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COSMETIC SURGERY AT STONY BROOK

11/4/2002




Our board certified plastic surgeons, Dr. Arora, Dr. Bui or Dr. Katz, offer patients a range of cosmetic service and treatment options, including the following:
FOR APPOINTMENTS CALL
(631) 444 4666
For more information about Dr. Arora, click here, Dr. Bui click here or Dr. Katz click here. To read a few words about your plastic surgeon and consultation visit click here. To schedule a free consultation for cosmetic services, or learn more about our practice, please call (631) 444-4666.

Botox

Our program in cosmetic surgery now provides Botox therapy for facial and neck wrinkles. This nonsurgical method of removing and/or reducing such wrinkles recently gained Food and Drug Administration (FDA) approval for the treatment of "frown lines" and, according to the American Society for Aesthetic Plastic Surgery, has already become the fastest-growing cosmetic procedure. Botox is a natural, purified protein that relaxes muscles by blocking nerve impulses. A few drops of it are injected with a tiny needle into the muscle that creates a wrinkle. When Botox is injected into a muscle, it blocks the nerve impulse from reaching that area, and as a result, the muscle weakens. As the muscle weakens, the skin overlying the muscle relaxes, and the wrinkles in the skin gradually soften and often disappear. Normal facial expressions are not affected by the treatments.

Before After

Our Botox specialist, as recommended, is fellowship trained and board certified in plastic surgery.

Patients usually see dramatic results within a few days. Existing frown lines, in most cases, disappear in about a week. Because the results are temporary, the therapy needs to be repeated after 3 to 6 months. When Botox is first injected, a minor sting is initially felt for a few seconds. Once the injection is complete, there is usually no discomfort. Nearly all patients continue their routine daily activity immediately after the treatment. Our Botox specialist is Dr. Balvant Arora, who last year joined our Division of Plastic and Reconstructive Surgery, and who has contributed to the establishment of our growing program in cosmetic surgery.
  • Reduces or eliminates wrinkles without surgery
  • Requires no sedation or anesthetic
  • Corrects underlying muscles (as opposed to the skin's surface or sub-layer the way peels do)
  • Provides dramatic effects as a cosmetic procedure for:
    • Vertical lines between the eyebrows
    • Horizontal forehead lines
    • Crow's feet
    • Horizontal lines in the neck
FDA APPROVAL
Botox was first approved by the FDA in 1989 to treat two eye-muscle disorders?uncontrollable blinking (blepharospasm) and misaligned eyes (strabismus). In 2000, it was approved to treat a neurological movement disorder that causes severe neck and shoulder contractions, known as cervical dystonia. As an unusual side effect of the eye disorder treatment, Botox softened the vertical frown (glabellar) lines between the eyebrows that tend to make people look tired, angry, or displeased. But until this improvement was actually demonstrated in clinical studies, the manufacturer of Botox was prohibited from making this claim for it. By April 2002, the FDA was satisfied by its review of studies indicating that Botox reduced the severity of frown lines for up to 120 days. The agency then granted approval to use the drug for this condition in people between the ages of 18 and 65. Botox therapy is one of the safest available for reduction of wrinkles. In the amounts used for wrinkle therapy, the only possible side effects are temporary and localized to the area of injection. It should be noted that the degree of improvement is variable. Occasionally, there is no improvement, and another form of treatment may be required.

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Laser Hair Removal
Dr. Arora performs hair removal with a non-invasive technology that uses laser therapy to eliminate hair growth. Laser is delivered to the skin by a hand-held unit. The energy is absorbed by the pigment in the hair root, damaging the hair follicle and stopping future growth. The darker and coarser the hair, the better the results usually are. Permanent hair reduction can be expected in most cases.

Virtually all areas of the body can be treated if the hair has at least some pigment in it. Most treatment sessions last about 15 to 20 minutes. Each pulse of laser light feels like a small pinch or slight sting similar to the snap of a rubber band against skin. No local anesthesia is needed. A series of treatments are generally required. After each session, the treated area may become slightly red and puffy, but this reaction usually subsides quickly and returns to normal within a day.

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Chemical Peel
In this procedure, Dr. Arora applies a chemical to the skin that removes its outer layer, which peels off, causing new, smoother skin to regenerate. He offers a variety of such treatments that remove cells from the skin surface and enhance the normal skin renewal process. This rejuvenation process helps to diminish fine lines and wrinkles, reduce the appearance of large pores, decrease roughness, enliven and even-out skin color and tone, and reduce the appearance of age and sun spots. More important, Dr. Arora's treatments will help to maintain healthy skin. He provides different chemical peels for each individual patient's special needs:
  • For refreshing and refining dull, tired skin
  • For oily, acne prone, thickened skin
  • For fine lines and wrinkles
  • For patients with hypersensitive skin
Individual treatments generally last about 15 to 20 minutes. There is virtually no recovery period. The peeling process usually has to be repeated a number of times in order to obtain the desired results. For deeper wrinkles and scars, laser skin resurfacing or Botox injections or collagen implants may be a better option than chemical peels.

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Collagen Implants
Collagen implants are a long-established method of softening or "plumping up" lines or wrinkles. Collagen is a natural protein found just beneath the skin which helps to maintain the firmness and suppleness of the skin. The natural production of collagen declines with age, eventually resulting in lines, wrinkles, and sagging features. Dr. Arora injects minute amounts of collagen just beneath the skin in the areas being treated. This replenishment helps to soften facial lines and plump up the skin tissue.

Collagen implants may be used to treat frown lines, nose to mouth lines, crow's feet, mouth corners, lip lines, or the border of lip to create full lips. It is sometimes used to smooth scar tissue. A single treatment takes just a few minutes. The effect can be seen immediately, and instant recovery is the norm. The results of collagen therapy can be quite extraordinary, although the treatments must be repeated every 4 to 6 months.

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Laser Vein Therapy
Laser vein therapy is a new approach for treating varicose veins and telangiectasias (small spider-like veins), which can be painful and may lead to more serious problems if not treated. The laser procedure performed by Dr. Arora is less painful than conventional vein therapy involving surgery or injections, and it results in less bruising, swelling, and scarring. It is a safe and effective method to remove/reduce the following:
  • Small leg veins/telangiectasias
  • Cherry angiomas
  • Hemangiomas
  • Facial spider veins
The particular laser system that Dr. Arora uses provides superior results. It enables him to deliver fully-variable bursts of laser energy at pulse widths in the 1 to 50 millisecond range. This clinically-proven treatment range permits precise matching of the laser's pulse width with the thermal relaxation times of the targeted blood vessel. The pulse widths created by this system are long enough to prevent bruising and short enough to prevent scarring. The procedure is performed on an outpatient basis, and patients should be able to return to work immediately.

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BODY CONTOURING SURGICAL PROCEDURES

Breast Augmentation (Augmentation Mammaplasty)
Breast augmentation is a surgical procedure that enhances the size and shape of the breasts. Indications for cosmetic surgery are small or asymmetrical breasts. It is often done for one of the following reasons:

  • To enhance your body contour if, for personal reasons, you feel your breast size is too small.
  • To correct a reduction in breast volume after pregnancy.
  • To balance a difference in size between your breasts.
  • To reconstruct the breast following breast surgery.
By inserting a saline-filled implant behind each breast, surgeons are able to increase your breasts by one or more bra cup sizes. Placement may be either directly under the breast tissue or beneath the chest wall muscle. Breast augmentation may be combined with breast lift (see below). The results of a breast augmentation can be seen immediately and can be quite exhilarating. You should be able to go back to work and resume some activities within a few days to one week, but breasts will be sensitive to touch for two to three weeks. You are a good candidate for breast augmentation if you are looking for improvement, not perfection, in the way you look. If you're physically healthy and realistic in your expectations, you may be a good candidate.

A breast implant is a silicone shell filled with either silicone gel or a salt-water solution known as saline. Because of concerns that there is insufficient information demonstrating the safety of silicone gel-filled breast implants, the Food & Drug Administration (FDA) has determined that new gel-filled implants, at the present time, should be available only to women participating in approved studies. Some women requiring replacement of the implants may also be eligible to participate in the study. Saline-filled implants continue to be available to breast augmentation patients on an unrestricted basis.

Breast Lift (Mastopexy)
Pregnancy, nursing and the aging process take their toll on a woman's breasts, and they eventually begin to sag and lose their shape and firmness. Breast lift is a surgical procedure that raises and reshapes sagging breasts, and (if desirable) reduces the size of the areola. Breast lift combined with implant surgery can enlarge as well as firm sagging breasts.

The technique involves removing excess skin and repositioning the breast tissue and nipples. Women with small, sagging breasts are the best candidates for breast lift. Breasts of any size can be lifted, but results in larger, heavier breasts are less enduring. The procedure takes from one to three hours, and it is usually performed in an outpatient setting, but a one to two day inpatient stay is not uncommon. The patient may receive a general anesthetic or local anesthetic with sedation.

Patients can go back to work in a week to 10 days and resume more strenuous activity in about a month. Scars are permanent, but usually fade and become less noticeable after several months to one year. The duration of results is variable. Factors such as pregnancy, age, weight fluctuations and breast size affect the longevity of the improvement. Women who have implants along with breast lift may have more enduring results.

Tummy Tuck (Abdominoplasty)
Tummy tuck is a major surgical procedure to flatten the abdomen by removing excess skin and fat from the lower abdominal region and tightening the muscles of the abdominal wall. Appropriate candidates for tummy tuck are men and women with large fat deposits or loose abdominal skin that does not respond to diet or exercise, and women with slack muscles and skin due to multiple pregnancies. Older patients whose skin has lost its elasticity may also find improvement. Obese patients who plan to lose weight should postpone surgery.

For complete tummy tuck, the surgeon generally makes an incision from hip to hip just above the pubic region. A second incision releases the navel from surrounding tissue. The surgeon separates the skin from the abdominal wall up to the ribs, lifts the skin flap, and tightens the abdominal muscles by pulling them closer together and stitching them into position. Excess skin is removed from the flap and a new hole cut for the navel, which is then stitched into place before the incisions are closed. For a partial or "mini" tummy tuck, the incision is shorter and the navel may remain in place.

Patients will need to stay home from work for two to four weeks and should wait four to six weeks or more to resume strenuous activities. Scars will fade and flatten in three months to two years (although the long term appearance of the scars varies from individual to individual). Results of abdominoplasty are often permanent, barring major weight gain.

Panniculectomy
Panniculectomy is a major surgical procedure for removal of the large abdominal apron of fat in obese patients. Panniculectomy may be performed in conjunction with other scheduled surgery, such as hysterectomy. Panniculectomy in obese patients is usually performed in a hospital due to the medical status of these patients and the extensive nature of the surgery. Patients may be hospitalized for one or two weeks or more, and complete wound healing may take several months. With preauthorization, this surgery is often covered by insurance.

Suction-Assisted Lipectomy (Liposuction)
Suction-assisted lipectomy (SAL), traditionally known as liposuction, is a method of removing unwanted fatty deposits from specific areas of the face and body. The surgeon makes a small incision and inserts a cannula attached to a vacuum device that suctions out the fat. Suction-assisted lipectomy is not an alternative to weight loss. It is intended for use on localized areas of fat that do not respond to diet or exercise. Areas suitable for liposuction include the chin, neck, cheeks, upper arms, area above the breasts, the abdomen, flanks, the buttocks, hips, thighs, knees, calves and ankles. Liposuction can improve body contour and provide a sleeker appearance. Surgeons may also use liposuction to remove lipomas (benign fatty tumors) in some cases.

The procedure takes from one to four hours, depending upon the amount of fat to be removed. Procedures that are not too extensive can be performed on an outpatient basis on patients under local anesthesia, although some surgeons may use an epidural block instead. Extensive procedures are usually performed on patients under general anesthesia.

Fluids as well as fat are lost during the procedure, so the patient will receive intravenous fluid replacement.

After liposuction, the patient can expect some temporary bruising, swelling, soreness and/or a burning sensation. The treated area may feel numb for a few months. The best and most long-lasting results from liposuction are in those patients committed to a healthy lifestyle, which includes proper nutrition and physical activity.

FACIAL SURGERY AND SKIN CARE SURGICAL PROCEDURES

Face Lift (Rhytidectomy)
Indications for a face lift include sagging facial skin and jowls and loose neck skin. The usual candidates are men and women over the age of 40 years. Performed on patients under general anesthesia, the procedure takes several hours. Patients should expect to experience temporary bruising and swelling. The facial skin may feel numb and tender, as well as dry. Typically, the patient will have a "tight" sensation in the face and neck. Risks include bleeding, infection, excessive scarring, asymmetry and an undesirable hairline change. Occasionally, injury to the nerves controlling facial muscles and temporary numbness occur. When injury does happen, it usually resolves, but on rare occasions, it is permanent. Poor healing is another possible risk.

The effects of a face lift typically endure for five to 10 years. One special consideration for men: the procedure results in repositioning beard-growing skin behind the ears, so after a face lift, it will be necessary to shave the area behind the ear or seek hair removal treatment. A face lift may be done in conjunction with other procedures, such as eyelid rejuvenation (blepharoplasty), chin augmentation, forehead or brow lift and skin rejuvenation procedures such as dermabrasion or dermaplaning, laser peel or chemical peel.

Forehead Lift (Brow Lift)
Indications for a forehead lift include visible signs of aging, such as deep forehead creases, hooding over the eyes, drooping eyebrows and frown lines above the nose and in the crow's feet area. The procedure involves removing excess tissue and redraping the skin to smooth the forehead, lift the upper eyelids and minimize frown lines.

The forehead lift is typically performed on men and women in there 40s to 60s to slow the signs of aging, but it is also appropriate for younger patients with droopy brows or furrows above the nose. The surgery takes from one to two hours and is generally performed in an outpatient setting on patients under either general anesthesia or local anesthesia with sedation.

After a forehead lift, the patient can generally go back to work within seven to 10 days and resume strenuous activities within a few weeks. The effects of a forehead lift endure for five to 10 years, sometimes even longer.

Eyelid Rejuvenation (Blepharoplasty)
Indications for eyelid rejuvenation surgery include drooping, hooded upper lids and puffy bags and/or extra skin below the eyes. Eyelid rejuvenation can correct these conditions. Eyelid rejuvenation can be performed alone or in combination with other procedures such as a face or brow lift.

Eyelid rejuvenation surgery consists of removing excess fat, skin and muscle from above and/or below the eyes.

The effects of eyelid rejuvenation will last for several years, and in some people, they are permanent. If upper-lid surgery is done to improve vision, the procedure may be covered by insurance, so it is important to maintain excellent documentation. Insurance carriers require preauthorization, preoperative assessment of visual fields, photo documentation, and occasionally, other testing by an ophthalmologist.

Nose Reshaping (Rhinoplasty)
Indications for rhinoplasty include over- or undersized, misshapen or humped nose; breathing problems associated with the nasal structure; aesthetically displeasing nasal tip or bridge; unattractive angle between nose and upper lip; and dysfunctional or unappealing nasal openings. Cosmetic or functional problems with the nose can occur in people of any age, and it is the facial feature that causes the most dissatisfaction in people displeased with their appearance. During rhinoplasty surgery, the surgeon separates the skin of the nose from the supporting framework of bone and cartilage, reshapes the framework and then redrapes the skin. Rhinoplasty surgery can be either open or closed, with the choice depending upon the nature of the problem and the surgeon's preferred technique.

In a closed procedure, the surgeon makes the incision inside the nostrils and reshapes the nose from within, without direct vision. In an open procedure, the surgeon makes a small incision across the columella (base of the center of the nose) and resculpts the structures under direct vision. In some cases, cartilage or bone grafts may be required. Open procedures are preferred for more complicated cases.

After rhinoplasty, patients can return to work or school within one to two weeks and resume strenuous activities within two to six weeks. The nose takes some time to settle into its new shape, and the final appearance may not be achieved for a year or more. Rhinoplasties performed to correct congenital deformities, relieve breathing problems or repair defects caused by trauma may be covered by insurance. Cases are judged on an individual basis and usually require preapproval.

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Our board-certified plastic surgeons ? Dr. Balvant P. Arora, Dr. Duc Tri Bui and Dr. Steven M. Katz ? perform cosmetic surgery to reshape normal structures of the face or body in order to improve appearance and self-esteem. Appearance is an important aspect of modern life. People today not only want to feel good inside; they also want to look good outside. People with a good self-image tend to have more confidence in their work, feel more secure in their relationships, and, as a result, interact more positively with friends, family, and new acquaintances. Having a good self-image has other very important components, but one of the most important is appearance. Sometimes even changing a minor cosmetic problem can make a big positive change, substantially increasing feelings of well-being and self-worth.

Additionally, many people hold jobs where appearance is important. In fact, in any job that involves interaction with others, people are apt to be judged (at least in some degree) by the way they look. Often encounters are fleeting, so that first impressions count. For some, retaining a youthful and pleasing appearance may be their means of remaining competitive in a crowded marketplace.

To achieve these ends, many men and women elect to undergo cosmetic procedures. The results are often beautiful and sometimes exhilarating but they are also often permanent, so it is important that you know what to expect before undertaking any of these procedures. These procedures are best performed by surgeons certified by the American Board of Plastic Surgery (ABPS), such as our plastic surgeons.

A few words about your plastic surgeon and consultation visit
It is important that you be aware that some risks attend even minor cosmetic procedures and that there is no guarantee that the effects will be exactly as you envisioned. The best assurance you have for a reliable outcome is to choose an experienced plastic surgeon certified by the American Board of Plastic Surgery who has performed the procedure many times before. The plastic surgeon's specific training and experience make him/her knowledgeable about the best techniques for specific problems (and specific patients), and the plastic surgeon's familiarity with the various procedures helps reduce the risk of complications.

Although it is good to learn about the various cosmetic procedures from the Internet or magazine articles, there is no substitute for a consultation visit. The following is a list of questions you should ask our plastic surgeons before making any decision about cosmetic surgery:

  • What procedures are available for the part of you that you would like to improve and what do they entail?
  • Does the procedure ordinarily require hospitalization or can it be done on an outpatient basis?
  • What type of anesthesia is generally used? (local, general, epidural, other?)
  • How much time is needed for recovery and when can normal activities be resumed?
  • What sort of outcome can you reasonably expect?
  • How long will the improvements last?
  • What are the possible risks?
  • Are there any special considerations that might influence your decision on whether or not to have the procedure? (For example, some skin procedures require that the patient avoid sun exposure permanently; patients need to know this before they elect the surgery.)
Each procedure can be evaluated according to the same checklist. This makes it easy to compare procedures when several options are available.

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For a free consultation and/or an appointment with Dr. Arora, Dr. Bui or Dr. Katz, please call (631) 444-4666, or click here for information and directions to their office.

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