The procedure is known as brachioplasty, an upper arm lift procedure that requires making an incision in the arm pit down to the elbow to allow for the removal of excess skin often left hanging following extreme weight loss. That the number of women having the procedure done has skyrocketed over the past 12 years would be an understatement. In 2000, there were only around 300 upper arm lifts performed in the U.S. In 2012, and for reasons as yet unknown, 15,457 procedures were done – a whopping 4,378% increase in upper arm lifts over the past decade, according to the American Society of Plastic Surgeons.

Women who have experienced significant weight loss – more than 100 pounds on average – opted for surgery to remove the excess residual arm flab. Strangely, diet and exercise trends in favor of extreme weight loss appear to run counter to the prevailing trend toward extreme obesity in the U.S.

In a recent poll of 1,219 U.S. women, the ASPS also found that celebrity status was a motivating factor in women who chose the upper arm lift procedure. Most of these women were age 40 and older.

America, in many ways, has become a land of extremes. Extreme behavior, extreme addiction, extreme expectations. Extreme weight gain and extreme weight loss to improve one’s appearance sometimes accompany an unhealthy orientation toward “self-centeredness” and, by contrast, “other-centeredness.”

It’s not a bad thing to have role models and even to imitate them if the reason is sound and the end product is positive. If you opt for an upper arm lift procedure, do it because you really need it and because it’s necessary to restore physical symmetry and balance following healthy weight loss.

Dr.  Ran Y. Rubinstein is a dual board certified facial plastic surgeon in New York with offices located at 200 Stony Brook Court, Suite 2, Newburgh, N.Y. Call 845-863-1772 for a consultation.

Swelling is an inevitable part of the rhinoplasty recovery process, but it often causes confusion and worry for patients due to its variable nature and tendency to disappear slowly. Though all rhinoplasty procedures result in significant swelling, cases that require the nose to be broken during surgery are especially prone to puffing up. Since swelling often persists for up to a year in normal rhinoplasty patients, let’s take a look at the typical stages of post-op swelling so you know what’s normal–and what isn’t.

Week 1 – Rhinoplasty Swelling

Though one might expect swelling to be most severe at this stage, the splint on the nose prevents excessive swelling to the nose. The patient may see swelling and/or bruising around the nose, but the nose itself is kept still by the splint.  Patients are often fearful of packing.  Dr. Rubinstein uses gentle techniques in breaking the nasal bones as well as special self dissolving sutures internal sutures to minimize bruising and bleeding.  His patients rarely require nasal packing and have very little bruising around the eyes.

Weeks 2-3 – Nose Surgery Swelling

Once the splint is removed, the patient will experience additional swelling in the nasal area, which may obscure the results of the rhinoplasty. Patients should not be worried if the nose doesn’t look perfect yet–there’s still a lot of healing to do after this stage.

Weeks 4-12

Though the nose will look pretty much like the final result at this point, it’s still too early to make hasty criticisms about the final product. There is usually still some swelling present that will slowly fade.

3 Months-1 Year

Though changes in remaining swelling are very subtle, an unhappy patient should wait at least a year before undergoing revision rhinoplasty. Usually, swelling disappears starting at the top of the nose, working its way down. Swelling can persist in the tip for 9-12 months.

One week	Pre Op	6 weeks Post Op	18 months Post Op

Preventing Swelling

There are several things you can do to keep swelling down after your surgery. Minimizing swelling will make your recovery more comfortable, and allow you to get a better sense of your true results. Here are some tips for preventing swelling:

• Use cold compresses around (not on) the nose for the first day or two following surgery
• Ask your surgeon about natural remedies, such as Arnica and Yunnan (a Chinese herb)
• Keep your head elevated
• Avoid alcohol for several days before your procedure
• Limit your salt intake

Need More Information?

Though the rhinoplasty recovery process varies from person to person, your surgeon will provide you with extensive information and advice on your recovery period so you can be well-prepared before you head to the operating room.

General Health

Since rhinoplasty is a fairly invasive surgery, patients must have a certain level of general health and wellness in order to undergo surgery. Nasal surgery is complex, requiring a great deal of finesse and skill, and the nose can take up to a year to fully heal. Poor health can compromise healing, cause anesthesia risks, and increase the chances of a poor outcome. In any case, you will most likely need to have a physical exam and blood test before surgery.

Smoking

If you’re a smoker, you might consider using your desire for surgery as motivation to help you quit. Ethical doctors refuse to operate on patients who continue to smoke before and after surgery. At a minimum, you’ll have to quit smoking for a few months or weeks before and after the procedure. It is advisable to stop as far in advance as possible, however, as smoking can compromise healing and cause other problems.

Unrealistic Expectations

Rhinoplasty surgery can produce excellent results that greatly improve the appearance of the nose and face as a whole, but it doesn’t usually work miracles. If you don’t have realistic expectations about your surgery, you may end up seeking a second, unnecessary surgery if your new nose doesn’t match your fantasy. Consider carefully how much improvement you expect, and discuss your goals with prospective surgeons.  Computer imaging can facilitate communication between you and your plastic surgeon.  If you and your doctor have a similar concept of what is an attractive nose, you are more likely to be happy with your results.

Health Conditions & Conflicting Medications

If you have a bleeding disorder, asthma, or other medical condition, you may not be eligible for a rhinoplasty. Check with your doctor and be sure to disclose all relevant conditions and medications during your rhinoplasty consultations.

Age

Since most people who undergo rhinoplasty surgery are young men and women, age is usually not an important factor for determining candidacy. However, teens who wish to have the surgery are not candidates for rhinoplasty until the nose has stopped growing. This age varies, with girls maturing faster than boys.  This is usually age 16 for girls and 17 to 18 for boys.   In contrast, older patients have to understand potential risks with anesthesia, medications, and nasal skin quality.  Older patients tend to want to desire less drastic changes as they have lived their entire life with their nose.

With money being so tight these days, many otherwise good candidates for facial cosmetic surgery may consider it a solution they can no longer afford. The good news is that not all cosmetic procedures involve surgery, and not all of them will cost you an arm and a leg just to erase some wrinkles around the cheeks and eyebrows. There are many effective cosmetic procedures now available at affordable price points that are minimally or non-invasive and range anywhere from $250 to less than $1,000.

• Botox is among the most popular and widely used injectables designed to smooth out facial wrinkles and fine lines around the eyes, mouth, cheeks and nose. The results are excellent and they depend largely on the skill and training of the plastic surgeon. As injectable fillers go, a Botox treatment session averages around $500 or less. In fact, according to the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS), the average cost of 20 units of Botox in 2012 was $300.
• The Chemical Peel procedure is designed to remove the outer layer of skin and reveal healthier, more youthful skin hiding below the surface. An acid-based solution is used to peel away the epidermal layer of the skin to get rid of those fine lines and wrinkles. It also works to resolve skin issues related to sun damage as well as superficial acne scars. It’s also affordable, with an average cost of $398 in 2012 as cited by the AAFPRS.
• Microdermabrasion is a highly affordable treatment option using an exfoliation technique to fade away wrinkles and other facial blemishes and make the skin more youthful looking. This procedure costs around $124, according to the 2012 AAFPRS statistics.
• Another technique similar to Laser Therapy is Intense Pulsed Light, or IPL Therapy. It’s used to remove defects in the skin that appear in the form of stretch marks, wrinkles, age spots, and sun damage. Unlike Laser Therapy, IPL shoots pulsed beams of broad spectrum light to get rid of these skin blemishes and helps resolve other skin issues such as rosacea and broken blood vessels in the face. Usually, only one session is needed and costs an average of $300 to $500.
• Like Botox, the hyaluronic acid Restylane and other products like Juvederm, Perlane, and Radiesse are injectable fillers used to get rid of wrinkles and plump up the lips and cheeks. The average cost of hyaluronic acid injections, according to 2012 AAFPRS statistics, is $597. Another affordable treatment option is Tretinoin, a topical cream with strong anti-aging ingredients which accelerate cell rejuvenation and collagen production under the skin.

So, what’s in your wallet? With these and other remarkable cosmetic procedures now widely available to consumers, it won’t matter as much, even when dollars are scarce.

A recent advertisement has come under fire for portraying one of the classic Disney Princesses as having had plastic surgery.

The advertisement, created by a plastic surgery group in Venezuela, shows The Little Mermaid with a full-on plastic surgery make over. It seems that Ariel has undergone breast augmentation, some form of lip enhancement, and possibly a blepharoplasty. The advertisement is part of an ad campaign called “We Make Fairy Tales Come True” and it shows Ariel swimming up to a plastic surgeon, laying on an operating table under a blanket, and then re-emerging with not only a new face but a new pair of legs to go with it.

Photo Courtesy of BuzzFeed

Many have long criticized Disney and other cartoon animators for drawing women with tiny waist lines and impossibly long legs. Barbie, the popular toy, is also scolded for the proportions the doll has (you can see what a life size Barbie would look like here).So the question remains, if we criticized these companies for not portraying women correctly, what then is the sentiment among chidlren when these “too beautiful to be true” Princesses now need plastic surgery?

Choosing to undergo plastic surgery should be made my consenting adults. Granted, there are times when children under 18 can be considered candidates for plastic surgery, but to market and advertise to them outright is a step in the wrong direction.

Does the type of browlift procedure that you use depend on the age of the patient? I am 76 years old and wonder if I would be able to have the less invasive endoscopic brow lift.

Answer

a) Minimal brow sagging can be addressed non surgically with Botox injections and or non surgical skin tightening such as Thermage treatments.

b) Minimal to moderate brow sagging with normal hairline in patients open to surgery:  Endoscopic brow lift is the best option.  There are no big incisions, rather small punctures, and the brows are lifted using endoscopes and TV cameras.  Other treatment options such as Thread Lifts have not been shown to give long lasting results.

c) Severe brow sagging esp. with a receded hairline is best addressed with a more traditional brow lift procedure where the hairline can actually be lowered to a more youthful position while at the same time providing the most effective time tested lifting of the brows.  There is more bruising and downtime but the results are well worth it.

Answer:
I would use artificial over the counter tears. Dryness can be caused after surgery by lower lid malposition. If the lid is pulled out or down, usually due to swelling, the natural tears may not bathe the cornea sufficiently. This usually resolves itself by 12 weeks and is not common. If it persists, the lower lid malposition may have been caused by scar tissue and or over aggressive skin removal and this will have to be addressed surgically. You should follow up with plastic surgeon further evaluation. Click Here to learn more about Blepharoplasty in Middletown.

Answer: Hump reduction, taking down a bump, may seem very simple yet this part of the rhinoplasty where experience, and knowledge of the nasal anatomy is critical for a natural result that won’t compromise your breathing after surgery.
a) Bony part of the hump. This is usually removed with a small chisel either thru a closed or open approach. the rough edges are filed down with a rasp. This will leave an opening in the bridge of the nose, which is why the nose has to be broken, to bring the walls of the nose back together closing the gap created by removing the bony bump. If this is done in a traumatic way, the surgeon can dislocate the upper lateral cartilages, which form part of the cartilaginous bump as well as the main breathing support to the airway, causing collapse of the nose and blockage. In addition if too much of the bony bump is removed, it can create a ski slope appearance. My philosophy is to be conservative, you can always remove a little more but to replace missing bony bridge after over reduction is much more difficult.
b) The cartilage part of bump. this is in the mid portion of the bridge of the nose. The integrity of this cartilage must be maintained. A cartilaginous bump can be reduced without actually removing any of the cartilage. By reshaping it and using the portion that was reshaped as a support mechanism, also called spreader grafts, safe cartilage hump reduction can be performed. This takes more time and skill than just simply removing a piece of the cartilaginous bump.

Answer: There are two possible causes:
a) Over aggressive pinning of the mid portion of the ear. this can result in a “telephone deformity” as described in your question. Revision surgery would be helpful but only once the swelling has subsided, at the earliest, 3 months post op.
b) Normal swelling in the lower and upper part of the ear may cause it to temporarily protrude out. Time is on your side. Wait and see how it appears once the swelling subsides. The mid portion of the ear may also relax a bit over the next few months balancing things out.

Answer: There are different types of neck lifts, all of which primarily address the neck more than the jaw line.
a. Mini neck lift: Only sagging skin is addressed thru a small incision behind the ears.
b. Neck lift with platysma muscle tightening: the sagging underlying muscles are lifted as well. The neck bands created by muscle cords are also addressed thru a small incision under the chin. Sedation is usually required.
c. Direct neck lift: excess skin is directly removed in the mid-line of the neck rather than big incisions behind the ears and into the hairline. The advantage is that by addressing skin where it is sagging the most, in the middle of the neck, a better neck lift result can be obtained. The muscles can also be tightened. No sedation anesthesia is needed, and surgery time is much shorter i.e. cost much lower. This is a very effective, economical, minimal downtime way to address the neck. The only drawback can be that in the initial healing phase, a visible mark is present in the front of the neck. Healing of the scar is facilitated with Fraxel laser treatments starting 6 weeks post surgery.