Procedures & Services
Cosmetic Surgery Procedures
Considering a change in your face or neck? Browse through the services offered by our double board certified Facial Plastic Surgeon, Dr. Robert DeFatta.
Patients interested in softening fine lines around their eyes, mouth, and forehead without the need for an invasive or time-consuming treatment may want to consider botox.
Botox is one of the most extensively studied and widely known aesthetic treatments available today. It has been approved for use in 78 countries, with 10.9 million of vials sold in the U.S. alone since 2002. This injectable can be used to treat a wide variety of facial wrinkles, including crow’s feet, forehead lines, vertical lip lines, and chin dimpling.
What to expect at your initial visit
The Botox injection is normally injected directly into the muscle with a tiny needle.
Results of Botox Injections
Results of botox injections are normally seen within a few days. The results generally last 3-4 months and require occasional touch-ups.
Recovery after Botox
There is generally no recovery period after a botox injection. You can go directly back to your normal activities.
Eyes are a prominent facial feature. It is the surrounding skin, rather than the eyes themselves, that conveys emotion. The tissue, muscle, fat, hair and lashes all contribute to the wide array of expressions. Age, sun exposure and hereditary factors all contribute to wrinkles, deep lines, and puffiness around the eyes.
The aging process can cause unwanted changes in expression, causing us to look permanently fatigued and older than we really are. These changes in appearance can cause emotional distress and sometimes even visual impairment. An eyelid lift, or blepharoplasty, is designed to restore a more youthful appearance to your eyes. It may involve the upper lids, the lower lids, or both.
TechniquesTraditional Blepharoplasty: An incision is made in the crease of the upper lid toward the temples. Once healed, it is not noticeable when the eye is open. On the lower lid, the incision is made along the lash line toward the temples and is hidden by lashes when healed.
The Transconjunctival Approach: This is a somewhat newer technique for lower lid blepharoplasty, involving an incision inside the lower lid. Fat can be removed through this incision, but excess skin cannot be eliminated.
Laser resurfacing or chemical peeling of the eyelids is a non-surgical alternative that may delay the need for a surgical blepharoplasty. It results in significant tightening of the skin around the eyes, but will not affect the fat around the eyes and may even accentuate it.
Please ask your doctor if you have any questions about which procedure is right for you.
The SurgeryLocal anesthesia is given around the eyes. An intravenous line is started so that sedation may also be given. During the procedure, you will be awake but comfortable and relaxed. General anesthesia may also be used.
This procedure is performed on an outpatient basis. It is important to arrange for care after the surgery. Someone must drive you home and be available to care for you for the first 24 hours.
Recovery: What to ExpectThe area surrounding the eyes will remain swollen in the days following the surgery. It should begin to subside after the first day. Some vision blurring is normal.
The stitches are usually dissolvable. Swelling and bruising will persist for about 10 days, but you can begin wearing makeup to help conceal these concerns. You may expect to resume normal activity within 10 days, and start enjoying your new look within approximately 10-14 days. It may take about 6 months for the scars to lose their redness.
Wrinkling will recur later in life, however, it is unlikely that the “bags” will recur because the fat has been removed. Deeper wrinkles around the outer eye extended onto the temple are not greatly affected by the eyelid lift. These areas may be treated with laser resurfacing.
Dr. DeFatta performs brow lift and forehead lift to raise eyebrows and reduce ridges and furrows on the forehead, thus creating a smoother, more youthful appearance. This procedure can be performed in conjunction with other surgeries.
Newer techniques now allow us to perform Forehead Lifting through small incisions in the scalp by using an endoscope and specialized instruments. This accelerates the healing process.
As we age, there is often a gradual descent of the eyebrows from a higher, arched position to a flatter lower location. This will increase the amount of loose skin in the upper eyelids and give the eyes an older, tired appearance. It can, at times, even cause a peripheral visual field defect decreasing the ability to see objects coming from the sides. Early on, Botox may be used to selectively shape the brows and elevate them a few millimeters. However, as time passes, gravity and skin laxity will progress. Elevation of the brows will help place them in a more favorable position, opening up the eyes, decreasing upper eyelid laxity and generally giving a more youthful appearance. The brows may be elevated by incisions at various locations at or above them.
Incisions may be made in the brow (occasionally done in facial paralysis patients), in the middle of the forehead (in patients that have very deep creases) or behind the hairline. Dr. DeFatta’s most commonly performed technique for elevating the brows is the endoscopic brow lift. In this technique, he makes a few small incisions behind the hairline (except if hairline receded) on each side. Through these incisions, a small camera is inserted allowing the release of the brows and re-suspension at a higher level. There are some tiny screws and staples that are used to help support the brows in an elevated position. They are then removed in the office with minimal discomfort a couple weeks after surgery.
Mentoplasty: Surgery of the Chin
A well-defined chin helps give balance to the face and creates a major part of one’s profile. When people look in the mirror, most focus on the size and shape of their noses, their ears, sagging jowls, or fine wrinkling of the skin. But even though few examine their chins with the same discerning eye, having a “weak chin” is certainly not an asset. Surgeons who specialize in rhinoplasty, or surgery of the nose, are often the first to suggest that changes in chin size or shape may enhance a profile as much as rhinoplasty. It is common for the facial plastic surgeon to recommend chin surgery in addition to nose surgery when the surgeon sees that chin augmentation is necessary to achieve facial balance and harmony. Fortunately, this is a relatively straightforward procedure that can make a major difference.
If you are wondering how chin surgery could improve your appearance, you need to know how the surgery is performed and what you can expect from this procedure. Your surgeon can address many of your concerns and provide you the information to begin considering chin surgery.
Successful facial plastic surgery is a result of good rapport between patient and surgeon. Trust, based on realistic expectations and exacting medical expertise, develops in the consulting stages before surgery. Your surgeon can answer specific questions about your specific needs.
Is Chin Surgery Right for You?
As with all elective surgery, good health and realistic expectations are prerequisites. It is also key to understand all aspects of the surgery. A pleasing, balanced profile can be achieved by inserting an implant or moving the bone forward to build up a receding chin, or by reducing a jutting or too prominent chin. The result can be greater facial harmony and an increase in self-confidence.
Another possibility for improvement through chin surgery is submental liposuction in which excess fatty tissue is removed to redefine the chin or neckline. When there is a contributing problem of dental malocclusions or birth defects in the structure of the jaw itself, surgery of the jaw can improve the form and function of the lower face and greatly enhance appearance.
Your consultation can help you decide on the type of surgery that addresses your concerns. Your surgeon can also provide information on new medical techniques for chin surgery and offer recommendations for supplementary surgery that can ensure the greatest improvement.
Making the Decision For Chin Surgery
Whether you are interested in chin surgery for functional or cosmetic reasons, your choice of a qualified facial plastic surgeon is extremely important. During the consultation, your surgeon will thoroughly examine your chin and jaw to pinpoint problems. In some instances, the surgeon will suggest chin surgery as a supplement to rhinoplasty because a small chin can make the nose appear larger. Your surgeon will weigh other factors that could influence the outcome of surgery such as age, skin type, and attitudes toward surgery. The surgical procedure will be described in detail along with reasonable projections. If you opt for surgery, your surgeon will describe the technique indicated, the type of anesthesia to be used, the surgical facility, any additional surgery, and risks and costs.
Understanding the Surgery
To augment the chin, the surgeon begins by making an incision either in the natural crease line just under the chin or inside the mouth, where gum and lower lip meet. By gently stretching this tissue, the surgeon creates a space where an implant can be inserted. This implant, made of synthetic material that feels much like natural tissue normally found in the chin, is available in a wide variety of sizes and shapes. This allows custom fitting of the implant to the configuration of the patient’s face. After implantation, the surgeon uses fine sutures to close the incision. When the incision is inside the mouth, no scarring is visible. If the incision is under the chin, the scar is usually imperceptible.
In chin reduction surgery, incisions are made either in the mouth or under the chin. The surgeon sculpts the bone to a more pleasing size. For orthognathic surgery, the surgeon will make an incision inside the mouth and reposition the facial bones. The procedure, depending on the extent of the work, takes less than an hour to approximately three hours.
What to Expect After the Surgery
Immediately after surgery, the surgeon usually applies a dressing that will remain in place for two to three days. You will experience some tenderness. Post-operative discomfort can be controlled with prescribed medications. Chewing will probably be limited immediately after chin surgery, and a liquid and soft food diet may be required for a few days after surgery. Most patients feel a stretched, tight sensation after the surgery, but this usually subsides in a week.
After approximately six weeks, most swelling will be gone, and you can enjoy the results of your procedure. Rigorous activity may be prohibited for the first few weeks after surgery. Normal activity can be resumed after approximately ten days.
Facial plastic surgery makes it possible to enhance your appearance and eliminate signs of premature aging that undermine self-confidence. By changing how you look, facial plastic surgery can improve your self-image.
Insurance does not generally cover surgery that is purely for cosmetic reasons. Surgery to correct or improve genetic deformity or traumatic injury may be reimbursable in whole or in part. It is the patient’s responsibility to check with the insurance carrier for information on the degree of coverage.
Laser Skin Resurfacing: As one of the most exciting and innovative scientific achievements of the decade, Laser technology is being utilized throughout the healthcare community. Dr. DeFatta uses lasers to treat sun-damaged skin, facial wrinkles, and scars in a procedure called laser skin resurfacing.
What is a laser?
The word “laser” is an acronym, which stands for Light Amplification by the Stimulated Emission of Radiation. A surgical laser, such as the CO2 laser, is a beam of light capable of removing unwanted tissue, such as scarred, lined, wrinkled, and otherwise imperfect skin. The laser vaporizes skin cells by emitting bursts of radiation that are absorbed by water in these cells. Laser light penetrates to a very precise, controlled depth, making the procedure safe and predictable while reducing the risk of scarring or pigmentation problems. As a result of this treatment, you are left with more natural looking skin.
What areas can be treated with laser resurfacing?
The laser is used to reduce tiny wrinkles, acne scars, and other minor skin imperfections, especially around the mouth and eyes. It can improve sun-damaged and acne scarred skin, problems that often cause concern to both men and women.
Before Surgery
Prior to surgery, Dr. DeFatta and you will discuss the goals for facial improvement. After determining the appropriate procedure, we will fully describe the procedure, what results to expect and the costs. The skin is usually pretreated prior to surgery to improve the healing time.
The Procedure
A local anesthetic is given to ensure that you are comfortable throughout the procedure. The area is cleansed and draped. Dr. DeFatta directs the laser beam toward your skin imperfections. The laser quickly and accurately vaporizes the outermost layers of skin just four or five cells in thickness.
What can be expected?
In most cases, only one treatment is needed. The initial redness fades in a few weeks to a light pink, which can be concealed with makeup. The discoloration usually disappears in one or three months. The goal of laser resurfacing is to enhance facial appearance. Expectations by the patient must be realistic, and results should be anticipated as improvements rather than total corrections. Results of the surgery depend on many factors such as the size, shape, and location of the imperfection and the patient’s heredity, age and general skin condition.Surgery Using Lasers
What is a laser? A laser is a high-energy beam of light that can selectively transfer its energy into tissue to treat the skin. Lasers contain a material that produces and amplifies light. Two mirrors cause the light to reflect back and forth through this material. The result is a light beam that is collimated and intense. This light is either one pure color or several different pure colors. These properties which separate the laser from a light bulb, are important to the medical application of lasers.
Many procedures cannot be done without the laser. Likewise, many procedures are better performed without the laser. Even with the sparkle, pure color, and high-energy beam, the laser is not always the best tool for surgery. The choice of using a laser or other surgical methods is carefully made by the facial plastic surgeon. Your surgeon has the preference to consider the results, the possible complications, and the alternatives.
Many procedures can be performed with different lasers. The choice of the laser depends on many factors, including the surgeon’s experience, the size of the area to be treated, and the expectations of the patient.
What Can Laser Surgery Do For You?
The use of lasers in medicine is complex, and your facial plastic surgeon is trained in the use of lasers and understands how and when to use a laser. Your will decide if a laser is appropriate, and which laser is best for the situation.
In medicine, physicians can use lasers to make incisions, vaporize tumors, close blood vessels, selectively reduce pigmentation, or even treat skin wrinkles. The laser makes it possible to change tissue without making an incision. So a surgeon can treat birthmarks or damaged blood vessels, remove port-wine stains, and shrink facial “spider veins” without major surgery.
Is it any wonder that many facial plastic surgeons use lasers on a routine basis? They use the laser as a “light scalpel.” The tissue is left sterile, and bleeding is greatly reduced. When the laser is used to treat port-wine stains, no cuts are made. The laser energy penetrates through the skin to shrink the abnormal blood vessels that are the cause of these marks.
What Can Laser Surgery Do For You?
Laser Skin Peeling– Lasers can be used to reduce wrinkles around the lips or eyes, even the entire face, softening fine wrinkles and removing certain blemishes on the face.
Laser Removal of Birthmarks and Skin Lesions – Port-wine stain birthmarks respond remarkably well to laser treatment. The abnormal blood vessels that cause these marks are reduced in size by the laser. This results in a lightening of the treated area. Skin growths, facial “spider veins,” warts, and some tattoos respond to laser surgery. Most situations take more than one laser treatment, but some respond to a single treatment.
The facial plastic surgeon often uses the minimum laser intensity possible. The low intensity requires many treatments. However, the low intensity also preserves as much of the healthy tissue as possible. This produces an aesthetically pleasing result. Many of these laser surgeries are performed as outpatient treatments in hospitals or offices.
New Lasers– There are constant technologic advances which lead to even new applications of future generations of lasers.
Please ask Dr. DeFatta to discuss the latest advances with you.
Understanding the Surgery
After your surgeon has indicated that a laser can be helpful in the surgery, your surgeon will explain the laser of choice and what can be accomplished. As with all surgery, the laser has its limitations. Often the results are spectacular. Your surgeon will give you the best judgment for the particular procedure.
Some surgeons may use local anesthetics to numb the treated area before the surgery. Surgery can sometimes be done in the surgeon’s office; other times the surgeries are performed in outpatient facilities at a clinic or hospital. Your surgeon will decide on the appropriate method, dictated by the nature of the surgery.
Because safety is a major component of laser use, your surgeon will describe safety precautions before the surgery. If you are treated with a local anesthetic, you will be required to wear protective glasses or goggles during laser use.
What To Expect After Laser Surgery
After the surgery, you will probably experience some swelling and skin redness for several days. Antibiotic ointments may be used during the healing process. It is important for the patient to follow all the post-operative directions of the surgeon, particularly in using sunblock and avoiding sun exposure.
The full impact of the laser may not be apparent for a month or two, especially with vascular deformities. Additional treatment sessions will not be scheduled until the healing process for a particular treatment is complete.
It is important for the patient to realize that lasers have specific applications. The facial plastic surgeon is experienced in the use of the laser and is the best source of information as to whether laser surgery is appropriate for your condition.
Insurance does not generally cover surgery that is done purely for cosmetic reasons. Surgery to correct or improve congenital deformities or accidental skin injuries may be reimbursable in whole or in part. It is the patient’s responsibility to check with the insurance carrier for information on the degree of coverage.
In cases of protruding or over-developed ears, the procedure of otoplasty may be an option. Otoplasty is commonly referred to as “pinning back” of the ears. It is available for children once their ears have stopped developing around the age of six. Over-developed ears can be the cause of psychological stress and trauma and should be treated at a young age before it becomes a serious issue. Dr. DeFatta is trained in several surgical procedures, in order to eliminate the majority of the problems related to protruding ears.
Before Surgery
To better understand your overall health, we will evaluate your medical history prior to surgery. In addition, a complete examination of your ears is made in order to take the most effective surgical approach. All issues such as shape and types of anesthesia used will be discussed.
Dr. DeFatta will provide you with pre-operative instructions that may include the elimination of specific drugs containing aspirin several weeks before surgery to minimize excess bleeding. Antibiotics may also be prescribed to prevent infection.
The areas that will be excised are marked and digital photographs are taken in order to document the amount of improvement after surgery.
Otoplasty
The procedure can be performed under IV sedation or general anesthesia and the doctor will discuss this option with you. Dr. DeFatta has the option of either folding the cartilage located on the back of the ear or removing excess cartilage. Sutures are placed and bandages applied to speed the healing process. The procedure typically takes only one hour.
Post-Operative Information
After the operation patients should expect to bruise around the area that fades in 2 to 3 weeks. Pain associated with the operation is minimal and can be easily treated with oral medication. Numbness is to be expected. The bandages are needed for up to a week. Refraining from sleeping on the ears is required and patients are advised to use a very soft pillow. Showering and shampooing may begin after dressing is removed. Consult with Dr. DeFatta before attempting any athletic or precarious activities that may affect the healing process. An elastic supporting headband holding the ears should be used nightly for 1 month after surgery.
Rhinoplasty & Septoplasty
Dr. DeFatta performs rhinoplasty in order to reshape the nose. Appearance can be improved for those people who are dissatisfied with the shape and size of their nose. Nasal reconstruction was one of the first cosmetic procedures ever developed and is among those most frequently performed today. Rhinoplasty is a surgical procedure in which deformities of the nose are corrected by removing, rearranging or reshaping bone or cartilage.
Reasons for Surgery
Reasons include reducing the size of the nose, removal of bumps as well as improving the angle of a nose. Conditions may be natural or due to external trauma to the face. This operation will also help patients who have difficulty breathing. The operation can be performed on all age groups, including teens and the elderly.
Before Surgery
Occasionally, a medical history along with a careful examination is conducted in order to evaluate your general health. We will discuss with you the way your nose can look in relation to your other facial features. Digital photographs and computer imaging allow Dr. DeFatta to evaluate the appropriate procedure to achieve the desired results. Pre-operative instructions may include the elimination of certain drugs that contain aspirin or aspirin-like compounds in order to minimize the possibility of excess bleeding. Antibiotics may be prescribed before surgery to prevent infection.
Method of Surgery
In most cases involving a reduction in shape or size of the nose, angle or removal of a hump, the skin of the nose is separated from the underlying skeleton of bone and cartilage. The bone and cartilage are then reshaped and the skin re-draped over the surface. Patients who have a deviated septum may benefit by correction of this problem. The incisions are placed inside the nose unless the surgeon uses an open approach, in which case the incisions are made across the tissue between the nostrils. In cases where the nostrils flare, the surgeon may make an incision at the junction between the nose and the skin of the upper lip to narrow the flared appearance. It is not unusual to combine rhinoplasty with chin augmentation to improve the profile.
Insurance
Your insurance company may pay for all or part of the costs associated with your surgery if it is performed as a result of nasal obstruction. It is recommended that you check with your carrier to determine if there is coverage.
Post-Operative Information
The recovery takes one to two weeks. Most people resume their normal activities within a week or two. Following surgery, a lightweight splint is applied to maintain the new shape of the nose. The splint is removed within a week. Nasal splints may be inserted at the time of surgery to protect the septum. These are removed within a week. There is always some stuffiness of the nose, especially when work has been done on the nasal septum.
Pain is minimal and is controlled with medications. Bruising occurs around the eyes but begins to fade within a few days. Discoloration usually disappears in two weeks.
Rhytidectomy (Facelift)
Many factors cause the skin to wrinkle and sag; i.e., exposure to the sun, genetics as well as the natural aging process. Children and young adults have smooth, round faces due to fatty tissue that is evenly distributed throughout the contours of the face. As you age the skin sags and fits more loosely. These folds become prominent, especially around the chin, the jawline and along the neck.
Dr. DeFatta performs rhytidectomies, or facelifts, to enhance your appearance and correct these conditions. A facelift involves tightening of the facial and neck muscles as well as the removal of any excess skin. The procedure is often performed in conjunction with additional cosmetic surgeries such as blepharoplasty (eyelid surgery), forehead lift, chin augmentation, liposuction and/or rhinoplasty (nasal surgery). These procedures can be performed any-time after signs of aging appear in order to attain a more youthful appearance.
Before Surgery
We will evaluate your medical history in order to determine your overall health. Dr. DeFatta will discuss with you how your face can look and what you can expect from surgery. Our objective is to create a natural appearance that is pleasing to you. Photographs and computer imaging are performed to determine the amount of improvement after surgery.
We will provide you with preoperative instructions that may include the elimination of specific drugs containing aspirin several weeks before surgery to minimize excess bleeding. Antibiotics may also be prescribed to prevent infection. You may be instructed to shampoo your hair the night before surgery. A small amount of hair may be shaved around your ears and temples.
Surgery
A Rhytidectomy can be performed under IV Sedation or general anesthesia in our state-of-the-art surgical facility. These options will be discussed in detail with you. Premedication is administered for relaxation. Incisions are made inside the hairline at the temple, running in front of the ear then around the earlobe and behind the ear, ending in the hair of the scalp. The loose skin is separated from underlying tissue and is pulled up and back. Excess skin is removed. Sagging muscles and connective tissues are tightened. In some cases, fatty deposits are removed from beneath the chin and neck. Small sutures are used to close the incisions. The procedure may take up to five hours depending on whether any other procedures are performed at the same time.
Post-operative Care
It is recommended that you stay one night in the recovery care center to receive specialized care from the nursing staff. Bandages are applied to the area of surgery and are removed within a few days. Pain is moderate and controlled with oral medications. Your sutures are removed within the first 5 to 10 days. In order to minimize scarring, the doctor may remove the sutures in stages. Scarring fades quickly. Swelling and discoloration decrease within two weeks. Tightness in your face will be present for several weeks and there may be slight changes in your hair pattern around the incision. It is recommended that you avoid the sun for several weeks after surgery. Healing is gradual so you will not notice final results for up to 6 months. Improvement varies, depending on your initial condition. In most cases, a single procedure achieves the desired results. Most patients who have had facelifts are pleased with their new, more youthful appearance.
When the skin is in the process of recovering from an injury, whether the result of an accident, surgery, a burn, or acne, scarring will occur wherever multiple layers of the skin have been affected. Once a scar forms, it is permanent but may be made less visible or relocated surgically.
With very few exceptions most people are self-conscious about facial scars. Some people may also experience diminished functioning of the eyes, mouth, or nose due to scarring. If you’ve wondered how facial scar revision could improve your appearance, your self-confidence, or your level of facial functioning, you need to know how scar revision works and what you can expect from this procedure. This pamphlet can address many of your and provide you the information to begin considering facial scar revision surgery.
Successful facial plastic surgery is a result of good rapport between patient and surgeon. Trust, based on realistic expectations and exacting medical expertise, develops in the consulting stages before surgery is performed. Your surgeon can answer specific questions about your specific needs.
Is Facial Scar Treatment For You?
The most basic requirement for all surgery is good health. Other requirements are more subtle and should be carefully considered in discussion with your surgeon. Expectations of the surgery and of the surgeon must be realistic. A person considering facial scar revision must understand that there is no way to remove scars completely. The goal is to improve the appearance of the scar either by disguising it, relocating it, or minimizing its prominence. Skin color and type, age, and the type of scarring are all important factors that must be part of the discussion prior to surgery.
Different types of scars respond to different plastic surgery techniques. The timing of surgery is another important choice. Some surgeons advise against any scar revision in cases of injury for a period that might extend up to a year after the injury. This interval allows the body enough time to heal fully.
Making the Decision For Scar Treatment
Whether the surgery is desired for functional or cosmetic reasons, your choice of a facial plastic surgeon is of paramount importance. Your surgeon will examine the scar in order to decide upon the proper treatment and inform you of outcomes that can be expected from facial scar revision surgery.
Different scars require different treatments. For example, severe burns that destroy large sections of skin cause the skin to heal in a puckered way. As the skin heals, muscles and tendons may be affected by this “contracting” movement. Keloid scars are a result of the skin’s overproduction of collagen after a wound has healed. These scars generally appear as growths in the scar site. Hypertrophic scars, unlike keloids, do not grow out of the boundaries of the scar area, but because of their thick, raised texture, can be unsightly and may also restrict the natural movement of muscles and tendons.
Some facial scars are unattractive simply because of where they appear on the face, while others affect facial expressions. All surgical possibilities will be discussed in the initial consultation along with risks involved for each type of scarring.
The agreement between you and your surgeon on how to proceed is a prerequisite for successful surgery. After you both decide to proceed with scar revision, your surgeon will inform you about the anesthesia, the surgical facility, any supportive surgery options, and costs.
Because scars are highly individualistic and the patient’s attitude toward scars is so personal, maximum improvement in facial scars may require more than one procedure, and more than one technique may be employed.
Understanding the Surgery
When a scar is of the contracture type, surgery generally involves removing the scar tissue entirely. Skin flaps, composed of adjacent healthy, unscarred skin, are then lifted and moved to form a new incision line. Where a flap is not possible, a skin graft may be used. A graft involves taking a section of skin tissue from one area and attaching it to another, and time must be allowed following surgery for new blood vessels and soft tissue to form. Z-plasty is a method to move a scar from one area to another, usually into a natural fold or crease in the skin to minimize its visibility. While Z-plasty does not remove all signs of a scar, it does make it less noticeable.
Dermabrasion and laser resurfacing are methods a surgeon uses to make “rough or elevated” scars less prominent, by removing part of the upper layers of skin with an abrading tool or laser light. Clearly, the scar will remain, but it will be smoother and less visible.
Keloid or hypertrophic scars are often treated first with injections of steroids to reduce size. If this is not satisfactory, the scars can be removed surgically, and the incisions closed with fine stitches, often resulting in less prominent scars.
What to Expect After the Surgery
You can expect to feel some discomfort after facial scar revision surgery. Some swelling, bruising and redness are generally unavoidable. It is important for you to follow your surgeon’s after care recommendations to the letter. Though the sutures will be removed within days after the surgery, your skin needs time to heal. Surgeons generally insist on decreased activity after surgery and instruct the patient to keep the head elevated when lying down, to use cold compresses to reduce swelling and to avoid any activity that places undue stress on the area of the incision. Depending on the surgery performed and the site of the scar, the facial plastic surgeon will explain the types of activities to avoid. No medication should be taken without first consulting the surgeon. It is important to remember that scar tissues require a year or more to fully heal and achieve maximum improved appearance.
Facial plastic surgery makes it possible to correct facial flaws that can undermine self-confidence. Changing how your scar looks can help change how you feel about yourself.
Insurance does not generally cover surgery that is purely for cosmetic reasons. Surgery to correct or improve scars caused by injury may be reimbursable in whole or in part. It is the patient’s responsibility to check with the insurance carrier for information on the degree of coverage.
Being diagnosed with a cancerous mole on my face was terrifying. When meeting with Dr. DeFatta, I immediately felt at ease and knew I was in good hands. After my operation, there was no evidence that I ever had surgery and Dr. DeFatta even sat down with my husband to assure him the surgery was a success. A patient couldn’t be in better hands than with Dr. DeFatta and his staff.
Shirley M.
Cosmetic Surgery Procedures
Considering a change in your face or neck? Browse through the services offered by our double board certified Facial Plastic Surgeon, Dr. Robert DeFatta.
Patients interested in softening fine lines around their eyes, mouth, and forehead without the need for an invasive or time-consuming treatment may want to consider botox.
Botox is one of the most extensively studied and widely known aesthetic treatments available today. It has been approved for use in 78 countries, with 10.9 million of vials sold in the U.S. alone since 2002. This injectable can be used to treat a wide variety of facial wrinkles, including crow’s feet, forehead lines, vertical lip lines, and chin dimpling.
What to expect at your initial visit
The Botox injection is normally injected directly into the muscle with a tiny needle.
Results of Botox Injections
Results of botox injections are normally seen within a few days. The results generally last 3-4 months and require occasional touch-ups.
Recovery after Botox
There is generally no recovery period after a botox injection. You can go directly back to your normal activities.
Eyes are a prominent facial feature. It is the surrounding skin, rather than the eyes themselves, that conveys emotion. The tissue, muscle, fat, hair and lashes all contribute to the wide array of expressions. Age, sun exposure and hereditary factors all contribute to wrinkles, deep lines, and puffiness around the eyes.
The aging process can cause unwanted changes in expression, causing us to look permanently fatigued and older than we really are. These changes in appearance can cause emotional distress and sometimes even visual impairment. An eyelid lift, or blepharoplasty, is designed to restore a more youthful appearance to your eyes. It may involve the upper lids, the lower lids, or both.
TechniquesTraditional Blepharoplasty: An incision is made in the crease of the upper lid toward the temples. Once healed, it is not noticeable when the eye is open. On the lower lid, the incision is made along the lash line toward the temples and is hidden by lashes when healed.
The Transconjunctival Approach: This is a somewhat newer technique for lower lid blepharoplasty, involving an incision inside the lower lid. Fat can be removed through this incision, but excess skin cannot be eliminated.
Laser resurfacing or chemical peeling of the eyelids is a non-surgical alternative that may delay the need for a surgical blepharoplasty. It results in significant tightening of the skin around the eyes, but will not affect the fat around the eyes and may even accentuate it.
Please ask your doctor if you have any questions about which procedure is right for you.
The SurgeryLocal anesthesia is given around the eyes. An intravenous line is started so that sedation may also be given. During the procedure, you will be awake but comfortable and relaxed. General anesthesia may also be used.
This procedure is performed on an outpatient basis. It is important to arrange for care after the surgery. Someone must drive you home and be available to care for you for the first 24 hours.
Recovery: What to ExpectThe area surrounding the eyes will remain swollen in the days following the surgery. It should begin to subside after the first day. Some vision blurring is normal.
The stitches are usually dissolvable. Swelling and bruising will persist for about 10 days, but you can begin wearing makeup to help conceal these concerns. You may expect to resume normal activity within 10 days, and start enjoying your new look within approximately 10-14 days. It may take about 6 months for the scars to lose their redness.
Wrinkling will recur later in life, however, it is unlikely that the “bags” will recur because the fat has been removed. Deeper wrinkles around the outer eye extended onto the temple are not greatly affected by the eyelid lift. These areas may be treated with laser resurfacing.
Dr. DeFatta performs brow lift and forehead lift to raise eyebrows and reduce ridges and furrows on the forehead, thus creating a smoother, more youthful appearance. This procedure can be performed in conjunction with other surgeries.
Newer techniques now allow us to perform Forehead Lifting through small incisions in the scalp by using an endoscope and specialized instruments. This accelerates the healing process.
As we age, there is often a gradual descent of the eyebrows from a higher, arched position to a flatter lower location. This will increase the amount of loose skin in the upper eyelids and give the eyes an older, tired appearance. It can, at times, even cause a peripheral visual field defect decreasing the ability to see objects coming from the sides. Early on, Botox may be used to selectively shape the brows and elevate them a few millimeters. However, as time passes, gravity and skin laxity will progress. Elevation of the brows will help place them in a more favorable position, opening up the eyes, decreasing upper eyelid laxity and generally giving a more youthful appearance. The brows may be elevated by incisions at various locations at or above them.
Incisions may be made in the brow (occasionally done in facial paralysis patients), in the middle of the forehead (in patients that have very deep creases) or behind the hairline. Dr. DeFatta’s most commonly performed technique for elevating the brows is the endoscopic brow lift. In this technique, he makes a few small incisions behind the hairline (except if hairline receded) on each side. Through these incisions, a small camera is inserted allowing the release of the brows and re-suspension at a higher level. There are some tiny screws and staples that are used to help support the brows in an elevated position. They are then removed in the office with minimal discomfort a couple weeks after surgery.
Mentoplasty: Surgery of the Chin
A well-defined chin helps give balance to the face and creates a major part of one’s profile. When people look in the mirror, most focus on the size and shape of their noses, their ears, sagging jowls, or fine wrinkling of the skin. But even though few examine their chins with the same discerning eye, having a “weak chin” is certainly not an asset. Surgeons who specialize in rhinoplasty, or surgery of the nose, are often the first to suggest that changes in chin size or shape may enhance a profile as much as rhinoplasty. It is common for the facial plastic surgeon to recommend chin surgery in addition to nose surgery when the surgeon sees that chin augmentation is necessary to achieve facial balance and harmony. Fortunately, this is a relatively straightforward procedure that can make a major difference.
If you are wondering how chin surgery could improve your appearance, you need to know how the surgery is performed and what you can expect from this procedure. Your surgeon can address many of your concerns and provide you the information to begin considering chin surgery.
Successful facial plastic surgery is a result of good rapport between patient and surgeon. Trust, based on realistic expectations and exacting medical expertise, develops in the consulting stages before surgery. Your surgeon can answer specific questions about your specific needs.
Is Chin Surgery Right for You?
As with all elective surgery, good health and realistic expectations are prerequisites. It is also key to understand all aspects of the surgery. A pleasing, balanced profile can be achieved by inserting an implant or moving the bone forward to build up a receding chin, or by reducing a jutting or too prominent chin. The result can be greater facial harmony and an increase in self-confidence.
Another possibility for improvement through chin surgery is submental liposuction in which excess fatty tissue is removed to redefine the chin or neckline. When there is a contributing problem of dental malocclusions or birth defects in the structure of the jaw itself, surgery of the jaw can improve the form and function of the lower face and greatly enhance appearance.
Your consultation can help you decide on the type of surgery that addresses your concerns. Your surgeon can also provide information on new medical techniques for chin surgery and offer recommendations for supplementary surgery that can ensure the greatest improvement.
Making the Decision For Chin Surgery
Whether you are interested in chin surgery for functional or cosmetic reasons, your choice of a qualified facial plastic surgeon is extremely important. During the consultation, your surgeon will thoroughly examine your chin and jaw to pinpoint problems. In some instances, the surgeon will suggest chin surgery as a supplement to rhinoplasty because a small chin can make the nose appear larger. Your surgeon will weigh other factors that could influence the outcome of surgery such as age, skin type, and attitudes toward surgery. The surgical procedure will be described in detail along with reasonable projections. If you opt for surgery, your surgeon will describe the technique indicated, the type of anesthesia to be used, the surgical facility, any additional surgery, and risks and costs.
Understanding the Surgery
To augment the chin, the surgeon begins by making an incision either in the natural crease line just under the chin or inside the mouth, where gum and lower lip meet. By gently stretching this tissue, the surgeon creates a space where an implant can be inserted. This implant, made of synthetic material that feels much like natural tissue normally found in the chin, is available in a wide variety of sizes and shapes. This allows custom fitting of the implant to the configuration of the patient’s face. After implantation, the surgeon uses fine sutures to close the incision. When the incision is inside the mouth, no scarring is visible. If the incision is under the chin, the scar is usually imperceptible.
In chin reduction surgery, incisions are made either in the mouth or under the chin. The surgeon sculpts the bone to a more pleasing size. For orthognathic surgery, the surgeon will make an incision inside the mouth and reposition the facial bones. The procedure, depending on the extent of the work, takes less than an hour to approximately three hours.
What to Expect After the Surgery
Immediately after surgery, the surgeon usually applies a dressing that will remain in place for two to three days. You will experience some tenderness. Post-operative discomfort can be controlled with prescribed medications. Chewing will probably be limited immediately after chin surgery, and a liquid and soft food diet may be required for a few days after surgery. Most patients feel a stretched, tight sensation after the surgery, but this usually subsides in a week.
After approximately six weeks, most swelling will be gone, and you can enjoy the results of your procedure. Rigorous activity may be prohibited for the first few weeks after surgery. Normal activity can be resumed after approximately ten days.
Facial plastic surgery makes it possible to enhance your appearance and eliminate signs of premature aging that undermine self-confidence. By changing how you look, facial plastic surgery can improve your self-image.
Insurance does not generally cover surgery that is purely for cosmetic reasons. Surgery to correct or improve genetic deformity or traumatic injury may be reimbursable in whole or in part. It is the patient’s responsibility to check with the insurance carrier for information on the degree of coverage.
Laser Skin Resurfacing: As one of the most exciting and innovative scientific achievements of the decade, Laser technology is being utilized throughout the healthcare community. Dr. DeFatta uses lasers to treat sun-damaged skin, facial wrinkles, and scars in a procedure called laser skin resurfacing.
What is a laser?
The word “laser” is an acronym, which stands for Light Amplification by the Stimulated Emission of Radiation. A surgical laser, such as the CO2 laser, is a beam of light capable of removing unwanted tissue, such as scarred, lined, wrinkled, and otherwise imperfect skin. The laser vaporizes skin cells by emitting bursts of radiation that are absorbed by water in these cells. Laser light penetrates to a very precise, controlled depth, making the procedure safe and predictable while reducing the risk of scarring or pigmentation problems. As a result of this treatment, you are left with more natural looking skin.
What areas can be treated with laser resurfacing?
The laser is used to reduce tiny wrinkles, acne scars, and other minor skin imperfections, especially around the mouth and eyes. It can improve sun-damaged and acne scarred skin, problems that often cause concern to both men and women.
Before Surgery
Prior to surgery, Dr. DeFatta and you will discuss the goals for facial improvement. After determining the appropriate procedure, we will fully describe the procedure, what results to expect and the costs. The skin is usually pretreated prior to surgery to improve the healing time.
The Procedure
A local anesthetic is given to ensure that you are comfortable throughout the procedure. The area is cleansed and draped. Dr. DeFatta directs the laser beam toward your skin imperfections. The laser quickly and accurately vaporizes the outermost layers of skin just four or five cells in thickness.
What can be expected?
In most cases, only one treatment is needed. The initial redness fades in a few weeks to a light pink, which can be concealed with makeup. The discoloration usually disappears in one or three months. The goal of laser resurfacing is to enhance facial appearance. Expectations by the patient must be realistic, and results should be anticipated as improvements rather than total corrections. Results of the surgery depend on many factors such as the size, shape, and location of the imperfection and the patient’s heredity, age and general skin condition.Surgery Using Lasers
What is a laser? A laser is a high-energy beam of light that can selectively transfer its energy into tissue to treat the skin. Lasers contain a material that produces and amplifies light. Two mirrors cause the light to reflect back and forth through this material. The result is a light beam that is collimated and intense. This light is either one pure color or several different pure colors. These properties which separate the laser from a light bulb, are important to the medical application of lasers.
Many procedures cannot be done without the laser. Likewise, many procedures are better performed without the laser. Even with the sparkle, pure color, and high-energy beam, the laser is not always the best tool for surgery. The choice of using a laser or other surgical methods is carefully made by the facial plastic surgeon. Your surgeon has the preference to consider the results, the possible complications, and the alternatives.
Many procedures can be performed with different lasers. The choice of the laser depends on many factors, including the surgeon’s experience, the size of the area to be treated, and the expectations of the patient.
What Can Laser Surgery Do For You?
The use of lasers in medicine is complex, and your facial plastic surgeon is trained in the use of lasers and understands how and when to use a laser. Your will decide if a laser is appropriate, and which laser is best for the situation.
In medicine, physicians can use lasers to make incisions, vaporize tumors, close blood vessels, selectively reduce pigmentation, or even treat skin wrinkles. The laser makes it possible to change tissue without making an incision. So a surgeon can treat birthmarks or damaged blood vessels, remove port-wine stains, and shrink facial “spider veins” without major surgery.
Is it any wonder that many facial plastic surgeons use lasers on a routine basis? They use the laser as a “light scalpel.” The tissue is left sterile, and bleeding is greatly reduced. When the laser is used to treat port-wine stains, no cuts are made. The laser energy penetrates through the skin to shrink the abnormal blood vessels that are the cause of these marks.
What Can Laser Surgery Do For You?
Laser Skin Peeling– Lasers can be used to reduce wrinkles around the lips or eyes, even the entire face, softening fine wrinkles and removing certain blemishes on the face.
Laser Removal of Birthmarks and Skin Lesions – Port-wine stain birthmarks respond remarkably well to laser treatment. The abnormal blood vessels that cause these marks are reduced in size by the laser. This results in a lightening of the treated area. Skin growths, facial “spider veins,” warts, and some tattoos respond to laser surgery. Most situations take more than one laser treatment, but some respond to a single treatment.
The facial plastic surgeon often uses the minimum laser intensity possible. The low intensity requires many treatments. However, the low intensity also preserves as much of the healthy tissue as possible. This produces an aesthetically pleasing result. Many of these laser surgeries are performed as outpatient treatments in hospitals or offices.
New Lasers– There are constant technologic advances which lead to even new applications of future generations of lasers.
Please ask Dr. DeFatta to discuss the latest advances with you.
Understanding the Surgery
After your surgeon has indicated that a laser can be helpful in the surgery, your surgeon will explain the laser of choice and what can be accomplished. As with all surgery, the laser has its limitations. Often the results are spectacular. Your surgeon will give you the best judgment for the particular procedure.
Some surgeons may use local anesthetics to numb the treated area before the surgery. Surgery can sometimes be done in the surgeon’s office; other times the surgeries are performed in outpatient facilities at a clinic or hospital. Your surgeon will decide on the appropriate method, dictated by the nature of the surgery.
Because safety is a major component of laser use, your surgeon will describe safety precautions before the surgery. If you are treated with a local anesthetic, you will be required to wear protective glasses or goggles during laser use.
What To Expect After Laser Surgery
After the surgery, you will probably experience some swelling and skin redness for several days. Antibiotic ointments may be used during the healing process. It is important for the patient to follow all the post-operative directions of the surgeon, particularly in using sunblock and avoiding sun exposure.
The full impact of the laser may not be apparent for a month or two, especially with vascular deformities. Additional treatment sessions will not be scheduled until the healing process for a particular treatment is complete.
It is important for the patient to realize that lasers have specific applications. The facial plastic surgeon is experienced in the use of the laser and is the best source of information as to whether laser surgery is appropriate for your condition.
Insurance does not generally cover surgery that is done purely for cosmetic reasons. Surgery to correct or improve congenital deformities or accidental skin injuries may be reimbursable in whole or in part. It is the patient’s responsibility to check with the insurance carrier for information on the degree of coverage.
In cases of protruding or over-developed ears, the procedure of otoplasty may be an option. Otoplasty is commonly referred to as “pinning back” of the ears. It is available for children once their ears have stopped developing around the age of six. Over-developed ears can be the cause of psychological stress and trauma and should be treated at a young age before it becomes a serious issue. Dr. DeFatta is trained in several surgical procedures, in order to eliminate the majority of the problems related to protruding ears.
Before Surgery
To better understand your overall health, we will evaluate your medical history prior to surgery. In addition, a complete examination of your ears is made in order to take the most effective surgical approach. All issues such as shape and types of anesthesia used will be discussed.
Dr. DeFatta will provide you with pre-operative instructions that may include the elimination of specific drugs containing aspirin several weeks before surgery to minimize excess bleeding. Antibiotics may also be prescribed to prevent infection.
The areas that will be excised are marked and digital photographs are taken in order to document the amount of improvement after surgery.
Otoplasty
The procedure can be performed under IV sedation or general anesthesia and the doctor will discuss this option with you. Dr. DeFatta has the option of either folding the cartilage located on the back of the ear or removing excess cartilage. Sutures are placed and bandages applied to speed the healing process. The procedure typically takes only one hour.
Post-Operative Information
After the operation patients should expect to bruise around the area that fades in 2 to 3 weeks. Pain associated with the operation is minimal and can be easily treated with oral medication. Numbness is to be expected. The bandages are needed for up to a week. Refraining from sleeping on the ears is required and patients are advised to use a very soft pillow. Showering and shampooing may begin after dressing is removed. Consult with Dr. DeFatta before attempting any athletic or precarious activities that may affect the healing process. An elastic supporting headband holding the ears should be used nightly for 1 month after surgery.
Rhinoplasty & Septoplasty
Dr. DeFatta performs rhinoplasty in order to reshape the nose. Appearance can be improved for those people who are dissatisfied with the shape and size of their nose. Nasal reconstruction was one of the first cosmetic procedures ever developed and is among those most frequently performed today. Rhinoplasty is a surgical procedure in which deformities of the nose are corrected by removing, rearranging or reshaping bone or cartilage.
Reasons for Surgery
Reasons include reducing the size of the nose, removal of bumps as well as improving the angle of a nose. Conditions may be natural or due to external trauma to the face. This operation will also help patients who have difficulty breathing. The operation can be performed on all age groups, including teens and the elderly.
Before Surgery
Occasionally, a medical history along with a careful examination is conducted in order to evaluate your general health. We will discuss with you the way your nose can look in relation to your other facial features. Digital photographs and computer imaging allow Dr. DeFatta to evaluate the appropriate procedure to achieve the desired results. Pre-operative instructions may include the elimination of certain drugs that contain aspirin or aspirin-like compounds in order to minimize the possibility of excess bleeding. Antibiotics may be prescribed before surgery to prevent infection.
Method of Surgery
In most cases involving a reduction in shape or size of the nose, angle or removal of a hump, the skin of the nose is separated from the underlying skeleton of bone and cartilage. The bone and cartilage are then reshaped and the skin re-draped over the surface. Patients who have a deviated septum may benefit by correction of this problem. The incisions are placed inside the nose unless the surgeon uses an open approach, in which case the incisions are made across the tissue between the nostrils. In cases where the nostrils flare, the surgeon may make an incision at the junction between the nose and the skin of the upper lip to narrow the flared appearance. It is not unusual to combine rhinoplasty with chin augmentation to improve the profile.
Insurance
Your insurance company may pay for all or part of the costs associated with your surgery if it is performed as a result of nasal obstruction. It is recommended that you check with your carrier to determine if there is coverage.
Post-Operative Information
The recovery takes one to two weeks. Most people resume their normal activities within a week or two. Following surgery, a lightweight splint is applied to maintain the new shape of the nose. The splint is removed within a week. Nasal splints may be inserted at the time of surgery to protect the septum. These are removed within a week. There is always some stuffiness of the nose, especially when work has been done on the nasal septum.
Pain is minimal and is controlled with medications. Bruising occurs around the eyes but begins to fade within a few days. Discoloration usually disappears in two weeks.
Rhytidectomy (Facelift)
Many factors cause the skin to wrinkle and sag; i.e., exposure to the sun, genetics as well as the natural aging process. Children and young adults have smooth, round faces due to fatty tissue that is evenly distributed throughout the contours of the face. As you age the skin sags and fits more loosely. These folds become prominent, especially around the chin, the jawline and along the neck.
Dr. DeFatta performs rhytidectomies, or facelifts, to enhance your appearance and correct these conditions. A facelift involves tightening of the facial and neck muscles as well as the removal of any excess skin. The procedure is often performed in conjunction with additional cosmetic surgeries such as blepharoplasty (eyelid surgery), forehead lift, chin augmentation, liposuction and/or rhinoplasty (nasal surgery). These procedures can be performed any-time after signs of aging appear in order to attain a more youthful appearance.
Before Surgery
We will evaluate your medical history in order to determine your overall health. Dr. DeFatta will discuss with you how your face can look and what you can expect from surgery. Our objective is to create a natural appearance that is pleasing to you. Photographs and computer imaging are performed to determine the amount of improvement after surgery.
We will provide you with preoperative instructions that may include the elimination of specific drugs containing aspirin several weeks before surgery to minimize excess bleeding. Antibiotics may also be prescribed to prevent infection. You may be instructed to shampoo your hair the night before surgery. A small amount of hair may be shaved around your ears and temples.
Surgery
A Rhytidectomy can be performed under IV Sedation or general anesthesia in our state-of-the-art surgical facility. These options will be discussed in detail with you. Premedication is administered for relaxation. Incisions are made inside the hairline at the temple, running in front of the ear then around the earlobe and behind the ear, ending in the hair of the scalp. The loose skin is separated from underlying tissue and is pulled up and back. Excess skin is removed. Sagging muscles and connective tissues are tightened. In some cases, fatty deposits are removed from beneath the chin and neck. Small sutures are used to close the incisions. The procedure may take up to five hours depending on whether any other procedures are performed at the same time.
Post-operative Care
It is recommended that you stay one night in the recovery care center to receive specialized care from the nursing staff. Bandages are applied to the area of surgery and are removed within a few days. Pain is moderate and controlled with oral medications. Your sutures are removed within the first 5 to 10 days. In order to minimize scarring, the doctor may remove the sutures in stages. Scarring fades quickly. Swelling and discoloration decrease within two weeks. Tightness in your face will be present for several weeks and there may be slight changes in your hair pattern around the incision. It is recommended that you avoid the sun for several weeks after surgery. Healing is gradual so you will not notice final results for up to 6 months. Improvement varies, depending on your initial condition. In most cases, a single procedure achieves the desired results. Most patients who have had facelifts are pleased with their new, more youthful appearance.
When the skin is in the process of recovering from an injury, whether the result of an accident, surgery, a burn, or acne, scarring will occur wherever multiple layers of the skin have been affected. Once a scar forms, it is permanent but may be made less visible or relocated surgically.
With very few exceptions most people are self-conscious about facial scars. Some people may also experience diminished functioning of the eyes, mouth, or nose due to scarring. If you’ve wondered how facial scar revision could improve your appearance, your self-confidence, or your level of facial functioning, you need to know how scar revision works and what you can expect from this procedure. This pamphlet can address many of your and provide you the information to begin considering facial scar revision surgery.
Successful facial plastic surgery is a result of good rapport between patient and surgeon. Trust, based on realistic expectations and exacting medical expertise, develops in the consulting stages before surgery is performed. Your surgeon can answer specific questions about your specific needs.
Is Facial Scar Treatment For You?
The most basic requirement for all surgery is good health. Other requirements are more subtle and should be carefully considered in discussion with your surgeon. Expectations of the surgery and of the surgeon must be realistic. A person considering facial scar revision must understand that there is no way to remove scars completely. The goal is to improve the appearance of the scar either by disguising it, relocating it, or minimizing its prominence. Skin color and type, age, and the type of scarring are all important factors that must be part of the discussion prior to surgery.
Different types of scars respond to different plastic surgery techniques. The timing of surgery is another important choice. Some surgeons advise against any scar revision in cases of injury for a period that might extend up to a year after the injury. This interval allows the body enough time to heal fully.
Making the Decision For Scar Treatment
Whether the surgery is desired for functional or cosmetic reasons, your choice of a facial plastic surgeon is of paramount importance. Your surgeon will examine the scar in order to decide upon the proper treatment and inform you of outcomes that can be expected from facial scar revision surgery.
Different scars require different treatments. For example, severe burns that destroy large sections of skin cause the skin to heal in a puckered way. As the skin heals, muscles and tendons may be affected by this “contracting” movement. Keloid scars are a result of the skin’s overproduction of collagen after a wound has healed. These scars generally appear as growths in the scar site. Hypertrophic scars, unlike keloids, do not grow out of the boundaries of the scar area, but because of their thick, raised texture, can be unsightly and may also restrict the natural movement of muscles and tendons.
Some facial scars are unattractive simply because of where they appear on the face, while others affect facial expressions. All surgical possibilities will be discussed in the initial consultation along with risks involved for each type of scarring.
The agreement between you and your surgeon on how to proceed is a prerequisite for successful surgery. After you both decide to proceed with scar revision, your surgeon will inform you about the anesthesia, the surgical facility, any supportive surgery options, and costs.
Because scars are highly individualistic and the patient’s attitude toward scars is so personal, maximum improvement in facial scars may require more than one procedure, and more than one technique may be employed.
Understanding the Surgery
When a scar is of the contracture type, surgery generally involves removing the scar tissue entirely. Skin flaps, composed of adjacent healthy, unscarred skin, are then lifted and moved to form a new incision line. Where a flap is not possible, a skin graft may be used. A graft involves taking a section of skin tissue from one area and attaching it to another, and time must be allowed following surgery for new blood vessels and soft tissue to form. Z-plasty is a method to move a scar from one area to another, usually into a natural fold or crease in the skin to minimize its visibility. While Z-plasty does not remove all signs of a scar, it does make it less noticeable.
Dermabrasion and laser resurfacing are methods a surgeon uses to make “rough or elevated” scars less prominent, by removing part of the upper layers of skin with an abrading tool or laser light. Clearly, the scar will remain, but it will be smoother and less visible.
Keloid or hypertrophic scars are often treated first with injections of steroids to reduce size. If this is not satisfactory, the scars can be removed surgically, and the incisions closed with fine stitches, often resulting in less prominent scars.
What to Expect After the Surgery
You can expect to feel some discomfort after facial scar revision surgery. Some swelling, bruising and redness are generally unavoidable. It is important for you to follow your surgeon’s after care recommendations to the letter. Though the sutures will be removed within days after the surgery, your skin needs time to heal. Surgeons generally insist on decreased activity after surgery and instruct the patient to keep the head elevated when lying down, to use cold compresses to reduce swelling and to avoid any activity that places undue stress on the area of the incision. Depending on the surgery performed and the site of the scar, the facial plastic surgeon will explain the types of activities to avoid. No medication should be taken without first consulting the surgeon. It is important to remember that scar tissues require a year or more to fully heal and achieve maximum improved appearance.
Facial plastic surgery makes it possible to correct facial flaws that can undermine self-confidence. Changing how your scar looks can help change how you feel about yourself.
Insurance does not generally cover surgery that is purely for cosmetic reasons. Surgery to correct or improve scars caused by injury may be reimbursable in whole or in part. It is the patient’s responsibility to check with the insurance carrier for information on the degree of coverage.
Being diagnosed with a cancerous mole on my face was terrifying. When meeting with Dr. DeFatta, I immediately felt at ease and knew I was in good hands. After my operation, there was no evidence that I ever had surgery and Dr. DeFatta even sat down with my husband to assure him the surgery was a success. A patient couldn’t be in better hands than with Dr. DeFatta and his staff.
Shirley M.