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Frequent Questions About Cosmetic Surgery in San Diego, La Jolla and Temecula/Murrieta..
How should I select a surgeon?
It is important to establish rapport with the surgeon since you place
total confidence in that doctor's ability. Select a surgeon who compares
alternatives, explains clearly what will be done for you and the rationale
for the approach selected. Be sure he discusses convalescence and possible
risks. Choose a surgeon who communicates and has a clear understanding
of your desired result.
You should carefully evaluate the proposed surgery and the surgeon himself
before proceeding. Insist on certain qualifications. Ask specific questions
about the doctor's training. Is the surgeon Board Certified? Has he fellowship
training or specialized training in the procedures you want performed?
A specialist does the same procedures far more often and therefore has
greater experience and skill than most surgeons. Does the surgeon have
aesthetic taste compatible with yours? These questions can be answered
through referrals to other patients, and physicians.
This is an actual patient of Dr. Pousti.
Why should I choose a surgery center?
A surgery center offers high quality in the nursing team, anesthesia
and post-op care available. Having surgery in a surgery center gives you
peace of mind that every detail has been checked and checked again.
What should I know about anesthesia?
When necessary, twilight sleep or light general anesthesia is administered
by a competent anesthetist or anesthesiologist. The level of anesthesia
will vary with the needs of each patient. The type of anesthetic is clearly
described at the time of consultation and is tailored to the patient's
needs for surgery. The patient will remain in the recovery area until
able to be discharged. Your surgeon will ask you to have a friend or family
member to drive you home after the operation.
What are the risks?
Although complications are possible, they are very rare. Most patients
accept the risks after consideration. A full description of every possible
complication is beyond the scope of this text, but risks specific to each
procedure will be discussed in the appropriate section.
How long will my recovery be?
The period of recovery depends on the surgery performed. After surgery
strenuous physical activities are limited. You can resume normal activities
within a few days depending upon the surgical procedure.
In some cases there will be temporary swelling, bruising and discomfort.
The most common concern is an uncomfortable feeling, not pain. Pain is
surprisingly minimal and easily controlled with medication. Mild analgesics
are used in most cases, but stronger medication is given when necessary.
The surgeon will discuss your postoperative visits for removal of dressings
and sutures. Special arrangements are made for patients who are from out
of town and arrangements are usually available for patients who do not
live in the area, or choose to spend a few days after surgery away from
their families.
Care is taken to place the incision in the natural skin creases or skin
folds along inconspicuous areas so they are not visible when the healing
process is completed. The incision may be pink for several weeks postoperatively,
but is easily camouflaged the day after suture removal. Complete maturation
of the surgical area takes more than one year, though in most cases after
one or two weeks, only the patient and physician can detect the surgical
incision. Time is the single most important factor in the healing process.
How are fees determined?
In general cosmetic surgery is not covered by insurance. Insurance will
only pay when the surgery is done for reconstruction of deformities caused
by accidents or when surgery improves function which is impaired by a
physical deformity such as a septal deviation in rhinoplasty (nasal surgery).
If an insurance company is to be billed for the surgery, the doctor's
office staff will usually submit the insurance claim forms and documents
to your insurance company for payment.
Fees are generally determined based on each patient's needs. Fees are clearly explained to the patient at the time of the first
consultation.
Why should I schedule an initial consultation?
At the time of your visit the extent of your surgery will be carefully
discussed and an evaluation made. A consultation helps to clarify the
patient's desires and the surgeons plan. There is no standard operation
which applies to the same patient. An operation will be designed during
this consultation specifically for you and all of the details will be
explained.
The most important goal of the consultation is to clearly communicate.
Caution is advised in looking at before and after photos. These can often
be misleading and may not reflect your particular needs. To help bridge
the gap, computer graphics are often employed. Some surgeons are using
this tool to show patients what they will look like after surgery.
In general, the consultation helps the patient understand what can be
achieved. It helps the doctor understand the patient's desires and, most
importantly, it gives the patient an opportunity to ask valuable questions
and decide if surgery is right for them.
Why are pictures taken before and after surgery?
Pictures are taken prior to surgery to help plan the procedure. They
are useful guides which surgeon will use in planning and preparing for
your procedure. In addition, postoperative photos are taken to enable
you and the surgeon to evaluate the results of the procedure.
Informed Consent
You will be asked to review and sign a form that clearly describes your
desired operation. This informed consent is a legal document and your
authorization allows the surgeon to perform the surgery.
LIPOSUCTION
Q: Are there different types of liposuction?
A: Some offices use different names which mean
the same thing. You may hear words such as “lipoplasty” “liposuction”
or “suctioning lipectomy” -- they all mean the same thing.
Q: Can liposuction be used as a weight loss method?
A: No, liposuction is used to get rid of isolated
areas of fat which are diet and/or exercise resistant NOT for weight loss.
Q: Who is a good candidate for liposuction?
A: The best candidates for liposuction are
people at their normal weight who have isolated areas of fat. Firm, elastic
skin allows for a better outcome. The patient’s age is not a factor,
however, older patients have less skin elasticity and may not achieve
the same results as younger patients.
Q: How long do I need to be off of work?
A: It is suggested that you take off of work
for 3-5 days after surgery but continue to avoid strenuous activity for
one month after surgery.
Q: When can I get back to my normal routine?
A: Each San Diego Cosmetic Surgery patient
differs with recovery times. Also, the recovery time will vary depending
on how much liposuction was performed. Most patients are able to return
to work 2-7 days after surgery depending on the areas treated.
Q: When can I start exercising?
A: Dr. Pousti will assess each patient and
discuss returning to their exercise regimen. We highly recommend walking
within the first couple of days - this helps with the swelling, constipation,
etc. Depending on the areas treated, most patients are able to resume
exercise 2-4 weeks after the procedure.
Q: Anything I can do to decrease the
swelling?
A: Most of our San Diego Cosmetic Surgery
patients find that walking helps decrease the swelling after liposuction
surgery.
Q: Will the fat return to the area that
was treated?
A: If after liposuction surgery one does
not eat healthy and exercise regularly, the fat cells that remain in the
treated area will grow. The fat cells that have been removed are gone
forever. Liposuction is not meant to be used as a weight loss program.
Q: Can I do multiple areas at the same
time?
A: Yes. Dr. Pousti will discuss what procedures
may be performed at the same time while still being safe. Many patients
will opt to have liposuction and breast augmentation surgery OR liposuction
and tummy tuck surgery at the same time. Combination surgeries can give
dramatic results.
Q: Will I be wearing any special garments
after the surgery?
A: Yes. When you wake up after the procedure,
a garment will be on the treated areas. This compressive garment is there
to assist in the healing process and to decrease the amount of swelling.
Dr. Pousti will discuss the amount of time you will need to wear the garment
- depending on what areas are treated.
BREAST
AUGMENTATION
Q: Should implants be placed under the muscle
or over the muscle?
A:
The decision to do a sub-muscular (under the muscle) or sub-glandular
(under the breast tissue) breast augmentation is based on several factors.
Some of these factors include the patient’s preference and the patient’s
anatomy. Each type of augmentation has its pro’s and con’s.
In general, however, all things being equal, I prefer to do sub-muscular
breast augmentations. This type of augmentation is associated with less
chance of seeing or feeling the breast implant. This operation is also
associated with a decreased risk of breast implant hardening (encapsulation
or scar tissue formation). Sub-muscular breast augmentation interferes
with the performance of mammography less so than does sub-glandular breast
augmentation.
On the other hand, sub-muscular breast augmentation is generally associated
with more patient discomfort and a longer period of time to achieve the
final cosmetic results compared to the sub-glandular breast augmentation.
Weighing the pro’s and con’s of each type of augmentation,
whenever possible, I prefer to perform a sub-muscular augmentation to
achieve an end result with fewer complications and a better aesthetic
result.
Breast before augmentation |
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Breast after subglandular augmentation |
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Breast after submuscular augmentation |
Q: How long do I need to be off of work?
A: It is recommended that you take one week
off of work after breast augmentation surgery and continue to avoid strenuous
activity and heavy lifting for 4 weeks after the surgery. I also ask the
patients to not drive for 2 weeks after the surgery.
Q: Who is too old to get a breast augmentation?
A: Breast augmentation can be performed from
an age of 18 years old on up. You are NEVER too old to improve the appearance
of your breasts.
Q: Is it necessary to wait until after having
children before having breast augmentation surgery?
A: No, it is a matter of choice for each
woman. More than half of patients perform the surgery before having children
and the majority of them have no problems breast feeding afterwards. The
incisions used are small and the surgeon attempts to minimize the amount
of disruption of the glands to the nipple/areola. The underlying breast
implant does not harm the breast fed baby in any way.
Q: How do I decided what size to go?
A: The size that a patient decides to achieve
is a very personal decision. Often time the patient wishes to achieve
a “natural look” to simply improve the proportionality of the
upper and lower body. Some patients, however, want a “round”
look. For these patients a “natural look” is not a priority
and they are not concerned if other people know that they have had a breast
augmentation. In making this decision, it helps to discuss your goals
with your surgeon. Pictures are often helpful as a form of communication
between the patient and the surgeon. Often times, discussing “cup
size” is useful but one must be careful since “cup size”
depends on the manufacturer of the bra.
Q: Do breast implants interfere with mammography?
A: Yes. Breast implants, regardless of their
location in the sub-muscular or sub-glandular location, can interfere
with mammography. Generally, the breast implants placed in the sub-muscular
position tend to interfere with mammography less than those placed below
breast tissue. Mammography centers are well accustomed to performing mammography
on patients who have had breast implants (using displacement techniques).
Q: Can sensation of the nipple/areola be lost
after breast augmentation surgery?
A: Yes, a small percentage (<5%) of patients
have permanent nipple/areola sensation loss after breast augmentation
surgery. Many patients have temporary loss or hyper-sensitivity of the
nipple/areola complex. The surgeon takes great care during the operation
to avoid injury to the nerve supply to the nipple/areola complex.
Q: How do I decided on the incision (approach)
to be used during breast augmentation?
A: Several approaches are available to perform
the breast augmentation. These include the following: an incision under
the areola, under the breast (just above the infra-mammary fold), and
in the axilla (arm pit). The choice of incision is a decision made by
the patient and the surgeon. In general, we try to use the incision which
is best hidden and therefore less visible. Often times, this decision
is made based on the patient’s anatomy. For example, if the patient
has some amount of excess skin under the breast, an incision can be well
hidden in this area (just above the infra-mammary fold) otherwise an incision
around the areola tends to heal very nicely and becomes barely visible
with time.
Q: How do I decide to go over or under the muscle
with the breast implant?
A: The decision to do a sub-muscular (under
the muscle) or sub-glandular (under the breast tissue) breast augmentation
is based on several factors. Some of these factors include the patient’s
preference and the patient’s anatomy. Each type of augmentation has
its pro’s and con’s. In general, however, all things being equal,
I prefer to do sub-muscular breast augmentations. This type of augmentation
is associated with less chance of seeing or feeling the breast implant.
This operation is also associated with a decreased risk of breast implant
hardening (encapsulation or scar tissue formation). Sub-muscular breast
augmentation interferes with the performance of mammography less so than
does sub-glandular breast augmentation.
On the other hand, sub-muscular breast augmentation is generally associated
with more patient discomfort and a longer period of time to achieve the
final cosmetic results compared to the sub-glandular breast augmentation.
Weighing the pro’s and con’s of each type of augmentation, whenever
possible, I prefer to perform a sub-muscular augmentation to achieve an
end result with fewer complications and a better aesthetic result.
Q: What is capsular contracture?
A: This is scar tissue that forms around
the breast implants causing the breasts to harden. This hardening may
be associated with tenderness and pain. This is the most common complication
with breast augmentation. Sub-muscular breast augmentation helps to deter
capsular contracture. Massage may be useful, especially for implants placed
above the muscle. If severe capsular contracture occurs, it may be necessary
to remove the scar tissue and replace the implant (preferably in a sub-muscular
position).
Q: Who should perform my breast augmentation
surgery?
A: The physicians most qualified to perform
breast augmentation surgeries are board certified plastic surgeons. It
is important to get information regarding the surgeon’s training.
Can the surgeon perform this procedure in a major hospital in your city?
What do other patients say about the surgeon’ s ability to communicate
and his level of care post-operatively?
Q: What do the implants feel like?
A: In general, implants feel firmer than
your own breast tissue. Also, the appearance and feel of augmented breasts
depends on how much breast tissue the patient had pre-operatively. In
general, the more tissue the patient the patient has pre-operatively,
the more natural the look and feel post-operatively.
Q: What medications should I stop before surgery?
A: It is recommended not to take any aspirin
containing medication, ibuprofen containing medication or any herbs or
weight loss medications for at least 2 weeks before surgery.
Q: How do I reduce nausea post-operatively?
A: Unfortunately, nausea is a common problem
after many surgical procedures. Many medications can be used intra-operatively
in an attempt to reduce this problem. Post-operatively, nausea can be
reduced by minimizing the use of narcotics and taking the medication with
a small amount of food in the stomach. If nausea is not relieved by these
measures, anti-nausea medication may be prescribed.
Q: How do I know if I need a breast lift?
A: A breast lift (mastopexy) is an operation
used to treat ptotic (sagging) breasts. A consultation with a well qualified
plastic surgeon can help answer this question for you. In general, evaluating
the position of the nipple/areola complex in relation to the fold under
the breast (infra-mammary fold) will help determine the need for lifting.
Different types of breast lifting operations are available depending on
the severity of the sagging. Reviewing pictures of patients with similar
situations may be helpful in deciding how to proceed.
Q: What can I expect post-operatively?
A: Unfortunately, most patients experience
a moderate to significant discomfort post-operatively. This seems to be
increased with sub-muscular breast augmentation compared to sub-glandular
breast augmentation. Many patients are unable to sleep because they are
not used to sleeping on their backs. Soreness of the back and neck may
be related to this difficulty finding a comfortable position. Some patients
choose to use 2 pillows and sleep in a reclined position.
Q: What is symmastia?
A: This is when the two breasts communicate
in the midline (cleavage area). This may be done to “increase cleavage”
by dividing the soft tissue or muscle fibers at the medial edges of the
breast. This can be seen with implants placed over or under the muscle.
It is a correctable problem -- it is callenging and requires surgical
intervention.
Q: What is the difference between textured and
smooth implants?
A: Texturing refers to the surface of the
breast implant. Textured implants have a rough surface in an attempt to
prevent contracture formation (especially when the implants are placed
above the muscle). This does not appear to be relevant in the sub-muscular
position. Textured implants may be associated with rippling more than
smooth implants.
Q: What is a “Tuberous Breast”?
A: Tuberous Breasts, otherwise known as constricted
breasts, are associated with some breast tissue deficiency especially
medially (around the cleavage area). The appearance of the breasts can
vary greatly from a very severe deficiency of breast tissue to mild deficiency.
Often times, the patient will have different size and shape between the
right and left breast. This is a correctable condition. Of ten, implants
can be used to improve the size, shape and symmetry of the breasts.
Q: How long will
I have to wear this special bra?
A: Normally, the
bra will need to be worn for 2-4 weeks. There are reasons why the bra is
important and following San Diego Cosmetic Surgeon's, Dr. Pousti, directions
will give you the best possible results. Each patient is different and so
the recovery will also be different.
Q:
How long do I have to wear the bandeau?
A:
The amount of time that the bandeau needs to be worn depends on your specific
situation. On average, the bandeau will be worn for 2-4 weeks after the
procedure by our cosmetic surgery patients.
Q:
When can I start to exercise?
A:
Dr. Pousti does not recommend heavy weight lifting or strenuous exercise
until 6 weeks after the procedure. Patients may walk and do leg exercises
soon after the procedure.
Q:
How long is the recovery?
A:
Every San Diego Cosmetic Surgery Patient is different in their recovery.
Most patient's are able to resume the majority of their normal activities
4-6 weeks after the procedure.
Q:
Do I have to do any special exercises to massage the implants?
A:
There will be exercises that Dr. Pousti and his office staff will review
with you. Generally, when the implants are placed in the sub-muscular
position, massage has not been found to be necessary.
Q:
Anything I can do to decrease the possibility of getting capsular contractures?
A:
No. Our San Diego Cosmetic Surgeon, Dr. Pousti, will do all that he can
during and after the procedure to decrease the chance of capsular contracture.
By placing the breast implant under the muscle, the risk of getting capsular
contracture will be decreased. Dr. Pousti follows his patients long term
to diagnose encapsulation and there are now medications that may be used
to combat this problem.
Q:
Do these implants have warranties?
A:
Yes, these breast implants have life time warranties. The breast implant
companies will cover the cost of the breast implants for life and will
also supply a stipend to cover some of the cost associated with returning
to surgery (anesthesia, surgery center, etc.) for 10 years after your
primary procedure.
Q:
Can I get silicone implants?
A:
At this time, there are special categories that a Cosmetic Surgery patient
will need to fall into to be able to request silicone gel implants. We
can discuss these criteria with you at the consultation if you are interested.
The FDA is assessing the possibility of allowing patients to use silicone
gel implants but at this time, it is not FDA approved for all patients.
Q:
I have friends from out of town/state who have gone to see Dr. Pousti,
how can I schedule a surgery without coming in for a consultation if I
live out of state?
A:
Our San Diego Plastic Surgery office has many patients coming from out
of town/state to have Dr. Pousti perform their breast augmentation surgery.
We can discuss the majority of what we need to via e-mail. Our office
tries to work with your schedule so that the inconvenience is minimized.
Q: When do the stitches
come out?
A: The stitches usually come out 5-7 days
after surgery.
Q: When can one shower
after this procedure?
A: After the stitches are removed, the patient
is allowed to shower.
Q: If I have to have
the surgery redone later in life, will the incision be made in the same
place as the original?
A: Usually, yes, the incision would be made
in the same area.
Q: Will I need expanders
to achieve the size I want?
A: Usually, expanders are not necessary.
Q: Do you use sizers
during surgery to best determine size?
A: Yes, I always use sizers.
Q: How many different
sizes of implants do you take into the OR?
A: I always have all breast implant sizes
available in the OR.
Q: Do you make over-sized
pockets?
A: Pockets are slightly larger than the implants
used. This will allow for some movement of the implants so as to resemble
natural breasts as much as possible.
Q: If I develope a
capsule and the implants have to be removed, will I be able to have them
put back again?
A: Most of the time, patients wish to have implants
replaced after removal of capsules (capsulotomy).
Q: What guarantees
are offered with the implants?
A: Currently, the implants are warrantied for
life by the implant manufactorer. They also provide a stipend to return
to the OR if an implant leak occurs within the first 10 years.
Q: What is the best
way for me to determine the size implant I will need to go from where
I am to where I want to be?
A: Often, by looking at pictures, we can ascertain
your goals of size and shape of breast desired.
Q: Will I be able
to sleep on my stomach?
A: In general, approximately 2-3 months after
surgery, one is able to sleep on their stomach.
Q: Who prescribes
the painkillers and can we collect them prior to surgery?
A: All necessary prescriptions will be prescribed
by the doctor several weeks prior to surgery (at the pre-op appointment).
EYELID
SURGERY
Q: How does a person get rid of the constant
“puffiness” under the eyes?
A: A lower blepharoplasty (lower eyelid surgery)
can get rid of the pockets of fat that can cause the puffiness.
Q: Is there any way to alleviate the heavy feeling
of the eyes that make it difficult to hold the eyes open?
A: Yes, upper eyelid surgery can alleviate
the “heaviness” that people feel around their eyes when the
excess skin of the eyelid weighs down on them.
Q: Where is the incision for eyelid surgery?
A: The incision for upper eyelid surgery
is hidden within the natural fold of the upper eyelid and extends slightly
beyond the outside corner. For the lower eyelid, the incision is also
hidden but below the lower eyelashes.
Q: How long do I need to take off from work
after eyelid surgery?
A: It is suggested that you take off 3-5
days from work after eyelid surgery but refrain from strenuous activity
for up to one month after the surgery.
FACELIFT
Q: What is a good age to have a facelift?
A: There is no specific age for having a
facelift. The results of a facelift can be subtle or very dramatic depending
on the patients appearance before surgery.
Q: Are the incisions
visible after facelift surgery?
A: No, if done correctly, all of the incisions
associated with facelift surgery can be hidden in normal creases / folds
of the face or in the hairline.
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