Bo-Tox

Bo-Tox or Botulism Toxin, is one of the newest and hottest topics in plastic surgery. It is a medicine produced by Allergan Corporation which temporarily paralyses muscles into which it is injected. The benefit for plastic surgery is that many wrinkles of the face are caused by contraction of muscles and by using botulism toxin we can stop these muscular contractions and cause the wrinkles to dissolve. The muscle itself is paralyzed by the botulism toxin, completely relaxing the muscle and the skin over it.

Botulism toxin is most successful in the forehead and around the eyes. It is a quick, painless procedure that can be done at your lunch hour or at the end of the day for most patients. It involves a simple injection of the botulism toxin into the muscle that is involved in the wrinkle, but does need to be done in a very controlled way, so as not to produce any adverse effects. Adverse effects which people worry about are redness, hematoma/bleeding, or paralysis of muscles in the area which we do not desire to be paralyzed. By consulting a Board Certified Plastic Surgeon such as Dr. Stelnicki, the risk of botulism toxin is markedly reduced. Botulism toxin can be a beautiful adjunct to cosmetic surgery or used as the primary means of rejuvenating the face, especially with the beginning of some signs of facial aging. We have significant success with it in getting rid of frown lines in the forehead, deep furrows in the forehead, or crow's feet around the eyes.

In order to get a botulism consult, simply call our office and ask for a Bo-Tox evaluation. Frequently if Bo-Tox is done in combination with one or two other people, there can be significant cost-savings to the patient, as the bottle of botulism toxin can usually be divided between 2 or 3 individuals.

After the use of Bo-Tox, people can return to work immediately. The full effects of the Bo-Tox are not seen for 2 or 3 days, but there can be a significant diminution in facial wrinkles, laugh lines, etc. Bo-Tox can be used in the other areas of the face, such as around the mouth, but needs to be used in these areas only under very special circumstances, as it can limit the function of some of the muscles around the mouth. Dr. Stelnicki will be happy to talk about the huge benefits that patients can achieve with Bo-Tox, as well as any potential risks to it, which are, in his hands, minimal to none. If you have any questions, please call our office.

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Skin Conditioning

Skin conditioning can also be achieved through a variety of skin enhancing systems such as Micromedics and Novamed. These are long-term solutions to improving the skin. They address, specifically, areas where there is excess oiliness in the skin, dry areas of the skin. They rejuvenate the skin and make it more natural, smoothing the oil while exfoliating the surface and bringing it down to a more natural tone and color. The skin care specialists in our office are happy to discuss these treatment modalities with you at any time. These are done on an 8 week basis with the treatments either once a week or once every other week and leading to long term beautification with their continued use.

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Chemical Peels

Chemical peeling is a process of facial rejuvenation where chemical solutions are used to improve facial texture and remove damaged layers of outer skin. It is helpful in patients with facial blemishes, wrinkles, and uneven skin pigmentation. Chemical peels include phenols, trichloroacetic acids (TCA), and alphahydroxy acids (AHAs). Which is best for you needs to be decided based on your overall desire for facial rejuvenation and your overall skin texture. Chemical peels can be performed in conjunction with facelift procedures but it is usually not a substitute for these kind of procedures nor will they prevent or slow the aging process.

A chemical peel is most commonly performed for cosmetic reasons. It usually enhances your appearance and your self-confidence. It also can be used to remove precancerous skin lesions and soften facial acne.

Alphahydroxy acids such as glycolic acid or fruit acids are the mildest peels. These peels can provide a smoother, brighter looking skin for people who cannot spare the time to recover from a TCA or phenol peel. These types of peels are excellent for fine wrinkling and treatment in the areas of dryness or uneven pigmentation but do need to be repeated multiple times. They are usually applied weekly for long intervals to get the best results. The doctors can integrate this type of treatment modality into your daily facial hygiene regimen. It can also be mixed with facial washes or certain skin moisturizing creams to improve your skin texture.

Trichloroacetic or TCA is an intermediate peel. It is used in many concentrations but is most commonly used for medium depths. It treats fine surface wrinkles, superficial blemishes, and pigment problems. Results of TCA peel are less dramatic than those of the phenol peel and can produce an excellent cosmetic result with minimal recovery time.

Phenol is the strongest peel and should be used only in selected patients. It deeply penetrates the face for deep wrinkles and areas of blotchiness and also can remove precancerous skin growths but must be used with caution as it can produce abnormal facial scarring if not performed under the most stringent conditions.

All peels carry some risks such as abnormal healing with either hyper or hypopigmentation and, of course, most peels need more than one application. HA peels may cause stinging or redness, irritation, crusting. With a TCA peel, depending on the concentration of TCA, there may be a longer healing time. Higher concentrations require long healing times because they penetrate deeper. Patients are told to avoid sun exposure for several months following this peel and may need to repeat it. With the phenol peel, new skin frequently looses its ability to make pigment, this means that not only will your skin be lighter in color but also you have to be protected by heavy sun block from the sun forever. These types of peels tend to permanently cause damage to the melanocytes and although are excellent for removing wrinkles, do lighten the skin on a permanent basis.

Which type of peel is good for you needs to be discussed carefully with our doctors. In general, alphahydroxy acid peels are used to smooth rough or dry skin, to improve the texture of sun damaged skin, aid in the control of acne, can be mixed with a bleaching agent to correct pigment problems. AHAs are used in the pretreatment of skin prior to TCA peel. A series of peels may be needed to get an optimal result.

TCA smoothes out wrinkles, removes superficial blemishes, and corrects pigment problems. It can be used in the neck or other body areas and usually is coordinated with pretreatment with Retin-A or AHA cream. Treatment usually takes 10-15 minutes and then may require sun avoidance for several months.

Phenol is used to correct blotches, deep wrinkles, and remove precancerous growth. It is used usually only on the face and is not recommended at all in dark-skinned individuals and needs to be carefully coordinated in terms of treatment with Dr. Stelnicki.

Your peel will typically be performed in the office. During a TCA peel an AHA solution is applied that cleans your skin. This process usually takes up to 10 minutes. This is followed by a cleansing of the skin. You may feel a slight tingling sensation during this time. This will take up to 10-15 minutes for TCA peels.

What you should expect in your chemical peel is that the doctor will apply solutions to your face in preparations for the peel. It will usually be a degreasing solution which helps open pours and make the peel more effective. The peels may take up to 15 minutes, you will feel a tingling during this and maybe even a slight mild burning sensation similar to a light sunburn. The skin will then be lifted off and leaving a sort of reddish hew to the face. The reddish hue to the face can last anywhere from a few days to two months depending on the depth of the peel. After your peel, wemay prescribe a mild pain medication for you and will instruct you to keep your face clean of any scabbing, using petroleum jelly, and covering it with a medicated gauze. You should diligently keep any crusting from developing it on your face as this can increase scarring and decrease the overall final result. Your face may become slightly swollen, especially around the eyes, and if your peel is done around the mouth, the doctor will usual prescribe an antiviral medication to prevent any herpes or a cold sore outbreak. Depending on the depth of the peel, you may be able to return to work within a few days or it may be several weeks. Usually following 2-3 weeks of healing, most patients are able to return to normal life and cover the results of the peel with topical makeup.

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Breast Augmentation

If you were considering breast augmentation, the use of a board certified plastic surgeon who has training and experience in augmentation mammoplasty or breast augmentation is the first and most important choice you can make. This surgery not only serves to enhance and beautify the female form, but it also significantly improves the contour and self-esteem of many female patients. It is ideal for women who want to enhance their body contour for personal reasons and feel that their breast size is too small. It is also used to correct a decrease in breast size that can occur following pregnancy.

Breast augmentation is particularly useful for obtaining symmetry between both breasts. Many women have asymmetrical breast size and form, some as much as a cup size or two in difference. Breast augmentation surgery, if properly chosen, can lead to an increase in symmetry between the two asymmetric breasts. Breast augmentation can also be used as an adjuvant following breast surgery for the treatment of cancer.

Breast augmentation surgery is done in two ways. Breast augmentation surgery is done by placing an implant either underneath the breast tissue or underneath the patient's muscle in order to augment the overall breast mound. Through this method the surgeon is able to increase the woman's bustline by one or more cup sizes.

When consulting with our office a variety of issues will come into play. These will include the placement of incision, the size of the augmentation desired, the type of implant desired, the location of the implant, and how it affects your overall appearance. One of the best ways to pick your implant size is to bring in photos of women you have seen in magazines who have a breast size & shape you like. The doctor will then discuss the feasibility of creating this form on your personal physique. In addition, several websites have HIPPA privacy compliant photos of a variety of pre and post op augmentation patients. One site, www.breastimplants411.com is particularly helpful. Feel free to browse these sites to find the size you desire.

The doctors get into specifics about the breast augmentation health related concerns must first be addressed. We will obtain a detailed history regarding breast cancer, abnormal masses or discharge from your breasts, and perform a thorough breast exam in order to insure healthy breast tissue. One in eight women in the United States throughout the course of their life will develop breast cancer and it is important first to insure that prior to any breast enhancement surgery that the underlying risk of malignancy has been ruled out. It is very important to know that breast implants do not cause cancer or do not prevent the detection of breast cancer as long as the patient commits to performing the recommended breast self-examination and follows the mammography screening protocols as recommended by the American Cancer Society.

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Incision Choices

There are many places that incisions can be placed in order to place a breast implant. Classically, incisions have been placed below the breast along what is called the inframammary fold. This is a natural crease that occurs at the junction between the lower part of the breast and the chest wall. This incision is completely hidden when the patient is standing and is an excellent incision for a placement of a variety of different types of implants.

A second incision which is routinely used is the periareolar incision. This incision is made at the junction between the dark part of the nipple areolar complex and the lighter part of the skin. Because this is a natural transition zone it is an excellent place for hiding scars.

A third incision choice is the axillary incision. Using endoscopic techniques, Dr Stelnicki is able to perform a safe dissection of the underlying breast pocket and underlying muscle with excellent visualization of the entire area. This allows accurate placement of the implant and decreases the risk of any postoperative bleeding or infection. This incision is an excellent choice for women who do not want any scars on the breast itself, as the incision is in the axilla and all the surgery is done underneath the skin.

The last incision that is being used today is the incision around the belly button or the periumbilical incision. Our office does not routinely perform this surgery, as in its current state Our staff considers it to be experimental and possibly dangerous. This incision choice is mentioned here only to educate the reader about the options available on the market today.

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Implant Type

There are many types and varieties of implants available today. For primary augmentation the preferred implant is a saline implant. This implant is filled with the same saltwater that is present in our blood stream and produces an excellent contour of the breast. It can be adjusted at the time of the operation to improve symmetry between the right and left side of the breast and comes in a variety of shapes, including round and a natural teardrop shape that can be used to optimize the outcomes and achieve the desired results for the breast.

Silicone implants are available for some patients on a study protocol. Silicone offers the advantage of a slightly more natural feel, but does not give any enhancement in terms of the overall look of the breast. In 1992 there was concern that silicone was causing various collagen vascular diseases, such as a lupus-like condition in certain patients. However, this has not, to date, been found to be validated by a multitude of scientific studies. Still, patients who are concerned about the silicone gel which is used in these implants, should decline placement of these implants. If you do desire silicone, we can work with you to enroll you in certain study protocols that would allow you to have silicone, but this type of implant is recommended for only selected patients.

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Placement

The placement of the implants is also important. Implants can be placed either under the skin or under the muscle. Placement under the skin is a faster operation that involves less bruising postoperatively and a quicker recovery. However, the implants are more palpable and are more prone to wrinkling. There is also a higher risk of abnormal scarring around the implant with the subcutaneous placements and increasing the risk of long-term deformity of the breast, called capsular contraction. Dr. Stelnicki's preferred method in most patients is to place the implant below the muscle. Placing it below the muscle significantly decreases the risk of 1) abnormal contour around the implant, 2) palpability of the implant, 3) the risk of wrinkling, and 4) the risk of capsular contraction. However, in some patients who have had previous implants placed in a subcutaneous position, replacement of the implant into the same pocket may be beneficial and warranted.

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General Surgical Risks

We want you to understand fully the risks involved in surgery so that you can make an informed decision. Although complications are infrequent, all surgeries have some degree of risk. All of us at our office will use our expertise and knowledge to avoid complications in so far as we are able. If a complication does occur, we will use those same skills in an attempt to solve the problem quickly. The importance of having a highly qualified medical team and the use of an accredited facility cannot be overestimated.

NORMAL SYMPTOMS

  1. SWELLING AND BRUISING: Moderate swelling and bruising are normal after any surgery. Severe swelling and bruising may indicate bleeding or possible infection.
  2. DISCOMFORT and PAIN: Mild to moderate discomfort or pain is normal after any surgery. If the pain becomes severe and is not relieved by pain medication, please call us at (954) 983-1899
  3. CRUSTING ALONG THE INCISION LINES: We usually treat this with antibiotic ointment.
  4. NUMBNESS: Small sensory nerves to the skin surface are occasionally cut when the incision is made or interrupted by undermining of the skin during surgery. The sensation in those areas gradually returns – usually within 2 or 3 months as the nerve endings heal spontaneously.
  5. ITCHING: Itching and occasional small shooting electrical sensations within the skin frequently occur as the nerve endings heal. Ice, skin moisturizers, and massages are frequently helpful. These symptoms are common during the recovery period.
  6. REDNESS OF SCARS: All new scars are red, dark pink, or purple. Scars on the face usually fade within 3 to 6 months. Scars on the breasts or body may take a year or longer to fade completely.

COMMON RISKS

  1. HEMATOMA: Small collections of blood under the skin are usually allowed to absorb spontaneously. Larger hematomas may require aspiration, drainage or even surgical removal to achieve the best results.
  2. INFLAMMATION AND INFECTION: A superficial infection may require antibiotic ointment. Deeper infections are treated with antibiotics. Development of an abscess usually requires drainage.
  3. THICK, WIDE OR DEPRESSED SCARS: Abnormal scars are uncommon and may occur even though we have used the most modern plastic surgery techniques. Injection of steroids into the scars, placement of silicone sheeting onto the scars, the use of Mederma or Scar Guard or further surgery to correct the scars is occasionally necessary. Some areas on the body scar more than others, and some people scar more than others do. Your own history of scarring should give you some indication of what you can expect.
  4. WOUND SEPERATION OR DELAYED HEALING: Any incision, during the healing phase, may separate or heal unusually slow for a number or reasons. These include inflammation, infection, wound tension, decreased circulation, smoking or excess external pressure. If delayed healing occurs, the final outcome is usually not significantly affected, but secondary revision of the scar may be indicated.
  5. SENSITIVITY OR ALLERGY TO DRESSING OR TAPE: Occasionally, allergic or sensitivity reactions may occur from soaps, ointments, tape (eg. Blisters) or sutures used during or after surgery. Such problems are unusual and are usually mild and easily treated.
  6. INCREASED RISKS FOR SMOKERS: Smokers have a greater chance of skin loss and poor healing because of decreased skin circulation.
  7. INJURY TO DEEPER STRUCTURES: Blood vessels, nerves and muscles may be injured during surgery. The incidence of such injuries is rare.

RARER COMPLICATIONS

  1. If they are severe, any of the problems mentioned under Common Risks may significantly delay healing or necessitate further surgical procedures.
  2. Medical complications such as pulmonary embolism, severe allergic reactions to medications, cardiac arrhythmias, heart attack, and hyperthermia are rare but serious and life-threatening problems. Having a certified anesthetist present at your surgery reduces these risks as much as possible. (Failure to disclose all pertinent medical data before surgery may cause serious problems for you and for the medical team during surgery.)

UNSATISFACTORY RESULT & NEED FOR REVISIONAL SURGERY

  1. All plastic surgery treatments and operations are performed to improve a condition, a problem or appearance. While the procedures are performed with a very high probability of success, disappointments occur and results are not always acceptable to patients or the surgeon. Secondary procedures or treatments may be indicated. Rarely, problems may occur that are permanent.
  2. POOR RESULTS: Asymmetry, unhappiness with the result, poor healing, etc. may occur. Minimal differences are usually acceptable. Larger differences frequently require revisional surgery.

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Specific Risks Following Augmentation

  1. CAPSULAR CONTRACTION: Capsular contraction is the most common "complication" or side effect of breast implant surgery. During surgery, a pocket is created for the implant that is somewhat larger than the implant itself. During healing, a fibrous membrane called a capsule forms around the device. Under ideal circumstances, the pocket maintains its original dimensions and the implant "rests inside, remaining soft and natural. For reasons still largely unknown, however, the scar capsule shrinks or contracts in some women and squeezes the implant, resulting in various degrees of firmness and make the breast round. This contraction, if it occurs, can occur soon after surgery or many years later can appear in one or both breasts.
    Capsular construction is not a " health" risk, but it can detract from the quality of the result and cause discomfort, pain, or distortion of the breast contour. In cases of minor contraction, we usually will not suggest surgical correction. Cases of very firm contraction may require surgical intervention. Capsular contracture may reoccur after surgical procedures to treat this condition. Rarely, if the contraction recurs and cannot be eliminated, the occasional patient may choose to have the implants permanently removed.
  2. HEMATOMA: Some postoperative bleeding into the pocket containing the breast implant may occur. If the bleeding is minimal, the body will absorb it with time. Should post-operative bleeding occur, it mat require surgical intervention. This is not dangerous and should not affect the results of surgery. Please refer to medications to avoid before and after surgery.
  3. INFECTION: Post-operative infection is very uncommon, but possible. It may occur in the immediate post-operative period or at any time following insertion of a breast implant. Subacute or chronic infections may be difficult to diagnose. We reduce this to a minimum by giving intravenous antibiotics during surgery and oral antibiotics after surgery. Most infections are mild and resolve without incident. If a serious infection develops and does not respond to antibiotics, the implant may have to be removed for about 3 months. After the infection is treated, the implant can usually be safely replaced. It is extremely rare that an infection would occur around an implant from a bacterial infection elsewhere in the body, however, prophylactic antibiotics may be considered for subsequent dental procedures, dental cleaning or other surgical procedures.
  4. LOSS OF SENSATION TO SKIN OR NIPPLES: Nerves that supply skin or nipple sensation may be cut or damaged while the pocket or space for the implant is being created. Although this does not happen routinely, it can happen no matter how carefully the surgery is performed. If sensory loss occurs, the nerves slowly recover over a period of 1-2 years in about 95% of cases. It is the same risk with any of the surgical incisions, i.e. around the nipple, under the breast or in the armpit.
  5. EXPOSURE OR EXTRUSION OF IMPLANT: Thin skin, inadequate tissue coverage, capsule formation, infection or severe wrinkling may all contribute to the erosion of an implant through the skin or scar. Should this very rare complication occur, temporary implant removal may be indicated, however the implant should be able to be replaced at a later time.
  6. WRINKLING: Wrinkling is possible with saline implants. Some wrinkling is normal and expected. With the use if saline implants, visible wrinkling under the skin has been more noticeable. This is more common in women with thin breast tissue. All contoured implants are textured. Textured implants have a greater tendency to wrinkle Occasionally, the edge of the implant or the valve of the implant can br felt. These problems are usually mild and require no treatment. Sometimes the palpable valve, wrinkling and/or folds may be confused with palpable tumors and questionable cases must be investigated. Experience has shown that the wrinkles frequently improve or even disappear within a year. (See Subpectoral Placement below.)
  7. ASYMMETRY: Although having both breast match is the surgical objective, perfect symmetry if the breast cannot always be achieved. If your breasts had slightly different shapes before surgery, they may remain slightly different after surgery. In spite of careful attention to detail, the dissected pockets may end up slightly different in shape or height due to the healing process. If this becomes a problem after healing, you may later need additional surgery. There are no guarantees as to the shape, size, or results of the breasts. Good results are expected but not guaranteed.
  8. SUBPECTORAL PLACEMENT IF THE IMPLANT (UNDER THE MUSCLE): If the implants are under the pectoralis muscle, a unique set of risks apply. Occasionally during construction of the muscle, the implants will temporarily be flattened amd/or pulled upward. Occasionally, the implants may "ride" higher than their original position because of the muscular construction. Implants are placed under the muscle to reduce the frequency of capsular contraction. Implants are usually placed under the muscle in thin, small-breasted women to provide mor "cover" over the implant. Placing the implants under the muscle may reduce visible wrinkling. Your mammograms will be easier to read if the implants are placed behind the muscle as compared to behind the breast tissue.
  9. DEFLATION: If for any reason the valve or implant covering fails, the saline will leak out, be absorbed and then be excreted by your body. Ruptured or deflated implants can not be repaired. Rupture can occur as a result of injury, for no apparent cause, or during a mammography. This causes no medical harm, but the implant will need the be replaced in a secondary procedure. Breast implants can not be expected to last forever. The rate of saline implant leakage is quoted at about 1-2% over many years. The implants are guaranteed for life. There would be no charge for a new implant itself.
  10. LOSS OF SKIN, BREAST TISSUE, OR NIPPLE: This is an extremely rare complication of breast enlargement. It usually develops from an infection that has gotten out of control and results in the death of the involved tissues. This very rare complication will usually involve only small areas that will eventually heal with good wound care. Secondary surgery is a remote possibility.
  11. INTERFERENCE WITH BREAST FEEDING: Most women with breast implants have nursed their babies successfully. At times there is no scientific evidence that breast feeding is a problem, however there is a very limited research that has been done in this area. Nevertheless, any breast surgery can theoretically interfere with your ability to breast feed, although this would be uncommon.
  12. CALCIUM DEPOSIT IN THE TISSUE AROUND THE IMPLANT: In some patients, a thin layer of calcium will develop within the scar capsule surrounding the implant. This usually occurs several or more years after the implant has been inserted. In these patients the added density of the scar may reduce the detectability of lesions close the scar on mammograms. Breast cancers may still be visible and detectable when specialized techniques arte used. Should this occur additional surgery may be necessary to remove and examined the calcifications.
  13. BREAST CANCER: There is no evidence linking implants to increased breast disease and breast cancer. The only clinical studies available show that the prevalence of breast cancer in women with implants is the same or even slightly lower than that in women without breast implants! Furthermore, two studies have shown, to date that the stage of breast cancer detection in women with implants appear to be identical to that found in the overall population.
  14. INTERFERENCE WITH MAMMOGRAPHY: You should alert the technician to the fact that you have implants. Special techniques will be used and extra views may be needed in order to see as much of the breast tissue as possible. Even under the most ideal circumstances some breast tissue may remain unseen and a suspicious lesion missed. Because the breast is compressed during mammography, it is possible, but rare, for an implant to rupture. On occasion, specialized mammography, ultrasound or MRI studies may be of benefit to evaluate breast lumps and the condition of the implant.
  15. SYNMASTIA (LOSS OF CLEAVAGE): This is a unusual problem that can develop after normal augmentation either above or below the muscle. The skin over the lower sternum (breastbone) pulls away from the bone, and normal cleavage is reduced or eliminated. In its more serious form, the pockets on either side merge to form a single pocket. In the more minor form, the pockets remain separate, but the skin tents upward. Reduced fibrous or elastic "strength" in the subcutaneous tissue may be contributory but is difficult to predict. If the problem develops, correction will require secondary surgery.
  16. IMMUNE DISORDER: Some women have claimed that gel prostheses have contributed to or stimulated connective tissue disorder such as systemic lupus erythematosis, scleroderma, rheumatoid arthritis etc. Other complications involving the nervous system, skin and immune systems have been reported. Reports claiming a causal relationship between silicone gel and such symptoms have been published in the medical literature and widely reported in the press. To the present time, no such relationship has been established scientiftically. Gel implants are not available for routine use because of the concerns of the Food and Drug Agency. The saline (salt water) used to fill saline implants is harmless and is excreted in the urine should the implants leak or rupture.
  17. PRESENCE OF SILICONE RUBBER: Saline-filled implants are made of silicone rubber. Although silicone rubber has not been implicated in any diseases, and has been used in many types of implants, its use is under investigation. It is possible and rare, that small pieces of implant material may separate from the implant. This should be of no consequence.
  18. THROMBOSED VEINS: Thrombosed Veins, which resemble cords occasionally develop in the area of the breast and resolve without medical or surgical treatment.
  19. No guarantee has been given to me as to the shape, size, or results of the breasts. Good results are expected but not guaranteed.

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Mammograms

When performing a mammogram following breast augmentation, a special technique called the Eklund Technique should be used, which displaces the breast tissue away from the implant. Using this technique significantly improves mammography and allows excellent visualization of the surrounding breast tissue. This, combined with breast screening and self-exam, leads to no increased risk of breast cancer in patients who have undergone augmentation mammoplasty.

Dr's Stelnicki will perform breast augmentation in a certified surgery center. It can be done with either general anesthesia or sedation which is given in the vein, as well as some local anesthetic. A certified anesthesiologist of anesthetist will be used for the operation to insure a safe surgical procedure.

In preparation for the surgery you should make sure that you have not been lactating within at least 6 months prior to the surgery and that there is no current discharge from your nipples. This decreases the risk of any infection of the implant. You should also stop any smoking at least 2 weeks prior to surgery and you should discuss with your doctor any concerns you have about loss of nipple sensitivity. On the day of surgery you should have someone come with you to drive you home that day. You will not be able to do any heavy lifting for several weeks.

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Specific Post-Op Instructions

  1. ACTIVITY: Avoid exercise, heavy lifting and straining for three weeks minimum. You may however do normal activities at any time if they cause no pain or discomfort. Let your body tell you what you can do or not do.
  2. DRESSINGS: Do not get the dressings wet in the first week after surgery. You may bathe in a small amount of water. After the first week the dressings will be removed and you will be able to go in the shower.
  3. SHOWERING AND BATHING: You may shower after 72 hours. If you prefer to bathe you may do so.
  4. SUTURES: The Dr. or the nurse will remove the sutures 10-20 days after surgery.
  5. EXPOSURE TO SUNLIGHT: Scars take at least one year to fade completely. During this time, you must protect them from the sun especially if naked. Even through a bathing suit, a good deal of sunlight can reach the skin and cause damage. Wear a sunscreen with a skin – protection factor (SPF 30) at all times when in the sunshine. Be extremely careful if areas of your breast skin have reduced sensitivity.
  6. EXERCISE: You may take gentle walks within a few days. DO not return to exercise (or heavy lifting) for 3 weeks. That includes leg exercise, stationary bicycle or fast walking. No swimming, golf or tennis for 6 weeks.
  7. DRIVING: You may drive 5 days after surgery if you have a car with power steering. 7 days with stick.
  8. After your first post-operative visit you must wear an underwire bra for 6 weeks. This bra will be worn continuously for the first 3 weeks, then at night for the second 3 weeks. Please bring 1-2 bras with you to your 1 week post-op visit for fitting.

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Specific Post-Op Instructions

  1. ACTIVITIES: It is important that you not engage in strenuous activities in the first 3 weeks after surgery. Aerobic exercise will raise your blood pressure, which could cause late bleeding and harm your result. If your job keeps you sedentary, you may return to work when you feel comfortable, usually five days after surgery.
  2. HEALING OF SENSORY NERVES: Regeneration of the sensory nerves is accompanied by tingling, burning or shooting pains, which all disappear with time and are nothing to be alarmed about. If, however this is accompanied by swelling or redness, infection or bleeding, then you will need to come to the office.
  3. ASYMMETRY: It is quite common for the two breasts to heal differently. One may swell more, one may feel more uncomfortable, or the shapes may differ initially. After complete healing, they should look remarkably similar and natural. If you are concerned, ask questions.
  4. "SLOSHING" SENSATION: You may hear and feel "sloshing" in your breast after surgery. This is not the implant! It is the air that is trapped in the space around the implant and the natural fluid that accumulates after an operation. It will be absorbed by the body within a few weeks.
  5. SHINY SKIN: The skin of your breasts may become shiny. This is a result of the swelling that occurs after surgery. Within a few weeks, the edema and swelling will subside and the skin will look more normal.
  6. SENSITIVITY: As the nerves regenerate, the nipples commonly become hypersensitive. This will subside with time. You may find that gentle massaging helps.

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Post-Op Care For Outpatients

  1. VERY IMPORTANT: If you have EXCESSIVE bleeding, pain, nausea, vomiting, fever, sudden enlargement of your breasts, rashes or difficulty breathing call the office at (954) 565-7575
  2. Your first 24 hours: When you go home, a family member or a responsible adult must drive you because you have been sedated. A responsible adult should remain with you for 24 hours. If you have any questions about these matters, please ask one or our nursing staff. Under no circumstances are you to drive for 24 hours.
  3. When in bed lie on your back with two or three pillows under your head and shoulders for 72 hours.
  4. After discharge GO DIRECTLY HOME TO BED.
  5. You may get up and go to the bathroom only with the help of a family member or friend. If you feel dizzy or faint when walking or on the toilet you must lie on the floor until you feel better. Otherwise you will faint which could cause serious injury.
  6. DRESSINGS: Wear your surgical gown at all times for the first 7 days.
  7. BLISTERS: If you feel itching, pulling or redness under the dressing paper tapes, you must lift the tape from the skin otherwise it may develop a blister. If a blister develops it must be covered with an antibiotic ointment at all times preferably Bacitracin. DO NOT apply hydrogen peroxide to the blister. Even though this area will look red for quite a while it will usually heal without residual. This area must be covered with a sunscreen 30 SPF for three moths otherwise it could result in a pigmented area.
  8. ACTIVITY: Take it easy and pamper yourself. Try to avoid any straining. You may go to the bathroom, sit and watch TV, etc., but no matter how good you feel, DO NOT clean the house, rearrange the attic, etc!!! DN NOT do any form of exercise. We do not want you to bleed and cause any more swelling and bruising this is unavoidable. Do not lift anything heavier than 5 pounds including children.
  9. DIET: If you have any post-operative nausea, carbonated sodas and dry crackers may settle your stomach. If nausea is severe, call your doctor. If you feel normal, start with clear liquids and bland foods, and if those are well tolerated, progress to a regular diet. Try to drink as much fluid as you can in the first 48 hours as will alleviate a lot of nausea. Gatorade is excellent for this purpose. Eat before taking pain medications and antibiotics. Avoid heavy, greasy and spicy foods for 24 hours after the surgery.
  10. NARCOTICS: The pain medications you have been prescribed are narcotics. These medications can make you extremely nauseated. If you cannot tolerate these medications, take extra strength Tylenol, two at a time, but no more than eight a day. Also use the muscle relaxant given to you. This will significantly decrease your pain.
  11. CONSTIPATION: The narcotic pain medications can make you constipated. You may take any mild laxatives.
  12. SMOKING: Smoking reduces capillary flow in your skin. We advise you not to smoke at all during the first 14 days after surgery.
  13. ALCOHOL: Alcohol dilates the blood vessels and could increase post-operative bleeding. Please do not drink until you have stopped taking the prescription pain pills, as the combination of pain pills and alcohol can be dangerous.
  14. DRIVING: Please don't drive for at least 5 days after general anesthesia or intravenous sedation or while taking prescription pain pills.
  15. POST OPERATIVE APPOINTMENTS: It is very important that you follow the schedule of appointments we establish after surgery.
  16. DO NOT take Asprin, Motrin, or similar products.

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Before & After Photos





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Face Lift

The facelift or rhytidectomy is one of the main forms of plastic surgerical facial rejuvenation. However, the extent of facial rejuvenation depends on the patient's age, skin tone, desire, and overall medical health. A facelift is atypically performed to restore the aging face. Facelifts not only remove sagging skin but also tightens the neck, getting rid of unsightly jaws at the border of the lower jaw and turkey gobbler deformity below the neck.

Dr's Stelnicki is one of the few practitioners in south Florida who are trained in the weekend or mini facelift. In this technique, the surgeon is able to perform an operation that, when performed on a Thursday, leaves minimal bruising and allows the patient to go back to work as early as the following Monday. It is an excellent treatment for early signs of facial aging and works very well in the patient who is in their late 30s to late 40s range. It involves a combination of surgical tightening of the skin and ultrasonic suction on the neck in order to tighten up the neck musculature, removing any excess fat and eliminate drooping layers of skin. There is minimal scarring and the recovery time is very rapid and is really the ideal facelift for the young executive who desires a slight improvement in appearance but cannot take several weeks off for a full facelift.

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Post-Op Intructions

  1. Rest-minimal physical activity, no heavy lifting or bending for the first 24 hours. Stay out of sun and heat. Ice should be placed on sides of face for the first 24 hours. Cold compresses can be used on eyes.
  2. You may have whatever you want to eat or drink (without excessive chewing). Drink plenty of liquids (water, juices & ginger ale).
  3. Sleep with your head elevated – A recliner is ideal.
  4. Bruising and swelling is normal and to be expected.
  5. In the event you have any sudden, extreme swelling with large bulging areas, or extreme pain, contact the office immediately, regardless of the time of day or night (954) 565-7575
  6. Positively DO NOT take Aspirin or Aspirin containing drugs such as Bufferin, Empirin, Excedrin, etc.
  7. Wash hair after the dressing is removed. You may use shampoo or conditioner.
  8. DO NOT use a hairdryer until the sutures have been removed.
  9. You will need to return in one day for your first post-operative visit.
  10. DO NOT remove head dressing, unless so advised by your doctor.
  11. These are general guidelines. Your doctor may have additional instructions. Follow his/her recommendations.

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Laser

Laser therapy is another modality for improving signs of facial aging. The two lasers most commonly used today are the Erbium laser and the CO2 laser. Our doctors have extensive experience using both of these lasers in facial rejuvenation. However, the current trend is to perform minimal laser therapy because due to the fact that long term studies have shown that deep invasive laser can not only cause scarring but, also, change the pigment of the face; making it either hyperpigmented or hypopigmented. If laser therapy is to be performed, it should be done for small wrinkles in delicate areas, such as around the mouth, the eyes, or on the chin. A minimal setting should be performed to avoid changes in pigmentation and either the Erbium laser or a blend laser with combining Erbium and CO2 should be used.

Dr. Stelnicki has both these lasers available and is happy to discuss the risks and benefits of laser therapy with you. Laser is also used as an adjuvant therapy to enhance the results of other cosmetic surgery operations such as blepharoplasty, face lifting, etc.

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Pre-Op Instructions

  1. If you are having any laser around the mouth, talk to your doctor about pre-op "cold sore" prevention.
  2. Limit sun exposure 1 month prior to treatment
  3. Remove all makeup on the day of surgery.

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Post-Op Instructions

  1. Take post-op cold sore medication.
  2. Keep face clear at all times with soap and water.
  3. Apply petroleum jelly to face 3 or 4 times a day.
  4. Cover face with xeroform gauze at all times for 48 hours.
  5. Avoid all sun exposure.

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Dermabrasion

Dermabrasion is another method for treating facial wrinkles and rejuvenating the face which has been well proven over the years. Dermabrasion reduces built-up hardened layers of skin and causes the skin to repair itself in a rejuvenatory fashion that tightens the skin and lessens wrinkling. Dermabrasion is particularly effective in treatment of wrinkles around the lips and mouth and is also effective in treatment of deep acne scarring. Dermabrasion is an excellent technique for smoothing surfaces of the skin where there is a lot of irregular patches and has the lowest risk of creating hypo or hyperpigmentation in a patient. Recovery time for dermabrasion is similar to laser. It requires approximately 3 to 6 weeks of recovery depending on the patient's skin type and the depth of dermabrasion. Like laser, the patient should be placed on an antiviral drug to prevent either canker sore or herpes breakout around the lips. Dr's Stelnicki & Brooks can discuss the risks and benefits of these three non-incisional therapies for facial rejuvenation with you.

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Pre-Op Instructions

  1. If you are having any laser around the mouth, talk to your doctor about pre-op "cold sore" prevention.
  2. Limit sun exposure 1 month prior to treatment
  3. Remove all makeup on the day of surgery.

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Post-Op Instructions

  1. Take post-op cold sore medication.
  2. Keep face clear at all times with soap and water.
  3. Apply petroleum jelly to face 3 or 4 times a day.
  4. Cover face with xeroform gauze at all times for 48 hours.
  5. Avoid all sun exposure.

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Blepharoplasty Post-Op Instructions

  1. Rest with minimal physical activity, no heavy lifting or bending, especially day of surgery. Stay out of sun and heat.
  2. Keep head elevated. Can use 2-3 pillows.
  3. While awake, apply ice compresses to eyes. Fill a bowl with ice cubes and tap water and keep a clean washcloth in this ice water while one is on your eyes. Rotate the washcloths when the coolness disappears. Do this for 24 hours following surgery (except during sleeping hours). During the first 24 hours some drainage of blood from the incisions is normal – you may blot the area but do not rub or press hard.
  4. May shower on day after surgery.
  5. You may have some difficulty completely closing your eyes (especially at night) for the first week or two. This is normal and should resolve as the swelling recedes.
  6. Your eyes may feel itchy or even dry for a period of time. During this time, continuous use of eye wash may be recommended. You may purchase from a drug store "natural tears" drops to soothe and lubricate your eyes.
  7. On the other hand, your eyes may remain somewhat wet for a time. This, however, requires no treatment.
  8. You may expect some blurring of vision for a few days. This is normal and will resolve as the swelling recedes. You may need to restrict driving during this time.
  9. Some bruising and swelling of the eyelids is natural and to be expected following Blepharoplasty.
  10. In the event you have extreme swelling with bulging of the eye, loss of vision (not just blurring) or extreme pain, this could indicate a problem and you should call the office immediately, regardless of the time of day (or night). (954) 565-7575.
  11. These are general guidelines. Your doctor may have additional instructions.
    Follow his/her recommendations.

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Suction Lipectomy Post-Op Instructions

  1. The first 24 hours should be spent mostly resting at home with minimal physical activity.
  2. You will be placed in a post-surgical garment that must be worn at all times unless showering or bathing.
  3. You may remove the girdle to shower/bathe the day following surgery.
  4. Increase your activity gradually as tolerated. Exercise is encouraged after about on week (bicycling, massage, etc.) and will be discussed with you at your first post-operative visit.
  5. Some swelling and bruising is normal and it may take 2-6 weeks before it disappears. It may take several months to see the final results.
  6. A regular diet is permissible if there is no nausea, drink plenty of liquids.
  7. In the event of EXTREME pain, swelling, bruising or if you have any questions, please do not hesitate to call the office at (954) 565-7575.
  8. Some blood spotting from the incisions is normal and temporary.
  9. You may experience temporary numbness or soreness in the areas of liposuction for the first few weeks following surgery. This is a normal part of the healing process.
  10. If stitches are used at the incision sites, they usually need to be removed within one week after surgery.
  11. If you have any questions or need further information, please do not hesitate to call the office (954) 565-7575.
  12. These are general guidelines. Your doctor may have additional instructions.
    Follow his/her recommendations.

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