Facial Procedure

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FACE

In a crowd of strangers, or in the company of friends, your face defines who you are. People often judge you at face value. And your confidence rises or falls depending on your perception of your appearance. While everyone wants to look their best, stress, ageing, and the environment take their toll. When the tell tale signs appear, enhance your looks through a variety of surgical and non-surgical cosmetic procedures that reverse the effects of time and make you eager to face the world.

FACIAL PROCEDURE:

Forehead Lift

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Synonymous to : Brow lift, Temporal Lift, Lateral Brow Lift, Forehead Rejuvenation

A significant number of patients who come to our office present primary concerns about the appearance of their upper face. Their common complaint is that they are often mistaken for looking tired, sad, or even angry when, in fact, they don't feel those emotions. They usually attribute their negative emotional state to the appearance of their upper eyelids and would usually request for upper blepharoplasty. This false perception of psychological pessimism of the face is due to the appearance of the upper eyelid which is affected by the brow position.

The eyebrow, which is a distinguishing portion of our forehead, contains hair follicles. The human eye, which includes the eyebrow and eyelids, is responsible for expressing one's non-verbal emotions. The contour, shape, and position of the eyebrow can suggest sadness, anger, confusion, and alertness. The eyebrows droop down as a person ages, causing fullness and hooding of the upper eyelid. This change in the brow position is often accompanied by deep transverse lines on the forehead, vertical lines at the glabelar area, and crow's feet at the lateral sides of the eyes.

The eyebrows' position can be altered surgically to help change the patient's facial expression; this is called forehead lift, or brow lift. It can be lifted by excising the excess skin of the forehead through an incision behind or just along the hairline. But for some patients who heal easily, especially Caucasians, the incision can be placed just above the eyebrows. The contour and shape of the eyebrows can also be altered by lifting the lateral half of the eyebrow, to raise the brow upward and back for a more youthful position which is executed through an incision at the temple area of the scalp. This procedure is called temporal lift. All of these procedures also improve or soften the deep transverse lines on the forehead, crow's feet at the sides of the eyes, and frown lines over the glabelar area. They result in a younger and relaxed look.

I often perform this as an out-patient procedure in our fully-equipped ambulatory surgical facility. However, patients may be admitted for a day or two in a hospital if they prefer comfort and relaxation immediately after the surgery. Whether performed as an out-patient or a hospital procedure, pre-operative laboratory and medical clearance are required. The procedure will last for 60 to 90 minutes. Forehead lift or temporal lift can be done under deep sedation with local anesthesia or general anesthesia. Patients are required to wear tight dressing or compression garments for one to two weeks. This will help the skin redrape to the muscle of the face, assist in controlling swelling, and prevent fluid from accumulating under the skin. There will be some swelling and mild bruising of the face that will last for two to three weeks. Sutures are removed seven days after the surgery.

Any patient planning to have this procedure will require ten to 14 days for the initial consultation, laboratory, medical clearance, surgery, follow-up, suture removal, and early recuperation. After these, the patient is safe to travel since wounds are dry and healed.

Possible risks and complications:

Unfavorable scarring

Bleeding (hematoma)

Infection

Poor wound healing

Anesthesia risks

Blood clots

Correctible hair loss at the incisions

Elevated hairline

Facial nerve injury with weakness or paralysis

Facial asymmetry

Skin loss

Numbness or intense itching

Changes in skin sensation

Eye irritation or dryness

Eyelid disorders that involve abnormal position of the upper eyelids (eyelid ptosis), loose eyelid skin, or abnormal laxness of the lower eyelid (ectropion) can co-exist with sagging forehead and eyebrow structures; brow lift surgery will not correct these disorders; additional surgery may be required

Fluid accumulation

Pain, which may persist

Skin contour irregularities

Skin discoloration and swelling

Sutures may spontaneously surface through the skin, become visible, or produce irritation that requires removal

Possibility of revisional surgery

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Facelift

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Synonymous to : Facelift, Rhytidectomy, Facial Rejuvenation

Ptosis, wrinkling or fine lines of the face, is largely the result of aging, massive weight loss, actinic damage, or genetic disorder acting singly or in combination with one another. The aged look of the face results from the gradual reduction of facial soft tissue volume.

To better analyze the face and the changes that it sustained through time, it is divided into three regions. The forehead is observed for dynamic and static transverse lines, ptosis of the brow, and vertical glabelar lines between the brow. The mid-face is noted for hollowing of the cheek; deep nasojugal, nasolabial, and labiomental furrow; and hooding of the upper eyelid skin and lower eyelid bags. Poor jawline definition is accompanied by laxity of the neck skin with vertical lines and is often seen at the lower third of the face.

These significant changes can be addressed by rhytidectomy, or commonly known as face lift. There are two general types of face lift procedure: the open or surgical face lift, and the non-surgical face lift which is also known as thread lift. Both the non-surgical and the surgical face lift reduce the sagging skin, soften the deep nasolabial folds, smoothen the sagging skin of the neck, and improve the definition of the jawline, thus restoring a youthful appearance. A face lift procedure addresses only the sagging and atrophic facial tissues. It has no effect on the quality of facial skin. It is also not a treatment for irregular skin pigmentation which can be addressed by a resurfacing procedure.

This rejuvenation or restoration procedure is done by re-suspending the soft tissues of the face with placation sutures, and removing or excising the excess inelastic skin of the face. The resulting scar is oriented along the natural line of the face; this is placed along the anterior border of the ear and turns back at the ear lobule going to the posterior hair line, thus making it very inconspicuous. Majority of patients who seek facial rejuvenation often have a simultaneous concern with the appearance of their eyelids. Most would complain of hooding and fullness of the upper eyelid skin with baggy lower eyelids. This can be addressed through upper and lower blepharoplasty. It�s very common for patients consulting for a face lift procedure to also need a blephraoplasty surgery and vice versa. The results of both procedures are very complementary and they maximize the individual effect.

Facial rejuvenation can also be attained through a minimally invasive procedure without any surgical incision. This procedure, called thread lift surgery, involves inserting non-absorbable barbed sutures under the skin to lift the soft facial tissues and attain a more youthful look. This procedure results in less swelling compared to the traditional open face lift. The result may only last for two to three years.

Thread lift surgery is performed as an out-patient procedure in a fully-equipped ambulatory surgical facility. Patients may also be admitted to a hospital for a day or two if they prefer to have more comfort and relaxation immediately after the surgery. Whether performed as an out-patient or as a hospital procedure, pre-operative laboratory and medical clearance is required. This is done a day before the surgery. The procedure will last for three to four hours under deep sedation with local anesthesia or general anesthesia. This can be performed simultaneously with other cosmetic procedures for patients with good physical health. Patients are required to wear tight dressing or compression garments for one week to help the skin redrape to the muscles of the face, control swelling, and prevent fluid accumulation under the skin flap. There will be some swelling and mild bruising of the face that will last for several days or weeks. Sutures are usually removed seven days after the surgery.

Patients planning to have this procedure will be required to allot ten to 14 days for the initial consultation, laboratory, medical clearance, surgery, follow-up, suture removal, and early recuperation. After these, the patient is safe to travel since wounds would have dried and healed.

Possible risks and complications:

Unfavorable scarring

Bleeding (hematoma)

Infection

Poor wound healing

Anesthesia risks

Correctible hair loss at the incisions

Facial nerve injury with weakness

Facial asymmetry

Skin loss

Numbness or other changes in skin sensation

Fatty tissue found deep in the skin might die (fat necrosis)

Fluid accumulation

Pain, which may persist

Skin contour irregularities

Skin discoloration, sensitivity, or swelling

Sutures may spontaneously surface through the skin, become visible, or produce irritation that requires removal

Unsatisfactory results may include asymmetry, unsatisfactory surgical scar location, and unacceptable visible deformities at the ends of the incisions (It may be necessary to perform additional surgery to improve the results.)

Deep vein thrombosis, cardiac and pulmonary complications

Possibility of revisional surgery

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Blepharoplasty

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Synonymous to: Eyebag Removal, Slit Eye Surgery, Eye Fold Creation, Double Eyelid Surgery, Deep Set Eye, Eye Bag Surgery

Rejuvenation of the eyelid area is technically called blepharoplasty, the procedure used to improve the appearance of the upper eyelids, lower eyelids, or both, restoring firmness to the area surrounding the eyes and making you look more rested and alert. A lot of patients who seek to improve the appearance of their eyes complain that they have a lot of loose and excess skin at their eye area, giving them a tired and aged appearance that does not reflect their actual age.

The changes that occur with aging at the eyelid area are very noticeable and often affect a patient�s self esteem. These changes can be fullness and hooding of the upper eyelid skin, poor definition of the upper eyelid folds, and puffiness or bagginess of the lower eyelid. They can be very prominent and affect the facial profile or appearance of the patient, giving him or her a tired, sad, and haggard appearance.

Eyelid surgery can treat loose or sagging skin of the periorbital area, redefine or recreate the upper eyelid folds, or hide the natural contour of the upper eyelid. It can address the excess skin that hangs from the upper eyelid (sometimes impairing vision) and the excess fatty deposits that appear as puffiness in the upper eyelids or bags under the eyes. It can also remedy droopiness, excess skin, and fine wrinkles of the lower eyelid.

Unlike brow lift, the effects of a blepharoplasty procedure are more localized on the eyelid area. The skin surrounding the eyes is the area where the first signs of aging set in. As early as the second to the third decade of life, skin redundancy and fat protrusion in the periorbital area can be noted. Through time, this may progress to deep wrinkling with hooding of the upper eyelid skin, puffy lower eyelids, and may be accompanied by drooping of the eyebrows. These give the face a tired, sad, or angry expression. Blepharoplasty is a surgical procedure that addresses these issues in the eyelid area. It can brighten the face, improve the definition of the upper eyelid folds, and restore a more youthful appearance. This is attained by removing the loose, sagging skin of the eyelids and the excess fat that bulges from them.

This procedure is done under local anesthesia and takes two to three hours to complete. The incision is oriented along the natural fold or crease of the upper and lower eyelids so that the result will be a very inconspicuous scar. Patients should not worry about the final appearance of the scar since this is much concealed and hardly noticeable. Excess skin and protruding fats are excised to create a smooth and crisper appearance of the eyelid skin. This will also improve the definition of the upper eyelid fold. This procedure is usually performed in a fully-equipped out-patient surgical facility without compromising the patient�s health, safety, and the results. After the procedure, the patient may go home or stay at a hotel to rest and recuperate. Patients must be aware and accept that there will be mild swelling and bruising for two to three days after the procedure. However, this will start to subside on the fourth day onwards. The patient�s eyes would be socially presentable by the seventh to tenth day after the surgery because much of the swelling would have subsided by then. Sutures are removed on the fourth to fifth day after the procedure.

Patients planning to have this procedure are required to allot ten to 14 days for the initial consultation, laboratory, medical clearance, surgery, follow-up, suture removal, and early recuperation. After these, patients are safe to travel since wounds are already dry and healed by then.

Possible risks and complications:

Unfavorable scarring

Temporarily blurred or impaired vision

Dry eyes

Difficulty closing your eyes

Lid lag, a pulling down of the lower eyelid may occur and is often temporary

Ectropion, rolling of the eyelid outwards

Bleeding (hematoma)

Poor wound healing

Infection

Fluid accumulation

Blood clots

Numbness and other changes in skin sensation

Anesthesia risks

Pain, which may persist

Skin discoloration and swelling

Sutures may spontaneously surface through the skin, become visible, or produce irritation that requires removal

Deep vein thrombosis, cardiac and pulmonary complications

Possibility of revisional surgery

Loss of eyesight

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Rhinoplasty

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Synonymous to : Nose Augmentation, Nose Lift, Alar Trimming, Tip Plasty, Nose Job, Reduction Rhinoplasty, Nasal Reshaping

Rhinoplasty, or cosmetic nose procedure, enhances the features and contour of the nose. Each individual has different nasal features. The nose of each patient requesting rhinoplasty surgery has specific characteristics that are influenced by and dependent on racial origin. For example, Caucasians often have a high bony bridge that may be accompanied by a dorsal hump, crooked bony bridge, and drooping nasal tip. Asians, on the other hand, often have a low bony bridge, round or bulbous nasal tip, and wide and flaring alar base with overhang of the alar rim. These give a strong facial feature and explain why most Asians have a more masculine nasal profile.

These less pleasing features of the nose may affect the self-esteem of some patients and the way other people look, appreciate, and accept them. This can be corrected and enhanced by a rhinoplasty procedure. Rhinoplasty is not a single standardized procedure for all patients requesting aesthetic improvement of the nose area. There are several procedures that can enhance the features of the nose. They include infracture rhinoplasty, reduction rhinoplasty, tip plasty, augmentation rhinoplasty, and alar trimming. This can be performed alone or combined together to satisfy the needs of the patient.
To better evaluate the nose, it is divided into three general parts or regions: the nasal dorsum or bony bridge, the nasal tip, and the ala or alar lobule. The type of cosmetic nose enhancement procedure that a patient will need varies and depends on the area of the nose that is of great concern to the patient. For Caucasians that have a dorsal hump or crooked nasal dorsum, they would need infracture rhinoplasty to straighten and smoothen the bridge of their nose. A drooping nasal tip, on the other hand, will need a tip plasty to increase tip projection.

For Asians, rhinoplasty is a more challenging procedure. There are numerous features of the Asian nose that may need correction or enhancement with rhinoplasty. Very common among Asians is a low nasal bridge due to a less prominent or not fully developed nasal bone. This can be enhanced through augmentation rhinoplasty. This is performed by inserting a nasal implant, either silicone or gortex, through an incision inside the nose. The nasal implant is inserted into a pocket created under the skin and on top of the bony bridge. This will increase the height of the bony bridge or dorsum of the nose.

A round or bulbous nasal tip, another common feature of the Asian nose, is due to a well-developed and large cartilage at the nasal tip. This cartilage widens the tip of the nose and makes it less defined. This is corrected through a tip plasty procedure that excises the excess cartilage at the tip of the nose to narrow it down and give it more definition. Tip plasty also increases the projection of the nasal tip, something much needed in an Asian nose which is usually deficient in height at the nasal tip.

For the alar region of the nose, the ideal width of the alar base should not go beyond the medial end of the eyes. For a nose to be aesthetically appealing, the collumela should be exposed and not covered by an overhanging alar rim when viewed from the side. It is very common among Asians to have a thick and overhanging alar rim with a wide and flaring alar base. This can be enhanced by alar trimming surgery, a procedure that narrows down the alar width of the nose and removes the excess or overhanging alar rim, thus exposing the collumela. Nasal implants are made from soft yet solid material. These can be in many forms and compositions, i.e., silicone block, gortex, medpore, etc. These implants are bio-compatible, do not cause toxic reaction to the body, can be sterilized, and their shape can be contoured and removed when needed. Silicone oil, used in the past for injection to augment the bridge of the nose, is different from silicone implants. Silicone oil is liquid in form and had been associated with many complications such as infection, extrusion, inflammation, and contour deformity. Results with silicone oil injection are very unpredictable, and the rate of complications is very high. This is the reason why most trained cosmetic surgeons don�t perform the procedure.

As earlier mentioned, rhinoplasty is not a single standard procedure that could address all the features or needs of an Asian or Caucasian nose. There are several types of rhinoplasty procedures, and it will be difficult for the cosmetic surgeon to recommend what procedure will best suit a particular patient without doing a thorough physical examination. It is best that a patient should visit a cosmetic surgeon to know all the options.

Rhinoplasty patients need to prepare prior to surgery. For two to three weeks, they are required to avoid smoking, alcoholic beverages, aspirin, steroids, NSAID�s, pain medications like mefenamic acid and naproxen, vitamin E supplements, herbal tea and herbal medications, and blood-thinning medications like coumadin and heparin. Said medications and social activities will make patients bleed a lot during surgery and delay their healing. Patients must be of good health to be a good candidate for surgery. Patients with any medical illness like asthma, allergies, hypertension, bleeding disorder, emphysema, and poor wound healing will require further treatment prior to surgery. This is best discussed with your cosmetic surgeon.

The rhinoplasty procedure is commonly performed under local anesthesia in a doctor�s office or out-patient surgical facility that is accredited by the local health department. Patients who are agitated before the procedure may request sedation for more comfort and relaxation during surgery. Patients may be required to wear a splint in the form of tapes or plaster of paris on the nose for approximately a week or longer depending on the type or extent of operation and the surgeon�s preference. Some bruising and swelling should be expected on the first two to three days after the procedure, but they will subside after one to two weeks. The patient�s nose is usually socially presentable by the seventh to tenth day. It may take several months for the nose to fully settle, so it takes time before you may appreciate the full effect of the procedure. Sutures are usually removed on the third to fourth day after surgery.
For the rhinoplasty procedure, patients are advised to allot eight to ten days. This period of time is enough for consultation, laboratory, surgery, follow-up, suture removal, and recuperation. After these, patients are safe to travel back home or work since all of the wounds are dry and healed.

Possible risks and complications:

Infection

Poor wound healing

Anesthesia risks

Bleeding (hematoma)

Nose asymmetry

Cardiac and pulmonary complications can occur in longer surgical procedures and may be associated with the formation of, or increase in, blood clots in the venous system

Change in skin sensation (numbness)

Nasal airway alterations may occur after a rhinoplasty or septoplasty that may interfere with normal passage of air through the nose

Nasal septal perforation (a hole in the nasal septum) may develop but is rare; additional surgical treatment may be necessary to repair the nasal septum, but it may be impossible to correct this complication in some cases

Pain, which may persist

Unfavorable scarring

Skin contour irregularities

Skin discoloration and swelling

Skin perforation by nasal implant or implant extrusion

Sutures may spontaneously surface through the skin, become visible, or produce irritation that requires removal

Possibility of revision surgery

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Alar Trimming / Alar Plasty

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This is frequently requested by Oriental patients. Asians usually have a wide and round nasal tip with overhang of the alar lobule area. Alar trimming is commonly performed on a patient with a wide nostril and flaring alar lobule. This procedure will improve the contour and definition of your nasal alar lobule area. This is done either under local anesthesia or intravenous sedation depending on the preference and comfortableness of the surgeon and the patient. Usually lasting for 45 to 60 minutes, it is done as an out-patient procedure. There is minimal swelling afterwards, and it usually subsides after one to two weeks. Sutures are removed on the third to fourth day after the operation.

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Ear Surgery / Otoplasty

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Ear deformity at an early age, especially at birth or during the first month of life, could be addressed by splinting technique. Ear surgery, or otoplasty, is usually done on children above the age of five or six to set prominent ears back closer to the head or to reduce the size of large ears. Ears are almost fully grown by then, and the earlier the surgery, the less teasing the child will have to endure. Ear surgery on adults is also possible, and there are generally no additional risks associated with ear surgery in either age group.

Most surgeons recommend that parents stay alert to their child's feelings about protruding ears; they shouldn�t insist on the surgery until the child wants the change. Children who feel uncomfortable about their ears and want the surgery are generally more cooperative during the process and happier with the outcome. Ear surgery is usually performed as an out-patient procedure, or at a hospital that may require admission (usually for pediatric patients). Occasionally, a surgeon may recommend that the procedure be done as an in-patient procedure depending on the patient�s age and other medical conditions. The surgeon makes a small incision at the back of the ear. He or she will then sculpt the cartilage and bend it back toward the head. Non-absorbable stitches may be used to help maintain the new shape. Occasionally, the surgeon may remove a piece of cartilage to provide a more natural-looking fold when the surgery is complete. In less complicated cases, skin is removed and stitches are used to fold the cartilage back on itself to reshape the ear without reshaping cartilage. This is done either under local or general anesthesia, depending on the patient�s age. In most cases, there is a faint scar at the back of the ear that will fade with time.

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Mentoplasty

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Synonymous to : Chin Augmentation (Implants) , Chin Reduction

Chin surgery, also known as mentoplasty, is a procedure that re-contours the size and shape of the jawbone at the chin area. This is either through enhancement or augmentation with the use of an implant, or reduction surgery on the bone. Chin surgery is best combined with nose surgery in order to achieve facial proportion, as the size of the chin may magnify or minimize the perceived size of the nose. Chin surgery helps provide a harmonious balance to your facial features so that you feel better about the way you look. The features of our face may be affected by the size and shape of the bone at the chin area. A small chin bone may project a weak facial profile, while a well developed bone with excess chin projection have a more masculine or strong look.

Chin augmentation is a popular procedure because it�s a relatively easy operation for the patient while producing noticeable changes in the silhouette of the face. This procedure uses surgical implants to alter the underlying structure of the lower third of the face, providing better balance to the facial structures. Implant materials used for chin surgery are safe, do not cause toxic or allergic reaction to the body, can be sterilized, don�t cause soft-tissue diseases or malignant transformation, and can be removed when needed. Augmentation of the chin can also be achieved by manipulation of the jawbone, and utilizing this technique usually provides a more dramatic correction than with the use of prosthetic implants.

Another form of manipulation of the jawbone is by chin reduction. This is a surgical procedure that reshapes the contour of the bone at the chin area. The bone height and width is modified to suit the patient�s facial profile and obtain harmony of the facial structures. This is done by shaving a portion of the bone with an osteotomy machine. A thorough radiographic evaluation of the patient�s facial skeletal structure is needed prior to surgery. This will provide information on the degree of skeletal imbalance and the amount of bone that should be removed in order to achieve facial proportion.

The surgery is performed either under local anesthesia or intravenous sedation depending on the extent of the procedure. This is usually performed at an out-patient surgical facility that is accredited by the local health department. A short incision is created either through the mouth or under the chin. The chin implant is inserted to a pocket that is created under the muscle of the chin and above the bone. The incision is closed with absorbable sutures when created inside the mouth, while non-absorbable sutures are used for incisions under the chin. The initial results after the surgery may be obscured by swelling and some bruising. It is helpful to apply cold compress at the chin area for a few days immediately after the surgery to reduce the amount of swelling. This is temporary and may resolve after two to four weeks, but patients are advised that the final outcome will be evident after four to six months. A pressure dressing or bandage is placed to provide compression to the chin and hold the implant or bone in place. This will also help reduce discomfort and swelling after surgery. Sutures are usually removed after seven to ten days.

Individuals planning to undergo chin augmentation procedure are prepared prior to the scheduled surgery. For two to three weeks, patients are advised to avoid smoking; alcoholic beverages; steroids; NSAID�s or pain medications like mefenamic acid and naproxen; herbal tea and herbal medications; vitamin E; blood thinning medications like aspirin, heparin, and coumadin; regulated drugs like Valium; prohibited drugs like methamphetamines; diet pills; and oral contraceptive pills. These medications and social activities may delay healing, prolong bleeding during surgery, and may interact with the medications used during the procedure. It is advised that patients discuss this further with their surgeon to minimize possible risks and complications.

The surgery is performed either under local anesthesia or intravenous sedation depending on the extent of the procedure and patient�s preference. This is usually performed at an out-patient surgical facility that is accredited by the local health department. A short incision is created either through the mouth or under the chin. The chin implant is inserted to a pocket that is created under the muscle of the chin and above the bone. The incision is closed with absorbable sutures when created inside the mouth, while non-absorbable sutures are used for incisions under the chin. The initial results after the surgery may be obscured by swelling and some bruising. This is temporary and may resolve after two to four weeks, but patients are advised that the final outcome will be evident after four to six months. Sutures are removed on the fifth to seventh days after surgery. Prospective patients planning to have this procedure are required to allot eight to ten days. This time will be used for the initial consultation, laboratory, medical clearance, surgery, follow-up, suture removal, and early recuperation. After this, the patient is safe to travel since wounds are dry and healed.

Your plastic surgeon and/or 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.

Possible risks and complications:

Unfavorable scarring

Bleeding (hematoma)

Infection

Poor wound healing

Anesthesia risks

Nerve injury with weakness

Asymmetry

Numbness or other changes in skin sensation

Pain, which may persist

Skin contour irregularities

Skin discoloration, sensitivity or swelling

Sutures may spontaneously surface through the skin, become visible, or produce irritation that requires removal

Unsatisfactory results may include asymmetry, unsatisfactory surgical scar location, and unacceptable visible deformities at the ends of the incisions which may make it necessary to perform additional surgery to improve the results.

Possibility of revision surgery

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Cheek Augmentation / Malar Implant

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Just like the chin, cheek enhancements also create a strong aesthetically appealing facial profile. Plastic surgeons use facial implants to improve and enhance facial contours and volume. Frequently, these implants will help provide a more harmonious balance to your facial features. Cheek implant surgery usually takes about 45 minutes to more than an hour. When cheek implants are being placed in conjunction with another cosmetic procedure such as a facelift, forehead lift or eyelid surgery, the implants may be inserted through the incisions made for those procedures. Otherwise, an incision will be made either inside your upper lip or your lower eyelid. A pocket is then formed and an implant is inserted. This may require only local anesthesia combined with a sedative. However, a general anesthesia may be recommended if the patient is agitated. There could be some swelling after the operation but it usually subsides after several days or weeks. After surgery, a dressing will be applied to minimize discomfort and swelling. The severity and duration of such effects may vary, especially if another cosmetic procedure was done at the same time.

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Dimple Assignment

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A dimple of the cheek skin is a soft tissue invagination that becomes prominent on facial animation or smiling. This is usually located lateral to the lip commisure. Some people find it aesthetically appealing as it complements their facial profile. The procedure is usually done by creating a core biopsy incision inside the mouth. Absorbable sutures are then used to plicate the skin and the subcutaneous cheek muscle. This suturing technique in effect will produce dimpling on facial animation or smiling. The procedure is usually performed for 30 to 45 minutes under local anesthesia with intra-oral incision. Swelling and slight bruising will be noted after 24 to 48 hours, but they will eventually subside after seven to ten days.

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Hair Transplant

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Hair loss is primarily caused by a combination of aging, hormonal changes, and a family history of baldness. As a rule, the earlier hair loss begins, the more severe the baldness will become. Hair loss can also be caused by burns or trauma, in which cases hair replacement surgery is considered a reconstructive treatment. This procedure could enhance your appearance and self-esteem, but results won�t necessarily match your ideal outcome. We would advise you to extensively discuss your expectations with your surgeon prior to the procedure. Hair transplant surgery uses your existing hair, and it is important that patients have healthy growing hair at the back and sides of the head to serve as donor area. Other factors such as hair color, texture, and waviness may also affect the cosmetic result. This procedure is done in stages under local or intravenous sedation, depending on the patient�s and surgeon�s preference and comfortableness.

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Double Eye Lid / Slit Eye Procedure

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Double eye lid surgery, commonly known as slit eye procedure, is commonly requested by Oriental patients such as Chinese, Japanese, and Koreans, or patients with poorly developed upper eyelid folds. The procedure creates a well-defined slightly slanted upper eyelid fold, resulting in brighter and youthful looking upper eyelids. Incisions are oriented in the natural fold of the eyes, and the procedure usually lasts for 30 to 60 minutes. This is done under local anesthesia. There could be some swelling and bluish discoloration on the first two to three days after the procedure. The swelling and bruising will usually subside after one to two weeks, and the thin surgical scars will become less visible and gradually blend into your eyes� natural lines. Sutures are removed on the third to fifth day after the operation.

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