SURGICAL PROCEDURES

Life is short—insecurities are a waste of time.

Dr. Christian Kirman and his team are equipped to help you stop doubting your appearance and start living an awesomely confident, energized existence. Being excited about how you look is worth the investment. We exist to get you to a happier place and ensure your treatment is a success. Exceeding expectations is the best part of what we do.

Using only the most advanced techniques, Dr. Kirman has mastered a variety of aesthetic enhancements for the body, breasts, face and hands.

At any time, feel free to email us directly with your questions or schedule a consultation (925) 344-8008.

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BREASTS

Breast LIFt

A breast lift (mastopexy) is a popular outpatient procedure performed under general anesthesia to improve the appearance of sagging breasts. More complex than a basic skin lift, it entails sculpting the breast tissue to ensure the results are shapely, desirable and designed to last. The nipple is repositioned on the chest wall for a perkier, more youthful appearance.

Many women undergo a mastopexy if they’re unhappy with their sagging breasts, most commonly after pregnancy. Some opt to get breast implants at the same time in order to achieve the more voluptuous look they’ve always wanted.

A breast lift is recommended to help women who experience:

• Breast sagging due to pregnancy, nursing, gravity, weight gain or loss, normal aging and/or heredity.

• Stretched tissue surrounding the nipple.

What To Expect

Biologically speaking, breasts are sisters, not twins, so there will always be slight differences in the symmetry of your breasts after a breast lift (minor adjustments can be made if post-surgical asymmetry is bothersome). You will also experience scarring around the nipple. These incision lines – and there are different types depending on your situation – last a lifetime, but will fade and significantly improve over time. Bear in mind that getting pregnant can compromise your results, so ideally you should wait until you’re done having a family to undergo a breast lift.

Before

We recommend bringing photos of the look you would like to mimic, especially if you’re planning to go up a few cup sizes. Prior to your surgery, you’ll get to know your anesthesiologist and nurses and we will do everything possible to make you feel at ease. Dr. Kirman will mark the perfect lifted position where your nipple will be, and design the contour of the breasts. What to wear for the first few days following your surgery will be important – pick items that open in front and wear slip-on shoes so you don't have to bend over.

During

In the operating room, you'll undergo general anesthesia or sedation before Dr. Kirman removes the extra skin, lifts, and reshapes your breast tissue. If you have opted for implants, they will be inserted at this time. Your incisions will be secured and bandaged comfortably.

After

You’ll be moved to a room where you will be closely monitored by Dr. Kirman, then released the same day. Your bandages will be removed during your first follow-up visit after your surgery. Stitches are used beneath the skin and never seen, and will typically not need to be removed at all as they will dissolve slowly over the next several weeks. For the first few days, you may need medication to manage your pain. Following surgery, you’ll be offered liquids to drink and a small snack. Our nursing staff will make sure you’re feeling well and comfortable going home.

Things To Consider

• If your breasts are large and heavy, you’ll see a much improved lift, but the results may not be as long-lasting as a breast lift performed on smaller breasts because the skin may have been significantly stretched.

• Following your surgery, you can get back to work in about a week. You may need more time if your work requires more physical activity.

• You’ll need to be gentle with your breasts and avoid exercise and strenuous physical activity for two weeks or more.

• A support bra will keep your breasts from jostling around until any swelling, bruising or redness at the incisions go away, usually within a few weeks time.

• Your nipple sensation may be altered for several weeks. Often times they are numb, but occasionally they may be more sensitive than normal. It may be a few months before sensation in your nipples return to normal.

• Be prepared to rest and sleep on your back continuously in an inclined position (25-to 45-degree angle) for the initial postoperative period or while significant swelling remains. You can keep your head and chest elevated with wedge pillows with an incline design or by sleeping in a recliner chair.

FAQS

Q. How long does a breast lift take?

A. About two to three hours.

Q. How long do breast lift results last?

A. If you don't have significant weight loss or gain, which can stretch the skin, or plan to get pregnant, your new breasts and lifted nipple position will last for decades with only a bit of settling taking place over that time.

Q. Will it hurt?

A. Expect some mild discomfort during and after surgery..

Q. Can I still breastfeed after a breast lift?

A. Yes.

Q. Will insurance cover my breast lift?

A. Unless your breast lift is done as part of a mastectomy reconstruction, it will likely be considered cosmetic surgery. Your health insurance likely won’t cover it.

Q. Will I need an additional breast lift later on?

A. It's possible. In time, some women choose to get a repeat breast lift as a ‘touch-up’ procedure to improve the overall look of their breasts. But a full-length procedure will usually not be required.

 

Breast Augmentation

Breast augmentation yields some of the most satisfying results in plastic surgery. The procedure can be used to add natural-looking volume, reduce sagging or simply perfect your proportions. New methods of enhancement ensure completely natural-looking results and a barely-visible scar. Breast augmentation surgery is also helpful for creating symmetry in the chest if one breast is smaller or droopier than the other, which is common.

After childbirth and breastfeeding, this procedure artfully restores breasts to their former pre-pregnancy glory, usually in conjunction with a breast lift. During surgery, an incision is made, breast tissue is lifted, and a ‘pocket’ is created in the breast area for slipping the implant inside. For decades, implants (silicone, saline or gel) have been relied upon to create more volume up top, but if you have a bit of extra fat to spare elsewhere on your body, fat transfer can be used to create the same effect. Still relatively new, fat transfer uses liposuction to remove fat from another area of your body (thighs, stomach and/or hips) and transfers it into your breasts. 

Saline implants are silicone shells filled with saline. They can either be pre-filled to a predetermined size or filled at the time of surgery to allow for custom modifications.

Silicone implants are solely available in pre-filled form so often require a slightly longer incision. They are filled with a smooth, squishy gel that feels more like real breasts and come in all sorts of shapes and sizes.

Cohesive gel implants, often referred to as ‘gummy bear’ implants are pre-filled with a cohesive gel that’s comprised of crosslinked molecules of silicone, so they’re firmer, thicker and able to hold their shape better than traditional silicone.

Breast augmentation is ideal for women who:

• Want their figure to be more proportioned and ‘hour glass’-shaped

• Want their clothes to fit better without resorting to padded bras and ‘chicken cutlets’

• Seek to restore their breast size or shape after childbirth

• Want to regain symmetry if one breast is smaller than the other

What To Expect

Understandably, women always want to know what to expect when it comes to breast implant scars and pain. The procedure is no spa day, but if you’re really adamant about adding more volume to your chest, you’re sure to love the results. One thing to be mindful of is that bigger breasts sometimes means bigger areolas.

As for the incisions and resulting scars, there are several options. An incision can be made underneath the breast near the natural crease, in the navel, near the armpit or around the lower edge of the areola. Pictures may help you better decide which method is best for you. General anesthesia or intravenous sedation is used so you're comfortable throughout the procedure. 

Before

During our consultation, you’ll be able to see and touch breast implants of various sizes and shapes to determine which ones appeal to you. You will also be encouraged to ‘try on’ different implants in your bra, under a tight tank top or t-shirt to see how you’ll look. As with any procedure, you’ll need to stop smoking for at least six weeks to ensure your body can heal optimally.

During

For your safety during the surgery, various monitors will be used to check your heart, blood pressure, pulse and the amount of oxygen circulating in your blood. Following insertion and placement of breast implants, sutures are used to close the surgical incisions. Your chest area will be dressed in a surgical compression bra to provide support and assist with healing. Breast augmentation with autologous fat transfer requires two procedures: liposuction and fat injection. Using liposuction techniques, fat cells are removed from other areas of your body with a thin cannula, then the fat is processed and injected into your breasts. Your liposuction incisions will be closed with sutures, and you will wear compression garments over the donor areas.

After

Post-procedure, you’ll be wrapped in a surgical dressing or support bra and taken into a recovery area, where we will ensure you’re on your way to a speedy recovery. As the anesthesia wears off, there may be some discomfort at your chest, such as a sore or tight feeling. Your dressings will be removed within a week. Sometimes tissue glue or tape is used, which eventually and naturally falls off within about two weeks. Since this is an outpatient procedure, you’ll be able to return home after the initial recovery period and your chosen pre-operative pal should be prepared to drive you home and help with your recovery.

Things To Consider

• Your implants will likely need to be replaced down the line, in about ten years. After breast implant surgery, you should have a periodic examination to monitor your implants.

• We recommend a mammogram before (and a few months after) surgery. Following treatment, you should continue to perform breast self-examinations and regular check ups.

• Expect to refrain from lifting, pulling or pushing anything that causes pain and limit strenuous activity or upper body twisting if this causes discomfort during your recovery.

FAQS 

Q. Will it hurt?

A. Breast augmentation surgery stretches the breast tissue and muscles so can be painful – especially when implants have been placed under the chest muscle. Typically, the most pain is experienced within the first 48 hours after surgery. Your level of pain will decrease day by day and can be effectively treated with various pain medications. Your breasts may feel tight and sensitive to the touch and your skin may feel warm or itchy. You may also experience difficulty raising your arms.

Q. How much downtime should I expect?

A. You should be able to walk without assistance immediately after breast augmentation surgery. It is very important that you walk a few minutes every hour to reduce the risk of blood clot formation in your legs. You may be able to return to work within a few days to a week, depending on your the work you do.

Q. How long will the procedure take?

A. Most breast augmentation procedures take from one to three hours.  

 

Breast Reduction

The larger your cup size and greater the depth of your cleavage, the more sagging is inevitable. With time you may begin to develop back, neck or shoulder pain. Carrying around heavy breasts can affect your posture and also prevent you from doing normal activities like running and jumping. What’s more, it can be hard to find undergarments that fit and flatter.

Breast reduction (mammoplasty) has extremely positive, body-loving results, and these women are among the most satisfied patients we treat. Breast reduction surgery is performed under general anesthesia. Techniques vary, with most incisions occurring around the areola, down the center of the lower breast and under the natural curve of the breast (Dr Kirman uses alternate incisions whenever possible to minimize the length of scarring). Excess breast tissue, fat and skin are ultimately removed and the nipple and areola are repositioned to a perkier position.

A breast reduction is recommended to help women who experience:

• Back, neck or shoulder pain caused by heavy breasts

• Persistently painful bra strap marks or rashes due to large breasts

• Excessive sagging in the chest

• Disproportionate body-to-breast ratio that adversely affects posture

What To Expect

Breast reduction is a very empowering surgery promising an immediately visible and life-improving change. What you’ll gain: freedom from physical pain associated with heavy breasts, a more pleasing appearance and better fitting clothes.

Before

During the initial consultation, it’s all about creating goals. Dr. Kirman will sit down with you and design the surgical technique that will give you the best results. You will be advised not eat or drink for six to eight hours prior to surgery and refrain from using lotions, creams or powders. You’ll want to arrive at the surgery center in loose, comfortable clothing that buttons down the front for easy on-and-off.

During

Although it’s considered an outpatient procedure, you’ll be placed under general anesthesia and be completely asleep during your breast reduction. Incisions will be made using the techniques designed for you and the excess breast skin and tissue will be removed.  Your nipples will be repositioned to sit higher and more naturally on the breast. If your breasts are extremely large, the nipple may need to be removed so it can be moved to its new position safely.

After

Expect to show your breasts some gentle TLC for four to six weeks following surgery. To keep things in place, you’ll be dressed in soft gauze dressings that may need to be changed once or twice, then removed the next day (the dressings will ultimately be replaced with a 24-hour support bra that can be taken off while you shower). Strenuous activity should be avoided for one month. Any bruises usually disappear within two weeks. Although most swelling will subside after the first month, the breasts will not achieve their final shape until the skin has fully relaxed in about six to 12 months.

Things To Consider

• You’ll likely keep the normal sensation in your nipples and maintain the ability to breast-feed.

• Your breast reduction scars will fade over time, but they will be permanent.

• Be prepared: your breasts may swell and become tender during your initial menstrual period after surgery. It’s also possible you may experience occasional pains for a few months during your flow.

• Numbness or hypersensitivity of the breast and nipple may be experienced by some women for up to a year following breast reduction surgery. In rare cases, these altered sensations may be permanent.

FAQS

Q. Will it hurt?

A. A lot of work has been done within your breasts, so there may be some pain for the first several days. Typically, the most pain is experienced within the first 48 hours after surgery. Your level of pain will decrease day by day and can be effectively treated with various pain medications. Your breasts may feel tight and sensitive to the touch and your skin may feel warm or itchy. You may also experience some soreness when raising your arms.

Q. How long before I’m fully healed?

A. Because breast tissue is significantly disrupted during surgery, it may take six months to a year before all swelling subsides and the final breast reduction surgery results become apparent.

Q. How long does it take to get back to normal after breast reduction surgery?

A. The recovery period ranges from several days to a week or two.

Q. How long does a breast reduction take?

A. On average, up to four hours. A breast reduction will usually take longer than a breast lift.

 

Breast Reconstruction Surgery

Overcoming cancer is an enormous triumph, and living without a breast, or only a portion of a breast, following a mastectomy is a situation that affects every woman differently. Some choose to embrace it. Some pad their bra with silicone breast inserts. Others opt to undergo breast reconstruction surgery, which promises many physical and psychological benefits. Assuredly, there are no greater surgical results than feeling like you are back to your complete self.

Through reconstructive plastic surgery techniques, your breasts, nipples and areola can be ‘rebuilt’—and the original symmetry can be restored—using implants or donor tissues from other parts of your body. The procedure can replace the skin and breast tissue, which varies from patient to patient according to the width, size and location of the original tumor and its proximity to the nipple, which may be removed along with the cancer.

Commonly a breast lift, breast reduction or breast augmentation is needed on the other side to attain the best results. If only one breast needs an aesthetic boost, it alone can be reconstructed to match the other one. Immediate reconstruction can be done during mastectomy surgery to lessen the trauma of having a breast removed, as well as the expense and discomfort of having two major operations.

You are a candidate for breast reconstruction if:

• You’ve been diagnosed with breast cancer and had or will have a mastectomy (surgical removal of a breast).

• You’ve been diagnosed with breast cancer and had or will have breast conservation surgery, such as partial mastectomy or lumpectomy (surgical removal of the tumor and surrounding breast tissue).

• You have a genetic mutation and will have a prophylactic mastectomy (removal of non-cancerous breast to prevent cancer).

What To Expect

You’ll have decisions to make: Do you want to use your own tissue? Or do you want to opt for implants? (In some cases, you may opt for a combination of both). Following a mastectomy, the skin of the breast is very delicate and has limited circulation, though this eventually improves with time.  Sometimes the decision is already made for you if your skin is so thin there’s not enough of your own tissue to do an implant reconstruction.

That being said, there are a couple of different breast-friendly donor sites that exist on your body for transfer to your breasts. Your lower abdominal skin and fat can be used to recreate a new breast and the results are said to be akin to a tummy tuck (the donor area in the stomach is often flatter and tighter).

A traditional method for this procedure is the TRAM flap (Transverse Rectus Abdominus Muscle) which sacrifices your abdominal muscles that make up you 'six-pack'. Dr. Kirman however uses advanced techniques of the DIEP or SIEA flaps (Deep Inferior Epigastric Perforator or Superficial Inferior Epigastric Arteries) that will spare your abdominal muscles completely. Your belly skin and fat can be moved to the breast position and, through microsurgical technique, the circulation is restored to the tissue (the arteries and veins are then re-connected to those in the chest area).

The Latissimus Dorsi is the large muscle on your back, which can be brought to your chest to bring healthy skin and tissue to be paired with an implant to create a new breast as well.

A tissue expander—which is a temporary breast implant slowly filled from underneath the skin to get larger over time—can be used to stretch the breast skin to the ideal size and shape for an implant. The expander has a port, which is essentially a metal or plastic valve, that allows for the gradual addition of a salt water solution over time until the skin gradually is stretched enough to accommodate an implant. This process can take several weeks.

A biologic tissue matrix, donated from a once-living being such as a human or pig, can be processed and sterilized to remove all cells and make it safe for your use. It can be used to provide a solid framework and support your breast for your blood vessels to grow and eventually become your own live tissue. These biologic tissue matrices are almost always used along with breast implants in reconstruction. 

Before

Prior to surgery, you will not be able to eat or drink anything after midnight. Depending on your chosen surgical method, you should expect to stay overnight or a few nights at the hospital. You’ll want to prepare your home to make it as comfortable and easy to navigate as possible.

During

There are several different types of breast reconstruction operations to recreate the breast mound. How this is done varies greatly and Dr. Kirman will walk you through it in great detail.

After

No matter what specific type of breast reconstruction surgery you undergo, you’ll have at least one drain placed beneath your incisions, for about a week, that will need emptying. One of the most common patient complaints is that the breasts look and feel swollen or bruised after surgery. This is only temporary.

Things To Consider

• Reconstructed breasts will not have the same sensation nor feel of the original breasts they’re replacing.

• There will be visible scars, both from reconstruction and mastectomy and at the donor site (usually the back, abdomen or buttocks). If only one breast is affected, it alone may be reconstructed. In addition, a breast lift, breast reduction or breast augmentation may be recommended for the opposite breast to improve symmetry of the size and position of both breasts.

• Even though breast reconstruction is optional, it does not fall under ‘cosmetic surgery,’ since it is part of the treatment of a disease, and therefore will be covered by your insurance per The Women’s Health and Cancer Rights Act.

• It’s possible to do a successful breast reconstruction months or even years after your mastectomy, giving you plenty of time to mull over this very important decision. If chemotherapy or radiation has been planned or already started, reconstruction surgery is planned around those treatments will not affect your care.

FAQS

Q. Will it hurt?

A. Breast reconstruction surgery can be complex and can involve other areas of your body, and can be painful. Typically, the most pain is experienced within the first few days after breast reconstruction surgery. Your level of pain will typically decrease each day and may be effectively treated with various pain medications. Your breasts and chest may feel tight. You may also experience difficulty raising your arms.

Q. Does reconstruction increase the risk of my cancer returning?

A. Reconstructive breast surgery is not linked to an increase in the risk of cancer returning, nor does it make detecting returning cancer any more difficult. The risks of recurrence depend on a number of factors, including the stage of disease, characteristics of the cancer and any additional breast cancer treatments.

Q. How long does the breast reconstruction process take?

A. It varies. The reconstruction process can usually take about six months to one year if no further cancer treatment is necessary. Sometimes it takes multiple surgeries to make the reconstructed breast look like the remaining natural breast. Mastectomy surgery can take two to three hours to complete. If you're having an implant or tissue expander inserted at the same time or for a future reconstruction surgery, this will take another hour or two. If you are using your own body tissue for breast reconstruction, this will add three to six hours to your surgery. 

Q. How long is the recovery process?

A. It can take six weeks to fully recover from reconstructive surgery that’s been done at the same time as a mastectomy.

Q. How soon before I can work out again?

A. You’ll gradually be able to increase how much you walk, but it will be close to six weeks before you will be able to resume an aggressive cardio routine and three months before you’ll be able to lift any weights.

Q. When can I resume having sex?

A. Sooner than you think. It depends on a couple of factors: the specific type of surgery you had, how much discomfort or pain you are in, and when you feel ready to reveal your new breasts.

 

Gynecomastia Surgery

Enlarged breasts in men are more common than you think, and are the result of gynecomastia, which can occur at any age due to hormonal changes, heredity, obesity or the use of certain medications. For a lot of men, so-called ‘man boobs’ are the difference between pursuing an active lifestyle and staying home. Gynecomastia surgery aims to boost your confidence and get you to the beach – with the confidence to take your shirt off.

Male breast reduction methods involve liposuction, cutting out excess glandular tissue or a combination of liposuction and excision. Often only a few small incisions are needed. This generally results in less healing time and discomfort due to being minimally invasive.

Gynecomastia surgery will benefit you if:

• Your enlarged breasts make you reluctant to take your shirt off in public, participate in sports or go the gym

• You want to improve your physique and upper body proportions

• You’re experiencing issues with physical discomfort or self-esteem because of enlarged breasts

• You’ve already tried diet and exercise to reduce your breast size... but could not

 What To Expect

Before

Prior to your procedure, you’ll need to carefully follow pre-operative instructions. Specific medications and even certain nutritional supplements may thin your blood, so you’ll need to stop taking these for two weeks beforehand. You’ll also need to stop smoking one month before surgery because it can slow your healing, increase the risk of surgical complications and worsen scars. Consider it a golden opportunity to quit smoking altogether. 

During

Intravenous sedation or general anesthesia will be administered to keep you comfortable during surgery, depending which is best for you. Excision techniques requiring an incision are used whenever glandular breast tissue or excess skin must be removed or if the areola must be reduced or the nipple repositioned. Liposuction techniques require the insertion of a thin hollow tube or cannula through a few small incisions. It’s moved in a controlled motion to loosen excess fat, which then gets removed by vacuum suction. Often times, gynecomastia is treated with a combination of both liposuction and excision for best results.

After

You’ll be bandaged, comfortably wrapped in a compression garment and given instructions for care. The first couple of postoperative weeks are critical to a successful recovery and the best results, so plan to wear your compression garments all day and night to give you the flattest, most toned results. When the anesthesia starts to fade, you may have some soreness, bruising and swelling but Dr. Kirman will prescribe pain medication to help with all this. 

Things To Consider 

• You will emerge with improved chest contours, both when you’re dressed and undressed, and enjoy results that will last a lifetime.

• Gynecomastia is caused by an excess of breast tissue, not obesity (aka pseudogynecomastia). Dr. Kirman will help you determine which one you have and how to treat it.

•  Successful gynecomastia surgery requires skin with good elasticity. If you’re 50 or older, have significant sun damage, stretch marks or have undergone gastric bypass surgery, Dr. Kirman may adjust your surgical plan to give you your best possible results.

• You should not be significantly overweight prior to surgery. In fact, you’ll need to at least try to get within 40 pounds of your ideal body weight.

• Extracurriculars like marijuana, steroids and alcohol (in excess) are theorized to cause gynecomastia, therefore you should expect to quit them after undergoing your breast reduction surgery.

• You’ll need to avoid sun exposure and tanning for about six weeks. UV rays can prolong swelling, as well as cause permanent discoloration and scarring.

• You may notice a temporary decrease in breast sensation but this should return after a year at most.

 FAQs

Q. Will it hurt?

A. For most patients, the pain is moderate and extra-strength Tylenol does the trick. Depending on how much liposuction is required, you may experience some soreness equivalent to a day of intense exercise and be given a prescription for pain medicine.

Q. How soon can I see results?

A. Initial results can be seen – or at least imagined – straight away but due to swelling, it can take up to six months to see your final results.

Q. How long do results last?

A. Your results should be permanent. However, if you gain weight in the future and it contributes to breast tissue, you may need to have it removed again.

Q. What kind of scarring can I expect?

A. It varies according to the amount of breast tissue removed and the elasticity of your skin. Larger breasts are associated with larger incisions, but results are still satisfying with scars that are barely noticeable because they’re hidden in the creases of the skin. Smaller breasts involve smaller incisions, usually just large enough to admit a thin liposuction tube. If your areolas are large and require reshaping, a scar may be visible all the way around the areola. Note: After male breast reduction surgery, the diameter of the areolas may decrease all on their own – about 10 to 50 percent from their original size. This happens when significant amounts of glandular tissue are removed.

Q. What is the recovery time?

A. When you’re treated with the usual combination of liposuction and breast gland tissue excision, you can bet on being back to work within seven to 10 days after surgery. If you’re a gym guy, you can resume low-impact exercise in about two to three weeks at which point you can also slowly and gently begin to build upper body strength with weights. 

FACIAL REJUVENATION

Your face is one of your most identifiable features to others, and to you. Over time you may lose the youthful contours of your face due to any number of reasons, from genetics, gravity, sun exposure, and stress. Facial rejuvenation can address these changes by firming and tightening the skin in the face, eyes, and neck areas.

 

Brow lift

Your eyebrows can start to droop with age, altering the appearance of your eyes as you once knew them. In some instances, the sagging can begin to affect your vision. If you feel gravity tugging at your eyes, brow lift surgery can rejuvenate your look by repositioning your brows so they sit higher on your face while also restoring a more youthful contour to your forehead, upper eyelids and brows.

A brow lift, also known as a browplasty or forehead lift, not only corrects droopy brows and upper eyelids but it can also diminish deep frown lines and furrows that can make you look perpetually angry or sad. Your results last over time, beyond any injectable toxin or filler, to physically lift and suspend your forehead. Some brow lift techniques can also lower a high hairline and improve facial symmetry. Different surgery methods (all of them involving different lengths and location of incision) will affect your outcome.

If you have intense eyebrow droop with deep wrinkles an open forehead lift may be the key to revealing a more refreshed you. Sometimes called classic or coronal, this is the original and conventional method of brow lift wherein an incision is made across the top of the head and the skin is lifted away from underlying tissue. The scar hides just behind the hairline and can be covered with your hair. Excess skin is removed during this procedure and your forehead muscles are adjusted to reduce the appearance of wrinkles.

If you’re under 40 and your skin is still elastic, with only mild to moderate brow droop, you may opt for an endoscopic brow lift. This procedure uses an endoscope (a viewing instrument with an attached video camera), inserted under the skin through tiny incisions in the scalp. The operative area is displayed on a large monitor to show the internal structures of the forehead with great detail, and results in less incision and scarring. An endoscopic brow lift usually involves three short incisions along the top of the scalp and a temple incision on each side of the face, which will be completely hidden with a longer hairstyle.

If you have crow’s feet at the outer corners of your eyes, the limited-incision brow lift combines the non-endoscopic brow lift technique with limited incision. It uses only a portion of the ends of the coronal technique incision to lift and tighten the tail of the eyebrows, and it does so without an endoscope. As for the scars? They’re virtually undetectable to the naked eye, stealthily tucked away at the temporal hairline. The good news is they’ll go unnoticed, even if you may be balding at the temples.

You may benefit from a brow lift if you have:

• A sagging or low brow that creates a permanently furrowed or angry look

• Excess skin hanging over your eyes, possibly even marring your vision

• Deep horizontal lines or creases that run across your forehead

• Deep frown lines or furrows between the brows that need more than a treatment of Botox

What To Expect

Some people who undergo a brow lift report a positive impact on their social life, as they look happier and more approachable. To get a general idea of the pleasing result you can expect, gently lift the skin above your brow, at the forehead, and see what kind of difference it makes.

Before

During your brow lift consultation Dr. Kirman will walk you through all of the varying surgical options, anesthesia choices and how best to achieve your aesthetic goals based on the various surgery techniques.

During

Your brow lift will be performed under general or local anesthesia with sedation and will take about an hour or two depending on surgical technique. Your skin will be cleansed and your hair will be held away from the area of incision. The remaining skin will be pulled taut for an immediately ‘lifted’ look, and cut(s) will be sutured closed after excess tissue and skin have been removed.

After

You can choose to go home the day of your surgery, provided you have a designated person to take care of you. There will be dressings on your forehead that you’ll have to wear for the first 24 hours or for few days after your surgery and you’ll be advised to put cold packs around your eyes for up to 48 hours to reduce swelling and bruising. A follow-up appointment will be required in the next few days and, after a week, Dr. Kirman will remove all of the stitches (drains will not be needed). You’ll likely be a bit swollen, bruised and maybe even numb. It’s important to know that blood usually collects below the eyelids and bruises the lower lids, even if they weren’t operated. It’s only temporary. After about three weeks of healing, the skin starts to improve and the brow area will begin to look more natural.

Things To Consider

• If you’re worried about baggy eyelids or crow’s feet, there’s a chance you may actually require eyelid surgery (blepharoplasty) instead of a brow lift. And, in some instances, you may need both a brow lift and an eye lift. If, when you lift the skin around your eyes, most of the upper eyelid droop goes away, then you’ll benefit from a brow lift. However, if the sagging brow is lifted and excess skin still hovers uncomfortably over your eyelids, a combo of brow lift and eye lift may be beneficial. Good news: if you’re having both of these surgeries to improve vision that’s been affected by excess skin, it may be covered by insurance.

• You may experience total numbness of your scalp at the incision site of an open brow lift and it can go on for a year after surgery, sometimes longer.

FAQs

Q. Will it hurt?

A. You can expect some discomfort and tightness, particularly with an incision made across the top of the head, but medication should suffice to take any post-operative pain away. Your forehead may feel a little (or a lot) numb or even tingly, but this should be temporary.

Q. What kind of downtime should I expect?

A. Allow yourself about 10 days to heal before returning to work. During your initial week of recovery, you can be mildly active and take walks to help get the blood flowing in your legs. Strenuous activity or hard-core gym workouts should be avoided.

Q. When will I be able to wear makeup again?

A. In about two weeks.

Q. When can I expect to see results?

A. The browlift is one surgery where results are visible and immediate, but you will be swollen at first, which makes it hard to imagine just how great you’ll look after you’ve healed. The final and best results reveal themselves in about six months time.

Q. How long will my results last?

A. Gravity will continue to assault the skin, but assuredly frown lines and wrinkles in your brow will never be as bad as they once were. Being diligent about sun protection, refraining from smoking and adopting a healthy lifestyle will prolong your result anywhere from 10 years to a lifetime.

Q. Will a browlift give me a ‘surprised’ look?

A. No. The goal is to look more youthful, not to defy gravity completely.

Q. Will my hairline look different after brow lift surgery?

A. Probably not, but it depends on the surgical approach.

 

Eye lift

If your eyes appear persistently tired due to fleshy, sagging or excess eyelid skin and fat, there’s a surgical fix: the eye lift, or blepharoplasty. It’s important to note that an eye lift, performed by itself, may not eliminate issues like crow’s feet and dark circles. However, it can help you dramatically battle against drooping eyes. The procedure aims to do the heavy lifting that creams and serums cannot.

The tone and shape of your lids gradually – and inevitably – changes over time with age, and puffy or lax skin can add years to your appearance. So can bulging fat and lax muscle, both of which can obstruct your vision and make it difficult to wear contact lenses or apply makeup. If this is the case, insurance may help cover your eye lift surgery. And more great news: eyelids heal quickly and the scars are virtually invisible, hidden in the folds of the skin.

An eye lift is used to treat patients concerned with:

• Fatty or fleshy skin that hangs over the upper eyes, especially if it obstructs their vision

• Pads of fat that protrude underneath the eyes resulting in puffy bags under the eyes and fatigued appearance

What To Expect

An eye lift is an outpatient procedure, which means you’ll be home the same day (the only time you would need an overnight hospital stay is if you ambitiously plan to have several complex surgical procedures at the same time). As for pain, Dr. Kirman will inject numbing medication into your eyelids and prescribe medication to help you relax.

Before

You shouldn’t expect to have any cocktails or alcohol about a week before your operation and you won’t be allowed to eat or drink anything eight hours before surgery. You will be tired and groggy from the general anesthetic and, since it will not be safe for you to drive, you’ll need your family and friends by your side for at-home nursing assistance once you leave our facility.

During

If you have surgery on both your upper and lower eyelids, Dr. Kirman will work on your upper lids first. During an upper blepharoplasty, excess skin and fat are removed through a small incision that’s stealthily hidden in the natural folds of the eyelid. If the lid is beginning to droop, the muscle that raises the upper lid can actually be tightened to correct this. The incision is closed with sutures. During a lower blepharoplasty, fat in the lower eyelids is removed or repositioned through a small incision at the lashline that will essentially be hidden under your eyelashes. Upper and lower blepharoplasties are often performed together, and can be masterfully combined to achieve desired results through a combination of other treatments such as an eyebrow or forehead lift, face lift or neck lift.

After

Immediately after your eye lift, your eye area will be wrapped in tiny sterile bandages and you’ll be given an ointment, and some eye drops, to prevent dryness of the eye. Swelling and bruising are perfectly normal and cold compresses will greatly benefit you in the days to follow. Medication will be prescribed to help you manage any discomfort. Permanent stitches will be removed in three to five days after surgery. Self-absorbing stitches will dissolve on their own.

Things To Consider

• Dr. Kirman will evaluate you for possible surgical risk factors to eliminate complications. This includes dry eye, diabetes and thyroid eye disease.

• Smokers are at increased risk of surgical complications because they heal more slowly. You’ll need to quit a few weeks prior if you decide to undergo an eye lift.

• It’s worth noting that people of Asian descent may have different goals for their look than other ethnic groups because of the unique shape of their eyes. Your surgical technique can simply be adjusted to create the look you desire. 

FAQS

Q. Will it hurt?

A. Any pain from an eye lift will be tolerable. It’s nothing the right medication can’t treat. Dr. Kirman will make sure you’re comfortable.

Q. How long does an eye lift take?

A. Usually about one to three hours.

Q. How long will my results last?

A. Upper eyelid surgery can last you a solid five to ten years. Lower eyelid surgery rarely needs to be repeated. Of course, you should expect your eyes to age as usual after you’ve had the procedure. You’ll look exponentially improved for at least a decade, but there’s no cheating Mother Nature long-term.

Q. What’s the recovery time?

A. Between four and six weeks for all swelling to completely go away.

 

Face lift

Not so long ago, face lifts were associated with results that looked a bit too obvious and ‘tightly pulled.’ Surgical techniques have come a long way in recent years, and now both men and women are opting to have face lifts performed at a much younger age – as early as 40-something – since they can expect better results while the skin still has some elasticity. The face lift remains the single-most effective procedure for making that mid-life ‘comeback.’

A face lift, also called a rhytidectomy, is the ultimate in facial rejuvenation because it corrects skin that’s lost elasticity. It fixes marionette lines, jowls and a double chin through the removal of excess skin, then repositions and tightens underlying tissues, pulling it taut and closing it with sutures. Behold smoother, more defined contours. The results go beyond any filler, laser or topical treatment.

The traditional face lift, in which the surgeon makes incisions in the hairline at the temples and around the front of the ears, remains the most comprehensive and sophisticated surgical approach for tightening loose or sagging skin on the face and neck. The scars are virtually invisible: narrow, flat and hidden in the natural folds and creases behind the ear, so you can still wear ponytails and those short hairstyles.

Of late, the face lift has spawned a number of more minimally invasive, ‘limited-incision’ surgeries, such as the so-called ‘mini-face lift,’ weekend face lift’ and ‘lunchtime lift,’ all of which aim to correct sagging skin on the lower third of the face and restore definition to the chin. These methods involve making tiny incisions around the ears or in the lower eyelids, temporal area or even underneath the upper lip.

 A face lift may be the answer if:

• Your face is tired-looking and drawn, and it no longer reflects how energized you feel on the inside

• Gravity, sun exposure and heredity have begun to take their toll and you’d like to turn back the clock about 10-15 years

What To Expect

Popularity is rising among ‘mini-face lifts’ that are less invasive than traditional face lifts. In fact, there’s a tendency among patients to want to believe they can achieve a better, more natural result from a mini-lift – and with fewer scars. Contrary to whatever you’ve heard, mini-face lifts can actually result in a more unnatural look than traditional face lifts. They cut the skin, but they don’t lift or redistribute the deeper tissue, which can create underlying tension resulting in wide scars and pulled-looking skin. That being said, we’re long-time fans of the traditional face lift for its effectiveness.

Before

You’ll be asked to stop smoking six weeks before your surgery to promote healthy wound healing and to minimize both scarring and complications. You can’t take aspirin or nonsteroidal anti-inflammatory medications (Advil, Motrin, Aleve), nor should you take any vitamins or homeopathic pills, which can cause bleeding. And if you color your hair like most of the population, you should do it just before surgery or you’ll have to wait a month. If your face lift is an outpatient procedure, you’ll need to make plans for someone to drive you home post-op and stay with you for the first 48 hours, unless you prefer to make other postoperative recovery options. Under no circumstances will you be permitted to go home alone. Decide what you’ll wear for the first few days making sure to pick items that open in front and do not have to be pulled over your head. The same kind of clothing should be worn on the day of surgery. Wear slip-on shoes. Plan where you will recuperate. If you have a recliner chair, this will come in very handy for elevating the feet, knees and head. If you do not have a recliner, be sure to have lots of pillows available to prop up your head and knees. If possible, keep your phone and remote control for the T.V. by your bed.

During

A face lift can take several hours to complete and more comprehensive procedures that also combine a neck lift or eye lift may take longer. Very effective measures will be taken to numb any pain. Local and general anesthesia are commonly combined during face lift surgery to keep you comfortably asleep for the procedure. Monitors will be used to keep watchful eye over your heart, blood pressure, pulse, and the amount of oxygen circulating in your blood while the skin undergoing surgery. Incisions are concealed around the ears and in the hair, and the skin is carefully elevated. The underlying tissues are then repositioned and secured to create a more youthful contour of the face. Excess skin is then removed, and the incisions are closed with sutures. 

After

Post surgery, you’ll be wheeled into a recovery area where our medical staff will hover over you like helicopters to make sure you’re doing okay. Bulky compression bandages will cover your cheeks and neck, providing gentle pressure to minimize the inevitable swelling and bruising. You can expect a moderate amount of pain that decreases in about 48 hours and can be managed with medication. Additionally, a very small tube may run under your skin just behind your ears to help drain some of the excess blood or fluid. You’ll need to keep your head elevated and keep the wrap in place for 24 hours and remove it only as directed for cleansing incisions or showering. It’s important that you stay upright (sitting, standing and walking without bending over) as much as possible after you return home to help relieve facial swelling. Don’t worry, during your initial post-op visit, the bandages and drains will be removed in lieu of a supportive elastic face garment. Be prepared to wait at least six months for your face lift to completely heal inside and out. You’ll require plenty of rest and plan on not doing any housework, heavy lifting, or exercise for at least a few weeks. Avoid hot showers, hot tubs and saunas for two to three weeks.

Things To Consider

• A face lift will not create a ‘new’ you in the way that a nose job might, but it will help you look younger than you really are. You must also understand that a face lift won’t stop the aging process or change the quality or texture of the skin.

• Once you opt for a face lift, you may also desire a neck lift, because changes in the face due to aging also have accompanying changes in the neck. Doing so will tighten the tissue along the jawline or under the chin (this will require an additional incision under the chin). A face lift does very little to correct the forehead or eye area, so you may also need a brow lift or eye lift.

• You can expect to experience some numbness around your ear lobes, face, and neck for several weeks after surgery.  A feeling of tightness in your neck is not unusual for a few weeks after surgery.

• Even cosmetically enhanced skin is at the mercy of aging, so once you’ve had a face lift you’ll need to take proper care to ensure it lasts as long as possible. Smoking and sunbathing should be permanently crossed off your to-do list.

FAQs

Q. Will it hurt?

A. Surprisingly, many patients don’t report a lot of pain. Any discomfort can be relieved with medication.

Q. What is the youngest age I can undergo a face lift?
A. Around 40 or 45, in which case treatment is usually referred to as a ‘maintenance’ lift. For some younger patients, liposuction and neck sculpting alone may provide the results they are looking to achieve. Face lift surgery can benefit patients who are in their 70s but the longer you wait, the less elastic your skin will be. Remember, your skin quality will be similar to what it was before your face lift. 

Q. Will my hairline change after a face lift?
A. If there’s a large amount of skin removed during your face lift, the hairline behind your ears may shift slightly, but your original hairline will likely remain intact.

Q. What kind of downtime should I expect?

A. You can return to your normal exercise routine in about a month and be back at work in as little as two weeks.

Q. Will my head be shaved?
A. No. In fact, you may even end up growing your hair longer than it is right now to hide any potential scars.

Q. Are results permanent?
A. A good face lift will last about ten years with proper care. Results are never permanent and you should still be prepared to wage your war against the effects of aging with a good skincare routine and healthy lifestyle. 

 

INJECTABLES

Juvéderm. Radiesse. Sculptra. Voluma. Belotero. They're all yours. 

Injectable fillers deliver gratifying—and immediate—results beyond what any skincare cream or serum can do, lending a more youthful, ‘plump’ appearance to everything from hollow cheeks to stringy hands. They can also be used to diminish acne scars, reshape the nose in lieu of rhinoplasty or cushion the balls of the feet. If you’re prone to wearing high heels and tired of the pain, this is what’s known as a ‘loub job’ and fashion-loving women swear by it.

In some instances, fillers can be almost as satisfying a facelift without the cost, pain or downtime. Not to be confused with Botox (which relaxes the muscle under a wrinkle), injectable fillers such as Juvéderm and Radiesse add volume to your face using hyaluronic acid, which is found naturally in the body. 

Before you can understand fillers, you have to understand the breakdown of collagen and elastin that’s inevitable as we age. Both of these serve to plump up the skin from within for a supple appearance. When we lose volume, the aesthetic solution is to replace it with injections.

Harnessing the power of natural protein, collagen fillers have been around for over twenty years and are highly effective for treating hollowed, aging areas of the face. These have an established safety record since they were one of the first kinds of dermal fillers available and are perhaps most widely known for augmenting lips. Collagen can also be taken from your own skin and harvested for re-injection. New ways of processing it have lowered the previous risks and new forms of synthetic collagens are now reaching a wider range of people.

Hyaluronic acid gel injections involve the use of a viscous fluid derived from a hyaluronic acid compound that’s frequently used to plump the lips, especially when there’s a collagen allergy. Hyaluronic acid fillers are reabsorbed by the body in a year’s time and don’t typically cause reactions because they boast the same chemical and molecular structure as hyaluronan, an enzyme that’s already present in your body to keep skin supple. Repeated injections can help to stimulate your body's own natural production of collagen.

Fat transfer, aka microlipoinjection or autologous fat transplantation, plumps the skin using your own fat to fill in deep wrinkles and acne scars or plump your lips. Fat can be liposuctioned from your stomach, back or thighs and moved to the areas that need to be treated. Results can be semi-permanent and re-injected fat lasts longer in areas of non-movement like hollow cheeks. In other more recent news, platelet-rich plasma injections (aka the vampire lift) have become another type of volumizer. Blood is drawn from the arm, processed and treated, and then injected into the face with results lasting up to 18 months.

Injectable fillers are ideal for treating cosmetic issues such as:

• Hollowed cheeks and under eyes

• Acne scars

• Bony hands

• Thin lips

• Any asymmetry of the face that can be corrected by adding volume

What To Expect

Injectable fillers are quick and simple. One of the substances listed above is injected directly beneath the skin using a fine needle (be prepared: this can often result in temporary bruising and swelling so you don’t want to schedule your appointment right before a big event). Unlike injectable toxins, injectable fillers will not compromise your ability to contract your facial muscles.

Before

Depending on what kind of filler you choose, there may be a few instructions you need to follow prior to the procedure. A topical anesthetic or a numbing agent may be used prior to treatment, but many people can get by on ice alone.

During

Most dermal fillers already contain local anesthetic to make the experience as comfortable as possible, so don’t worry about pain. The treatment area will be marked as target and the injections will be made with ice packs applied immediately after.

After

You may be numb for one to three hours following injection. Some minimal bruising, swelling and redness may occur but will usually clear up within one to two days. Normal activities, including work, can be resumed right away. Depending on your particular injection and treatment area, you may be advised to avoid speaking, smiling or making unnecessary expressions for the first few hours. Tender lips usually require extra precautions.

Things To Consider

• Results are only temporary, lasting six months at the most, so you’re going to need a touch-up to maintain your desired result.

• Swelling or bruising does usually occur and they’ll last a few days. You should carefully consider the risk of allergic reaction and formation of tiny bumps that could become permanent under the skin.

•  Filler treatments tend to be cosmetic in nature and usually aren’t covered by insurance. But sometimes coverage is available if you’re filling a scar or indentation resulting from an injury or accident.

FAQS

Q. Do fillers hurt?

A. Injectable fillers cause mild pain during and after injection.

Q. How long does the treatment take?

A. Less than 30-60 minutes in most cases.

Q. How long will fillers last?

A. The range is usually four months to a year, but it ultimately depends on the type of filler you get.

Q. When can I expect to see results?

A. It can take about two full weeks to see the benefits of treatment, after all the swelling has subsided. With time, you may need fewer maintenance appointments because weaker muscles atrophy and require fewer injections.

Q. Can I wear makeup after injections?

A. Yes, you can wear makeup the next morning to help with any bruising. Ice packs are also recommended to help return bruised skin to normal

 

BOTOX

Injectable botulinum toxin, more commonly known as Botox, temporarily erases etched-in wrinkles. The results you can achieve from it—without ever resorting to invasive surgery—may surprise you. Botox has many benefits, most notably the ability to immobilize (and therefore smooth) ‘wrinkles in motion.’ Wrinkles in motion are caused by any sort of movement, i.e. frowning, squinting and laughing.

When injected into the skin, Botox is extremely effective at temporarily erasing crow’s feet, horizontal lines that run across the forehead and frown lines between the eyes. Injecting it into the neck or sagging jowls can sometimes yield results rivaling a facelift.

Botox is ideal for treating cosmetic issues such as:

• Deep frown lines between your eyebrows that make you look perpetually sad or angry

• Wrinkles around the eyes and forehead

• Bands around the neck

• Asymmetry of the face that can be corrected by relaxing the muscles

What To Expect

You will still look like yourself after Botox, but more refreshed and rejuvenated. Botox – though highly publicized and misunderstood – has an excellent safety record.

Before

Be prepared to disclose a full medical history and any medications you’re currently using. Tell Dr. Kirman if you’ve had botulinum toxin injections in the past; are using NSAIDs such as aspirin, ibuprofen (Advil or Aleve, which can cause bruising), anticoagulants or blood thinners; or you are taking muscle relaxants, allergy or sleeping medications. Some medications cause complications, bleeding or extra bruising. Hydration will be very important before and after treatment to ensure a safe recovery.

During

Injections usually takes around 10-15 minutes. The doctor or nurse will ask you to remove your makeup and then you’ll be asked to make a facial expression while they mark the points of injection. You’ll feel a pinprick as the toxin is injected into your muscles with a very fine needle. Some areas of the face will be more painful to inject than others.

After

Post-treatment you may experience redness, swelling or bruising, but you can quickly return to your regular activities so long as you avoid and strenuous workouts or activities for 24 hours. Lying down after injection or massaging the treated area can cause complications – you definitely don’t want it to spread – so expect to sit upright for the rest of the day. And no immediate naps. A follow-up appointment will be scheduled just to check up on you. You may need a touch-up soon after yoru first injection to achieve your desired smoothness.

Things To Consider

• All potential side effects tend to be small-scale and short-lived but sometimes injections can cause a temporary and mild droopiness of the eyelid or eyebrow.

 • Sometimes bruising happens, but patients have been using it for decades without negative effects.

• Results are only temporary, lasting six months.

FAQS

Q. Will Botox hurt?

A. Most injections are slightly painful, kind of like getting a flu shot. You have the option of receiving topical anesthesia prior to the procedure, but sometimes ice is all that’s needed to numb the areas you want treated.

Q. Can I wear makeup after having injectable toxins?

A. Yes, but you’ll need to remove it before treatment.

Q. How long does Botox last?

A. The results can last anywhere from three to six months, depending on your skin and individual treatment, at which the skin returns to the relaxed state it was in before it was injected.

BODY

Armlift

 Fluctuations in weight, along with the usual culprits like age and genetics, can make the arms loose and underarm skin lax. In some cases, no amount of exercise can help with toning and firming this area, but there’s plenty that can be done surgically do to improve the tone and contour of your arms. An armlift, or brachioplasty, can re-shape them while also tightening and smoothing the supportive tissue that exists just under the skin. Excess skin is removed through incision, and sometimes liposuction is used to get rid of fat pockets in the upper arm. Countless patients undergo this procedure every year with positive, permanent results.

An arm lift is performed to:                                                                                                                         

Reduce excess skin and pockets of fat between the underarm and the elbow                                                     

Reshape your arms to create smoother skin and more toned, shapely contours

What To Expect

If your goal is to look better in form-fitting clothes and have more self-confidence, you will be tremendously happy with your results. However, an armlift usually leaves behind a tell-tale scar that makes some people still hesitant to wear tank tops and short sleeves.

Before

You will be sedated either intravenously or with general anesthesia, depending upon what’s best for you. In some cases, additional local numbing medicine will be injected into the surgical area.

During

Incisions will be made to remove excess skin, and liposuction may be used to remove excess fat. The skin will be sutured together for a taught appearance and better contour. If your skin sags near the armpit, it may simply need to be tucked away, resulting in a much smaller incision and smaller scar. Sutures can be inserted under the skin where they’ll gradually absorb into the body.

After

You will go home the same day of your procedure and have a speedy recovery, but you’ll need a friend or family member to keep you comfortable since you won’t be able to drive home or use your arms like you normally would. Your arms will be wrapped from wrist to armpit for the first 72 hours and a compression garment, which acts like a bandage, must be worn. In addition, a drain will help to remove the fluid that accumulates because of the incisions (this will help decrease postoperative swelling and bruising). You’ll be drinking only fluids for the first few hours after surgery then graduating to small bites, then full meals.

Things To Consider

If your loose underarm skin isn’t extreme, liposuction may be a better solution for you.

It will be at least one or two weeks before you can return to work and about ten days before you can drive.

Bruising and swelling will peak within the first 36 to 48 hours after surgery and will gradually subside over the next ten to fourteen days.

To minimize swelling, reduce inflammation and help with drainage, you’ll need to sleep with your arms elevated by two or three pillows for two weeks following your surgery.

Walking is the safest form of exercise during the first week of recovery. You’ll be advised against doing any physical activity that stresses your arms (i.e. lifting weights or a child) for a full four weeks.

Six weeks after your arm lift procedure, you should be able to resume your normal level of activity.

FAQs

Q. Will it hurt?

A. Any mild to moderate pain you experience is tolerable and can be controlled with the proper medication.

 Q. Will I have unsightly scars?

A. The level of scarring ultimately depends on your skin, but the good news is your scars will be in a fairly inconspicuous location. We will work with you to help minimize the scarring long-term.

Q. How long will results last?

A. Armlift results are permanent, although the skin will continue to show signs of age with time.

 

Liposuction

Liposuction succeeds where squats and lunges fail, removing stubborn dimples, pockets and bulges of fat on your hips, thighs, buttocks and abdomen. The procedure simultaneously sculpts and slims the body for an improved silhouette and smoother-looking appearance. Following a number of small incisions, excess fat is sucked out through a small, stainless steel tube called a cannula. The effectiveness of liposuction makes it one of the most popular surgical procedures available. 

You may be a candidate for liposuction if you have:

• Small, hard-to-shift fat deposits

• An undefined shape

What To Expect

Depending on the type of liposuction and how much fat will need to be removed, the procedure may require an overnight stay in hospital. Much smaller amounts can be removed as an outpatient procedure.

Before

Pre-treatment, you’ll be given either a local or general anesthetic, but again, this will depend on how much fat will be removed and the type of liposuction you're undergoing.

During

Tiny, linear incisions are made in the skin. The number can range from two to 12 or more, and can measure from 1/8 to 1/4 inch long. The average patient will be in surgery for three to seven hours as fat is sucked out of each incision. The duration ultimately depends on your body size, the number of areas being treated and the type of anesthesia used.

After

When lipo is performed as an outpatient procedure, you'll be able to go home in a few hours and return to work in two days. You will experience bruising, swelling and soreness for at least two weeks. If your incisions require stitches, they will be removed in about 10 days and, depending on your treatment, you may have to wear some kind of compressive garment for a couple of months to control swelling. 

Things To Consider

• Healing is gradual and the best results sometimes take up to a year to reveal their full aesthetic potential.

• The best candidates are non-smokers who are in good health with fairly firm, elastic skin. Loose, hanging fat will need further treatments such as a tummy tuck, arm lift or body lift. 

FAQ

Q. Will it hurt?
A. Post-lipo, you will experience soreness and tenderness, which will subside gradually and go away completely after about eight weeks. Lipo carried out under general rather than local anesthetic is usually more painful post-op. Medication will be prescribed to ease the pain.

Q. Will I experience scarring?
A. Scars will depend upon the size and placement of the incisions, but Dr. Kirman will take every precaution to make them as discreet as possible, aiming to hide incisions in the natural creases or folds of the skin.

Q. How long will results last?A. Liposuction results are permanent but the procedure will not prevent you from gaining weight in the future. A balanced diet and exercise plan will remain the most effective strategy for keeping weight off.

 

Bodylift / Lower Body Lift / Thigh Lift

Extreme sagging in the skin usually develops after some kind of dramatic fluctuation in weight, especially after weight loss surgery or pregnancy. Other culprits include aging, gravity and a loss of skin elasticity. If your skin no longer hugs the contours of your body, or has become so loose it impedes your mobility, a bodylift, lower-bodylift (belt lipectomy) or thigh lift may benefit you. These makeover procedures target saggy skin to result in a dramatic transformation following weight loss. Combined with liposuction, they can lift and tighten the underlying skin matrix, and smooth the overlying skin. Beauty bonus: They can also improve the appearance of stretch marks and cellulite.

A bodylift, lower-bodylift or thigh lift procedure is ideal for:

• Post-bariatric patients

• Patients who have experienced massive weight gain and loss and have excess skin as a result.

•  Patients who need a tightening of the skin in their thighs and buttocks along with a tummy tuck.

What To Expect

There is no way to avoid a scar, but incision length and pattern will depend on the amount of skin to be removed and its location.

Before

If you’re committed to getting any type of surgical lift, plan to reach your ideal weight before surgery – that weight should be stable for about a year. If you’ve chosen IV sedation, which reduces the risk of pulmonary embolism, you’ll need to make arrangements for someone to drive you from the clinic after the surgery. The use of general anesthesia can sometimes require recovery in the hospital. Once you’re prepped for the procedure, Dr. Kirman will mark the locations on your body where the incision(s) will be made.

During

Excess skin and tissue will ultimately be removed through incision(s) and the skin will be pulled taut and tightly closed with stitches that dissolve. If you undergo a body lift, a pain pump that distributes small amounts of anesthetic numbing medication may be placed into your abdomen area, which you’ll wear for about five days to minimize pain.

After

About an hour after your surgery, you’ll be awake and alert, wrapped in a custom-fitted compression garment and a dressing or bandage on your incisions. A tiny drain may temporarily be placed under your skin to help drain excess blood or fluid that may collect. To reduce the risk of potential complication, a special diet may be prescribed. Do not expect to resume normal activities for four to eight weeks, and that includes driving.

Things To Consider

• A bodylift, lower-bodylift or thigh lift isn’t for anyone who is hoping to cheat their weight loss efforts with a quick fix. If fat reduction is your goal, we may suggest liposuction or non-invasive body contouring.

• A tummy tuck and buttock lift may also be performed all in one operative session. Sometimes these are performed in stages (for instance, an inner thigh lift is usually performed in a second surgical session).

• If you’re considering a future pregnancy, postpone having any type of bodylift. Pregnancy will dramatically change the result.

FAQs

Q. Will it hurt?

A. In this instance, even if you have a high pain tolerance, any form of surgical lift will probably hurt, but you’ll be given anesthetic medications to help you get through it at home.

Q. When can I expect to see results?

A. Results are visible almost immediately, but final results may take several months to fully develop. Your scars will remain, but the overall results can last a lifetime with consistent exercise and healthy eating habits.

Q. How long do these procedures take?

A. About two to seven hours is the norm, although your surgery may very well be split into two separate sessions.

Q. What is the downtime?

A. You need to give your body ample time to heal but you will likely be able to resume a normal, light routine in two to three weeks time, with some limitations.

Q. How long do the results last?

A. The results last a lifetime with good nutrition and regular exercise, but gravity and aging never stop, so you will still be faced with the challenge of skin laxity as you get older.  

 

Tummy Tuck

If the most intense weight loss and diet efforts have failed to firm up your abdominals, a tummy tuck (abdominplasty) can remove loose skin and underlying fat, while also tightening the muscles for a slimmer silhouette. If you’ve had several pregnancies, this is the ideal treatment for restoring your body to its former post-baby glory. Men are also candidates for this surgery, particularly if they’ve lost a large amount of weight and have stretched skin as a result.

There are two main types of tummy tuck surgery:

Full abdominoplasty which requires a cut around the navel and lower abdomen to remove fat and excess skin, and tighten the muscles.

Partial abdominoplasty, which involves a much smaller incision and is better suited if most of your loose skin sits below your navel.

A tummy tuck is an ideal treatment for:

• Sagging, excess abdominal skin that can’t be treated through diet and exercise

• Extreme stretch marks on your abdominals

What To Expect

Tummy tuck surgery typically ranges from one to six hours, and may require an overnight stay in the hospital. Most commonly, patients are released the same day, into the care of a friend or family member who plans to stay with them overnight.

Before

During your consultation, your torso will be examined and medical issues discussed. Pre-surgery instructions will also be given: you can prepare yourself by stocking ice packs, bandages, petroleum jelly, prescribed medications and loose clothing.

During

Your torso will be marked with a pen indicating where incisions will be made. Local anesthesia may be administered, although most tummy tucks are performed under general anesthesia. Fat is removed through a process of liposuction and sagging muscles are pulled taut and stitched together.  Excess skin is then trimmed (this simultaneously helps eliminate stretch marks) and your belly button may also be moved to a more flattering position.

After

A surgical drain will be inserted to alleviate any pain and reduce fluid. Your abs will be swollen and bruised, wrapped in compression bandages and numbed with the appropriate pain medication. Bear in mind you will need assistance to get around your living quarters for at least 24 hours and will also need to keep your head elevated while you sleep for the next two weeks—your official period of ‘rest and relaxation’. The surgical drain will require emptying three times a day, and will be removed during a follow-up appointment with Dr. Kirman (in about a week post-op). Another visit will be needed thereafter to remove the stitches. 

Things To Consider

•Be prepared to stop smoking prior to surgery, and hopefully afterward—for good.

•It’s wise to wait to have a tummy tuck until after having children. 

FAQ

Q. Will it hurt?

A. There will be pain, swelling and discomfort but most patients insist it’s worth it after seeing their results. The first week will be the worst, but it should be manageable with medication.

Q. What is the recovery time?

A. Allow for two to six weeks of recovery time. All strenuous activity should be avoided during this period.

Q. Will I have a scar?

A. Dr. Kirman takes every measure to minimize scarring. You’ll have the best chance of healing if you follow doctor’s orders and avoid direct sun exposure, keep your incisions clean and avoid strenuous activity.

Q. How long will my tummy tuck results last?

A. Results from a tummy tuck are permanent, given you are in good health. Extreme weight gain or weight loss or can manipulate your results over time, so taking measures to maintain a stable weight should be a priority.

 

Sclerotherapy

Nearly all cases of spider veins—the result of genetics, pregnancy, obesity, hormonal changes or prolonged standing (not leg crossing, that’s a myth)—can be cleared with in-office sclerotherapy. Specifically, our office uses FDA-approved Asclera. These saline injections safely ‘shut down’ the blood vessels, causing them to tighten up and dissolve. The good news is uncomplicated spider veins don’t pose any real threat to your health and your body doesn’t need these veins for circulation, so they can be easily and safely eliminated.

Sclerotherapy is used to treat the following conditions:

• Spider veins

• Small varicose veins (usually 4mm or less)

What To Expect

A slerotherapy injection takes just minutes to administer. However, it can result in temporary bruising, and veins may get darker before they disappear, which makes this an ideal winter treatment since you can hide under clothes without having to turn down any pool party invitations.

Before

Most patients take a few Tylenol at least an hour before the treatment to help cut down the sting from the needle, but many say it’s less painful than laser hair removal.

During

Some veins may sting while others won’t hurt at all during the treatment. Saline, which quickly works its way through the veins, can leave an itching feeling for a few minutes.

After

Your legs will be wrapped tightly with Ace bandages and you’ll sleep in support hose at night for a few days following the treatment to reduce swelling and keep the saline in place. Asclera therapy typically requires three to five sessions, once a month. [Not sure, is this accurate?]

Things To Consider

•Sclerotherapy is not suitable for if you are pregnant or breast-feeding.

•If you have more serious blood clots or DVT (deep vein thrombosis), alternative treatment will be necessary.

 • Side effects often include swelling, stinging and bruising.

•In extremely rare cases, it’s possible for a treated vein to reopen and consequently reappear.

FAQ

Q. Will it hurt?

A. Sclerotherapy involves needles and no anesthesia. It will hurt a little, but it’s perfectly tolerable

Q. What is the recovery time?

A. You can go home right away, but will need to wear compression dressings for between one and three weeks after your treatment. You should also avoid strenuous workouts for a good two weeks

and stay out of the sun.

Q. Will I experience any scarring? 

A. Typically not. More common side effects are itching, redness and bruising, which should fade and disappear in a matter of days.

Q. How long will my results last?

A. After completing your session, or course of sessions, treated veins shouldn’t return, however new ones can appear as you get older.