What We Do

Plastic Surgery

Comprehensive range of cosmetic & reconstructive breast surgery services

*Disclaimer: All photos on this page are models


Face

Facial cosmetic procedures include facelifts, eyelid rejuvenation, brow lift, blepharoplasty, neck lift, and rhinoplasty

Breast (Cosmetic)

Breast enhancement surgeries including breast augmentation, breast reduction, breast lift, nipple repair, and more

Breast (Reconstruction)

All breast reconstruction procedures required after mastectomy—tissue or implant based, revision, nipple repair, etc

Body

Body contouring—tummy tuck; torso, arm, and thigh contouring after major weight loss; liposuction; revision of scars, and other

Transgender

Services for those with gender dysphoria—breast aug & other feminizing procedures for male to female and "top surgery" for female to male

Skin Cancer

Critical surgical procedures related to the "remove and repair" steps of skin cancer treatment include excision and Mohs surgery

Face

Facial cosmetic procedures include facelifts, eyelid rejuvenation, brow lift, blepharoplasty, neck lift, and rhinoplasty

Breast (Cosmetic)

Breast enhancement surgeries including breast augmentation, breast reduction, breast lift, nipple repair, and more

Breast (Reconstruction)

All breast reconstruction procedures required after mastectomy—tissue or implant based, revision, nipple repair, etc

Body

Body contouring—tummy tuck; torso, arm, and thigh contouring after major weight loss; liposuction; revision of scars, and other

Transgender

Services for those with gender dysphoria—breast aug & other feminizing procedures for male to female and "top surgery" for female to male

Skin Cancer

Critical surgical procedures related to the "remove and repair" steps of skin cancer treatment include excision and Mohs surgery

Disclaimer: All photos on this page are models

Our Focus

How we deliver care matters

EXPERTISE

From our award-winning surgeons, to our aesthetic specialists, to our excellent supporting staff, we take pride in our level of experience & expertise

PATIENT EXPERIENCE

Everything we do centers on making your plastic surgery experience second to none, and results in you feeling more confident in your appearance

CUSTOMIZED CARE

We want to understand your unique needs and customize an approach that best fits you; an individualized approach that leads to lasting, positive results

Beauty is confidence

Facial Procedures

Facial cosmetic procedures include facelifts, eyelid rejuvenation, brow lift, blepharoplasty, neck lift, and rhinoplasty. We perform minimally invasive facial contouring with microliposuction, volume structuring and restoration with fat grafts, and can also improve facial contour and symmetry with selective use of facial implants.

Facelift

A face lift is performed in order to restore a person’s appearance to give a natural and rested look to your face. We use a multi-layer approach to reshape the muscles, skin and connective tissue. Our rejuvenating technique allows the muscles to heal better and more rapidly.

A face lift, also known as rhytidectomy, is the removal of facial wrinkles that result from aging, gravity, exposure to the sun, and the daily stresses of life. This procedure can help make you look younger and fresher, thereby enhancing your self- confidence. It is commonly performed after the age of 40, when skin starts to sag and deep creases may start to appear on cheeks and between the nose and mouth. At this time, you might also notice some folds and fat deposits around the neck, or a double chin forming.

Facelift Procedure

A facelift is generally a fairly lengthy surgical procedure normally performed with a combination of local anesthesia and sedation that takes up to 2 to 5 hours. It typically begins at the temples right above the hairline, following a natural line in front of the ear, and continuing behind the earlobe to the lower scalp. If the neck requires some correction, a small incision may also be made under the chin. To improve the contour, fat may be trimmed from around the neck and chin.

Next is the tightening of the underlying muscle and membrane, and then the skin is pulled up and excess skin removed. After closing the incision, cotton dressing is used to bandage the face and head. This helps to prevent swelling and also to provide good support for 2 to 3 days. Bruising and swelling normally decrease to “socially acceptable levels” within 10 to 20 days. But remember, we all heal differently. Any significant discomfort can be reduced with some pain medication. You can expect some numbness, which normally disappears within a few weeks or months.

Recovery and Final Result

Although a face lift cannot stop the clock of aging, most patients feel that their faces look up to 10 years younger. We use only the most advanced, cutting-edge techniques and technology. These advanced techniques ensure the highest possible quality for all our clients

Brow and Forehead Lift

Forehead lifts can smooth deep creases in the forehead and lift sagging eyebrows to create a less tired, more alert appearance.

Upper and Lower Eyelid Lift

Nasal Surgery (Rhinoplasty)

Rhinoplasty, commonly referred to as “nose surgery” or a “nose job”, is a surgical procedure to correct the appearance or deformities of your nose. In some patients, this may include correcting breathing problems.

Your nose reaches its final shape and size in late teenage years. Some men and women may notice that the tip of the nose is too large or too wide in comparison to the rest of their face. Nose surgery can refine the tip of the nose to provide better definition and a better fit for your face. Nose surgery can reduce or in some cases, increase the size of your nose to better match the rest of your facial features. Most commonly, nose surgery is done to both refine the tip and remove the hump on the bridge of your nose.

Nose surgery addresses the excess cartilage and bone structure that is causing the undesired appearance. By narrowing and decreasing the height of the nasal bones, the operation can correct a wide appearance. Some patients will have a deviated nose with deviated septum that is causing breathing problems, most commonly after an injury days to years prior. Nose surgery can improve the breathing and straighten the nose to its previous shape.

Rhinoplasty is done as an outpatient procedure, meaning that you go home the same day of your surgery. The incisions for the nose surgery are concealed within your nostrils and there is often a small incision at the bottom of your nose, which heals imperceptibly within a few weeks. You may have packings in your nose for 1-2 days that is subsequently removed in the office. You will have swelling and may have bruising around the eyes, especially if the nasal bones required fracturing (breaking) to give you the look you are after. This will cause some bruising to occur around your eyes and may last for several days to 1 week. You will require 1-2 weeks off from work.

Your safety is paramount. All our procedures are performed by Board Certified Plastic Surgeons accompanied by an anesthesiologist or CRNA in a AAAASF certified operating room to assure your safety.

Ear Setback (Otoplasty)

Ear surgery, also known as otoplasty, can improve the shape, position or proportion of the ear with no impact to hearing. It can correct a defect in the ear structure that is present at birth, or it can treat misshapen ears caused by injury.* *Source: plasticsurgery.org

Neck Lift

People can age in different ways in the face and the neck. As women and men between the age of fifty to sixty five will notice, these two regions may look quite different at this point in their life. A person may have a youthful face with no wrinkles or sagging yet their neck may have loose skin and vertical bands which has not maintained the same signs of youth as they see in their face. Or they may have a slender youthful neck but be developing jowls and deep folds along the line between the nose and the mouth.

While a full facelift (rhytidectomy) addresses both facial and neck aging these two areas can also be operated on independently of each other. A necklift is simply the lower half of a facelift with fewer scars in the cheeks. Most of the skin in a necklift is removed behind the ear and along the hairline in the neck. Frequently there will be a small scar under the chine to allow adjustment of the fat and muscle layers under the skin in the neck.

Because this procedure takes less time to perform than a full facelift the cost is lower and the recovery time may be a few days less. Bruising in the neck can be covered by scarfs and turtleneck sweaters so a patient might feel more comfortable being seen in public a few days after the surgery. Most patients who have a necklift return to work in ten days, rather than 14 days after a full facelift.

Patients who are not using nicotine and are in good general health are candidates to be considered for this procedure. Nicotine can cause delayed healing along the incisions in both a necklift as well as a facelift.

Any patient on anticoagulant therapy must be capable of stopping this medication for two weeks or more around surgery without running the risk of increased chances for blood clots or strokes.

Other risks in a necklift include temporary and rarely numbness in the skin of the neck. Excessive bleeding can cause a blood clot to form under the skin in the neck, called a hematoma, that might require returning to surgery to remove the clot and find the source of bleeding. Skin loss, infections and heavy scars behind the ear are other rare risks associated with this procedure.

Patients who have a necklift can feel more confident in the way their profile looks, and how they look more youthful in photographs. The smoother look compliments the lack of aging in their face so there is less discrepancy in the signs of aging both above and below the jawline. It remains an easy procedure to recover from and in many patients is the only procedure they may need to maintain a youthful appearance as they enter their sixties and seventies.

Fat Injections

Some patients may want to consider fat injections, which uses fat harvested from the patient's own body which can then be re-injected to enhance facial fullness, fill creases or build up shallow contours.

How fat injections are administered

Fat injection requires a more extensive procedure than "off-the-shelf" soft tissue fillers.

A "donor area" must be determined (such as the abdomen or buttocks) and liposuction is used to extract the fat. The suctioned fat can then be transferred to the face, as a graft. The grafted fat then has to redevelop a blood supply in order to survive.

Fat injection results

In the face, most of the transferred fat usually survives, but the results can be a bit less predictable. The use of fat transfer involves additional discomfort in the donor area. This is a minor surgical procedure that can be performed in the surgeon's treatment room or in an operating room.*

*Source: plasticsurgery.org

Chin and Cheek Implant

Insertion of special implants may enhance projection and appearance of the chin and/or cheeks to create better facial symmetry and proportion.


Be the best version of you

Breast Procedures

The breast is often identified as the feature that makes a woman feel feminine. Many factors affect the size and shape of the breast including genetics, weight, child-bearing, and age. There are many different reasons that a woman might seek breast enhancement surgery. At Polyclinic Plastic Surgery we believe that a beautiful breast is one that is subtly enhanced and fits the proportion of a woman’s frame.

Breast Augmentation

The breast is often identified as the feature that makes a woman feel feminine. Many factors affect the size and shape of the breast including genetics, weight, child-bearing, and age. There are many different reasons that a woman might seek breast enhancement surgery.

At Polyclinic Plastic Surgery we believe that a beautiful breast is one that is subtly enhanced and fits the proportion of a woman’s frame. We focus on providing natural, full cleavage and making sure that the nipple is positioned on the most projecting portion of the breast. Our providers are experts in breast augmentation surgery utilizing saline or silicone implants as well as breast lifts and the all-natural augmentation utilizing the patient’s own fat cells to restore fullness.

When considering breast augmentation surgery the first decision is whether you would prefer to utilize your own fat cells, an implant, or a combination. Fat transfer augmentation provides only a modest increase in size, but is wonderful for restoring cleavage and can be used in combination with an implant if a greater volume is desired. It can also be used to reduce asymmetry between two different sized breasts by increasing the size of the smaller breast. Liposuction is performed in order to harvest a patient’s own fat and then injected through tiny incisions to reshape the breast. These injected fat cells become incorporated into the tissue over the following weeks to permanently enhance the breast. Size is limited by available fat cells to relocate as well as the initial size of the breast. Sometimes multiple sessions are required to achieve the desired result.

Let’s talk implants:

There are many different types of implants (saline, silicone, round, shaped, textured, smooth…) and it is best to have a detailed discussion with your doctor about which specific implant would be best for you. That said, the most basic difference is saline (a silicone shell filled with salt water) versus silicone. Both are safe and effective and each type has pluses and minuses. Saline is a good choice when there is adequate breast tissue to cover the implant and a large size is not desired. Silicone is a better choice when there is very little native breast tissue or a bigger size change is desired. Your doctor will go over the options in detail with you so that you can make the right decision to meet your goals and body.

The next decision is placement of the implant- either above the pectoralis major muscle (subglandular) or below it (submuscular). The sub glandular position has a higher chance of implant hardening over time (known as capsular contracture), but lower chance of “animation” (meaning the implant looks distorted when the pectoralis muscle is engaged). Again, depending on your anatomy, activities, and goals the right position is a decision made on an individual basis with your surgeon.

The last major decision is incision position. The most common incisions are in the crease under the breast (inframammary fold), at the edge of the areola (infra-areolar), or in the armpit (axillary). All of these incisions are concealed in some way- the inframammary fold incision by the breast itself, the infra-areolar incision by the color change between the areola and the breast skin, and the armpit by the location away from the breast. Discuss with your surgeon which incision would be best for you.

When should you consider a lift and when will just implants do the trick?

Implants will give a very slight lift to the nipple due to the “swingset effect” (the implant provides volume behind the nipple allowing the tissue to swing out and the nipple to look slightly raised). This is very modest and works for only very slight cases of sagging (or breast ptosis). Implants mainly address the volume of the breast whereas a lift addresses nipple position and overall breast shape. A breast lift is a trade off between scars and improved breast shape and nipple position.

What is the downtime?

Most patients are back to work in a week and back to all their normal activities at four to six weeks. Narcotic pain medications are prescribed post-operatively, but generally not necessary beyond the first week or two.

Where would I have surgery?

This is an outpatient (meaning you can go home the same day) procedure performed in our fully accredited operating rooms attached to the office. A board certified anesthesia provider will deliver deep sedation and monitor you during the procedure. This method of anesthesia known as monitored anesthesia care decreases the risk of post-operative nausea and vomiting from the anesthesia and shortens overall recovery time. Your safety is our first priority. All of our providers are board certified by the American Board of Plastic Surgery and our operating rooms adhere to the strictest safety standards as noted by our Medicare accreditation.

Breast Reduction

WHY CHOOSE A BREAST REDUCTION?

The surgery to reduce the size and improve the shape of a woman’s breasts is consistently found to be the single plastic surgery procedure with the highest satisfaction rating. Most of the women who choose to use this as a means of ending musculo-skeletal pain and soreness report near complete to complete reversal of symptoms such as chronic shoulder, neck and back pain. Also reduced or eliminated are tensions headaches, skin rashes below the breast, numbness and tingling in the hands and forearms and breast pain itself.

The operation itself removes a significant amount of breast tissue while preserving the nipple and establishing most of the remaining breast on the chest wall above the breast fold. A breast “lift” is always incorporated into this procedure. Over time, this can settle in and drop but never to the extreme that women present with when needing this procedure.

WILL INSURANCE COVER THIS PROCEDURE?

Insurance coverage varies by policy and company but most insurance plans have included this benefit if a woman meets certain criteria. Commonly this includes six months or more of failed conservative measures to reduce the musclo-skeletal symptoms common to women with large breasts. In addition, the plastic surgeon seeking pre-authorization for these procedures must submit an estimate of the weight in grams of the amount of tissue to be removed to be a curative rather than a cosmetic procedure. This is based on the patient’s height and weight at the time of the request.

HOW IS THE PROCEDURE PERFORMED?

There are many different ways to perform this procedure but the most common way reduces the areola with a ring scar around it, and in most cases preserving enough tissue connected to the nipple to nourish it and possibly maintain the ability to eventually breast-feed from this nipple. Almost all the types of breast reductions then result in a vertical scar from the new nipple location down to the breast fold. Additional incisions along the fold are also very common depending on the size of the breast being reduced. Sensation to the breast returns in most cases and many women report improved nipple sensitivity.

Occasionally very large breasted women will require that the nipple be grafted onto the breast like a common skin graft. The new smaller nipple usually does not have sensation and the ability to breast feed in the future is eliminated with this technique.

ARE THERE ANY RISKS?

Risks include bleeding, occasionally requiring that the woman be returned to the operating room to stop the source of bleeding. Delayed incisional healing can occur and may also require retuning to the operating room to close an opening in the scar.

Most small openings heal themselves in a few weeks. Infections can occur as with any large procedure but are not life threatening when this happens. Other risks include asymmetry, chronic pain and heavier than normal scarring.

If a woman goes on to gain a very large amount of weight after surgery it is possible she will incur increases in her breast size again. Breast re-growth without this weight gain is very rare and usually happens in younger patients who had early rapid breast growth in their early teen years.

Denial of coverage by an insurance company does occur for various reasons but the plastic surgeons at the Polyclinic can still perform the procedure by private payment. This results in a fixed price including anesthesia and facility costs. At times women whose insurance coverage requires removing more breast tissue than she would allow can also privately pay for the procedure with the surgeon and patient agreeing on how much tissue to remove that is far less than would have been required by the insurance company.

WHAT IS THE RECOVERY TIME?

Recovery varies by patient but most women return to work between seven to fourteen days after surgery. Most breast reduction patients are off of pain medication by seven days post operatively. Activity restrictions vary by surgeon but most commonly include a month or more before women can return to vigorous exercising, yoga or running.

The final appearance of the breast scars can take up to a year to finally fade, but all scars, regardless of the type of reduction preformed, should be well hidden in a bikini, bra or dresses.

Breast Lift (Mastopexy)

Mastopexy is a breast lift designed to re-establish a more youthful shape, often with a smaller, higher areola and most, or all of the breast brought back up on the chest wall. Sagging of the breasts is called Ptosis. Why this occurs can be more than just gravity and aging. Every breast when youthful has small fibrous bands of non cellular tissue called ligaments. Over time and also depending on genetic traits these ligaments stretch out and lose their elastic quality. This is when ptosis occurs. Premature ptosis is most likely due to an inherited tendency for loss of this ligamentous support.

The landmarks in an ideal woman’s breast include an equilateral triangle between the top of the breastplate and the two nipples and complete exposure of the breast fold when viewed from the front. Mastopexy surgery is a way to re-approximate these relationships in a breast that has drooped or sagged off the rib cage.

There are several different patterns that surgeons use to achieve these results. A peri-areolar incision leaves a small scar in a ring around the outer edge of the areola while removing 30 to 40 % of the outer rim of the nipple. This tightens the adjacent skin and can lift the nipple up to an inch or more. Usually no breast tissue is removed with this technique.

For more skin tightening and lifting a vertical mastopexy also removes skin and breast tissue from the central and lower portions of a sagging breast. The final scar is like the periareolar lift with a vertical scar down to the breast fold from the 6 o’clock position of the nipple. This is also called the lollipop lift or the Bunelli lift.

The anchor mastopexy removes additional skin from along the breast fold and includes both the vertical limb and a peri-areolar scar. This lift is the most aggressive of the three and can bring much or all of the remaining breast back up onto the chest. This scar is also called the inverted T.

The trade off in these operations is a scar that will fade over a year’s time for a youthful, more perky shape. Some reoccurrence of the former breast position may occur over a decade later but full loss of youthfulness is rare.

The risks of mastopexy include bleeding, infection, asymmetry, numbness, possibly permanent, and heavier than normal scarring. Secondary adjustment surgery to provide more symmetry is uncommon but sometimes needed to finalize the end result.

Satisfaction rates in all mastopexy patients is very high. All three operations can also be safely performed simultaneously with breast implant surgery. The implant is placed above or below the pectoral muscle during the lift through one of the exposed scars prior to the suturing at the end of the procedure. Combining these two procedures is safe and cannot only restore the more youthful breast position, it can add projection of the breast tissue forwards and upwards. Any type of breast implant can be combined with these procedures.

Inverted Nipple Repair

There are varying degrees of inverted nipples due to scarring and or duct shortening. Most of the time this can be corrected while preserving the ability to breast feed. Often inverted nipple repair assists with the ability to breast feed due to easier latching. Correction can be done as an outpatient procedure with local anesthesia (numbing medication). A tiny incision is made at the base of the nipple and any scarring or shortened ducts are released until the nipple is no longer inverted. The nipple is then sutured to an external stent, which is kept in place for a week during healing to reduce the risk of recurrence. You can return to work the following day. Often ibu-profen and tylenol are all that is needed for pain control after this minor procedure.

Keep calm and fight on

Breast Reconstruction

Breast Reconstruction encompasses a wide variety of procedures performed by our plastic surgeons to restore a woman’s breast after a mastectomy. Sometimes breast reconstruction is performed after a partial mastectomy to restore symmetry between the two sides and optimize the shape of the remaining breast tissue. The option to have this surgery exists for most women, and is considered part of their overall treatment plan.

Procedures
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Breast Reconstruction

What is breast reconstruction?

Breast Reconstruction encompasses a wide variety of procedures performed by plastic surgeons to restore a woman’s breast after a mastectomy. Sometimes breast reconstruction is performed after a partial mastectomy to restore symmetry between the two sides and optimize the shape of the remaining breast tissue. The option to have this surgery exists for most women, and is considered part of their overall treatment plan.

Why choose breast reconstruction?

Women choose breast reconstruction for unique and personal reasons. Patients with goals achievable by the surgery are happiest with their results. Common motivations include:

  • Appear closer to pre-mastectomy appearance when in clothing or swimwear
  • Eliminate the task of wearing an external prosthesis in a bra
  • Achieve a more natural feminine body contour

A reconstructed breast is a substitute for and not an exact replacement of the natural breast. The reconstructed breast(s) will not look, feel, nor have the same sensation as natural breasts. Yet, most women are satisfied with the final result.

Many women have improved body image and self-esteem after breast reconstruction. Unfortunately, some may have difficulty with the reconstructive surgical process and are disappointed with the outcome. Reconstruction usually requires multiple steps rather than one operation. There are several issues to consider when exploring breast reconstruction. A few are listed below.

Timing of reconstruction

Breast reconstruction can be either “immediate” (started at the time of the mastectomy) or “delayed” (started at a later date). There are advantages and disadvantages to each, but both can give good outcomes with careful patient selection.

The advantage of immediate reconstruction is that the reconstructive process is started at the time of the mastectomy; potentially decreasing the number of operations required for completion. Some women feel better knowing they have started the reconstructive process, and avoiding the appearance of the unaltered mastectomy. Good outcomes from immediate reconstruction require collaboration between the breast surgeon and plastic surgeon.

Delayed reconstruction has the advantage of fewer complications and in many cases more predictable outcomes. It is often a better option for women who have had or will require chest wall radiation, have other factors that increase their surgical risk, or are having tissue flap-based reconstruction.

Methods of reconstruction

Your plastic surgeon will discuss reconstructive options with you in detail, and make recommendations regarding a preferred method. Whatever course you decide, the full reconstructive process may take 6 – 12 months. The two primary types of reconstruction are implant-based and tissue- or flap-based. Both methods, through different means, achieve the goals of creating a “skin envelope” of the desired breast size and shape, covering a substitute for the missing breast tissue. In some situations a hybrid reconstruction is performed: a combination of tissue from elsewhere on the body with an expander and/or implant.

With implant-based reconstruction most of the time the first step is placement of a tissue expander behind the chest muscle. The expander has the appearance of a deflated implant, and over time, is filled with sterile saline (salt water) solution. As it expands, the overlying tissues and skin are brought to the desired shape, fulfilling the requirement for a skin envelope. At a second operation, the expander is removed, and an implant (either saline- or silicone gel-filled) is placed to substitute for the breast tissue.

In select cases, “direct to implant” reconstruction may be performed. In this case, a full sized silicone implant is placed at the time of the mastectomy so that there is only one surgery and recovery. This form of reconstruction requires close collaboration between the breast surgeon, plastic surgeon, and patient.

Tissue-based procedures use redundant skin (to create the desired skin envelope), and fat (to substitute for the breast tissue) from elsewhere on the body (abdomen, back, buttock, thigh). The re-located tissue also requires a blood supply, and there are various methods of achieving this.

Other Considerations

Some women may be candidates for advanced techniques of mastectomy including skin and nipple preserving. Unfortunately, the preserved skin and nipple will not have normal sensation, and most often will not have erectile function.

Surgery may be desirable on the opposite breast to improve symmetry. Options include: reduction, lifting, or enlarging the breast with an implant. Having both breasts removed and reconstructed does not guarantee symmetry.

Even when immediate reconstruction is planned, findings during surgery may alter the procedure and change the plan for immediate reconstruction. In this situation, delayed reconstruction will be an option.

Your breast surgeon and plastic surgeon can make individual recommendations regarding the type and timing of breast reconstruction. These will take into consideration: your overall health, the stage of your cancer and need for additional treatment, and the size and shape of your natural breasts.

Complications may occur with any surgical procedure. Your surgeons will discuss possible complications specific to your situation and preferred reconstructive method.

Some women find that thinking about reconstruction adds an undesired degree of complexity to the treatment decisions they face, and prefer to wait until after their cancer treatment is completed.

Whether reconstruction is immediate or delayed, implant- or tissue-based, most women are pleased with the outcome and happy with the decisions they have made.


 

Your Body is your temple

Body Procedures

Body contouring procedures include abdominoplasty (“tummy tuck”); torso, arm, and thigh contouring after major weight loss; liposuction of the torso, arms, and legs; and revision of scars and adverse consequences of prior trauma or surgery. These operations can frequently be performed in conjunction with other procedures, with an emphasis on safety and comfortable recovery during planning of combined procedures.

Arm Lift (Brachioplasty)

Cosmetic surgery procedures are designed to reshape facial and body structures to improve your appearance and self-esteem. Whether due to aging or following weight loss by diet, exercise, or with the help of bypass surgery, excess skin can be problematic. The extra skin can become unsightly and a nuisance.

In the arm, the excess skin and fat that hangs down can be removed with an arm lift, or brachioplasty. The scars are concealed as much as possible in your armpit and in the inner aspects of your upper arms. The more excess skin that needs to be removed, the longer the incision may be. An individualized consult will be able to tell you exactly how long the scars will be and what you can expect from the surgery.

The goal is a natural upper arm contour with better tone that better matches the contour of your lower arm. The arm lift may be combined with other plastic surgery procedures to dramatically improve your appearance.

Arm lift surgery is performed as outpatient surgery, which means you will go home the same day of your surgery. Because both upper arms are operated upon at the same operation, you will need assistance for several days before you become more independent. You will require 1-2 weeks off from work, possibly longer depending on your line of work.

Tummy Tuck (Abdominoplasty)

A “tummy tuck”, or abdominoplasty is a surgery to restore the anatomy and appearance of the abdomen. This is commonly done after pregnancy, weight loss, or aging stretches the skin and moves the six-pack muscles to the side (we call this “diastasis recti”). Women often express frustration that no matter how much time they spend at the gym, they are unable to achieve their “pre-baby” body. Most commonly, this is because the muscles have moved apart, which creates a “pooched” appearance to the belly from the side view and there is extra skin.

Where are the scars?

Scars for a tummy tuck typically go from hip to hip along the bikini line (hidden by underwear and swimwear) and around the belly button. The belly button remains in the same location, but the skin around it moves (which is why there is a scar around the belly button). Sometimes a shorter scar can be used or the belly button scar can be avoided depending on the amount of extra skin that needs to be removed.

What is the recovery time?

We use a subcutaneous pain pump that continually numbs up the incision and muscle repair for the first three days. This makes your recovery much more comfortable. Most patients are sore and slow-moving for the first week after surgery. Most of the time it is more comfortable to walk in a slightly hunched position for the first week or so. This is because the skin is much tighter once all of the loose skin is removed. Your body will gradually accommodate your new shape. Soreness improves every day and by the second week most patients are moving around normally and having only mild discomfort. If you have drains, they are typically removed in the first one to two weeks. It’s important not to lift anything heavy (more than 10 pounds) for six weeks after surgery. This will give your body time to heal and reduce the risk of getting a fluid collection or suboptimal scarring.

Drains or No Drains?

Anytime a raw surface is created the body produces fluid while it is healing (similar to a skinned knee). When this fluid accumulates under the skin it acts as a physical barrier to healing, which makes for a longer recovery. For this reason many surgeons will place a small plastic tube to collect and remove fluid during the early part of healing. Sometimes the drain can be omitted if special internal sutures are used to hold the tissue together. This is a matter of surgeon preference. Both methods are performed here at Polyclinic Plastic Surgery. Talk to your surgeon about which method he or she uses for more details.

Where would I have surgery?

This is an outpatient (meaning you can go home the same day) procedure performed in our fully accredited operating rooms attached to the office. A board certified anesthesia provider will deliver deep sedation and monitor you during the procedure. This method of anesthesia known as monitored anesthesia care decreases the risk of post-operative nausea and vomiting from the anesthesia and shortens overall recovery time. Your safety is our first priority. All of our providers are board certified by the American Board of Plastic Surgery and our operating rooms adhere to the strictest safety standards as noted by our Medicare accreditation.

Liposuction

Liposuction is the process of removing fat cells using a small thin metal tube called a cannula from a particular area. The most frequent question I get is, “will the fat come back in a different place?” If you maintain your weight, the answer is no. The mature human body has a fixed number of fat cells where excess energy is stored. These cells expand and contract as weight is gained and lost. Liposuction changes the overall number of fat cells by removing cells from a “problem area” and therefore changing the distribution. Every single fat cell can not be removed from a particular area, which is why if you gain weight you may see an increase in fat in the area that was liposuctioned or in other areas where fat cells exist as the remaining cells expand. Patients who are at their ideal weight, but who have a “problem area” are the best candidates for liposuction. Liposuction is not a weight loss method.

What is the downtime?

Most patients are back to work in a week or less and back to all their normal activities at four to six weeks. Narcotic pain medications are prescribed post-operatively, but generally not necessary beyond the first week or two. The first night you will likely have some fluid that leaks out- this is because dilute numbing solution is injected during the procedure in order to minimize bleeding and bruising and maximize your result. It is a good idea to put some towels down over your bedding for the first night or two.

There is generally some swelling that lasts about two weeks and weight gain that is related to swelling and water retention. Most of this is gone at a few weeks, but your final results are not visible for several months.

It is important to wear a compression garment at all times (except when showering) after liposuction. This helps reduce swelling and encourage the skin to shrink up giving you the best possible shape and result.

Where would I have surgery?

This is an outpatient (meaning you can go home the same day) procedure performed in our fully accredited operating rooms attached to the office. A board certified anesthesiology provider will give you continuous IV medications and monitor you during the procedure. This method of anesthesia known as monitored anesthesia care or twilight anesthesia decreases the risk of post operative nausea and vomiting from the anesthesia and shortens overall recovery time. Your safety is our first priority. All of our surgeons are board certified by the American Board of Plastic Surgery and our operating rooms adhere to the strictest safety standards as noted by our AAAASF and Medicare accreditations.

Labiaplasty

Labiaplasty refers to corrective surgery of the external female genitalia, also known as the labia. Labia naturally come in many different colors, shapes, and sizes. While there is a wide range of normal, many women prefer for their outer lips (labia majora) to cover their inner lips (labia minora). If this doesn’t happen naturally (or if the labia become stretched after childbirth or with age), it can be surgically corrected with a simple procedure. There are two main surgical approaches to labiaplasty- a trim and a wedge. The trim procedure involves trimming the extra tissue along the visible edge of the labia minora. The wedge procedure removes a wedge of tissue resulting in a short scar that is hidden inside the labia majora. Both techniques are effective- ask your surgeon which would be the better technique for your specific anatomy and goals.

For internal vaginal tightening we have a revolutionary new technology available that uses radiofrequency heating of the tissues to naturally stimulate collagen. Cooling is applied to the surface to allow deep heating without discomfort. This is a painless thirty minute procedure with no recovery and no downtime. It can be done with or without external surgery depending on your goals.

What is the downtime?

There is minor discomfort that lasts a week or two- most of the downtime is related to swelling and itching as the tissue heals. It is important to wash the area gently after each trip to the bathroom for the first week or so. Sexual intercourse should be avoided for six weeks while the tissues heal to avoid splitting the new scars open.

Where would I have surgery?

This is an outpatient (meaning you can go home the same day) procedure performed in our fully accredited operating rooms attached to the office. The procedure can be done with or without anesthesia depending on your anxiety level. If you choose to have surgery without sedation numbing cream is applied to the area about half an hour before beginning the procedure so that the injection of additional numbing medication is painless.

If you choose to have sedation, a board certified anesthesia provider will deliver deep sedation and monitor you during the procedure. This method of anesthesia known as monitored anesthesia care decreases the risk of post-operative nausea and vomiting from the anesthesia and shortens overall recovery time. Your safety is our first priority. All of our surgeons are board certified by the American Board of Plastic Surgery and our operating rooms adhere to the strictest safety standards as noted by our Medicare accreditation.

Be your true you

Transgender Procedures

Transgender medicine and surgery is a growing field that assists those with a diagnosis of gender dysphoria. Surgery can be an essential aid to alleviate anxiety associated with dysphoria. A number of procedures are available. Male to female transition can be aided by the performance of breast augmentation and other feminizing procedures. Female to male procedures may include “top surgery” which essentially involves a mastectomy and creation of a male chest anatomy.

Male to Female Procedures

Female to Male Procedures

  • Mastectomy
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Transgender Plastic Surgery

Transgender medicine is a growing field that assists those with a diagnosis of gender dysphoria. The recognition and treatment of this condition has become a commonly accepted area of medicine. As part of a patient’s transition, surgical options exist to assist with feelings of gender dysphoria. Some individuals become comfortable with their role and identity without surgery but for others, surgery is an essential aid to alleviate their anxiety. Gender affirming surgery can help to make patients feel more at ease in private and social settings. Studies show that subjective measures of well-being, cosmesis, and sexual function all show benefit to the individual.

A number of procedures are available to this group of patients. Male to female transition can be aided by the performance of breast augmentation and other feminizing procedures. These may include facial surgery such as rhinoplasty, forehead lift, and blepharoplasty. Liposuction, thyroid cartilage reduction, and fat transfer are other procedures that may be contemplated. Genital reassignment surgery is also an option for some. Breast augmentation procedures require only a small incision and the implantation of a breast implant.

Female to male procedures may include “top surgery” which essentially involves a mastectomy and creation of a male chest anatomy. Different procedures exist depending on the size and shape of the breasts. “Keyhole” procedures involve an incision around the edge of the nipple only and are applicable to those with small breasts. “Double incision” operations are required for those with larger breasts and often include reconstructing the nipple with a grafting procedure. Other surgeries that may be of value include liposuction, fat grating, pectoral implants, and facial procedures. Genital surgery may also be an option for select individuals.

All patients are required to have persistent, well-documented gender dysphoria. Pre-operative social transition is also a requirement. Hormone therapy prior to surgery is not required but may be recommended depending on individual circumstances.


 

Excisions & Mohs Surgery

Skin Cancer Procedures

The most common type of cancer is skin cancer. Effective treatment requires the skill of primary providers, dermatologists, pathologists, and surgeons coordinating to diagnose, remove, repair, and monitor the applicable skin areas. Our Plastic Surgeons here at Polyclinic know this process well, having extensive experience and expertise with critical procedures related to the “remove” and “repair” steps.

The procedure includes performing an excision to surgically remove the cancer and a small margin of normal skin surrounding it; as well as the more complex aspects of Mohs surgery to repair the area.

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Skin Cancer

The most common type of cancer is skin cancer. Effective treatment requires the skills of primary providers, dermatologists, pathologists, and surgeons who follow the principles outlined below.

Accurate diagnosis

The diagnosis of skin cancer is often made by a primary care provider or dermatologist performing a biopsy for sampling of a suspicious area of skin. If the area is small it may all be removed, and if larger, a portion is removed for examination by a pathologist. Three types of skin cancer make up the majority: basal cell carcinoma (the most common and least dangerous), squamous cell carcinoma, and malignant melanoma (least common and most dangerous). With an accurate diagnosis, treatment can start.

Excision

A plastic surgeon may treat the cancer by performing an excision; surgically removing the cancer and a small margin of normal skin surrounding it. This is generally and outpatient procedure performed with local anesthesia.

Margin control

This is how we know if we “got it all”. Most often the piece of skin removed containing the cancer and surrounding normal skin is sent to a pathologist who will again perform an evaluation; to be certain of the diagnosis, and check that there is no cancer at the edges of the tissue removed. This information may not be available for several days yet in most cases this works well as the visible margin of safety the surgeon sees will be confirmed by the pathologist. In certain circumstances, the removal of the cancer and checking of the margins is performed using a method called Moh’s Surgery. With this technique, a dermatologist with special training will excise the cancer, removing it in a step-wise fashion, and immediately check the edges until it is all removed. With either method of removal, the next step is to repair the area in a fashion that will best restore function and appearance.

Repair

Your plastic surgeon will use a variety of techniques to reconstruct the area after the cancer is removed, whether it was just removed, or was removed on a previous day by a Moh’s surgeon. The techniques range from simple (allowing the area to heal without surgery, or simply closing the wound) to more complex (rearranging remaining skin using flap procedures, or, grafting skin from another site). Again, these are mostly outpatient procedures performed with local anesthesia, either in the same sitting as the excision, or at a pre-arranged day in the case of Moh’s surgery.

Follow up

Patients with one skin cancer are at risk for developing additional skin cancers in the future. It is wise to have ongoing monitoring of the site of the original cancer (to check for recurrence) and the skin of the whole body to determine if new ones are occurring.