Cosmetic Plastic Surgery: Procedures at a Glance

This page offers a general overview of cosmetic surgery procedures. For more in-depth information on these procedures, please follow the links in the left column.

While this section explores cosmetic surgical offerings, many of these procedures may also fulfill true medical needs. You should understand that the circumstances and experience of every individual will be unique.

• If you're considering cosmetic plastic surgery, please ask your plastic surgeon for further information about the particular procedure and what you expect.
• In addition, please note that all surgery carries some uncertainty and risk, including the possibility of infection, bleeding, blood clots, and adverse reactions to the anesthesia. You can reduce your risks by choosing a qualified plastic surgeon and closely following his or her advice, both before and after surgery.

ABDOMINOPLASTY
(Tummy Tuck)

Procedure:	Flatten abdomen by removing excess fat and skin and tightening muscles of abdominal wall.
Length:	2 to 5 hours.
Anesthesia:	General, or local with sedation.
In/Outpatient:	Either depending on individual circumstances and extent of surgery.
Side Effects:	Temporary pain. Swelling, soreness, numbness of abdominal skin, bruising, tiredness for several weeks or months.
Risks:	Blood clots. Infection. Bleeding under the skin flap. Poor healing resulting in conspicuous scarring or skin loss. Need for a second operation.
Recovery:	Back to work: 2 to 4 weeks. More strenuous activity: 4 to 6 weeks or more. Fading and flattening of scars: 3 months to 2 years.

BREAST ENLARGEMENT
(Augmentation Mammaplasty)

Procedure:	Enhance the size of breasts using inflatable implants filled with saline.
Length:	1 to 2 hours.
Anesthesia:	Local with sedation, or general.
In/Outpatient:	Usually outpatient.
Side Effects:	Temporary soreness, swelling, change in nipple sensation, bruising. Breast sensitive to stimulation for a few weeks.
Risks:	Lack of implant permanence -- surgical removal or replacement of the implants may be required to treat problems, including: deflation; the formation of scar tissue around the implant (capsular contracture), which may cause the breast to feel tight or hard; bleeding or infection. Increase or decrease in sensitivity of nipples or breast skin, occasionally permanent. Mammography requires a special technique. (Note: Some women have reported symptoms similar to those of immune disorders. Ask your doctor about these and other FDA concerns.)
Recovery:	Back to work: a few days. Physical contact with breasts: 3 to 4 weeks. Fading of scars: several months to a year or more.
Duration of Results:	Variable. Implants may require removal or replacement.

BREAST LIFT
(Mastopexy)

Procedure:	Raise and reshape sagging breasts by removing excess skin and repositioning remaining tissue and nipples.
Length:	1 to 3 hours.
Anesthesia:	Local with sedation, or general.
In/Outpatient:	Usually outpatient. Sometimes inpatient.
Side Effects:	Temporary bruising, swelling, discomfort, numbness, dry breast skin. Permanent scars.
Risks:	Thick, wide scars; skin loss; infection. Unevenly positioned nipples. Permanent loss of feeling in nipples or breast.
Recovery:	Back to work: 1 week or more. Strenuous activities: 1 month. Fading of scars: several months to a year.
Duration of Results:	Variable; gravity, pregnancy, aging, and weight changes may cause new sagging. Results may last longer or be enhanced when breast implants are inserted as part of the procedure.

CHEMICAL PEEL
(Phenol and trichloroacetic acid [TCA])

Procedure:	Restore wrinkled, blemished, unevenly pigmented, or sun-damaged facial skin, using a chemical solution to peel away skin's top layers. Works best on fair, thin skin with superficial wrinkles.
Length:	1 to 2 hours for full face.
Anesthesia:	None; sedation & EKG monitoring may be used.
In/Outpatient:	Usually outpatient. Full-face phenol peel may require admission for 1 to 2 days.
Side Effects:	Both: Temporary throbbing, tingling, swelling, redness; acute sensitivity to sun. Phenol: Permanent lightening of treated skin; permanent loss of ability to tan.
Risks:	Both: Tiny whiteheads (temporary); infection; scarring; flare-up of skin allergies, fever blisters, cold sores. Phenol: Abnormal color changes (permanent); heart irregularities (rare).
Recovery:	Phenol: Formation of new skin: 7 to 21 days. Normal activities: 2 to 4 weeks. Full healing and fading of redness: 3 to 6 months TCA: New skin within 5 to 10 days.
Duration of Results:	Phenol: permanent, although new wrinkles may form as skin ages. TCA: variable (temporary).

COLLAGEN / FAT INJECTIONS

Procedure:	Plump up creased, furrowed, or sunken facial skin; add fullness to lips and backs of hands. Works best on thin, dry, light-colored skin.
Length:	15 minutes to 1 hour per session.
Anesthesia:	Collagen: usually none; local may be included with the injection. Fat: local.
In/Outpatient:	Outpatient.
Side Effects:	Temporary stinging, throbbing, or burning sensation. Faint redness, swelling, excess fullness.
Risks:	Collagen: allergic reaction including rash, hives, swelling, or flu-like symptoms; possible triggering of connective-tissue or autoimmune diseases. (A skin test is required before collagen treatment to determine whether an allergy exists.) Both: Contour irregularities, infection.
Duration of Results:	Variable; a few months to 1 year.

DERMABRASION

Procedure:	Mechanical scraping of the top layers of skin using a high-speed rotary wheel. Softens sharp edges of surface irregularities, including acne and other scars and fine wrinkles, especially around the mouth.
Length:	A few minutes to 1 hour. May require more than 1 session.
Anesthesia:	Local, numbing spray, or general.
In/Outpatient:	Usually outpatient.
Side Effects:	Temporary tingling, burning, itching, swelling, redness. Lightening of treated skin. Acute sensitivity to sun; loss of ability to make pigment (tan).
Risks:	Abnormal color changes (permanent). Tiny whiteheads (temporary); infection; scarring; flare-up of skin allergies, fever blisters, cold sores.
Recovery:	Back to work: 2 weeks. More strenuous activities: 4 to 6 weeks. Fading of redness: about 3 months. Return of pigmentation/sun exposure: 6 to 12 months.
Duration of Results:	Permanent, although new wrinkles may form as skin ages.

EAR SURGERY
(Otoplasty)

Procedure:	Set prominent ears back closer to the head, or reduce the size of large ears. Most often done on children between the ages of 4 and 14 years. (Occasionally covered by insurance.)
Length:	2 to 3 hours.
Anesthesia:	Young children: usually general. Older children or adults: general or local, with sedation.
In/Outpatient:	Usually outpatient.
Side Effects:	Temporary throbbing, aching, swelling, redness, numbness.
Risks:	Infection of cartilage. Excessive scarring. Blood clot that may need to be drained. Mismatched or artificial- looking ears. Recurrence of the protrusion, requiring repeat surgery.
Recovery:	Back to work or school: 5 to 7 days. Strenuous activity, contact sports: 1 to 2 months.
Duration of Results:	Usually permanent.

EYELID SURGERY
(Blepharoplasty)

Procedure:	Correct drooping upper eyelids and puffy bags below the eyes by removing excess fat, skin, and muscle. (Upper-eyelid surgery may be covered by insurance if used to correct visual field defects)
Length:	1 to 3 hours.
Anesthesia:	Usually locally with sedation or general.
In/Outpatient:	Usually outpatient.
Side Effects:	Temporary discomfort, tightness of lids, swelling, bruising. Temporary dryness, burning, itching of eyes. Excessive tearing, sensitivity to light for first few weeks.
Risks:	Temporary blurred or double vision. Infection, bleeding. Swelling at the corners of the eyelids. Dry eyes. Formation of whiteheads. Slight asymmetry in healing or scarring. Difficulty in closing eyes completely (rarely permanent). Pulling down of the lower lids (may require further surgery). Blindness (extremely rare).
Recovery:	Reading: 2 or 3 days. Back to work: 7 to 10 days. Contact lenses: two weeks or more. Strenuous activities, alcohol: about 3 weeks. Bruising and swelling gone: several weeks.
Duration of Results:	Several years. Sometimes permanent.

FACELIFT
(Rhytidectomy)

Procedure:	Improving sagging facial skin, jowls, and loose neck skin by removing excess fat, tightening muscles, redraping skin. Most often done on men and women over 40.
Length:	Several hours.
Anesthesia:	Local with sedation, or general.
In/Outpatient:	Usually outpatient. Some patients may require short inpatient stay.
Side Effects:	Temporary bruising, swelling, numbness and tenderness of skin; tight feeling, dry skin. For men, permanent need to shave behind ears, where beard-growing skin is repositioned.
Risks:	Injury to the nerves that control facial muscles or feeling (usually temporary but may be permanent). Infection, bleeding. Poor healing; excessive scarring. Asymmetry or change in hairline.
Recovery:	Back to work: 10 to 14 days. More strenuous activity: 2 weeks or more. Bruising: 2 to 3 weeks. Must limit exposure to sun for several months.
Duration of Results:	Usually 5 to 10 years.

FACIAL IMPLANTS

Procedure:	Change the basic shape and balance of the face using carefully shaped implants to build up a receding chin, add prominence to cheekbones, or reshape the jawline.
Length:	30 minutes to 2 hours.
Anesthesia:	Local with sedation, or general.
In/Outpatient:	Usually outpatient. Occasionally overnight hospital stay.
Side Effects:	Temporary discomfort, swelling, bruising, numbness and/or stiffness. In jaw surgery, inability to open mouth fully for several weeks.
Risks:	Shifting or imprecise positioning of implant, or infection around it, requiring a second operation or removal. Excess tightening and hardening of scar tissue around an artificial implant ("capsular contracture"), causing unnatural shape.
Recovery:	Back to work: about 1 week. Normal appearance: 2 to 4 weeks. Activity that could jar or bump face: 6 weeks or more.
Duration of Results:	Permanent.

FOREHEAD LIFT
(Browlift)

Procedure:	Minimize forehead creases, drooping eyebrows, hooding over eyes, furrowed forehead and frown lines by removing excess tissue, altering muscles and tightening the forehead skin. May be done using the traditional technique, with an incision across the top of the head just behind the hairline; or with the use of an endoscope, which requires 3 to 5 short incisions. Most often done on people over 40.
Length:	1 to 2 hours.
Anesthesia:	Local with sedation, or general.
In/Outpatient:	Usually outpatient.
Side Effects:	Temporary swelling, numbness, headaches, bruising. Traditional method: Possible itching and hair loss.
Risks:	Injury to facial nerve, causing loss of motion, muscle weakness, or asymmetrical look. Infection. Broad or excessive scarring.
Recovery:	Back to work: 7 to 10 days, usually sooner for endoscopic forehead lift. More strenuous activity: several weeks. Full recovery from bruising: 2 to 3 weeks. Limit sun exposure for several months.
Duration of Results:	Usually 5 to 10 years.

HAIR REPLACEMENT SURGERY

Procedure:	Fill in balding areas with a patient's own hair using a variety of techniques including scalp reduction, tissue expansion, strip grafts, scalp flaps, or clusters of punch grafts (plugs, miniplugs and microplugs). Works best on men with male pattern baldness after hair loss has stopped.
Length:	1 to 3 hours. Some techniques may require multiple procedures over 18 months or more.
Anesthesia:	Usually local with sedation. Flaps and tissue expansion may be done with general anesthesia.
In/Outpatient:	Usually outpatient.
Side Effects:	Temporary achy, tight scalp. Unnatural look in early stages.
Risks:	Unnatural look. Infection. Excessive scarring. Failure to "take." Loss of scalp tissue and/or transplanted hair.
Recovery:	Back to work: usually 2 to 5 days. More strenuous activities: 10 days to 3 weeks. Final look: may be 18 months or more, depending on procedure.
Duration of Results:	Permanent.

LASER FACIAL RESURFACING

Procedure:	Smooth the face and smooth fine wrinkles using a carbon dioxide (CO2) laser device that treats layers of damaged skin. Softens lines around the eyes and mouth and minimizes facial scars and unevenly pigmented areas.
Length:	A few minutes to 1 hour. May require more than 1 session.
Anesthesia:	Local with sedation, or general.
In/Outpatient:	Usually outpatient, unless combined with other surgical procedures that require hospitalization.
Side Effects:	Temporary swelling, discomfort. Lightening of treated skin. Acute sun sensitivity. Increased sensitivity to makeup. Pinkness or redness in skin that may persist for up to 6 months.
Risks:	Burns or injuries caused by laser heat. Scarring. Abnormal changes in skin color. Flare-up of viral infections ("cold sores") and other infections (rare).
Recovery:	Back to work: 2 weeks. More strenuous activities: 4-6 weeks. Complete fading of redness: 6 months or less. Return of pigmentation/light sun exposure: 6-12 months.
Duration of Results:	Long-lasting, but does not stop aging. New wrinkles, expression lines may form as skin ages.

LIPOSUCTION
(Suction-Assisted Lipectomy)

Procedure:	Improve body shape by removing exercise-resistant fat deposits with a tube and vacuum device. Can be performed using the tumescent technique, in which targeted fat cells are infused with saline containing solution with a local anesthetic before liposuction to reduce post-operative bruising and swelling. Common locations for liposuction include chin, cheeks, neck, upper arms, above breasts, abdomen, buttocks, hips, thighs, knees, calves, ankles. For larger volumes of fat or for fibrous body areas, ultrasound-assisted lipoplasty (UAL) may be used. UAL is a new technique in which a ultrasound probe is inserted beneath the skin to "liquify" the fat before it is suctioned.
Length:	1 to 2 hours or more. UAL: 20-40 percent longer than traditional liposuction.
Anesthesia:	Local, epidural, or general.
In/Outpatient:	Usually outpatient. Extensive procedures may require short inpatient stay.
Side Effects:	Temporary bruising, swelling, numbness, soreness, burning sensation. Tumescent: Temporary fluid drainage from incision sites. UAL: Larger incisions for cannula.
Risks:	Asymmetry. Rippling or bagginess of skin. Pigmentation changes. Skin injury. Fluid retention. Excessive fluid loss leading to shock. Infection. UAL: thermal burn injury caused by the heat from the ultrasound device.
Recovery:	Back to work: 1 to 2 weeks. More strenuous activity: 2 to 4 weeks. Full recovery from swelling and bruising: 1 to 6 months or more. Use of tumescent technique or UAL may decrease post-operative bruising and swelling.
Duration of Results:	Permanent, with sensible diet and exercise.

MALE BREAST REDUCTION
(Gynecomastia)

Procedure:	Reduce enlarged, female-like breast in men using liposuction and/or cutting out excess glandular tissue. (Sometimes covered by medical insurance.)
Length:	1 hour or more.
Anesthesia:	General or local.
In/Outpatient:	Usually outpatient.
Side Effects:	Temporary bruising, swelling, numbness, soreness, burning sensation.
Risks:	Infection. Fluid accumulation. Injury to the skin. Rippling or bagginess of skin. Asymmetry. Pigmentation changes (may become permanent if exposed to sun). Excessive scarring if tissue was cut away. Need for second procedure to remove additional tissue.
Recovery:	Back to work: 3 to 7 days. More strenuous activity: 2 to 3 weeks. Swelling and bruising: 3 to 6 months.
Duration of Results:	permanent

NOSE SURGERY
(Rhinoplasty)

Procedure:	Reshape nose by reducing or increasing size, removing hump, changing shape of tip or bridge, narrowing span of nostrils, or changing angle between nose and upper lip. May also relieve some breathing problems. (May be covered by insurance.)
Length:	1 to 2 hours or more.
Anesthesia:	Local with sedation, or general.
In/Outpatient:	Usually outpatient.
Side Effects:	Temporary swelling, bruising around eyes, nose and headaches. Some bleeding and stiffness.
Risks:	Infection. Small burst blood vessels resulting in tiny, permanent red spots. Incomplete improvement, requiring additional surgery.
Recovery:	Back to work: 1 to 2 weeks. More strenuous activities: 2 to 3 weeks. Avoid hitting nose or sunburn: 8 weeks. Final appearance: 1 year or more.
Duration of Results:	Permanent.

Source: http://www.plasticsurgery.org/public_education/procedures/CosmeticPlasticSurgery.cfm

Considering cosmetic surgery?

Introduction

Cosmetic surgery should not be undertaken lightly. Cosmetic surgery can change your appearance in ways that you might consider desirable but it can be expensive in time and money and, although uncommon, it has been known to result in some changes to your appearance which you may not always find pleasing in the future. It is important that you do not feel pressurised or obliged to have it. It should be a decision you take only after a lot of careful thought and questioning.

This page provides some questions to ask yourself about your reasons for wanting cosmetic surgery and your expectations of the results the procedure will bring, as well as providing some alternatives to cosmetic surgery.

If you feel you want to know more, this page will provide you with details of questions to ask to make sure that you can make a properly informed decision about whether to go ahead with the surgery, and which provider to choose.

Your reasons and expectations

As a first step, you need to think long and hard about why you feel you may benefit from cosmetic surgery. For example:-

• Do you expect it to change your life as well as your appearance, and how do you think your life will be better?
• Is it reasonable or likely that a change in your appearance will radically change your life?
• Are you considering surgery for yourself or to please someone else?
• Do you think that having surgery will improve your relationship or employment prospects?
• Is it reasonable to expect surgery to achieve the changes to your appearance that you are hoping for?

There are alternatives to cosmetic surgery. If you feel your concerns about your appearance result from anxieties about social situations or from problems with relationships, you might want to discuss with your GP or another professional the possibility of seeing a counsellor or psychologist. They may be able to help you to address your concerns in other effective ways. Useful information and self-help materials are available from organisations such as Changing Faces. If you have been considering cosmetic surgery because of employment issues, you may want to think about alternatives such as careers counselling.

Gathering Information

If you do feel that you could benefit from cosmetic surgery, then it is vital to ensure that you are as well informed as possible. The next step is to gather information about the procedure you are interested in and the hospitals or clinics who offer this procedure. However, you should note that it is not advisable to undergo cosmetic surgery if you are pregnant or if you have certain medical conditions, or if you are taking certain medications.

You may be nervous about asking for information, but hospitals and clinics with your best interests at heart will do everything they can to put you at your ease and will make sure that you get the information you need. You may find it helpful to write all your questions down so you don’t forget anything. Or you may prefer to attend consultations with your partner, or a relative or friend, who can remind you to ask for information if you forget.

If you have special needs – for example, if your first language is not English or you have a sensory impairment, then make sure that providers are able to supply information in a way that you can understand.

We also provide a “questions checklist” which you can print out and use when talking to hospitals, clinics and surgeons.

Cosmetic Surgery : Checklist

Talking to your GP

It's a good idea to talk to your GP if you're considering cosmetic surgery. He or she will be able to give you general advice about surgery, and about any particular health issues you should mention to your surgeon.

Talking to surgery providers

All companies who provide cosmetic surgery MUST be registered with the Healthcare Commission. You should ask to see a hospital or clinic’s registration and it is vitally important that you do not agree to have cosmetic surgery from any hospital or clinic who cannot provide details of their annual registration. The Healthcare Commission inspects all cosmetic surgery providers and prepares a report giving details of their findings. You can get Healthcare Commission inspection reports from the Healthcare Commission’s website. A link to this website is on the useful links page.

Cosmetic surgery useful links

When you first approach providers you may meet or speak to a patient adviser. The Department of Health believes that patients should receive advice about surgery ONLY from doctors and nurses, as they have the qualifications and expertise to give you high-quality advice. Check whether your adviser is a doctor or nurse, and whether they are registered with the General Medical Council or Nursing and Midwifery Council.

If you wish to go ahead you should be offered an appointment to talk to a surgeon. It is important to be honest when you meet the surgeon. Being clear about your expectations of the procedure will make sure that the surgeon can give you the correct advice about whether the procedure will achieve the results you want. Be truthful about any health or lifestyle issues that the surgeon may ask you about, as these could affect the results of your procedure. It is essential that you should tell the surgeon if you have any existing medical conditions or are taking any medications.

Make sure that you feel confident about the surgeon’s ability to perform the operation. Ask him or her about the qualifications they hold, how many procedures they have carried out, and how many patients needed revision surgery. Asking for “before” and “after” photographs of other patients who have had your chosen procedure will also give you information about the surgeon’s work.

The surgeon should provide full details of the procedure itself, including what will happen, how long it will take, what anaesthesia will be used, whether you will require an overnight stay, the level of pain you may experience, how long the results of the procedure will last, whether there will be any scars and any risks the procedure may carry. ALL surgery contains a certain element of risk – including risks associated with anaesthesia, infection and scarring. The surgeon should provide a full explanation of the general risks of surgery and any particular risks associated with your procedure. For those procedures requiring a general anaesthetic your anaesthetist should discuss with you, before your surgery, any issues that relate to the anaesthetic and your wellbeing and safety. Your anaesthetist should also discuss your preferences regarding anaesthesia and help you decide what would be best for you.

In common with all surgical procedures that involve an incision in the skin, cosmetic surgery procedures involving incisions will leave scars. These will be permanent and may be quite pronounced and inflamed at first but usually the scar tissue will subside and the redness will fade over time. This may happen over a period of weeks or it may take several months or even a year or so, depending on the location and extent of the incision(s).

The surgeon should also talk to you about any special regime you need to follow before surgery, the recovery time and the aftercare procedures. The success of your procedure may depend on following the pre-surgery regime and the aftercare advice, so you must make sure that you understand the advice and that you are prepared and able to follow it. For example, if the surgeon says that you would need to be away from work for two weeks following your operation, then you will need to make sure that you will be able to take sufficient time off work.

Your hospital, clinics or surgeon should give you written information to take away with you after the consultation so that you can refer back to it if you need to.

Arranging for surgery

After talking to the surgeon you may decide to go ahead with the procedure. But you should not feel that you have been pressured into a decision - you should be able to take as much time as you need, and you should avoid any provider who you feel is putting pressure on you to agree to surgery.

If you are asked to sign an agreement to go ahead with surgery then you must make sure that you understand and are happy with the agreement you sign. This agreement should include a written statement for you to sign, saying that you give your consent to the treatment.

The agreement should also include details of the cost of your procedure. Make sure that you understand what the price of your procedure covers, particularly in terms of aftercare and any revision surgery which may be necessary. Also, the agreement may include details of any financial penalties you may incur if you subsequently decide to cancel the agreement, so you will need to make sure you understand these penalties.

Even after deciding to have surgery it is important to have a “cooling off” period for you to come to a final decision, so check whether the agreement allows you to do this. Avoid any provider who offers “special deals” and “discounts” if you make a quick decision to go ahead with the surgery.

Your records

The provider will retain a record of your treatment, which may include “before” and “after” photographs of you. You will need to think about whether you are prepared to let the provider show these photographs to other potential patients. The provider should ask you to give your consent if they wish to show photographs or any other part of your records to other patients.

Getting cosmetic surgery abroad

Cosmetic surgery abroad often costs less than in the UK. But this doesn’t mean that you can treat it any less seriously.

Ask the same questions as you would for cosmetic surgery in the UK. It’s worthwhile checking what the regulations are in the country you intend to have surgery in, as well as qualifications for surgeons, doctors, nurses and other practitioners who may be involved with your care. Also, remember to ask about what happens about how any complications during your procedure will be handled, about aftercare, and about any revision surgery that you might need after your original procedure. How will this be provided once you have returned to Britain?

In addition, you will need to make sure that you are able to communicate with the your doctor and others involved in your care in order to ask questions and understand the answers, and you may need a translator. You should also check whether the doctor, hospital or clinic have insurance which covers your procedure and whether it takes into consideration that you are from another country.

It is also important to know that not all countries have the same regulatory framework as England so standards may vary considerably. Remember that the Healthcare Commission, which is responsible for regulating and checking private cosmetic surgery in England, does not cover procedures carried out abroad. Unfortunately, it will not be able to help you if you have any problems while overseas.

If you cannot obtain satisfactory answers to your questions then you should think very carefully about whether to go ahead. Cosmetic surgery abroad may be cheaper than in the UK. But it if you are not able to be confident about whether it is safe, then it could end up being much more expensive in terms of risk, revision surgery and pain.

Source: http://www.dh.gov.uk