Fernando G. Serra

In general, my patients are showering after a couple of days, and they are wearing a light-control girdle, or spandex or Spanx pants. My patients are also given an ON-Q catheter, which makes surgery pain free by automatically and continuously delivering a local anesthetic. A Jackson-Pratt drain, which is used to remove fluid that can collect inside the body after surgery, stays in for a week or so to prevent infection. After 4-5 days, patients can resume driving, but they should not do any heavy lifting for the first 3 weeks after surgery.

In a full tummy tuck, excess skin from the pubic region to the belly button is totally removed. With a mini tummy tuck, half that much is removed, and there is no cut around the belly button. With a mini tummy tuck, liposuction can also be incorporated safely because there is no concern with blood supply issues to the skin flap.

We typically perform liposuction along with a mini tummy tuck. Many times patients can safely undergo liposuction to other areas of the body (including the inner or outer thighs or flanks) in conjunction with a full tummy tuck, but not in the abdominal region because of the potential loss of the blood supply to the skin. If a patient needs liposuction after a fully tummy tuck, we will let them heal for about six months and then go back and do liposuction.

In general, patients need to be relatively healthy. The best candidates for liposuction have places they want to improve where there is an excess of subcutaneous, or superficial, fat and moderate skin looseness. It is not for those who have loose or apron skin. If a patient has too much loose skin, than a more traditional procedure would be needed (such as a tummy tuck, thigh lift, arm lift, etc.)

The type and size of the implant is a conversation that needs to be had with your plastic surgeon. The size depends on how big the patient wants to be, and what size is appropriate for them. We want to match the patient's proportions. Therefore, if a patient has a breast width of 13 centimeters, the implant should have a diameter of 13 centimeters to obtain the best results.

The placement of the scar is a discussion to be had with your surgeon. Each has its pros and cons. A small incision can be made in the breast crease, in the lower border of the areola complex, or in the axillary (armpit) region.

With breast lift surgery, we remove the excess skin and tissue that's causing the droopiness, while shifting the nipple up. This creates a more perky, youthful breast shape. Sometimes scar patterns can be around the nipple complex. There is also a more involved scar pattern where we have to make incisions in the crease and around the newly positioned nipple with a vertical scar connecting the two.

Patients who have droopy breasts but have enough breast tissue can have just a lift; but if they have lost volume and have droopy tissue, than breast augmentation with a breast lift would be indicated for that patient.

For droopy eyelids, a patient should consider upper and lower eyelid lift.

In general liposuction is considered to be a permanent removal of fat. We are born with a finite amount of fat cells. Once these cells are removed, they do not come back. If a patient does gain weight after liposuction, the treated areas can get a little bit bigger but not a lot bigger. (We have to maintain some subcutaneous fat in treated areas to keep them smooth and to maintain the blood supply.) Untreated areas can hypertrophy (increase in volume) disproportionately more than the treated areas if the patient gains weight.

With breast augmentation, patients are usually showering after two days, and driving by five days, with no heavy lifting up to three weeks.

If there is massive weight loss in a patient, such as if they've had gastric bypass surgery, they are a candidate for body contouring procedures. This can include an arm lift (brachioplasty), a thigh lift, tummy tuck, flank plasty, face and neck lifts, total body lifts, and forehead lifts.

A powerful option is with skin rejuvenation. We can resurface the skin with old-school chemical peels, dermabrasions and lasers, which remove sun-damaged skin, allowing the skin to heal. The new skin epidermis is smoother, tighter and more taught in appearance.

Typically, patients are showering the next day, and they wear compression garments for 10 days. They can see an immediate difference; but swelling and bruising don't resolve until after about two weeks. Post-op photos are obtained at 3 months.

There is Mesotheraphy, where special substances (various types of FDA approved medicines, vitamins, and minerals) are injected underneath the skin for fat melting and absorption of fat in the body. There are also new technologies where ultrasound energy or external laser devices are used in order to try to melt fat without having to do an invasive procedure.

With facial rejuvenation, we can use surgery to restore the beautiful shape of the cheeks, jawline or neck. A youthful face has prominent cheeks that come down to a point in the chin. As we age, we get more of a jowly look, so we use facial reshaping with facelifts and neck lifts to create a more youthful appearance.

The fractional CO2 laser is the best technology for skin rejuvenation.

With a traditional, full facelift there is scarring in the temporal hair line, in front of and behind the ear. It tightens the forehead and upper eyelids, the mid-face and lower eyelids, the lower face and lips, and the neck. In a minimal-incision facelift, there are scars in front of the ear, but none behind the ear. With a mid-facelift, we prioritize the deep layers of the face (covering the area of the lower eyelids and the cheekbone area down to the level of the corners of the mouth), lifting the cheeks, which gives them a fuller, more youthful appearance. This is produced using scar patterns behind the ear.

There are three main forms of liposuction. The most common is Tumescent liposuction, which is the mechanical break-up of large volumes of subcutaneous fat with large cannulas using local anesthesia. Ultrasonic Assisted Liposuction (UAL) uses high-pitched sound waves to liquefy fat in a specific area before it is removed. It is primarily used for fat removal in hard-to-treat areas such as the chin, neck, cheeks, knees, calves, and ankles. SmartLipo is a form of laser-assisted lipolysis where laser energy can be introduced into the subcutaneous layer using a slender cannula to melt fat prior to fat removal. Laser liposuction also tightens the skin, which we do not see with other treatment modalities.

It differs in males and females. In women, a brow lift typically raises the eyebrows just above the supraorbital rims and follows with a nice curving arch. In men, the correct position of the brow is at the level of the supraorbital rims.

The decision depends on the quality and the amount of skin within the abdominal region. If the patient has some subcutaneous fat, but good skin, liposuction can be effective. If the patient has extra skin hanging over the abdominal crease, then they are better off with a tummy tuck.

Nipple numbness is always a possibility with any type of breast surgery, but the incidence is remote.