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SAFETY STANDARDS FOR OUTPATIENT SURGERY
There are a number of safety standards for outpatient surgery.
Some surgeons operate in their office facilities which are not certified. There are No Standards in place for those facilities.
AAAASF has the Easiest Standards for outpatient surgery.
AAAHC, JCAHC have Medium Standards for outpatient surgery.
Medicare has the Toughest Standards for outpatient surgery and holds the surgeons, their RNs, and anesthesia providers to the highest safety standards.
The Institute of Facial and Cosmetic Surgery is a State Licensed Medicare approved Surgery Center.
One of the most important steps in assuring a satisfactory rhinoplasty outcome is selecting the right surgeon. Since rhinoplasty ranks among the most challenging of all cosmetic procedures, at a bare minimum you should find a surgeon with genuine rhinoplasty expertise, considerable rhinoplasty experience, and a resume of consistently favorable results. A good surgeon will also be an effective communicator, a patient listener, and a compassionate caregiver. Although there are many surgeons who meet these criteria, there are many more that fall short, so careful and conscientious research is mandatory. And because rhinoplasty is an elective, non-emergent procedure, there is no excuse for failing to investigate the qualifications and credentials of your care provider – failing to do so means gambling with your face.
While the quality of your rhinoplasty outcome depends in large measure upon the quality of your rhinoplasty surgeon, finding a surgeon skilled in cosmetic nasal surgery is sometimes difficult. Unfortunately, there is no single reliable method for finding the right surgeon. Moreover, information sources may be inaccurate, contradictory, or difficult to access. Consequently, information is best gathered from all available sources and then carefully evaluated and cross-referenced to derive the best possible assessment. The process can be time-consuming and challenging, but for most individuals, a satisfactory choice eventually becomes clear.
Although the choice of surgeon is critically important, no surgeon can guarantee a perfect outcome. To the contrary, because nasal surgery is performed on swollen and distorted tissues that can change shape without warning, slight cosmetic imperfections are inevitable in virtually any nose, regardless of who performs the surgery. Even a well-meaning and highly talented surgeon cannot foresee or prevent every conceivable problem, so realistic expectations are essential. However, the time spent finding an established rhinoplasty specialist with a track record of happy patients is well worth the effort. Finding the right surgeon can make the difference between a dramatic cosmetic enhancement, and a scarred, unattractive nose.
In general, surgeons who specialize in a particular surgical niche tend to have greater interest and skill in that subspecialty. Typically, this translates into better and more consistent surgical outcomes, whether it is vascular tumors of the brain, total hip replacements, or cosmetic nasal surgery. Although finding a surgeon board certified in plastic surgery or facial plastic surgery is a good start, it by no means assures a satisfactory rhinoplasty will ensue. There are several different paths that can lead to credentialing in rhinoplasty surgery, including plastic surgery, otolaryngology (ear, nose, and throat surgery), facial plastic surgery, and oral surgery. Each has advantages and disadvantages and no educational pathway has an exclusive lock on quality outcomes. Leaders in rhinoplasty have emerged from each of these educational pathways and in virtually every instance, their practices have been focused largely on nasal surgery.
Liposuction, Liposculpture, Lipoplasty and a variety of other terms are all used to describe one of the most common cosmetic procedures performed annually in the United States. Each year several hundred thousand women and men seek improvement in various areas of their body using Liposuction techniques. Liposuction is a procedure that can help sculpt the body by removing unwanted fat from the abdomen, hips, buttocks, thighs, knees, upper arms, chin, cheeks and neck. Liposuction has undergone many refinements in the last several decades, including the tumescent technique. With the Tumescent Technique, large volumes of saline solution, local anesthesia, and adrenaline are infused into the fatty area being treated to cause swelling. This enables your surgeon to maneuver a small instrument called a cannula, connected to a vacuum machine, superficially under the skin. The cannula is inserted into the fatty tissue through tiny incisions. Your surgeon gently moves it around under your skin and suctions away the unwanted fatty deposits to reveal more attractive contours.
The best candidates for Liposuction are normal-weight people with firm, elastic skin who have localized areas of excess fat. You should be physically healthy with realistic expectations and understand that Liposuction is not a weight loss procedure. Skin which has lost elasticity from weight gain, pregnancy or aging may not be appropriate for Liposuction. Liposuction can effectively treat and sculpt problem areas of the body including the chin/neck, chest (gynecomastia or male breast tissue), upper arms, “love handles” (flanks), back, abdomen, hips, inner thighs, “saddle bags” (outer thighs) and knees. Every patient is different and several factors may influence which areas are most amenable to Liposuction including your skin tone, underlying medical conditions or previous surgeries performed near the area to be contoured. During your consultation with one of our doctors at The Institute of Facial and Cosmetic Surgery you will become familiar with which type of procedure will best meet your cosmetic needs. For example, you may feel you want Liposuction in the abdominal area, but after a consultation with one of our doctors you may learn that Tummy Tuck (Abdominoplasty) combined with Liposuction may more effectively meet your goals.
Generally, Liposuction procedures are limited in both the volumes removed and the amount of time spent under anesthesia. The time required to perform Liposuction may vary considerably depending on the size of the area, the amount of fat being removed, the type of anesthesia and the technique used. The American Society of Plastic Surgeons has recommended that no more than 5 liters of fat be removed in any one setting. All of our procedures are performed in our fully state licensed surgery center.
If efforts to remove unwanted hair leave you with bumps, nicks, burns, or the hassles of repeated shaving, tweezing, or waxing, laser hair removal may be an option worth considering.
Laser hair removal is a technique that uses beams of highly concentrated light to penetrate the hair follicles. The light is absorbed by pigment in the hair follicles and destroys the hair within the follicle. Next to Botox injections, laser hair removal is the most commonly performed cosmetic procedure in the U.S.
Benefits of Laser Hair Removal
Lasers are useful for removing unwanted hair from the face, leg, arm, underarm, and bikini line as well as other areas where unsightly hair is a problem.
Benefits of laser hair removal include:
Precision. Lasers can selectively target dark, coarse hairs while leaving the surrounding skin undamaged.
Speed. Each pulse of the laser takes a fraction of a second and can treat many hairs at the same time. The laser can treat an area approximately the size of a quarter every second. Small areas such as the upper lip can be treated in less than a minute, and large areas, such as the back or legs, may take up to an hour.
Predictability. Ninety percent of patients have permanent hair loss after an average of three to five sessions.
How to Prepare for Laser Hair Removal
Laser hair removal is more than just “zapping” unwanted hair; it is a medical procedure that requires training to perform and carries potential risks. Prior to having laser hair removal, you should thoroughly check the credentials of the doctor or technician performing the procedure.
Once you have planned laser hair removal, you should limit plucking, waxing, and electrolysis for six weeks before treatment. That’s because the laser targets the hairs’ roots, which are temporarily removed by waxing or plucking. You should also avoid sun exposure for six weeks before and after treatment. Sun exposure decreases the effectiveness of laser hair removal and increases the risk of complications following treatment.
What to Expect During Laser Hair Removal
Just before the procedure, the hair that will be undergoing treatment will be trimmed to just a few millimeters above the skin surface, and the laser equipment will be adjusted according to the color, thickness, and location of the hair being treated, as well as your skin color.
Depending on the laser or light source used, you and the technician will need to wear appropriate eye protection. It will also be necessary to protect the outer layers of the skin with a cold gel or special cooling device. This will help the laser light penetrate the skin.
Next, the operator will give a pulse of light to the treatment area and watch the area for several minutes to make sure the optimal parameters were used and to check for adverse reactions before proceeding. Depending on the area being treated, treatment time may range from 15 minutes to an hour.
Recovery and Risks
After treatment, the treated area of your skin will look and feel much like it is sunburned for a day or two. Cool compresses and moisturizers may help. Unless you experience blistering, you will be able to wear makeup the following day.
Over the next month, the treated hair will fall out. Wearing sunscreen for the following month will help prevent temporary changes in the color of the treated skin.
Blisters are rare, but are more likely in patients with darker complexions. Other potential side effects are swelling, redness, and scaring. Permanent scarring or changes in skin color are rare.
Costs of Laser Hair Removal
At the Institute of Facial & Cosmetic Surgery, the cost for laser hair removal varies widely, depending on the size of the area being treated and the time required for the treatment.
Because each person’s pattern of hair growth is unique, it is difficult to predict exactly how many treatments will be needed to completely get rid of unwanted hair or the exact cost of doing so. For a better idea of the cost for your particular hair problem, you should schedule a consultation with our Skin Care Specialists.
When the procedure is completed, you may be given ice packs or aloe gels, anti-inflammatory creams or lotion, or water to relieve any discomfort. You may be scheduled for your next treatment four to six weeks later. Treatments will be repeated until hair growth stops.
We’ve all heard the clichés: Wrinkles are a roadmap of your life. But many of us would rather not be reminded of the distance we’ve traveled. What can you do? First, understand what causes wrinkles. Then, if you still want to reduce wrinkles, explore your treatment options.
What Causes Wrinkles?
The following factors are the most significant contributors to wrinkles:
Aging and Wrinkles
Wrinkles are a by-product of the aging process. With age, skin cells divide more slowly, and the inner layer, called the dermis, begins to thin. The network of elastin (the protein which causes skin to stretch) and collagen fibers (the major structural proteins in the skin), which support the outer layer, loosen and unravel, causing depressions on the surface. With aging, skin also loses its elasticity, is less able to retain moisture, oil-secreting glands are less efficient and the skin is slower to heal. All of these contribute to the development of wrinkles.
Facial Muscle Contractions
Lines between the eyebrows (frown lines) and lines jutting from the corner of the eyes (crows feet) are believed to develop because of small muscle contractions. Smiling, frowning, squinting and other habitual facial expressions cause these wrinkles to become more prominent. Over time, the expressions coupled with gravity contribute to the formation of jowls and drooping eyelids.
Sun Damage and Wrinkles
Exposure to ultraviolet radiation (too much sun) can result in premature aging of skin. Premature aging of the skin is called photoaging. The ultraviolet sunrays that cause photoaging damage collagen fibers and cause the excessive production of abnormal elastin. When ultraviolet light damages skin tissue, an enzyme called metalloproteinase is produced. This enzyme creates and reforms collagen. During the process, however, some healthy collagen fibers are damaged, resulting in a disorganized formation of fibers called solar scars. Wrinkles develop when the rebuilding process occurs over and over.
Smoking and Wrinkles
Healthy skin perpetually regenerates. While old collagen is broken down and removed new collagen is produced. Researchers have found that smoke causes a marked reduction in the production of new collagen. A lack of new collagen results in the development of wrinkles.
What Are the Treatment Options for Wrinkles?
There are numerous over-the-counter treatment options for wrinkles, including various creams and lotions. Prescription treatments, including the retinoid creams Renova and Retin-A, are also an option.
Removing skin layers to reduce wrinkles or irregular depressions is an effective way to regain smoother, more youthful looking skin. Dermabrasion (scraping layers away) and chemical peels (dissolving skin away) are two of the traditional methods used in skin resurfacing. Laser skin resurfacing with an ablative laser (such as an erbium or carbon dioxide laser) is another technique that, like dermabrasion and deeper chemical peels, may require some downtime during the healing process.
Other lasers, known as non-ablative lasers, may also be beneficial in treating wrinkles. These lasers work by heating the dermis and stimulating collagen growth. This process, which leaves the outer layers of skin intact, has no downtime associated with it. However, the results are not as dramatic as the ablative lasers which actually remove the surface layers of skin.
Botox collagen and other injections are the additional techniques available to help minimize wrinkles.
If you are considering treatment for your wrinkles, ask Dr. Constantine which procedure is right for you. There is no replacement for your doctor’s professional advice. Each person has his or her own individual needs; similarly, each procedure fulfills its own specific need.
Your antiaging cream may contain vitamin C or E. Put these antioxidants to work from the inside, too. Eating foods rich in these vitamins, plus the mineral selenium, can help protect your skin against sun damage. They may even help reverse signs of aging, like wrinkles and skin discoloration.
As you age, your skin changes. Your body doesn’t produce as much collagen, and the elastin that allows skin to spring back into place gets weaker. You also don’t create or lose skin cells as fast. To boost aging skin, exfoliate to remove dead skin, use a nondrying soap, and moisturize often. Ask our esthetician about what would work best for you.
Have you been considering a Face Lift?
Many women-and some men-are finding that a facelift can restore not just their youthful look, but also their youthful energy. However, promises of eternal youth might make you forget that a facelift is a major medical procedure with serious risks. Before you decide to undergo surgery to turn back the clock, you need to gather enough information to make a wise decision.
Choose the Right Surgeon
A facelift is a surgery, and you would never jump into a surgery without a little research. First, you need to do is choose a surgeon carefully. Always make sure that your surgeon is board-certified and keeps up on continuing education. If you’re not sure, ask. If you have friends or family members who have had a facelift with good results, ask them who did their surgery.
If not, ask a potential surgeon for referrals, and follow up on them. Call them and ask them about their procedures, the results, cost and follow up. Even better, see their facelifts in person. Find out if there is anything they are not satisfied with. Ask them if they would return to that doctor. If they had problems, were they dealt with promptly and appropriately?
Your surgeon should be technically skilled, but your surgeon should also be realistic about what the facelift can do for you. Your surgeon should discuss the procedure with you thoroughly-the expectations as well as the risks. He or she needs to make sure you are a good candidate for the surgery.
Who Makes a Good Candidate for a Face Lift?
You may have several reasons for getting a facelift, but good candidates undergo the procedure only for themselves. Mindset is an important part of any medical procedure, but, with cosmetic surgery, realistic expectations are vital. A facelift can help smooth the lines and wrinkles on your face and may help you appear more youthful, but it cannot repair a damaged relationship or make you feel more worthwhile. Of course, a positive attitude is beneficial, but unrealistic expectations are a set-up for disappointment.
A good candidate for plastic surgery has more than the right attitude. As with any surgery, but especially elective surgery, the best candidate for a facelift is someone who is in good health. Not only will this reduce the risks of the surgery, but it also significantly reduces recovery time. As a part of ongoing good health, a prime candidate for a facelift doesn’t smoke. Smoking hinders circulation and slows healing.
What to Expect From a Face Lift
Your first visit to the plastic surgeon will be a consultation to discuss your medical history, expectations, desired outcome, drug allergies, current medications and drug, alcohol and tobacco use. You can expect the doctor to measure your face, take pictures, discuss options, determine a course of treatment and prepare you for the procedure if you are a good candidate.
At this time, you need to divulge your entire medical history and habits in case there are potential reactions. Don’t leave anything out. If a doctor isn’t concerned with your general health or rushes through the risks, you should move on. And if a doctor tells you you aren’t a good candidate, you have a right to a second opinion, but don’t go doctor-shopping until you find one who says yes. If you aren’t a good candidate, then you aren’t a good candidate, and you need to consider other anti-aging options for your own health.
On the day of your surgery, the first step is the anesthesia. You and your doctor will have already determined the best anesthesia for your individual circumstances.
Once the anesthetic is delivered and has taken effect, the doctor will make the incision, which is usually hidden within the hairline. Depending on the results you are after, a traditional facelift is often done along with other procedures to enhance the outcome. You and your surgeon may decide to include facial implants, soft tissue augmentation and filler to reduce wrinkles.
After the incision is made, your surgeon may sculpt or move fat from your face and neck, reposition the tissue underneath and lift the muscles. The skin is then put back in place, and the excess is removed.
The doctor will then use stitches or surgical adhesive to close the incision. The number and location of incisions depends on the specific embellishments and improvements you are having done. If you are having your neck area worked on, for example, you will have an additional incision near your ear lobe.
What to Expect After Your Face Lift
You might be able to go home that day, but it will take much longer before you see the final results of your facelift. While initial bruising and major swelling will subside over the first few days and weeks, swelling may not fully disappear until several months after your facelift. It’s important to be prepared for this initial swelling and pain and to understand that you won’t have the final results for a while after your procedure.
As with any surgical procedure, there are risks involved with a facelift. Discuss these potential risks and problems, such as scarring, infection, pain, numbness or other unsatisfactory results, with your surgeon prior to the procedure. Don’t be afraid to ask your doctor about any concerns or fears you have. It’s your body, and you have every right to understand the good and the bad that may come from your facelift.
There are no guarantees with a facelift. But, if you choose a qualified, trained surgeon who can demonstrate prior good results, and if you take good care of yourself before and after your surgery, you will be more likely to look and feel a little younger.
*source: Life 123 Theresa Hall
A thread lift was a much sought after alternative to full facelift surgery a few years back when I first wrote this article. Things have changed a lot since then and in 2011 very few board certified plastic surgeons now recommend the procedure to their patients.
Also called a ‘featherlift’ or ‘gentlelift’ – sometimes advertised as the lunch hour facelift – it was originally widely advertised as a non invasive quick procedure. Something that was seen as less expensive and much less invasive than face lift surgery.
A thread lift is so called because thin needles are used to insert clear polypropilane threads with tiny barbs just under the skin. The threads are then pulled tight to lift sagging skin and tissue on the face and neck.
Unlike a conventional face lift – no skin is removed – so the procedure relies on the skin tightening effect of the threads to create a younger looking face.
It sounds like a good idea – less invasive procedures are increasingly sought and are especially attractive to women who want a subtle lifting effect and little downtime.
The problem seems to be that there was widespread dissatisfaction amongst those that paid an average of around $3900 for a procedure which either caused long lasting problems or simply failed to have any lasting lifting effect at all.
“The Threadlift was a novel idea but just didn’t work in reality to justify what was a significant expense. At their best, they might have had a subtle benefit for a year but usually much less than that. For that reason, I am not aware of any real plastic surgeons who can offer proper surgeries and other treatments who still offer a Threadlift in their practices.” Richard P Rand MD Seattle Plastic Surgeon
The threads used in the procedure had been used internally for years in surgery and according to the experts they were totally compatible with body tissues and unlikely to be rejected. Unfortunately the experiences of patients did not support this claim – many people went back to their doctors – or to other surgeons – for corrective treatments because of problems with the threads that had been inserted. Common issues were the thread showing through thinner skin or causing headaches or pricking sensations under the skin.
Eventually the only FDA approved thread (Contour) for the procedure was withdrawn from the market and thread lift treatments are now done with dissolvable sutures.
While traditional full face lift surgery involves a general anaesthetic followed by an overnight stay in hospital and several weeks recovery time, a thread lift can be done in under an hour with ‘down time’ just 72 hours. No bandages are needed and after care is claimed to be minimal.
“The thread lift fails after 3 to 6 months. I put in many when they first came out and I subsequently refunded many patients and gave free facelifts to many others. It was a horrible disappointment for all.” Nasimul Huq, MD Niagara Falls Plastic Surgeon
Nonetheless I still can’t see how this can be sold as a pain free or non invasive procedure. Pulling up your skin and underlying facial tissue even with a local anaesthetic is bound to hurt. You are almost certainly going to be sore and possibly bruised and hurting for some time afterwards.
All well and good if you are prepared for that and even better if the results are just what you want – but if you are dissapointed then it’s tough that you went through the pain and discomfort for nothing.
The negative reactions from plastic surgeons to the results of thread lifts seem to have arisen from the many problems that they were seeing in their own offices from their patients or other doctor’s patients who didn’t like what had happened to them.
Comments from patients cover the gamut, from it didn’t work, it didn’t work long enough, facial distortion, extruding hooks, chronic pain, palpable lumps….” Brent Moelleken MD Beverley Hills Plastic Surgeon
Of all the facial treatments I’ve looked at – there do seem to be more problems and disappointments around thread lifts than any other. Only 24% of those expressing an opinion about thread lifts on the RealSelf review website thought the procedure was worth it and many had sorry tales to tell.
You may find the procedure still offered by doctors in your area but this is only likely to be among some dermatologists rather than board certified plastic surgeons who generally have given it a definite thumbs down.
The recommendation from cosmetic surgeons for an alternative to a thread lift seems to be to look at non surgical options like dermal fillers, LED light therapy or laser skin tightening and to consider a mini lift for a surgical alternative.