Considering Cosmetic Surgery?
Actual Patient
There are several important factors in making the decision to have cosmetic surgery. You must feel totally comfortable with your physician and the choice of procedure that both of you have decided on. It is imperative that you know your physician’s credentials, see before and after photos, know the post-operative course of treatment, and most importantly, that you are on the same page with your physician regarding what you are realistically wanting to achieve. Many patients have done their homework already when they come in for their initial consult. The internet provides a wealth of information on health issues including cosmetics. It is the Neigel Center’s goal to have every patient comfortable, knowledgeable and happy with their decision and results.
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If you are of Asian descent, it is essential that you find a doctor familiar with the unique anatomy of the Asian eyelid.
You must be able to discuss with the doctor your goals and understand what can and cannot be done. Fifty percent of Asians have eyelid creases. Some Asian patients just want a double eyelid. Others seek a full blepharoplasty, including removal of skin and fat. For whatever kind of eyelid surgery you seek, it is important to undergo an Asian and not a Western Blepharoplasty to match your other features for the most natural appearance. A Western lid crease and Western removal of fat will look very unnatural on an Asian face and most likely will lead to a very unhappy patient.
Some patients who don’t have an eyelid crease may end up with a crease anyway after surgery. That’s because the scar in the eyelid can sometimes cause an eyelid crease to form, even if the surgeon wasn’t trying to create one. The placement of the incision is extremely important in case this does happen so that the position of the incision ends up in the natural crease lines seen in Asian eyelids.
Many Asian patients have prolapse of fat, especially in their lower eyelids, which can be treated by laser eyelid surgery through the inside of the eyelid (laser transconjunctival blepharoplasty), thereby hiding the scar inside the eyelids. Laser surgery results in a much quicker rehabilitation and usually less bruising, bleeding and swelling.
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Blepharoplasty (Eyelift, Double Eyelid Surgery)
Cosmetic and functional eyelid surgery goes under many names, but when most people think of the procedure that can reverse the effects of aging and eliminate bags under the eyes, they’re thinking of a surgery called blepharoplasty, which is the removal of skin, muscle, and sometimes fat from the eyelids to enhance the appearance and tighten the area. Blepharoplasty, essentially an “eyelift”, can also result in a more wide awake look as well as eyes that appear larger and brighter.
The delicate, thin skin of the eyelid can sag because of a number of factors: age, heredity, allergies, and other systemic diseases. But a drooping eyelid can cause more than cosmetic problems. In some cases, this skin can hang over the eyelashes and actually block peripheral vision. At this stage surgery is more than cosmetic, and corrects a serious functional problem known as mechanical ptosis.
Some patients who require eyelid surgery not only have excessive skin on the eyelid but also cannot fully open the eyes because the muscle that opens the eyelid (levator muscle) has detached, weakened or become too loose. Although this can be compensated for by raising the eyebrows, the eyelid might eventually droop even more and block the front as well as side vision. Eventually raising the eyebrows doesn’t work and surgery is the only solution. Surgery to correct ptosis involves opening the eyelid in the same manner as a cosmetic blepharoplasty, with the additional step of strengthening the levator muscle. In a simple cosmetic blepharoplasty, only skin and muscle are removed. Here’s how it works: The first incision is made where the normal lid crease should be (this varies according to gender and ethnicity), and the appropriate amount of excess skin is removed.
With ptosis surgery a more extensive surgery is performed. A deeper cut is made, and the fat is exposed and possibly removed. The muscle that opens the eyelid is then exposed and tucked or pleated with several sutures across the eyelid. The incision site is closed with sutures, giving a precise plastic surgery hairline scar, positioned so that it will be hidden in the eyelid crease.
In lower lid blepharoplasty, the incision can be made just below the eyelashes or, in some cases, through the inside of the eyelids so the scar is completely and in most cases successfully hidden. Some patients also require a tuck in the corner of the lower eyelid to tighten any lax tissues so that the eyelid remains in a normal position at the end of surgery. The lower eyelid skin can be resurfaced with the carbon dioxide laser, which shrinks the excess skin and has the added advantage of diminishing crow’s feet, those fine wrinkles at the corner of the eyes.
How do you know if your surgery was successful? Compare your results with normal eyelids: The upper eyelid should be one to three millimeters below the limbus, the area where the colored part of the iris meets the white part of the sclera. The lower eyelid position should be at or just above where the edge of the lid margin meets the limbus. Remember, some skin must remain in the upper eyelid to allow it to close. If too much skin is removed, many complications can result, such as inability to close the eyes (lagophthalmos) and/or lid retraction in which the eyes open too widely and too much white is visible. This can lead to exposure problems, dry eyes, and the inability to blink properly. These are just general guidelines and may not be appropriate for every patient.
Although this general overview gives you an idea of what eyelid surgery entails, there are many parts to the procedure that must be tailored individually to each patient. A surgeon who fails to individualize each surgery increases the risk of complications.
36 year old female Lower Lid before and 3 months post op
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Breast Augmentation
Breast Procedures: Lifts, Augmentation & Reduction
There are many reasons why women have plastic surgery performed on their breasts. For some women, their breasts may be too small; for others, it may be a need to correct an imbalance or perhaps reconstruct their breast after mastectomy. Breast augmentation is the most frequently performed procedure on breasts in the United States. It can give women with small or unevenly sized breasts a fuller, firm proportioned look through the placement of implants. A breast lift (mastopexy) is performed to return youthful shape and lift to breasts that have sagged as a result of weight loss, pregnancy, loss of the skin’s natural elasticity or simply the effects of gravity. Breast of any size can be lifted, but results last longest when they are originally small and sagging.
Breast reduction: Large breasts may cause physical and mental discomfort and can even harm the women who have them – size and weight of large breasts can result in self-consciousness, improper posture, pain in the back and neck, indentation from bra straps, skin rashes, breathing problems and skeletal deformities. Breast reduction surgery is usually done to provide physical relief from these symptoms. Often times this will be covered by insurance.
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Brow-Lift
Many people have a common complaint of heavy eyelids. Often this is due to excess skin and a blepharoplasty (or eyelift) is used to fix this problem. Sometimes heaviness is due to gravity changes on the eyebrows themselves. A procedure that can be used to elevate the eyebrows is called an endoscopic brow or forehead lift. Through four or five incisions in the scalp, a light telescope with a TV camera attached is used to free up the forehead down below the eyebrows and elevate everything upward. The endoscope allows the surgeon to see what he is doing, allowing for more precise results. This is also sometimes called an upper face-lift. This can be done very naturally without giving a startled or surprised look. The forehead is redraped to where it used to be several years ago. The surgery is done on an outpatient basis, under local anesthesia with sedation (twilight sleep). It usually takes one to two hours to perform the surgery. Having droopy eyelids can cause visual field changes as well as changing your peripheral vision. A brow-lift can open up the eye area and raise droopy eyebrows. An endoscopic brow-lift can also significantly reduce the ridges on the forehead; in doing so you create a smoother, more youthful appearance. One of the advantages of an endoscopic brow-lift is a short recovery time.
67 year old male preop and post op browlift
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A facelift is a plastic surgery procedure that literally removes wrinkles and other signs of aging from your face. An incision is made near the hairline to avoid any visible scarring. The skin is then pulled up and back, creating a tightening effect, much like the original elasticity found in more youthful skin. The excess tissue is then excised and the patient is left looking years younger.
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Fat Transfer - Smoothing Out The Wrinkles
Fat transfer, also called autologous fat transplantation or microlipoinjection, plumps up facial features with a patient’s own fat and is a popular alternative to other wrinkle treatments. Fat transfer to the face is a safe, natural, non-allergenic procedure designed to re-contour your face and can provide definition to your cheeks and chin. It can also be used to correct facial deformities. Since fat transfer uses your own fat cells, you can never have an allergic reaction, because it is from your own body.
With fat transfer it is possible to have fat liposuctioned from your thighs and then transferred to any area of your body. Reinjected fat lasts longer in larger areas of non-movement, so it is very successful for the correction of sunken cheeks because this area does not move as often. Fat transfer can also correct atrophic aging of the hands, and post-surgical and post-traumatic defects. However, not every area of the body responds well to fat transfer, such as the breasts. Injecting fat into the breast makes it much more difficult to detect breast cancer with mammograms.
How is the procedure done?
Fat transfer is performed in our office on an out-patient basis. Both the area from which the fat is taken and the treatment site are anesthetized with a local anesthetic. Using a small needle attached to a syringe, fat is removed from a donor site where your fat is most tightly packed, such as your abdomen, or buttocks.
Once removed, your fat is processed to remove excess fluids and then re-injected using another needle, which is placed just under your skin beneath the wrinkle. This process may be repeated until the desired correction has been achieved.
Harvesting the fat cells for re-injection is often performed in conjunction with other procedures, such as a liposuction tummy tuck or cosmetic breast surgery. When fat is harvested during another procedure, it is possible for your surgeon to harvest a larger amount of fat, then freeze and store your fat for future injections when they become necessary.
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Laser Eyelid Surgery - It's All In The Eyes
Heaviness of the upper lids that causes “hooding” and no platform in which to apply makeup can be easily corrected. The “bags” under the eyes that give the look of tiredness also can be easily corrected. The surgery to repair this difficulty is called an Upper Lid Blepharoplasty and a Lower Lid Blepharoplasty, respectively. On an Upper Lid Blepharoplasty, the incision using CO2 laser is made in the crease of the upper lid. The fat is sculpted out and excessive skin is removed. The lower lid incision is made on the inside of the lid and the same process of sculpting is done. In some cases, if there is excessive skin on the lower lids, a “pinch of skin” or an extended blepharoplasty is performed to tighten and smooth out the area. In that case, a hairline incision will be made by the eyelash line, which heals well. As a patient, you should experience no post-operative discomfort. Your “down-time” will be 7 to 10 days, and that is only due to swelling and bruising that varies between individuals. In all, this is a commonly performed surgery with results that can take years off your eyes.
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Liposuction - Body Sculpting/Liposcution Provide A New Look
Whether it is the fat pad that is under the chin or the saddlebags that you have always hated, liposuction multiple areas is not uncommon to see. The areas of concern are usually abdomen, flanks, hips, and inner and outer thighs. Liposuction of the neck also is done quite often, but usually is done in conjunction with an S-Lift or another facial surgery. Tumescent fluid is used to inflate and anesthetize the area of concern. The sculpting is done with careful attention to fluid amounts and symmetry of the areas. This procedure is performed under local with sedation with a board-certified anesthesiologist. A body garment must be worn for several weeks after the surgery; patients become very comfortable wearing it. In the case of neck liposuction, a chinstrap will be worn for several days, then just at bedtime for several weeks. The results are amazing; you will be free of the unwanted fat deposits that sometimes diet and exercise may not resolve.
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Whether it be conducted in another part of the body or within the face or neck area, liposuction is defined as the removal of fat from deposits beneath the skin using a hollow stainless steel tube (called a cannula) with the assistance of a powerful vacuum. Liposuction can be accomplished either with the use of general anesthesia, or with heavy IV sedation, of totally by local anesthesia.
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Reduce Wrinkles and Lines with Pelleve Skin Tightening Treatments
Pelleve skin tightening treatments are among the latest anti-aging procedures available in the United States and can help you achieve – and maintain – a healthy, rejuvenated look. Skin tightening and firming treatments work by increasing collagen production in the body. More collagen means stronger, more resilient looking skin and a noticeable reduction in wrinkles and lines. If you want to get rid of lines and wrinkles, or just freshen up your appearance and achieve a more youthful look, ask about Pelleve skin tightening treatments. Dr Neigel will perform a thorough skin analysis and determine whether you are a good candidate for this effective skin rejuvenation procedure.
Preventing Wrinkles with Pelleve Skin Tightening
The amount of collagen in the body begins to disappear as the skin and body undergo the aging process. Collagen is essential for healthy, youthful-looking skin. It is the compound that creates the plumped and youthful glow, and low collagen levels usually result in the rapid formation of lines, wrinkles and loose or sagging skin. Skin tightening treatments such as Pelleve' use radio frequency energy to help the body rebuild collagen. This energy causes a tissue contraction that prompts the body to produce more and more collagen over a period of weeks. Some people can see results with Pelleve right away, and can expect to see progressive results over the course of about six months. Pelleve skin tightening treatments are completely painless and can be performed on almost all skin types. You will need to undergo a series of at least three 45-minute treatments in order to see significant results, and you’ll notice a dramatic reduction in lines and wrinkles within a few weeks after your first session.
Best Candidates for Pelleve Skin Tightening Treatments
Men and women of any age can undergo Pelleve skin tightening treatments without any side effects. The procedure is performed quickly and efficiently on an outpatient basis, and you can return to regular activities immediately after the procedure. Some people do experience some redness or skin sensitivity in the treated areas, but this usually resolves itself within 48 hours. You might be a good candidate for Pelleve skin tightening treatments if you:
+ Want to get rid of lines and wrinkles around the eyes and mouth
+ Are interested in achieving a more youthful appearance
+ Want to ward off signs of premature aging
+ Can commit to a series of at least 3 treatments spaced one to two weeks apart
+ Have been searching for a non-invasive skin rejuvenation procedure
+ Want to achieve a more youthful and rejuvenated look
Learn more about Pelleve skin tightening so that you can understand how the treatment works, and what to expect from each session. If you are interested in reducing wrinkles and lines, and achieving a more youthful look, set up a consultation with Dr Neigel. She will discuss the pros and cons of this procedure and determine whether you are a good candidate for this innovative skin rejuvenation treatment.
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Pelleve
Every year hundreds of thousands of people throughout the United States elect to improve the appearance and/or function of their noses through nose surgery or rhinoplasty. Some people want a different size or shape. Others wish to repair damage caused by an injury, and some just want to breathe easier.
Rhinoplasty is the reshaping of the nose. It can be performed on an outpatient basis under local or general anesthesia. The procedure usually takes an hour or two, though a complicated procedure may take longer. Most incisions are made inside the nose, where they are invisible. The skin and tissues of the nose, along with the underlying bone and cartilage, are sculpted by the surgeon to your desired new shape. If breathing problems are part of the reason for your interest in rhinoplasty, the procedure may be covered by your insurance.
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The S-Lift, also known as a mini-facelift, has caught the attention of many patients due to its natural results and minimal down time. As we all grow older, our bodies seem to be really affected by gravity. Our age can show in the area of the lower face, around the mouth and the jaw line. The S-Lift is pulling up from the jaw line and back from the mouth area smoothing out and softening the jaw line jowls and nasal-labial lines (lines between the nose and the corner of the mouth) to give a younger appearance. Although this is not a full-facelift, it is a subtle approach for patients not quite ready for the more involved facelift. The beauty of the surgery is minimal downtime due to the limited swelling and bruising seen afterwards.
S-Lift 46 year old female before
S-Lift 46 year old female 5 weeks after
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Tummy Tuck:
A Flat Abdomen Is Attainable Through Abdominoplasty
Abdominoplasty, also known as a tummy tuck, is for many women a dream come true to attaining the flat abdomen they desire. After having children, the abdominal muscles have been stretched and weakened, and the skin has also been stretched. Abdominoplasty isn’t only a surgery for women; the abdomen can be protruding on men as well. This could be the result of excessive fat that exercise will not help, and/or loose skin from dramatic weight loss. The surgery will provide tightening of the abdominal wall and removal of excess fatty tissue and skin. The ideal candidate should be stabilized in their weight loss and should be close to if not at their ideal weight. The postoperative time required following this surgery would be 10 to 14 days. In most cases this is an ambulatory procedure, which means that you do go home the same day as the surgery. Results are usually dramatic and will provide the flat abdomen that so many do seek.
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