are pleasantly surprised by how minimal the discomfort from the surgical procedure is.

5) What does a hair transplant cost?
Today hair restoration clinics typically provide free no obligation consultations, with surgical sessions priced either per graft or by the session. Prices typically average around $5 to $6 per graft.
It is normal for the price per graft to drop as the size of the surgical session increases. Many clinics will offer a reduced rate per graft once a certain surgical session size (i.e. 1,000 or 2,000 grafts) is exceeded.

6) How many grafts/hairs will I need?
The amount of grafts you will need ultimately depends on your degree of hair loss, now and in the future, and on how full you desire your hair to be.

7) What is the recovery/healing time?
With today’s very refined micro hair transplantation procedure the incisions are very small and less invasive than past procedures. This results in more rapid healing. Most patients feel fine within a day or two following surgery, although some numbness and mild soreness can be expected for several days following surgery.

9) Will people know I had a hair transplant?
Immediately following surgery a patient’s recipient area is typically pink with scabs forming around the micro incisions. These hundreds of tiny incisions will heal rapidly within a week to ten days.

During the first few days after the surgery a person’s hair transplants will be noticeable if there is no previous hair to mask these temporary scabs. However, most patients feel comfortable being in public without wearing a hat within 5 to 7 days following surgery. Once the transplanted hair grows out the results should look entirely natural, even under close examination.

10) When will my newly transplanted hair start to grow?
Normally it takes between three to five months following surgery before the transplanted hair follicles begin to grow new hair. The transplanted hair grows in very thin initially and gradually grows thicker and fuller over time. After one year a patient’s transplanted hair will be fully mature and will continue to grow for a life time.

11) Are the results permanent?
Since the hair follicles that are transplanted to the balding areas are genetically resistant to going bald, they will continue to grow for a life time – just as if they had been left in the bald resistant donor area.

12) How do I find an excellent hair restoration surgeon?
The most important decision in restoring your hair is the physician you choose. The skill, talent, and experience of hair restoration physicians vary widely, as do the end results. Who you choose will determine how natural and full your new hair will be for the rest of your life.

2) My nose sticks out too far. Can you fix that?
What you are describing is the projection of the nose. Take a moment to look at our before and after photos that demonstrates the improvements accomplished by changing the nasal projection. Another term you will here is projection of the nasal tip. The nose tip droops as we age. Many patients who request rejuvenation procedures are surprised to learn that by rotating the nasal tip slightly upwards, the nose regains a younger appearance.

3) How do you remove the bump in my nose?
First, when patients ask about a bump or hump in their nose, they are most often referring to the nasal bridge - the part of the nose that creates the profile seen from a side view of the nose. Plastic surgeons refer to the bridge of the nose as the dorsum and a hump is referred to as a dorsal hump. To reduce the size of this, a rasp (like a nail file or emery board) can be used to shave off and smooth down excess bone. Nasal skin is very accepting of this change and will drape or adhere well to the new shape.

4) When my nose is made smaller, what happens to the extra skin? 
Nasal skin has elasticity so it adheres to the new shape of the nose.

5) My nose is too close to my face. Can you fix that?
Plastic surgeons sometimes use a term "saddle nose" deformity - where the middle of the nose is too close to the face. A low bridge can be traumatic (from an accidental blow to the nose), the result of a disease process or congenital (from birth as seen in Asian noses).

One of the best ways to explain the process of repairing a low bridge is to begin with a look at Before and After Photos. Building up the dorsum of the nose can be accomplished in many ways. Each approach has advantages and disadvantages.

One repair option is to borrow cartilage from the patient's nasal septum, ear or rib. One obvious advantage of cartilage is that it does not introduce something foreign into the patient's body. A disadvantage for ear or rib cartilage is the need for a separate incision. Depending on the amount of cartilage needed, there may not be enough nasal cartilage to accomplish the task.

When trying to build up a bridge that was lowered too close to the face, there is often not enough available cartilage left in the nose from the previous rhinoplasty surgery. Cartilage can be difficult to carve into the right size and shape and can have rough edges that can show through the skin of the nose.

There are many artificial materials that are safe to use in the nose. Gortex®, a material that has been used successfully for years in heart surgery to replace valves, is soft, pliable and smooth under the nasal skin.
Again, ask review Before and After Photos and talk to patients who have undergone rhinoplasty surgery for this same concern. By all means voice your concerns but allow the final decision on how best to augment the nasal bridge to be up to the plastic surgeon.

6) My nose is too long/I have a droopy nose. Can it be shorter?
The profile line from between the eyes to the tip of the nose gives us the length of the nose. In our before-and-after rhinoplasty photographs, we demonstrate how shortening a nose that is too long brings it into proportion with the rest of the nasal features. As we age, the nasal tip loses support and drops. Using a cartilage graft to support the nasal tip, we create a more youthful appearance.

7) My nose is too wide. How do you fix that?
Many factors contribute to the width of the nose including the distance between the nasal bones, cartilage in the tip of the nose that is too wide and the thickness of the nasal skin, particularly at the tip of the nose. If the nose is too narrow or the nasal tip is turned up too much, the result doesn't look natural. Our before and after photos demonstrate how narrowing the nose makes it naturally more elegant.

8) Why is a chin implant sometimes recommended with rhinoplasty?
It's all about balance. Facial features in good proportion are perceived as beautiful. Chin augmentation readjusts overall facial proportions. In some cases, it is possible to reduce the appearance of the size of the nose just by adding the chin implant for balance. If neck liposuction is requested this can be performed through the same small incision used for the chin implant.

9) Will I still look like "me" after rhinoplasty surgery?
Many of our patients report that, upon return to work and routine daily activities, friends and acquaintances make the following remarks: "Gee you look great. Did you change your hairstyle?" or "Have you been on vacation?" Retaining your uniqueness is the sign of a successful rhinoplasty procedure. Although the change may be significant to you, it's not uncommon that friends and family don't really notice the specific changes. Before and After Photos

10) Yes, but I want to dramatically change the appearance of my nose. Can I do that?
This is an excellent question because it leads to evaluating realistic expectations. This question can only be answered on an individual basis. A sign of a good facial plastic surgeon is one who can tell the difference between realistic and unrealistic expectations and one who will be truthful about meeting each patient's desires. Our biggest referral source is from satisfied patients - ones who have had realistic expectations and were satisfied with results.

11) Will I have any incisions in my skin?
Most likely. See the illustration for placement of incisions in the column that supports the tip of your nose. This is called Open Rhinoplasty. These incisions heal very well and most patients and family members will not notice them after a few weeks.
When a patient wants the base of the nose narrowed, tiny incisions called Weir incisions are made in the outer rim (ala) very close to the junction of the nose to the face. Surprisingly, these incisions heal very well and are often imperceptible to others.


12) What's the difference between open rhinoplasty and closed rhinoplasty?
In an "open" rhinoplasty, a small V-shaped skin incision is made in the post that divides the two nostrils so the skin can be lifted up off the tip of the nose. This allows the facial plastic surgeon to work on the nasal tip cartilage in their natural position and see what needs to be done. It also allows better access to evaluate and correct asymmetry, projection (how far the nose sticks out from the face), overall length, a hump and how straight the nose is.
In closed rhinoplasty there is no external skin incision. Some plastic surgeons prefer closed rhinoplasty and can achieve excellent results. We prefer open rhinoplasty most of the time because an incision that heals extremely well is an acceptable trade off for the benefits of increased access and visualization.

13) What if I have a history of bad scars?
If you have pierced ears, the way you healed there is a good indication of how you will heal from your rhinoplasty surgery. Scars on the rest of the body typically are not an indication for how patients heal following facial plastic surgery. At the time of your consultation, it's important to show your plastic surgeon any previous scars that are of concern so he can give you a realistic assessment of your healing potential following facial plastic surgery.

14) Is rhinoplasty surgery painful?
After any surgical  cosmetic procedure, some discomfort can be expected. All patients are provided with prescriptions for pain medication. Patients sometimes use the prescription medication two to three days after their rhinoplasty surgery and then switch to acetaminophen. It is uncommon for patients to report unmanageable pain after their rhinoplasty surgery. Numbness behind the two front teeth is common and temporary.

15) When can I go back to work after rhinoplasty surgery?
Most patients take one week off work but others prefer two weeks. The cast on the nose comes off one week postoperatively. At that time, any residual bruising and swelling can be camouflaged with make-up. Patients who are more concerned with privacy prefer two weeks off work after their rhinoplasty surgery.

16) How long does the rhinoplasty surgery take?
The length of rhinoplasty surgery depends on several factors including the complexity of each person's nose. Many patients who have previously had a rhinoplasty are referred to the Quatela Center for Plastic Surgery for revision rhinoplasty surgery. Revision rhinoplasty is more difficult than primary rhinoplasty and can take a little longer because of corrections that need to be made as a result of the initial plastic surgery.

17) When can I "work out?"
Aerobic activities should be avoided for two weeks following rhinoplasty surgery and heavy weight lifting or more strenuous workouts should be avoided for three weeks postoperatively. It's important to avoid bending, lifting or straining during the postoperative rhinoplasty period as these activities can increase swelling and delay healing.

18) Can I drive myself home after rhinoplasty surgery?
NO. Because of the effects of anesthesia, patients are not able to drive themselves home after the rhinoplasty surgery. If you are from out of town and transportation is an issue, you may want to consider the accommodations at Carriage House located next door to the Surgery Center.

19) I'm from out of town. Where can I stay overnight in Rochester, NY?
Accommodations are comfortable and convenient for Lindsay House clients. The Strathallen, located "just down the street" provides upscale, affordable accommodations for Lindsay House visitors. For added convenience following plastic surgery, some patients elect to stay in our Carriage House, located adjacent to the Lindsay House. For guests without the benefit of family or friends in the Rochester New York area, our staff will be happy to assist you with arrangements for a smooth, restful experience following your rhinoplasty procedures.

20) How long should I stay in Rochester following rhinoplasty surgery?
Most patients stay in Rochester about seven to ten days following rhinoplasty surgery. After that it's ok to fly or travel long distances.

21) How old do I have to be to have a rhinoplasty?
Rhinoplasty should be performed only after nasal development is complete - for most patients this means after puberty. In general, plastic surgeons do not like to perform cosmetic rhinoplasty until a patient is about 16. Along with being more physically developed, a patient under 16 may change their concept of beauty as they mature. A patient needs to be mature enough to participate fully in the decision-making process as well as comprehend fully the procedure itself.

22) I don't like my rhinoplasty result. When can I have revision rhinoplasty?
It is vital that patients wait one full year before undergoing revision rhinoplasty. First of all, final results of rhinoplasty are not evaluated until one full year postoperatively. It takes a year for postoperative swelling to subside and healing to be complete. Changes, however subtle, continue throughout the 12-month course following rhinoplasty. As time goes by, the nose gradually looks different. Features refine as the swelling resolves. These refinements sometimes are enough for a result to be deemed acceptable.

A second consideration is scar formation. Revision rhinoplasty is challenging enough without battling through scar tissue that has not matured. Scar tissue is somewhat more compliant in the hands of the plastic surgeon when it has been allowed to soften over time. Even after a year the presence of scar tissue makes revision rhinoplasty surgery more complex.

Circumstances advocating revision rhinoplasty at less than one year after the primary (first) rhinoplasty are almost nonexistent. If a plastic surgeon recommends revision rhinoplasty at less than one year, at the very least obtain a second opinion. Give your nose every possible opportunity to "settle" and refine before undergoing another rhinoplasty surgery.

23) Why is a revision (secondary) rhinoplasty so much more difficult than a first-time (primary) rhinoplasty?
Many reasons. First, after any cosmetic surgery, scar formation creates a thick, tough layer that is more difficult to work with than original tissue. Second, the original location of (anatomical) landmarks have been altered. Third, cartilage needed to reshape the nose, which was available for use during a primary rhinoplasty, is no longer available to the surgeon performing revision rhinoplasty. Cartilage grafts borrowed from the ear or other parts of the body (as previously discussed) require a second incision. If artificial material is used in revision rhinoplasty, experience selecting and working with artificial material requires advanced skill level. Fourth, the overall skill level required to perform a successful revision rhinoplasty is greater. Revision rhinoplasty has humbled even the most experienced facial plastic surgeons.

24) What's the septum?
The septum is the internal divider of the nose made up of two components: 1) septal cartilage - the mobile, lower part of nose closer to lips, and 2) bony septum - the immobile upper portion of nose closer to eyes.

25) What is a septal perforation?
The nose is divided by the septum, a wall made of cartilage and bone that separates the right side of the nose from the left. A perforation is a hole or opening. Septal perforation is a hole in the septum. Trauma (whether from an accident or repeated nose picking) and nasal surgery are the most common causes of septal perforations but other causes include cocaine drug abuse.

Location and size of a septal perforation makes a big difference. If a septal perforation is small and posterior (close to the face), often times it causes no problems and a patient may even be unaware they have a septal perforation. If a septal perforation is anterior (towards the tip of the nose), air passing through the opening can make a distracting whistling sound. Because airflow is disturbed by the communication between the two sides of the nose, patients complain of nasal airway obstruction. Septal perforations can result in chronic crusting which compounds airway obstruction and creates a maintenance problem. Patients with septal perforations must keep edges of the nose lubricated so they don't dry out and bleed.

From a cosmetic standpoint, a septal perforation can spell trouble. If a septal perforation is large enough, bridge (profile line) support is lost, creating a weakened area in the nose that can collapse. This can result in a "dent" in the profile.

Septal perforation repair is challenging - even for an experienced plastic surgeon. If a septal perforation creates any of the problems discussed above, the perforation should assessed for repair prior to rhinoplasty.

26) What is possible from a revision rhinoplasty?
Nowhere in cosmetic surgery is communication more important than in revision rhinoplasty. It is essential to understand precisely what can and cannot be accomplished from revision rhinoplasty surgery. Few plastic surgeons are expert at rhinoplasty. Only facial plastic surgeons with advanced rhinoplasty skill and experience are qualified for revision rhinoplasty procedures.

When a facial plastic surgeon evaluates a patient for revision rhinoplasty, many factors are taken into account - not the least of which: whether the result the patient seeks is possible with revision rhinoplasty. To answer that question the plastic surgeon will take the following into consideration:

• Projection (how far the nose sticks out from the face)
  Opportunity for correction exists if no significant alteration was made to nasal tip cartilage during primary rhinoplasty
• Length (the length of the profile line from between the eyes to the tip of the nose)
  Opportunity for correction exists if no significant alteration was made to nasal tip cartilage during primary rhinoplasty
• Persistent dorsal hump
  Evaluate opportunity to shave down dorsal hump
• Bridge too low to face (over-correction of dorsal hump)
  Evaluate opportunity for correction with cartilage or artificial graft
• Nose too wide
  Evaluate opportunity for correction by narrowing nasal bones, narrowing nasal tip 
  cartilage, removing excessive scar tissue and evaluate nasal tip skin thickness
• Risk-benefit ration
  Is the improvement worth the risk? For example, will a significant improvement from the primary rhinoplasty be lost in the revision? Is it worth the trade off?
• Patient motivation
  For example, the primary rhinoplasty result is acceptable and the patient is following this year's latest "fad"? 
  Is the patient motivated to deal with the prolonged swelling that often accompanies revision rhinoplasty?

It is critical that the plastic surgeon present a realistic picture of the benefits and limitations of revision rhinoplasty. For patients with realistic expectations, even the most subtle improvements can make all the difference in the world.

27) Will I be awake during rhinoplasty surgery?
Using IV sedation (medicine administered through an IV) and local anesthesia (numbing medication administered in the surgical area), patients are asleep during rhinoplasty surgery. Patients do not hear or feel anything and are comfortable during their rhinoplasty surgery. Patients wake up very soon after the surgery is completed. Intravenous sedation is a type of anesthetic; therefore all patients must have a responsible adult to stay with them through the night following rhinoplasty surgery.

28) Can I have a face lift or brow lift at the same time as rhinoplasty?
Plastic surgery such as a browlift to address frown lines between the eyes, facelift to address a "turkey wattle" neck, blepharoplasty to remove "bags" of excess fat and skin around the eyes, and skin resurfacing such as a chemical peel to improve fine wrinkles can all be performed at the time of rhinoplasty.

29) I really want to do this but I'm nervous. What if I get stressed?
It's ok to be nervous. (Frankly, we would be nervous if you were taking this step lightly!) One of the best ways to deal with nervousness is to see what other patients have gone through. Your Consultation gives you an idea of questions that other patients have asked as part of their decision-making process.


RHINOPLASTY PREOPERATIVE INSTRUCTIONS:

1) What do I do to prepare for rhinoplasty surgery?
Although the preparation for your operation is pretty simple, it is an essential element in a successful outcome. To prepare for rhinoplasty surgery, a preoperative appointment will be scheduled with one of our experienced nurses.

2) What happens at the preoperative rhinoplasty appointment?
Many things! To name a few, you will meet with our nurses to review your health history, answer your questions, instruct you on how to prepare for rhinoplasty surgery, receive the prescriptions for use after surgery and tell you what to expect. Most of the instructions are listed here. This list of questions, however, will not take the place of a preoperative rhinoplasty visit, which is essential in determining a patient's understanding and readiness for surgery. We will be sure you are signing for informed consent.

3) What does informed consent mean?
Informed consent means you have an excellent understanding about the benefits of your plastic surgery as well as any risks, and all the preoperative and postoperative information. You are making an "informed" decision as to whether rhinoplasty surgery is right for you.

4) What are the risks of the rhinoplasty procedure?
As part of your initial consultation, your plastic surgeon will review your expectations for rhinoplasty surgery. At that time, he can provide a realistic picture of what surgery can and cannot accomplish. We will provide you with a written list of any risks reported in the medical literature associated with any procedures you are considering. Although risks from cosmetic surgery are uncommon, every patient should be fully informed of every risk associated with surgery.

5) What are some of the other things to do to prepare for rhinoplasty surgery?
We review your health history and any daily medications you may be taking. Because tobacco abuse impedes wound healing, you will be asked to stop for two weeks before rhinoplasty surgery and two weeks following surgery. Our nurses will be happy to discuss over-the-counter aids to help you with this.

6) What about my daily medications before rhinoplasty surgery?
You will have a preoperative appointment well in advance of your cosmetic surgery when our experienced staff will review all medications with you. If you are on "blood thinners," you will be asked to stop them approximately one week before rhinoplasty surgery. We will provide a "Medication List" for instructions on medications and supplements prior to plastic surgery.

7) I take vitamins and supplements. Do I need to stop them before rhinoplasty surgery?
Most vitamins and supplements have few side effects. However, there are some such as vitamin E and ginkgo-biloba that can affect bleeding during rhinoplasty surgery. We will provide a "medication list" that will provide more details. It is also imperative

8) Do I need any special prescriptions before rhinoplasty surgery?
Most patients do not need any special prescriptions before rhinoplasty surgery. Please let us know of any special medical concerns you may have. We do ask you to start Vitamin C, which promotes wound healing, one week before rhinoplasty surgery. We also ask you to start Arnica, a natural herb that significantly decreases bruising, the day before rhinoplasty surgery. Medications used after your nasal surgery are discussed below. You will be asked not to eat or drink anything after midnight the night before rhinoplasty surgery.

9) Why will I be asked not to eat or drink anything after midnight before the rhinoplasty procedure?
Anesthesia medications can cause stomach upset. The best way to prevent after effects from anesthesia will be to avoid food or drink from midnight the night before your rhinoplasty surgery. For patients with special concerns, such as a patient with diabetes, our anesthesia team will be happy to address special arrangements with you ahead of time.

10) What kind of anesthesia will I have?
Using IV sedation (medicine administered through an IV) and local anesthesia (numbing medication administered in the surgical area), patients are asleep during rhinoplasty surgery. Patients do not hear or feel anything and are comfortable while in the operating room. Patients wake up very soon after the rhinoplasty surgery is completed. Intravenous sedation is a type of anesthesia; therefore all patients must have a responsible adult to stay with them through the night following rhinoplasty surgery. Patients may not drive for 24 hours after their plastic surgery procedure and this time may be longer, depending on the procedure.

11) What happens when I check in for rhinoplasty surgery?
Our nurses will help you get ready for rhinoplasty surgery. Please let them know of any special needs you may have. Also, be assured that you have plenty of time for any last minute questions with your facial plastic surgeon.

12) Does someone have to stay while I have my rhinoplasty surgery?
No one needs to stay at the Lindsay House during your rhinoplasty surgery. However, you must have someone available by telephone at all times during your plastic surgery.

13) I'm concerned about privacy.
During a recent independent study, privacy was found to be one of the advantages that attracted people most to the Quatela Center for Plastic Surgery. Because all consultations, office visits, surgical and nonsurgical experiences take place at the same address, the check-in process is completely confidential.

RHINOPLASTY POSTOPERATIVE INSTRUCTIONS

1) What do I look like when I wake up from rhinoplasty surgery?
Following the procedure, you will have a cast on your nose with a drip pad under your nose to collect the mucous drainage. Your nose will be swollen. You may have some bruising under your eyes, however, this typically is more pronounced 24-48 hours after the rhinoplasty procedure.

2) How long will bruising and swelling last?
For most patients, bruising and swelling lasts about a week. If you bruise easily, it could last up to two weeks after rhinoplasty surgery, however, this is uncommon.

3) Can I do anything to prevent bruising after rhinoplasty surgery?
Most patients will have a little bruising. We can minimize bruising by using Arnica before and after the rhinoplasty procedure. Arnica is a natural "herb" that helps prevent bruising.

4) What does it feel like when I wake up from rhinoplasty surgery?
Your nose will be stuffy - like having a bad head cold - and you may experience a headache. We will make sure you are not nauseated or queasy. Our nurses will be right there with you as you wake up from rhinoplasty surgery to give you special attention. You may notice numbness on the roof of the mouth or behind the two front teeth. This will resolve with time.

5) Tell me more about the nasal packing.
After rhinoplasty surgery your nose will be packed with soft nasal packing. There will be soft silastic splints along each side of your septum (divider of the inside of the nose) and a cast on the outside of your nose. The nasal packing will prevent breathing through your nose so you will have to breathe through your mouth. Your mouth will become very dry. Drinks at the bedside along with a humidifier (cool or warm) may help.

6) What's a drip pad?
Following rhinoplasty surgery, soft gauze dressing is placed under your nose to contain draining red-tinged mucous. This drainage through your packs onto your drip pad is normal. Following your rhinoplasty procedure the nurses will teach you how to change the drip pad, which you will need for about 24-48 hours.

7) Why do I have tearing after rhinoplasty surgery?
You may notice that tears run down your cheeks. This is due to swelling and will subside during the first week following rhinoplasty surgery.

8) When can I blow my nose after rhinoplasty surgery?
You are not allowed to blow your nose for one week. Avoiding nose blowing minimizes bleeding and swelling following rhinoplasty surgery.

9) When I'm awake enough, can I drive myself home?
No. Someone will need to drive you home after your rhinoplasty surgery and stay with you that evening. Someone will need to drive you back to the Quatela Center for Plastic Surgery the following morning for packing removal.

10) Does someone have to stay overnight with me after rhinoplasty surgery?
Yes. You must arrange ahead of time for a responsible adult to stay with you the first night following rhinoplasty surgery.

11) Are there any dietary restrictions following rhinoplasty surgery?
No. Patients can eat whatever they want. Advance your diet from liquids to soft food to solids as tolerated. Please drink as much fluid as you can which will help you from becoming dehydrated. Also, it's not uncommon to have temporary numbness on the roof of the mouth (palate) behind the front teeth following nasal surgery so you may want to avoid extremely hot beverages immediately following rhinoplasty surgery.

12) Will I need any special prescriptions following rhinoplasty surgery?
Yes. Postoperative prescriptions are provided well in advance of rhinoplasty surgery day so you arrive home completely prepared.

13) When do I start taking these prescriptions?
Patients take their pain medication as needed. The other medications begin the evening following the rhinoplasty procedure.

14) When can I shower?
The nasal cast must remain dry and in place for one week following rhinoplasty surgery. Therefore, you should not shower until after the cast is removed. You may bathe and wash your hair in the sink any time following the rhinoplasty procedure.

15) What if my cast falls off?
While you are asleep, we warm the material that is used for your cast and gently apply it to your nose. As the cast cools, it takes the shape of your nose so it stays in place. It is very uncommon for a cast to fall off. If it does, just call us and we'll give you specific instructions. You will have a phone number to reach us 24 hours a day.

16) What if I have a lot of bleeding?
It 's not uncommon for patients to be anxious about this. We will teach you ahead of time how much drainage is too much. Our plastic surgeons and staff are available 24 hours a day to see you or just reassure you. If you have too much drainage, most commonly we meet patients in the office to help decrease the bleeding. You will be given the telephone number for our professional answering service if you need to page us for any concern. 

17) When is my first postoperative rhinoplasty appointment?
You will be asked to come to the Quatela Center for Plastic Surgery the following day for packing removal. Removal of nasal packing has been described by most patients as discomfort rather than pain. Packing removal will help relieve some of the pressure, however, due to swelling, you will not be able to breathe well through your nose for one week after rhinoplasty surgery.

18) Are there any instructions about routine daily activities?
Sleep with head of the bed elevated or use two to three pillows. Sneeze with your mouth open and do not blow your nose for seven days. Nasal congestion, facial fullness, headache and disrupted sleep are very normal postoperative symptoms and will decrease as the healing process occurs. Absolutely no bending, lifting or straining. If you have little children, bend at the knees or sit on the floor and let them climb on to your lap.

19) When will I look normal?
Most of our patients tell us that they look "normal" at about two weeks after their rhinoplasty surgery. You will still notice swelling and your final result is still a ways off. However, at two weeks you know you are well on the way to recovery.

20) How long does healing take?
Healing from rhinoplasty to evaluate the final result takes one full year. However, after three months, most patients have about 90% of their final result.

21) Can I wear my glasses or contacts after rhinoplasty?
It's best to allow a day or so before using your contact lenses following rhinoplasty. It's not uncommon for patients to tell us that giving their eyes a temporary rest from the contact lenses feels good for the first two to three days following rhinoplasty. It's OK to rest your glasses on the nasal cast. However, one week following rhinoplasty the cast is removed. At that time we will show you how to use the Frame-Ups ®to prevent your eyewear from resting directly on your nose. We strongly recommend that you use the frame-ups for postoperative rhinoplasty week #2 - which is the week following cast removal.

22) How can I learn more about rhinoplasty?
Several ways. First Contact Us or call (585) 244-1000 for any questions. If our Patient Care Coordinator can't answer them, she will gladly forward them to the appropriate plastic surgeon or staff member. You can learn more about how to Select A Plastic Surgeon, what happens at Your Consultation: Cosmetic appointment, or more about the training and experience of our Plastic Surgeons & Staff. We look forward to hearing from you!

1) How long will I be out of work?
This obviously depends on the type of work being done. Some general guidelines are as follows. Upper arm movements like reaching should be avoided for the first 1-2 weeks. Driving can begin after this time as long as the patient no longer needs pain medication. Patients should not lift anything heavier than 5 pounds for six weeks after the operation. This lifting restriction may prevent some women from returning to work. 

2) How long before I can exercise?
It is recommended that patients begin walking immediately after surgery. However, women should not perform any intense physical exercise for six weeks following the operation. Physical exercise including weight lifting, biking, jogging, and other forms of intense activities may cause implants to shift position or cause wound healing problems that may alter the appearance of the breasts after surgery. 

Women may start driving a car one week after surgery as long as they are not taking any pain medications. 

The pain from breast augmentation surgery generally can be well controlled with medication in the first 1-2 weeks following the surgery. It is important to note that severe or untreatable pain following surgery can mean infection or another complication. 

"Breast size" as measured by bra-size is variable and is often not a good way to measure final size. As a general rule, every 125-150cc of implant volume equals an increase in a single cup size. However, every patient's body is different. 

Unlikely. Depending on the size of the implant, most women find no trouble performing most physical activities following the surgery. Weight lifting, or lifting heavy objects will not affect the implant once the scar has properly healed. In fact, women body builders with implants attest to this! 

Yes. Placement of the implant below the breast tissue, as in subglandular placement, does not affect the ability of the breast to produce milk. Similarly, submuscular placement, or implant placement below one of the chest muscles preserves proper breast functioning. With the peri-areolar incision, an increased risk of breast-feeding problems may exist. In one study, 7/8 patients reported problems with breast-feeding following peri-areolar breast augmentation surgery. For women who choose the infra-mammary or trans-axillary incision, (incisions under the breast and through the armpit), breastfeeding is usually not a problem. 

Yes. Studies have shown that babies that are breast-fed by mothers who have received breast implants are not at increased risk of any disease. 

Many studies have addressed this question. It has been found that cancer detection is not delayed by having the implant behind the breast tissue. In addition, the risk of developing breast cancer is the same, as that in women without implants. Women with implants that do develop cancer have the same survival rates as women without implants. Breast implants do make it slightly more difficult to examine the breasts with mammography. However, special views during mammography are used to examine more of the breast tissue. It is slightly more difficult to see the breast tissue with mammography when the implants are placed in the subglandular versus the submuscular position. 

The saline implants that are currently in use have a shell or envelope made of silicone plastic. Silicone "gel" implants that were used from the 1960's until 1992 have been the subject of much controversy and even resulted in the short term ban of silicone gel implants in 1992. After much investigation, the FDA declared in 2001 that silicone implants do not place women at increased risk of disease. 

Sometimes additional surgeries may be required if there are complications from breast augmentation surgery including implant rupture, capsular contracture, or the development of breast asymmetry. In addition, implanted breasts will age just like any other body part and in the future some woman choose to have additional operations to correct the results of gravity and aging. 

Also known as reduction mammaplasty, breast reduction surgery removes excess breast fat, glandular tissue and skin to achieve a breast size in proportion with your body and to alleviate the discomfort associated with overly large breasts.

Overly large breasts can cause some women to have both health and emotional problems. In addition to self image issues, you may also experience physical pain and discomfort.

The weight of excess breast tissue can impair your ability to lead an active life. The emotional discomfort and self-consciousness often associated with having large pendulous breasts is as important an issue to many women as the physical discomfort and pain.

Also known as reduction mammaplasty, breast reduction surgery removes excess breast fat, glandular tissue and skin to achieve a breast size in proportion with your body and to alleviate the discomfort associated with overly large breasts.  

Is it right for me?

Breast reduction surgery is a highly individualized procedure and you should do it for yourself, not to fulfill someone else’s desires or to try to fit any sort of ideal image.
Breast reduction is a good option for you if:

• You are physically healthy
• You have realistic expectations
• You don’t smoke
• You are bothered by the feeling that your breasts are too large
• Your breasts limit your physical activity
• You experience back, neck and shoulder pain caused by the weight of your breasts
• You have regular indentations from bra straps that support heavy, pendulous breasts
• You have skin irritation beneath the breast crease
• Your breasts hang low and have stretched skin
• Your nipples rest below the breast crease when your breasts are unsupported
• You have enlarged areolas caused by stretched skin

The success and safety of your breast reduction procedure highly depends on your complete candidness during your consultation. You’ll be asked a number of questions about your health, desires and lifestyle.

• Why you want the surgery, your expectations and desired outcome
• Medical conditions, drug allergies and medical treatments
• Use of current medications, vitamins, herbal supplements, alcohol, tobacco and drugs
• Previous surgeries
• Family history of breast cancer and results of any mammograms or previous biopsies

• Evaluate your general health status and any pre-existing health conditions or risk factors
• Examine your breasts, and may take detailed measurements of their size and shape, skin quality, placement of your nipples and areolas
• Take photographs for your medical record
• Discuss your options and recommend a course of treatment
• Discuss likely outcomes of your breast reduction procedure and any risks or potential complications
• Discuss the use of anesthesia during your procedure for breast reduction

The decision to have breast reduction surgery is extremely personal. You will have to decide if the benefits will achieve your goals and if the risks of breast reduction surgery and potential complications are acceptable.
Your plastic surgeon and/or plastic surgery staff will explain in detail the risks associated with surgery. You will be asked to sign consent forms to ensure that you fully understand the procedure you will undergo and any risks or potential complications.

• Unfavorable scarring
• Infection
• Changes in nipple or breast sensation, which may be temporary or permanent
• Anesthesia risks
• Bleeding (hematoma)
• Blood clots
• Poor wound healing
• Breast contour and shape irregularities
• Skin discoloration, permanent pigmentation changes, swelling and bruising
• Damage to deeper structures - such as nerves, blood vessels, muscles, and lungs - can occur and may be temporary or permanent
• Breast asymmetry
• Fluid accumulation
• Excessive firmness of the breast
• Potential inability to breastfeed
• Potential loss of skin/tissue of breast where incisions meet each other
• Potential, partial or total loss of nipple and areola
• Deep vein thrombosis, cardiac and pulmonary complications
• Pain, which may persist
• Allergies to tape, suture materials and glues, blood products, topical preparations or injectable agents
• Fatty tissue deep in the skin could die (fat necrosis)
• Possibility of revisional surgery

• Breast reduction surgery can interfere with certain diagnostic procedures
• Breast and nipple piercing can cause an infection
• Your ability to breastfeed following reduction mammaplasty may be limited; talk to your doctor if you are planning to nurse a baby
• The breast reduction procedure can be performed at any age, but is best done when your breasts are fully developed
• Changes in the breasts during pregnancy can alter the outcomes of previous breast reduction surgery, as can significant weight fluctuations

The practice of medicine and surgery is not an exact science. Although good results are expected, there is no guarantee. In some situations, it may not be possible to achieve optimal results with a single breast reduction procedure and another surgery may be necessary.

Breast reduction procedures may be performed in your plastic surgeon’s accredited office-based surgical facility, an ambulatory surgical facility or a hospital. Your plastic surgeon and the assisting staff will fully attend to your comfort and safety.

If you experience shortness of breath, chest pains, or unusual heart beats, seek medical attention immediately. Should any of these breast reduction complications occur, you may require hospitalization and additional treatment.
The practice of medicine and surgery is not an exact science. Although good results are expected, there is no guarantee. In some situations, it may not be possible to achieve optimal results with a single surgical procedure and another surgery may be necessary.

Following your physician’s instructions is key to the success of your surgery. It is important that the surgical incisions are not subjected to excessive force, abrasion, or motion during the time of healing. Your doctor will give you specific instructions on how to care for yourself and minimize breast reduction surgery risks.
Be sure to ask questions: It’s very important to address all your questions directly with your plastic surgeon. It is natural to feel some anxiety, whether excitement for the anticipated outcome or preoperative stress. Discuss these feelings with your plastic surgeon.

Breast reduction procedural steps:

  
What happens during breast reduction surgery?

Breast reduction surgery is usually performed through incisions on your breasts with surgical removal of the excess fat, glandular tissue and skin.

In some cases, excess fat may be removed through liposuction in conjunction with the excision techniques described below. If breast size is largely due to fatty tissue and excess skin is not a factor, liposuction alone may be used in the procedure for breast reduction.

The technique used to reduce the size of your breasts will be determined by your individual condition, breast composition, amount of reduction desired, your personal preferences and the surgeon’s advice.

Medications are administered for your comfort during breast reduction surgery. The choices include intravenous sedation and general anesthesia. Your doctor will recommend the best choice for you.

Incision options include:

• A circular pattern around the areola

The incision lines that remain are visible and permanent scars, although usually well concealed beneath a swimsuit or bra.

• A keyhole or racquet-shaped pattern with an incision around the areola and vertically down to the breast crease

• An inverted T or anchor-shaped incision pattern

After the incision is made, the nipple (which remains tethered to its original blood and nerve supply) is then repositioned. The areola is reduced by excising skin at the perimeter, if necessary.
Underlying breast tissue is reduced, lifted and shaped. Occasionally, for extremely large pendulous breasts, the nipple and areola may need to be removed and transplanted to a higher position on the breast (free nipple graft).

The incisions are brought together to reshape the now smaller breast. Sutures are layered deep within the breast tissue to create and support the newly shaped breasts; sutures, skin adhesives and/or surgical tape close the skin. Incision lines are permanent, but in most cases will fade and significantly improve over time.

The results of your breast reduction surgery are immediately visible. Over time, post-surgical swelling will resolve and incision lines will fade. Satisfaction with your new image should continue to grow as you recover.

When your breast reduction procedure is complete, dressings or bandages will be applied to the incisions. An elastic bandage or support bra may be worn to minimize swelling and support the breasts as they heal.

A small, thin tube may be temporarily placed under the skin to drain any excess blood or fluid that may collect.
You will be given specific instructions for breast reduction recovery that may include: how to care for your breasts following breast reduction surgery, medications to apply or take orally to aid healing and reduce the risk of infection, specific concerns to look for at the surgical site or in your general health, and when to follow up with your plastic surgeon. Be sure to ask your plastic surgeon specific questions about what you can expect during your individual recovery period.

The results of breast reduction surgery will be long-lasting. Your new breast size should help relieve you from the pain and physical limitations experienced prior to breast reduction.
Your better proportioned figure will likely enhance your self image and boost your self-confidence.
However, over time your breasts can change due to aging, weight fluctuations, hormonal factors and gravity.

For many patients, the cost of breast reduction and other elective surgeries is a consideration. Breast reduction costs can vary widely. A surgeon's cost for breast reduction may vary based on factors such as his or her level of experience and the geographic location of the office.
Many plastic surgeons offer patient financing plans, so be sure to ask.
Cost may include:

• Surgeon’s fee
• Hospital or surgical facility costs
• Anesthesia fees
• Prescriptions for medication
• Post-surgery garments
• Medical tests

Breast reduction surgery is generally considered a reconstructive procedure and may be covered by health insurance when it is performed to relieve medical symptoms.
Many insurers determine whether to categorize breast reduction surgery as reconstructive surgery based on the amount of tissue that will be removed.

In any case, pre-certification is required for reimbursement or coverage. Insurance policies vary greatly. Carefully review your policy to determine coverage.

Your satisfaction involves more than a fee
When choosing a plastic surgeon for breast reduction, remember that the surgeon’s experience and your comfort with him or her are just as important as the final breast reduction costs.

Most people who are considering liposuction have many questions about the procedure. This information is not meant to take the place of a professional consultation, but it can help to clear up some general questions you may have.

1)  What is liposuction?
 Liposuction is the most frequently performed cosmetic surgery in the world. It is a simple procedure that improves the shape of your body by removing unwanted or excess fat cells. the procedure is performed by inserting a wand attached to a medical vacuum machine into areas of the body through a small incision.

2) Who can receive liposuction?
Most everyone can be considered a good candidate to receive liposuction. Above all, a candidate should have realistic expectations about what the procedure can do for them. Good candidates will have overall good health, be slightly above-weight and have supple, elastic skin. Liposuction works best for people who have pockets of unwanted fat that have not responded to dieting and exercise.

3) How do I prepare for liposuction?
Everything you need to know to prepare for liposuction will be discussed during an initial consultation with your surgeon. The surgeon will assess your health and discuss a few options that may be available. The safety and the most-likely outcome of the procedure will also be discussed. Once you decide to go ahead with the procedure, the surgeon will give you specific instructions that must be followed in the weeks leading up to date of the operation.

4) How is liposuction done?
 Patients are usually given a general and local anesthesia before the procedure. The surgeon will mark the spots on the body where incisions will be made and where the fat will be removed. After each incision, the surgeon will insert a small, hollow, steel tube called a canula under the skin through the incision. The canula is attached to a vacuum that pulls the fat into the canula to a collection container.

5) What are the different techniques?
 Several different techniques exist for performing liposuction. Two of the different techniques are described below:
Tumescent Liposuction This technique calls for the surgeon to inject a solution into the fatty areas to be treated before the canula is inserted. The injection contains a mixture of saline solution, a local anesthetic and a medication that contracts blood vessels. The injection has several purposes. It loosens the fat, it reduces blood loss, it reduces bruising and it anesthetizes the area.

Ultrasound-Assisted Liposuction In this technique, a special canula is used that has an ultrasound generator attached to it. The ultrasonic waves liquefy the fat cells, making them easier to remove. This method allows for more detailed body sculpturing and a quicker recovery time. Trauma is minimized with the result of less bruising and blood loss.

6) Are there any risks associated with liposuction?
Liposuction is a surgical procedure, and all surgical procedures inherently have an element of risk. Some complications that can be caused by liposuction include infection, bleeding, swelling and pain. The risks associated with the procedure are minimal when compared to other types of surgery. An experienced surgeon in a properly equipped operating room rarely sees serious complications set in.

7)  What type of anesthesia is used for liposuction?
 If only a small amount of fat is being removed, local anesthesia and a light sedative may be all that is required. Larger areas typically require that general anesthesia be administered. Your surgeon will discuss anesthesia options with you before the procedure.

8) What areas of the body can be targeted?
 Any areas with fatty deposits can be targeted by liposuction. The most common areas are the abdomen, hips, thighs, upper arms, neck and legs.

9) What is the recovery time?
 Recovery time varies by individual and by the amount of fat removed from the body. Recovery time also depends on the technique used to perform the liposuction. Most people are able to return to work within a few days and can fully resume their usual lifestyle in two to three weeks.

10)  How long does the procedure take?
Liposuction usually takes one to four hours to perform, depending on the area or areas treated. It is usually done on an outpatient basis, but an overnight hospital stay may be
recommended in some situations.

1) Do I need a Tummy Tuck Surgery?
During the initial consultation with the surgeon, you will be asked about the results you would like to achieve from the tummy tuck surgery. This will help determine whether realistic results can be achieved.
You may be a good candidate for a tummy tuck if you fall into one of the following categories:

1. You are a man or woman in relatively good condition bothered by fatty deposits and loose skin around the abdomen area.
   
2. Have an abdomen that protrudes and is out of proportion to the rest of your body.
   
3. A woman who has excessively stretched her abdominal muscles due to multiple pregnancies.
   
4. Have excess fatty tissue concentrated in the abdomen area.
   
5. Older people who, due to age, have sagging, loose skin on the abdomen or weakened abdominal muscles
   

2) How should I prepare for my Tummy Tuck?

During your initial visit with your surgeon prior to the tummy tuck surgery, be prepared to give a complete medical history including all your medications, allergies and previous surgeries. You will undergo a thorough physical examination and blood tests. If you are over age 50, an electrocardiogram may be taken. Photographs are important aids in planning and performing your Tummy Tuck, these will become a permanent part of your patient record and are taken before and several months after your procedure.

During your consultation, you will be given specific directions to help you prepare for your procedure. Instructions generally include taking vitamins, cautions about taking certain medication and drinking alcohol, the shaving process and use of anti-bacterial soap. You must not eat or drink anything eight hours before your procedure. If you take daily medication, ask your surgeon if it is safe to take before your procedure. If you have any sores on your body, if you have a cold, sore throat or allergic condition, inform your surgeon so you may be examined prior to your procedure.

IMPORTANT: Smokers must stop smoking completely at least two weeks prior to and two weeks after surgery.

3) About the Tummy Tuck surgical procedure..

The Place
The tummy tuck surgery may take place in either the surgeon's state of the art surgical facility or a local hospital.

Procedure Length
A complete tummy tummy tuck surgery normally takes between 2 and 5 hours depending on the particular procedures being performed. A partial tummy tuck, on average, lasts between 1 and 2 hours.

Anesthesia
You and your surgeon will decide on the type of anesthesia to be used in the surgery. A general anesthesia may be employed in order to to allow you to sleep through the operation. The second option is a local anesthesia which will allow you to stay awake for the duration of the procedure, combined with a sedative to keep you relaxed.

The Incision
Generally, a horizontal incision is placed just within or above the pubic area. The length of the incision, which extends laterally toward the pelvic bones, depends largely on the amount of skin to be removed. The contour of this incision will vary somewhat according to the structure of your abdomen and the style of bathing suit or undergarments that you prefer. Your plastic surgeon will try to keep the incision within your bathing suit lines, but this may not always be possible.

Some patients have loose skin above the navel. In such cases, the surgeon may make a second incision around the navel so that the redundant skin above it can be pulled down. The excess abdominal skin is then removed. The position of the navel remains unchanged.
Skin of the lower abdomen that contains stretch marks may be removed as well. Any remaining stretch marks may be somewhat flattened and improved, but you should not expect a dramatic change in their appearance. The procedure may include tightening of the underlying abdominal muscles using sutures.

4) Common Tummy Tuck techniques..

Typical Tummy Tuck:
In most situations, the surgeon will make a long incision from one side of the hip-bone to the other and another to release the navel from surrounding tissue. The skin tissue is lifted to reveal the abdominal muscles which are then tightened by pulling them together and stitching them into their new position. Extra skin is removed and a new hole is cut for the navel before finally closing the incisions.

Mini Tummy Tuck:
In cases where the amount of loose skin is minimal and the excess fat deposits are located below the navel, it may be possible to avoid an incision around the navel. In a mini tummy tuck , a horizontal incision is placed just within or above the pubic area. If there is loose skin above the navel, the surgeon may make a second incision around the navel. Skin in the shaded area is separated from the abdominal wall. To tighten the abdominal wall, the surgeon brings loose underlying tissue and muscle together with sutures. Sometimes liposuction may be used alone, or in conjunction with abdominoplasty, to remove abdominal fat.

Endoscopic Tummy Tuck:
An Endoscopic Tummy Tuck is another technique employed to minimize scarring and may be useful when patients have only a mild degree of excess fat and muscle laxity. Abdominal skin is pulled downward, and the excess is removed. A small opening is made to bring the navel through.

Your plastic surgeon will discuss with you the particular method that he or she recommends for achieving the best result in your particular case.

5) After your surgery..

Pain and discomfort may be felt within in the first few days after your tummy tuck surgery, but these can be regulated with medication. Depending on the procedures undertaken, you may be released within a few hours or remain in the hospital for a few days. During this time, you will notice swelling and bruising in your abdominal area; with time, everything will fade and you'll be back to normal. Any surgical drain applied during surgery will be removed within a week , at which time your dressings may also be changed or removed. Depending on the abdominoplasty technique used, you may be instructed to wear a support garment for several weeks. Stitches will be removed in stages over a period of approximately one or two weeks.

The day after surgery, you will be encouraged to get out of bed for short walks to promote blood circulation. Although you may not be able to stand up completely straight, it is best if you do not sit for long periods of time during the first several days. Straining, bending and lifting must be avoided, since these activities might cause increased swelling or even bleeding. You may be instructed to sleep on your back with a pillow under your knees.

How long before I can return to my normal activities?
It is important to realize that the amount of time it takes for recovery varies greatly among individuals. Depending on the extent of your abdominoplasty and your general physical condition, it may take you several weeks or months to feel like your old self again. Exercise will help you heal better and will reduce the chance of blood clots while toning the muscles. In many instances, you can resume most of your normal activities, including some form of mild exercise, after a few weeks. You may continue to experience some mild, periodic discomfort and swelling during this time, but such feelings are normal. Expect scars to take from 9 months to a year before fully disappearing.

6) How long before I can return to my normal activities?
It is important to realize that the amount of time it takes for recovery varies greatly among individuals. Depending on the extent of your abdominoplasty and your general physical condition, it may take you several weeks or months to feel like your old self again. Exercise will help you heal better and will reduce the chance of blood clots while toning the muscles. In many instances, you can resume most of your normal activities, including some form of mild exercise, after a few weeks. You may continue to experience some mild, periodic discomfort and swelling during this time, but such feelings are normal. Expect scars to take from 9 months to a year before fully disappearing.

Skin Tumors And Cancer:

1) What types of skin cancer are there?
There are three main types of skin cancer: basal cell carcinomas, squamous cell carcinomas and malignant melanoma.  The first two are slow-growing and easy to treat, but malignant melanoma is a dangerous, fast-growing cancer that spreads very quickly.

2) How common is skin cancer?
The official UK figures are 6,000 cases of melanoma a year and 62,000 cases of other skin cancers.  The incidence of melanoma is increasing, probably because of increased exposure to sunlight but also due to better diagnosis.  The figure of 62,000 other skin cancers is an underestimate because these cancers are slow-growing and often remain undiagnosed in elderly people.  Roughly three out of every four non-melanoma skin cancers are basal cell carcinomas and the other quarter are squamous cell carcinomas.

3) What are the risk factors for skin cancer?
For all types of skin cancer, over-exposure to ultraviolet light, from sunlight or sunbeds, is the main risk.  Research into malignant melanoma suggests that over-exposure in childhood puts people at risk of getting melanomas later in life.   There are several other things that increase the risk of skin cancer: having very fair skin that burns easily, having lots of moles (over 50) on your body, having had skin cancer before, your close relatives having skin cancer and being treated with anti-rejection drugs (ie after an organ transplant). 

4) What are the symptoms of melanomas - what do they look like?
The majority of melanomas occur on the head, neck, arms and back - ie the skin exposed most to sunlight.   Most of them are very dark or black, but they can sometimes be lighter brown or even speckled.  The surface is usually raised and sometimes rough.  They are not normally circular in shape, but some can be quite close to a circle.   In their early stages, they often look like a mole, but with a ragged outline or different shades of colour in it.  Sometimes, they appear to be a mole that is bleeding, oozing or crusty.  However, the most important thing is that melanomas usually change shape or colour as they grow.    Any spot that changes colour or shape should be reported to your doctor.

5) What do basal cell carcinomas look like?
The vast majority of basal cell carcinomas occur on the face.  They start as a small, pink, pearly or waxy spot, often circular or oval in shape.  As they grow, they become a raised, flat spot with a 'rolled' edge and they may develop a crust.  Next, they begin to bleed from the centre and an ulcer develops.  This is called a rodent ulcer and, if left long enough, it can become quite large and eat away the skin and tissue below.

6) What do squamous cell carcinomas look like?
Squamous cell carcinomas are most common on the limbs, head and neck.  They are pink and irregular in shape, usually with a hard, scaly or horny surface, although they can sometimes become an ulcer.  The edges are sometimes raised.  They can be tender to the touch.

7) How dangerous are skin cancers?
Malignant melanoma can be one of the most dangerous types of cancer.  They all spread into nearby tissues, but some grow faster and spread further than others.   If diagnosed late, treatment is not usually able to cure the cancer.

Squamous cell carcinomas also spread, but most of them spread so slowly that they are not very dangerous.  Even the ones that spread more rapidly can be effectively treated as long as they are diagnosed reasonably early.

Basal cell carcinomas almost never spread, apart from the slow growth of the rodent ulcer itself.  Even in advanced cases, treatment is almost always successful.

8) Does skin cancer run in families?
There are some rare, inherited skin diseases that make people highly sensitive to sunlight and much more likely to get any type of skin cancer.  People inherit their normal skin type and skin cancer is more common in paler, freckly skin.  In addition, there is good evidence that, if you have a close relative (brother, sister parent or child) with skin cancer, you have about twice the normal risk of getting that type of skin cancer.

9) What causes skin cancer?
Ultraviolet light - from sunlight or sunbeds - is the main cause of skin cancer.  It can damage the DNA that makes up the genes in skin cells.  The wrong type of damage to the wrong genes will make a cell become cancerous.    There are three types of UV light, called A, B and C.    UVC is filtered out by the atmosphere and does not get to our skin.  UVB was originally found to cause sunburn and skin cancer, but more recently, it has been discovered that UVA can also cause skin cancer.

10) Can sun beds cause skin cancer?
UVB is known to cause sunburn and skin cancer, so most sunbeds were originally designed to produce UVA only.  However, more recent research has found that UVA can also cause skin cancers.  As a result, many modern sunbeds produce far less UVA, although others still produce very high levels.

11) Does sun cream protect against skin cancer?
UVB is known to cause sunburn and skin cancer, so sun creams were originally designed to block out only the UVB.  We now know that UVA can also cause skin cancer and, these days, some sun creams block out a lot of UVA as well as UVB.  However, the main concern is that, because sun creams prevent burning, they make people think they can spend much longer in the sun, which will definitely increase their risk of getting skin cancer.

12) How is skin cancer treated?
For almost all non-melanoma skin cancers and for early melanomas, surgery to remove the cancer and a small amount of surrounding tissue is all that is necessary.   If a melanoma has spread, chemotherapy can be used, but it is not usually effective.  After a melanoma has spread, surgery and radiotherapy can be used on the secondary tumours.  This will prolong life but it is not a cure.

13) How effective are skin cancer treatments?
Surgical treatment of non-melanoma skin cancer is usually completely effective.  For melanomas, if the tumour can be removed surgically before it has spread, the treatment is usually very effective.  By removing more tissue around the tumour (the margin), the surgeon is more likely to remove the beginning of any spread and increase the chance of a cure.  Once a melanoma has spread around the body, treatment is usually aimed at prolonging life as the chance of a cure is very small.

14) Is early diagnosis important?
Early diagnosis is absolutely crucial for malignant melanoma (see above) as treatments for advanced melanoma are rarely effective. However, for other types of skin cancer, early diagnosis is sensible, but not a matter of life or death.

Cleft Lip and Palate:

1) What causes cleft lips and palates?
Cleft lips and palates happen when there isn’t proper closure of the facial structure during growth of a fetus. The parts of the face and mouth develop separately, but ordinarily come together in the early months of fetal life. If for some reason the process is interrupted, the fusing may not take place or only partially take place.  It is not known at this time why interruption in the fusing process happens.

For a small percentage of children born with cleft lip/cleft palate there may be a genetic factor. If one parent or child in a family has a cleft, the chances of a future child being born with a cleft increases.

2) What is the best way to feed a new baby with a cleft?
In the initial days feeding may be a challenge. A baby with a cleft may have difficulty making a tight seal around the nipple of a bottle or breast, and the baby with a cleft palate often cannot generate an effective suck.

There are special bottles and nipples which help to make the feeding easier. Some mothers planning breast feeding may decide to pump and use a bottle until the surgical repair has taken place.

Infants with cleft lip and/or palate may have longer feeding times which can cause them to get tired; they may swallow air with feeding. Sometimes breast milk or formula may come out the nose, but being aware of this you can experiment with positioning and some of the bottles available.

3) Where can I get special bottles to feed my baby?
The special bottles (usually a Haberman Feeder or Pigeon bottle) are available from Children with Special Health Needs a division of the Vermont Department of Health. Many hospitals also stock these specialized feeders.

4) When will my baby/child have surgery?
Cleft lips are usually repaired within the first three months after birth or when the baby weighs at least ten pounds. Cleft palates are usually repaired at nine to twelve months of age.

A consultation visit with a plastic surgeon soon after birth will give parents full details about the procedure and scheduling surgery.

5) What is Nasoalveolar Molding (NAM)?
Depending on the width of the cleft and the presence or absence of a cleft palate, a short period of reshaping the mouth and nose may be recommended.

NAM is a technique in which the alveolus (gum ridges) and/or nose are molded with an appliance similar to an orthodontic retainer. This is usually done by a specially trained orthodontist prior to surgery, in order to make surgery simpler.

The baby wears the appliance 24 hours a day for a period of weeks or months.  It does not interfere with feeding or breathing for the baby.

6) Will my child need any further treatment for the teeth?
Nearly all children with cleft palate need braces because the teeth closest to the cleft tend to come in at incorrect angles or not at all. Orthodontics may begin as early as age 5 or 6.

In some older children a “bone graft” is needed to allow the adult teeth to come in properly. Small bone fragments are taken from the hip and placed in the gap in the alveolus (bone edges of the gum) by an oral surgeon. This allows the adult teeth to have a solid surface to erupt into. The orthodontist and the oral surgeon will determine if this is necessary some time between ages 8 and 10.

7) What is Distraction Osteogenisis?
For some children with more severe facial problems more oral surgery becomes necessary when they are teenagers.

Distraction Osteogenisis (DO) is a surgical technique in which bones in the jaw are cut and an appliance applied. This procedure is usually done to advance the mid-face or upper jaw. After surgery the appliance is left on for 6-8 weeks and gradually adjusted, moving the bones (distraction).

The bone then responds by filling the gap with new bone. Mispositioned bones may then be gradually brought into more correct alignment. It may look awkward but is really fairly painless.

8) What is Cleft lip/palate clinic and when is the first visit?
The American Cleft Palate-Craniofacial Association recommends that children with clefts be seen by an team of doctors and care providers to best plan care and treatment.

The team includes:

• Plastic surgeons - perform reconstructive and cosmetic surgery.
  
• Oral surgeon - treats the mouth, jaws and face.
  
• Pediatric otolaryngologist - ear, nose and throat doctor.
  
• Orthodontist - treats misaligned teeth.
  
• Speech pathologist - evaluates and treats speech, language, voice, swallowing, fluency, and other related disorders.
  
• Geneticist - diagnoses, treats, and counsels patients with genetic disorders or syndromes.
  
• Audiologist - diagnoses and treatment of hearing problems.
  
• Social worker - performs casework and counseling.
  
• Nurses - coordinates care, clinic visits, provides support and information.

All have many years of experience working with children with clefts and their families.
The first clinic visit usually happens in the first year, but not necessarily before surgery.  For the first few years children are seen annually, but after that it may be every two or three years depending on the child and his/her needs. Certainly the family may always request an appointment.

9) Why do we need to come to clinic?
Coming to clinic allows the family to see many of the child’s health care providers at the same time. This can save time and travel for the family.

The clinic visit also gives the health care team the opportunity to discuss with each other and the families what may be the best plan for the child’s ongoing care with regard to cleft lip/cleft palate.

The members of the team offer expertise in many issues about cleft lip/palate and can coordinate ongoing services.

10) Why do I need to have my child’s hearing tested?
Annual hearing testing is recommended to monitor children with cleft lip/palate because they are more prone to middle ear infections and problems.
Testing may happen more frequently if middle ear problems last for a long time. If a child shows a decrease in hearing or is having chronic middle ear problems, they may be referred to an ear, nose, and throat (ENT) specialist.  

11) Will my child require speech therapy?
Because of the cleft in the roof of the mouth, children with cleft palate cannot seal off the nose when they talk. This may make the speech sound “hypernasal”.  By repairing the cleft at the appropriate time many children develop normal speech.

Despite palate surgery some children are unable to effectively seal off the nose when speaking and they may require speech therapy or an additional surgical procedure. A surgery called a “pharyngeal flap” uses tissue from the back of the throat to partially close off communication between the mouth and the nose, and improve speech.

12) What can Children with Special Health Needs help pay for?
CSHN is funded by state and federal funds. We can help pay for surgeries and procedures recommended by the clinic team and directly related to cleft lip, cleft palate or other craniofacial difference.

We say “help” because private insurance or Medicaid are always billed first. Some families are asked to pay a portion of the cost or a deductible depending on their income. It is important to complete annual cost share forms; this deductible is based on family income and size, and ranges from $0-$600/per year.

If you have questions about coverage for your child’s treatment talk with the CSHN nurses or social worker.

13) How can I talk to other families who have children with clefts?
The nurse or social worker on the team can facilitate matching families who would like to talk with another family who has experience with a child with a cleft lip or palate.

Burn Contructure:

1) How are burns caused?
Burns occur when heat from any source- hot liquids ( scalds ), hot solids, flames, ultraviolet radiation ( sun burn ) or radioactivity, electricity and chemicals destroy some or all of the different layers of cells which form the human skin. Respiratory insults resulting from smoke inhalation are also burn injuries.

2) What determines the severity of burn?
It depends on the depth the heat has penetrated which will depend on the temperature of the burning agent and the duration of exposure. Also on the surface area of the burn, the body region involved and the age and previous health condition of the patient. Even small burns can be very serious in children. Electric burns are usually very deep burns. Smoke burns can cause severe respiratory insufficiency.

3)What are the first aid procedures?
First remove the heat source, look for associated trauma and remove the non-sticking garments. Cool the burn with cool, clean water as soon as possible. Cool water eases the pain, removes the heat and lowers the temperature of the injured tissue therefore minimizing further injury. Cooling can be effective for 30 to 60 minutes after injury. Then wrap the wound in a clean towel and take the patient to the hospital.

4) What are the problems related to burns?
Large burns cause shock because of the loss of body fluids and infection because the protective covering of the skin is lost and the body immunity is lowered. If the burn wound is allowed to heal without intervention then the skin heals with contraction thus forming contractures which can lead to serious deformity and disability if overlying a joint or other vital areas of the body, besides being cosmetically very demoralizing for the patient.

5) How are burns managed?
The initial management involves resuscitaton for shock, taking care of the fluid balance, relieving pain and preventing infection. The long term management involves preventing the formation of contractures. These days early skin grafting can be done within the first week if the patient is stable. Skin grafting involves taking skin from the healthy areas of the body and putting it over the wound. The skin is the best dressing for the wound. It reduces the chances of getting an infection and prevents the formation of contractures.

6) How can burns be prevented?
The most important thing regarding burn injuries is that 95% of them are accidental and can be prevented with care and precautions. Public places and factories etc. should install proper fire alarms and fire firefighting equipment and should be built keeping the fire safety norms in mind. At home extreme care should be taken while working in the kitchen and children should not be allowed to play there.

1) What is vitiligo?
Vitiligo is a relatively common skin disorder, in which white spots or patches appear on the skin. These spots are caused by destruction or weakening of the pigment cells in those areas, resulting in the pigment being destroyed or no longer produced. Many doctors and researchers believe that vitiligo is an autoimmune-related disorder. Although researchers are not exactly sure what causes the autoimmune response, more is being learned every year. In vitiligo, only the color of the skin is affected. The texture and other skin qualities remain normal.

2) What does vitiligo look like?
Vitiligo appears as uneven white patches on the skin, that may vary from lighter tan to complete absence of pigment. Many people develop vitiligo bilaterally, in other words, if it appears on one elbow, it often appears on the other elbow. Researchers do not completely understand why this is. Others develop what is known as segmental vitiligo, where the patches develop in only one area or on

3) What are the symptoms of vitiligo?
People who develop vitiligo usually first notice white patches or spots (depigmentation) on their skin. The skin remains of normal texture, though some people experience itching in areas where depigmentation is occurring. The white patches are more obvious in sun-exposed areas, including the hands, feet, arms, legs face, and lips. Other common areas for white patches to appear are the armpits and groin and around the mouth, eyes, nostrils, navel, and genitals. Vitiligo generally appears in one of three patterns. In one pattern (focal pattern), the depigmentation is limited to one or only a few areas. Some people develop depigmented patches on only one side of their bodies (segmental vitiligo). For most people who have vitiligo, depigmentation occurs on different parts of the body, in a bilateral pattern (generalized vitiligo). In addition to white patches on the skin, some people with vitiligo may experience white hair growing in on the scalp, eyelashes, eyebrows, and beard.

4) I have vitiligo patches on my underarms, my feet and my genitals. Is this common?
For reasons we don't really understand yet, there are certain parts of the body, which are commonly affected in those who have vitiligo. The face, underarms, hands, wrists, fingers, feet, elbows, knees and genitals are among these areas. There are many theories about why such sensitive areas of the body seem to be commonly affected - the presence of many nerve endings, the bony nature, sweat glands, etc.

5) How does vitiligo develop?
The course and severity of pigment loss differ with each person. In many cases, vitiligo begins in a small area. Over time, other spots may appear, while existing spots may grow larger. Some people notice that their vitiligo may stay the same for years or even decades, and then suddenly new areas of depigmentation may occur. Occasionally, vitiligo patches will repigment spontaneously, all by themselves, with no treatment whatsoever. Many people with vitiligo do notice this happening at some point in their lives.

6) Is vitiligo at all contagious?
Vitiligo is NOT contagious. If it were, many more people in the world, including doctors who treat vitiligo and family members of those with vitiligo, would have the condition. There are many theories about what causes vitiligo, but many experts believe, and data supports the theory, that one must be genetically suscep

CAUSE AND EFFECT:

What causes vitiligo?
There are many theories about what causes vitiligo, and no one is positively certain. However, many doctors and researchers believe that a genetic predisposition or susceptibility to vitiligo exists in most people who develop vitiligo.

Vitiligo may result from a number of factors -- autoimmune, oxidative stress (excess of hydrogen peroxide), neurotrophic (interaction of melanocytes and the nervous system), and toxic (substances formed as a part of normal melanin production actually being toxic to melanocytes) hypotheses have been advanced. The mechanism involves progressive destruction of selected melanocytes, probably by cytotoxic T-cell lymphocytes.

Many believe that vitiligo is a type of autoimmune disorder, in which the body's immune system sees the pigment cells in the skin as foreign bodies, and attacks them. The basis for this autoimmune disorder is believed by many to be genetic. Stress, traumatic events, injury, or severe sunburns, may trigger or exacerbate vitiligo in those who are susceptible, though this has not been substantiated.

Other theories include the possibility that an abnormally functioning nervous system may produce a substance that injures melanocytes. Some believe that melanocytes in vitiligo patients may self-destruct, releasing toxic byproducts that then destroy other pigment cells. Another theory suggests that vitiligo is entirely genetic, and that there is a defect in the melanocytes that makes them more susceptible to injury.

We know that some cases of vitiligo arise from exposure to certain chemicals, for example, phenols used in photography. Surgery wounds or injuries to the skin have also been known to result in vitiligo, which can spread. The question is, are those people susceptible to vitiligo to begin with. Many experts say yes.

Finally, there are alternative theories about vitiligo that suggest diet, nutrition, and digestive disorders may play a role in the destruction of melanocytes. Some believe that internal pathogens within the digestive tract, such as yeast proliferation, might relate to vitiligo.

People stare at my spots. I am embarrassed by my vitiligo. Is there anything I can do?

First, understand that to most people, vitiligo is unusual, and perhaps a bit unsettling. Do not be afraid to tell people what it is, especially children. Kids are pretty smart these days, and everyone can understand if you explain that vitiligo is a condition in which the immune system sees the pigment cells as foreign bodies, and attacks them (our best explanation). Explain that it does not hurt, and that it is a genetic condition, and is not contagious.

Finally, try to maintain a normal lifestyle. If you enjoy hiking or sports, or swimming, then you should continue to engage in these activities (remembering sunscreen where appropriate). Don't avoid social situations and parties - these are good for your psychological well-being. In the old days, many people thought vitiligo was the result of burns or chemical spills. But people are becoming more aware about vitiligo, and it seems that almost everyone knows someoA deforming birth defect has a devastating psychological impact upon the child's parents, and it has the potential for lifelong impact upon the physical, psychological and socioeconomic well being of the child. Plastic surgery can improve or correct many of these birth defects. Because timing of surgery is often an important factor in improving the prospect for a successful outcome, early consultation should be sought with a plastic surgeon.
The primary care physician and the plastic surgeon work closely together in designing the most effective treatment plan for the affected child. Commonly, they work in the context of a multidisciplinary team. The family physician and pediatrician may work together with the surgeon to help the parents deal rationally with treatment options. The physicians also may counsel the parents regarding the emotional, psychological and financial resources that may be strained by treatment that sometimes requires many months or years to complete.

Will my baby have congenital anomalies?

At some point during her pregnancy, virtually every woman ponders the possibility that her baby will arrive with a congenital disorder. Statistically, about six percent of newborns worldwide have a congenital disorder. Although the medical community cannot identify the cause of every congenital disorder, it typically categorizes birth defects into one of four categories. Three of these categories, chromosomal, single-gene and multifactorial, cause genetic disorders, while the fourth category, environment, involves congenital disorders caused by the mother's environment, substance abuse or health. It is impossible to know for certain whether a baby will have a congenital disorder, but there are steps that can help prevent birth defects.

Genetic testing can help identify whether parents carry defective genes that might cause a birth defect. The science, however, is insufficient to identify every possible congenital disorder that has a genetic cause. For this reason, doctors must first obtain information about the patient, her family history of congenital defects and her family's medical history. Genetic testing can be performed before a couple decides to have a child, and if the risks are too great, conception can be avoided.

Hemangiomas and Other Benign Vascular Lesions of the Skin

Hemangiomas and lymphangiomas, the most common benign tumors of the skin in neonates, may be present at birth or appear in the first months after birth.

Some lesions regress and disappear in the first few months of life – e.g., the strawberry hemangioma. Large vascular lesions in critical locations can be life-threatening as well as disfiguring – e.g., multiple hemangiomas of the newborn involving skin, liver and intestinal tract.

Consultations with a plastic surgeon may include consults with other specialists such as a hematologist when a lesion is very large or life-threatening.

Laser treatment is often effective in the treatment of vascular lesions, including port-wine stain and unregressed strawberry hemangioma. Careful evaluation is required prior to laser treatment.

Pigmented Lesions of the Skin
Pigmented lesions in the newborn are frequently difficult to interpret regarding their present or potential malignancy.
Early consultation with a plastic surgeon and pathologist initiates (1) planning for surgical removal or other appropriate treatment and (2) providing treatment options and counseling to the parents.

Large congenital nevi pose a significant risk of early malignancy or later malignant transformation. Large and sometimes hairy nevi also are physically uncomfortable and psychologically damaging for child and parents. Surgical excision with skin grafting is often a treatment of choice.

Malformations of the Ear
Ear malformations such as microtia can severely affect a child's self-image, especially if the condition is allowed to go uncorrected until school age. The importance of well formed ears in overall facial aesthetics is, unfortunately, reflected in the teasing and bullying inflicted by schoolmates on a child with malformed ears.

Microtia is usually apparent at birth or soon after, and it is seen as a "remnant" ear lobule, concha, acoustic meatus, tragus and incisura intertragica. Microtia is typically unilateral. Bilateral microtia may be associated with severe hearing defects that require consultation with an otologist.

As soon as microtia is identified, the plastic surgeon should partner with the primary care physician in planning an approach to reconstruction. Consultation with the child's parents will help to plan the age at which reconstruction should begin; reconstruction is often recommended to be completed before the child enters school. Because autologous rib cartilage is commonly required to form a new ear framework, definitive reconstruction may take place at about age 5 or 6 years when rib growth has been adequate. Parents should be informed regarding potential complications of harvesting rib cartilage. Skin-flap techniques are commonly used to mobilize the skin used to cover the new ear framework.

The ultimate success of microtic reconstruction depends on patient selection, adequate counseling of parents, selection of the proper material for an ear framework, surgical skill, and detailed attention in the intraoperative and postoperative periods to prevent complications such as infection, skin flap necrosis and undue pressure on the ear.

Congenital breast asymmetry may be a manifestation of underlying congenital anomalies. Poland's syndrome, the most frequent congenital cause of breast asymmetry, results in thoracic structure deformities, breast asymmetry and ipsilateral syndactyly. Computed tomography and magnetic resonance imaging are definitive in identifying the thoracic deformities.

Treatment of breast asymmetry due to Poland's syndrome may include prosthetic augmentation, use of a musculocutaneous flap to fill hollow space on the exterior of the chest, or augmentation with tissue from the opposite breast. Definitive treatment includes surgical repair of the chest wall.

As in the case of other congenital deformities, Poland's syndrome may be seen in association with anomalies of other tissues and organs.

Skin Rejuvenation:

1) How does it work?
A light signal is sent to the body’s collagen production system, this then enhances the rate at which the collagen is produced. Additionally, irregular pigmentation absorbs the light and some of the melanin producing cells are disabled thus evening out skin colour. Finally, fine vessels that have become apparent at the skin surface can absorb the light and be removed.

2) What areas can be treated?
This procedure works well over the face, neck, chest, legs, arms and back of the hand. The Energist ULTRA™ System can also improve the appearance of thread veins, scars and pink stretch marks. We have also observed beneficial effects on active acne using VPL™.

3) Are there any side-effects?
Due to the special parameters used there are little or no side-effects. The treatment has been likened to being flicked by a small elastic band, but the skin may go slightly red for a few hours. If the area is over treated then there may be a chance of some slight blisters or crusting, however, this will resolve in 5 to 7 days.

4) Is there anything I need to do prior to, or after, treatment?
It is advisable to stay out of the sun, and away from tanning beds, for at least 6 weeks prior to any treatment to ensure that your skin is as close as possible to its natural colour. You must ensure that all cosmetics are removed from the treatment area with a good cleanser and then allow the skin to settle. As the skin may be slightly more sensitive post-treatment it is recommended to use skin products developed for sensitive skin and again avoid the sun or tanning beds.

5) How many treatments does it require?
In most cases you will see a result after 3 treatments but there is a significant improvement if the treatment is repeated routinely at regular intervals. There is no limit to the amount of treatments you can undergo.

6) How do I know if it has worked?
Your fully trained operator will be looking for specific reactions when undergoing a treatment. However, due to many interrelated physiological factors every individual reacts differently. The initial treatment will gauge what energy densities can be used to ensure an effective treatment. A review date will be set to assess the effectiveness of the treatments and then to make any amendments as required to the treatment protocol.

7) When will I see results?
As the improvement is gradual you will not see the result for about three months. Because you see yourself everyday it is difficult for you to recognise gradual improvements taking place. Thus, it is very important that good close-up photos are taken before the treatment and then upon review at three months, this will then show the improvement. Collagen can take up-to 9 months to fully mature so gradual improvements will continue over this time.

8) How often do you need treating?
After the initial treatment it is advisable to have a second treatment two to four weeks later. Depending upon age, severity of the condition being treated or amount of exposure to the sun, it may be advisable to have a course of treatments over a period of a year.

9) How many treatments can I have?
There is no maximum amount of treatments that can be undertaken; this can be seen as an ongoing skin care programme.

10) How long do the effects last for?
This depends on your lifestyle. However, improvements can continue over several months. The post treatment recommendations from a fully trained operator will provide you with a skin care regimen that will help maintain improvements.

11) For fine lines and wrinkles how much does the collagen increase by?
We cannot measure the amount of collagen produced due to everybody having a differing base level. But there will be a substantial increase in the rate of collagen production.

12) Where is the collagen produced?
New collagen is produced in response to an injury or surgery. The Energist ULTRA™ System “tricks” the body into believing it has been injured and thus starts producing new collagen.

13) Who can be treated?
The ideal age range for this treatment would be anybody up to the age of 60 years old. If you have a suntan it is advisable to wait until you are back to your base colour before undergoing treatment.

14) What photo skin types can be treated?
Fitzpatrick Skin types I-V are safely treated with no reports of any adverse affects on type VI skin. However, it is NOT recommended to treat Type VI skin.

15) Can this system be used with any other therapies?
Yes, the pulsed light works very well when used in conjunction with other treatment modalities. Such treatments include Microdermabrasion, Collagen or Botox injections, galvanic and soft peels.

16) How does it compare to CO2 and collagen enhancement lasers?
CO2 lasers are designed to burn off the top layer of skin, and thus stimulate new collagen production in response to this severe injury. Collagen enhancement lasers are specifically designed to target the small vessels to stimulate new collagen production. The Energist ULTRA™ system is able to treat all the signs of ageing or sun damage effectively during the same treatment.
 
               
17) What is skin rejuvenation?
Skin rejuvenation can be defined as any treatment used to fight the signs of aging and enhance the skin’s appearance.

18) How do Photo Facials work?
A laser vaporizes the top layers of the skin around your lines and wrinkles, making the surface appear flush with the surrounding skin. Collagen production is also stimulated to make the lines and wrinkles of your skin less deep and noticeable.

19) How long does a Photo Facial take?
Depending on the area of the skin that is treated, the procedure should take anywhere from 15 to 90 minutes.

20) What is Photo Facial recovery like?
Your skin will heal in 4-6 days. It will then appear sunburned, but the redness will improve over 1-4 weeks.

21) Does removal of Pigmented Lesions hurt?
There should be minimal discomfort and usually there is no need for topical anesthesia. However, our cosmetic surgeon will discuss this with you and may choose to use one on sensitive areas.

22) How many treatment sessions will I need to remove Pigmented Lesions?
Generally patients need 2-5 treatments. This will depend on the severity of the pigmented lesions and the amount of surface area they cover.

23) What is recovery of Pigmented Lesion Removal like?
Most patients are able to return to normal life following the procedure. You may experience some redness that should disappear within a few hours. Some pigmented lesions will darken before fading and flaking off.

24) What are the side effects of Vascular Lesion Removal?
Some redness may occur that lasts a few hours. There’s no bruising or discoloration of the skin, but swelling may occur lasting 1 – 2 days.

25) How many treatments will I need for Vascular Lesion Removal?
This will depend on the severity of your condition, but usually 1-4 treatments take place over the period of 1-3 months.

26) Are there any side effects of Laser Hair Removal?
There could be a slight reddening or swelling of the skin where treatment took place. Sunscreen is also recommended for any treated areas.

28) Who is the ideal candidate for Laser Hair Removal?
Anyone with unwanted hair they would like removed is a good candidate for this treatment. However, laser hair removal patients with darker pigmentation or extremely blonde, white, or gray hairs can be less responsive.

29) How many treatments do most patients need for Laser Hair Removal?
This depends on the areas you’d like to treat, but multiple sessions are usually needed. During your free laser hair removal consultation, our cosmetic surgeons can assess your needs more thoroughly to give you an estimate.

30) How do you treat Spider Veins?
Treatment is usually done through laser therapy or Sclerotherapy.

31) What treatment works best for Spider Veins on the face?
Laser treatment works the best because the veins are generally too small to be treated with Sclerotherapy.

32) What is Sclerotherapy?
A treatment for spider and varicose veins that involves injecting a liquid agent through a tiny needle directly into the vein. The chemical agent causes the vein to contract and then collapse.

33) Do you offer treatment for Skin and Scar Repair?
Yes, many different treatment options are available depending upon your specific skin condition. Please refer to theSkin and Scar Repair section of our website for more information.

Male Gynaecomastia:

1) Am I a candidate for male breast reduction?
The most important question you should ask yourself is: does the condition bother you both psychologically and physically?  Should the answer be positive, you should consider surgery and start to gather information that will help you make an intelligent decision while consulting with a Board Certified Plastic Surgeon who is experienced in this type of surgery, obtaining information from web sites and referrals.

2) Am I too young to have gynecomastia surgery?
In general, we recommend you wait until the age of 18 years. There are some circumstances where a person should consider it earlier. For this you will have to consult a Plastic Surgeon.
 

3) How do I choose the right Plastic Surgeon?
As a rule, he/she should be a Board Certified Plastic Surgeon and a member of the American Society of Plastic Surgeons (www.plasticsurgery.org). Most importantly, the surgeon should have experience with this specific procedure. In today's world, the Internet is an invaluable tool that can help you to make your decision by reading specific content and viewing photo galleries.

Communication with your surgeon's office staff and the physician are of paramount importance. Once you decide to have the surgery, you should interview a few surgeons and  expect to receive complete and satisfactory answers to all of your questions. Good rapport with the office staff and surgeon prior to surgery is essential for a successful end result.
 

4) What results can I expect?
You should discuss this with your surgeon prior to surgery, and make sure you fully understand everything that is involved while keeping your expectations realistic.  Your experienced surgeon can help you with this.
 

How many procedures of this nature has the surgeon performed?  In a month, in a year, in his career?
If he has significant experience, it should be substantiated with good quality pre and post-operative photos as well as references.
 

5) What are the surgical risks?
See the section on Surgical Risks.
 

6) What kind of scar should I expect?
Usually periareolar (about 1 inch scar in the lower part of the areola) that is generally inconspicuous. Sometimes, tiny scars remain in the armpit or chest after liposuction. Some people need more extensive procedures, and this should be discussed with your surgeon in detail prior to surgery.
 

7) Will I have pain that will require medication?
Usually pain is minimal, but since we want to make sure you will be comfortable, we do provide you with a prescription for pain medication.
 

8) How much time should I take off from work or school?
This depends on the type of work you do and the extent of the surgical procedure. Usually it's between 3 and 10 days, but healing time varies for each individual and should be discussed with your surgeon.
 

9) What types of anesthesia do you offer?
Local anesthesia is determined based on the type of surgical procedure and the patient's tolerance. Sedation is not a general anesthesia, but the patient is asleep. This is the preferred method in my office because it is safe when done by an experienced  Board Certified Anesthesiologist. General anesthesia is rarely needed in my office.
 

10) Is the operating room certified?
My office is certified by The Joint Commission on Accreditation of Healthcare Organizations. This commission certifies 80% of the major hospitals in the United States of America. This certification provides you with extra assurance on the highest quality standards of a surgical suite.
 

11) How should I prepare for the surgery?
Prior to surgery you should get detailed instructions from your surgeon's office.  Pre-operative testing is mandatory. You should stop medications such as blood thinner, aspirin, Advil,  Vitamin E and herbal remedies such as St. John's Wort and Ginkgo Biloba. Do not eat or drink eight (8) hours prior to surgery. Arrive on the day of surgery in comfortable clothing that is not tight or confining. Have a responsible person accompany you to and from the doctor's office.
 

12) What type of dressing will I have?
My personal preference is an elastic (ACE bandage) or surgical vest. Sometimes gauze dressing is all that is necessary.
 

13) Will I have a drain?
Usually not, but in cases of excessive bleeding, a drain will be necessary. This will be removed in a few days post-operative.
 

14) Should I change my own dressing?
This depends on the amount of bleeding or discharge, and should be discussed with your surgeon. It is always wise to have sterile gauze and surgical tape at home.
 

15) Will my health insurance cover this procedure?
In most cases, they do not cover this procedure.
 

16) What can cause gynecomastia?
Gynecomastia can be caused by drugs, steroids or  marijuana as well as other factors.  These should be discontinued prior to surgery to minimize recurrence.

Diabetic foot problems have reached endemic proportions all around the world. This article will answer only some of your queries regarding diabetic foot. It is advisable to visit your doctor at the earliest, if you have an actual problem.

1) What is diabetic foot?  
A wide array of problems can  constitute a diabetic foot,eg; wounds, ulcers, infections, blisters,calluses, deformities,  ischemia (lack of blood supply), gangrene etc; in a diabetic patient.

2) Who are more prone for these problems?
Chronic or uncontrolled diabetic patients with loss of sensation (neuropathy)of the feet, are especially prone to develop diabetic foot problems. 

3) What are the precipitating causes ?
A trivial injury to the foot, pinprick injury, shoe bite, burns, nail infection, careless self treatment of nail deformities, corns/calluses of the foot or foot deformities can precipitate a diabetic foot infection.

4) What are the symptoms and signs? 
Many patients have neuropathy(loss of pain sensation of the foot). Hence   in the early stages of infection the patient will have no pain. Only after the infection progresses, sometimes to alarming levels ,that the patient gets pain. To detect earlier is by looking for swelling or redness in the toes & foot and to report to the doctor promptly. By this way the complications associated with diabetic foot can be minimised. There can also be fever, pus discharge from wound, discolouration of skin and symptoms of high blood sugar. It is important to remember that diabetic foot infections can look very small on the surface but the damage and spread is much wider & deeper.

5) What is the treatment ?
At the least suspicion, it is best to consult the doctor. After a clinical examination and blood tests and xrays, the need for further tests or surgery will be determined.
Surgery can be either a simple nail or callus treatment as an outpatient, to inpatient treatment under some form of anesthesia- Incision &drainage of pus, removal of dead tissues and in some severe cases amputation.Simultaneously medical control of diabetes and other medications like antibiotics will be necessary. Wound healing is relatively slower in diabetes esp. when the blood supply to the foot is also affected.

6) What is the aftertreatment?
It is important to avoid putting load on the foot till the wounds are fully healed. Wound healing needs regular dressing and in some cases repeat surgery like skin graft and if the blood supply is reduced some form of vascular surgery. Smoking has to stopped. Regular hospital visits & diabetic control are essential. Long term the patient will need special footwear. Footcare includes washing feet with lukewarm water, foot inspection daily, trimming nails carefully, avoiding dry skin by use of emollients & avoiding barefoot walking.

7) What are the problems peculiar to India?
Early onset diabetes, High incidence of neuropathy, Poor control of diabetes, Poverty, Illiteracy, Barefoot walking, “Hawaii” chappals(not to be used in diabetics), Social & Religious practices, Poor personal & foot hygiene, Ignorance, Low awareness, Inadequate facilities for treatment, “Alternate” medicines etc.
With good awareness and diabetic control, the problems of diabetic foot can be minimised.

1) Where do you put the Botox?
The frown line between the eyebrows is caused by the action of a muscled called the corrugator. You can feel this muscle as a thickening just below the inside of your eyebrows, when you purposefully make yourself frown. Injecting Botox directly into the corrugator muscle stops your ability to draw your eyebrows together when you frown, resulting in the gradual fading of the frown line.

2) When does Botox start to work, and how long does it last?
The results of Botox treatment start to appear in three to ten days. The treated muscles will gradually regain their action over three to five months. When the frown line starts to reappear, a simple repeat treatment is all that is necessary to maintain the desired results. Please contact us for more details.

3) Who can perform Botox treatment?
Botox must be performed under the direction of a physician. Dr Day is trained, certified, and experienced

4) Is treatment effective for men and women?
Yes.

5) How much time does a Botox treatment take?
A few minutes only.

6) Is the treatment painful?
There is very little discomfort. Often, patients do not feel the tiny injection at all.

7) Who injects the botox?
All botox injections are done at our medical centre by Dr Joanna Day herself. We do not allow nurses or other "injectors" to perform the procedure, simply because we want to ensure you have the safest and most effective treatment available.

Hand Surgery:

1) What is the difference between an orthopedic surgeon and a hand surgeon? 
A) An orthopedic surgeon is a physician who specializes in treating the bones, joints, ligaments, muscles, and tendons of the musculoskeletal system. A hand fellowship trained surgeon has additional training in the treatment of the hand, elbow and shoulder. At Orthopaedic Associates of Central Texas all the surgeons are orthopaedic surgeons, and some have additional fellowship training or course training in the treatment specific to the hand.

2) Can I have surgery on both hands at the same time? 
A) There are few cases, endoscopic carpal tunnel releases and traumatic injuries to both hands that require urgent treatment, where bilateral surgery is recommended. However, in the situation where there is a choice and time is not critical, it is best to stage the procedures weeks apart to allow the patient to have one hand free without a dressing and with good strength as the operated hand recovers. This decision is a conversation between the physician and patient with all the benefits, risks and factors covered.

3) Once I decide to have the surgery, how soon can it actually take place? 
A) Once your insurance is approved and medical clearance is granted, the surgery can then be scheduled.

4) What type of anesthesia is used for these hand procedures?
A) The patient is sedated and comfortable throughout all procedures. In some cases a local or regional nerve block with a mild sedation is given for the procedure and other times intravenous medications for general anesthetic is used to make the patient comfortable. Your surgical anesthesia will be discussed in detail with the physicians at Round Rock Orthopaedics and Rehab.

5) What are the possible complications? 
A) Although uncommon, complications do occur occasionally during or following hand surgery. Infections are the most common complication and these can be prevented with pre-operative and post-operative antibiotics and gentle exercises. Other complications can include: phlebitis (blood clots of a vein), excessive swelling or bleeding, damage to blood vessels or nerves, and instrument breakage are the most common complications, but occur in far less than 1 percent of all arthroscopic procedures.

6) Is bleeding around the incisions after surgery normal? 
A) It is not unusual to have some mild bleeding through the small incision areas, and the area should be kept dry and covered. Should this happen and you are at home, you should reinforce the dressing with more sterile gauze. However, if bleeding persists, contact the office.

7) Can I go home immediately after surgery? 
A) Generally speaking, many patients can go home the same day as their procedure. It is important to have a healthy spouse or close family member for driving and at home to help them during the initial days after surgery. For those unable to depend on family or close friends, staying at the hospital for one to two days is occasionally an alternative.

8) What is the recovery time for most procedures? 
A) Hand surgery can entail as simple a procedure as a carpal tunnel release or foreign body removal which would allow immediate near full use of the hand, or as complicated as a wrist laceration involving all tendons and nerves which can take up to a year for an adequate functional recovery. The wounds can take several days to week to heal. Although the wounds are small and pain in the joint may be minimal, it takes several weeks or longer for the joint to maximally recover. You should follow the specific activity and rehabilitation program suggested by your physician to speed your recover and protect future joint function.

Expectations for Hand Surgery (Before and After Surgery)

Pre-operative: It will take approximately 45 to 60 minutes to get signatures for surgical consents and to review the instructions regarding your surgery. Be sure to bring a list of current medications, including the drug name, dosage, and the days and times you typically take them.
Pre-admission Appointment: Prior to this appointment—which takes place at the hospital—you should have had your pre-operative tests performed by your family doctor. This appointment will take approximately one to two hours for lab tests, including blood work, EKG, and chest X-ray. If you have a heart or lung condition, or if you are an insulin-dependent diabetic, you must see your family doctor prior to surgery and get medical clearance. Before you leave, you will also meet with someone from the anesthesia department.

Admission: You will be admitted to the hospital the morning of your surgery.

Medications: Stop anti-inflammatory medications and/or aspirin; if you take anticoagulants such as Coumadin, asprin or Lovenox, your surgeon will tell you how long you should cease taking them prior to surgery.

Food and drink: Do not eat or drink anything for eight hours prior to surgery, except for prescribed medications. On the day of surgery, if you do have a prescribed medication to take, swallow it with a small sip of water.

Length of Surgery: The length of surgery is typically one to two hours followed by another one to two hours in the recovery room.

Length of Hospitalization: Average stay for hand surgery is six to eight hours. Hand surgery is general performed in the outpatient setting, that you will arrive in the morning and generally go home the same day. This may vary on your specific procedure, family/home support, and other factors as outlined by your physician.

Anesthesia: Patients will undergo general anesthesia, and may benefit from regional nerve blocks for post-operative pain control.

Physical Therapy: It is important after surgery to regain full range of motion but to do it with the instruction of trained physical therapists and/or certified hand therapist. You will work with a physical therapist each day after surgery to help you retain a full and active range of motion. After you go home from the hospital, you will need physical therapy from three to six times a week for three to six weeks. Before surgery, please consult with our staff to arrange outpatient physical therapy with Orthopaedic Associates of Central Texas.
IMPORTANT: Prior to surgery, VERIFY INSURANCE BENEFITS FOR YOUR CONTINUOUS PASSIVE MOTION (CPM) AND PHYSICAL THERAPY. THESE ITEMS ARE NOT ALWAYS COVERED BY ALL COMPANIES. IT IS VERY IMPORTANT THAT YOU CONFIRM THE NUMBER OF PHYSICAL THERAPY VISITS APPROVED BY YOUR INSURANCE COMPANY FOLLOWING SURGERY. INFORM YOUR PHYSICAL THERAPY PROVIDER ABOUT WHAT HAS BEEN APPROVED BEFORE YOU BEGIN THERAPY.

Wound Care: The surgical dressing is usually removed after two or three days. You may keep the incision open to air as long as there is no bleeding or drainage. We will remove your sutures in the office approximately two weeks after your surgery.

Pain management: For the first one to two days after surgery, pain is very well controlled with a PCA (patient controlled anesthesia). It is important to maintain a schedule for the pain medications provided and prescribed. It is best to address the pain before it intensifies. Pain is manageable with medications and will lessen as your surgery heals. Pain medicine can cause itching, nausea, and/or constipation. These are all common side-effects of narcotic-based medications and do not necessarily indicate a drug allergy.

Driving: Most patients are able to safely drive a car approximately three days to two weeks after surgery. We recommend that patients do not drive cars with a manual transmission while they are healing because of the sudden and jerky movements that can accompany shifting gears and using the clutch.

Home Care: You will need help with meal preparation for several weeks following discharge from the hospital. We recommend that you have someone stay with you after you leave the hospital for at least a week (and longer if possible). If this is not possible, please let the nurse know you will need assistance after surgery.

Return to Work: Following hand surgery, depending on the joint, structures involved, and procedure, you will be able to return to sedentary work within one to four weeks after surgery. We recommend restricting certain work activities.