Santa Cruz Doctors

Crooked Nose - Nose Implant Possible?

Hi. I have a broken nose from a fight one and a half years ago. Luckily, the cartilage tip etc. is all intact, however the bone itself is not fitting straight and is going to one of the sides, which brings the cartlage etc. with it. It wont fit, they tried 2 times, it still goes to one of the sides. Is it possible to "cut" the bone in half, attach a implant to the top part in order to make it fit with the lower part of my "forehead" where the break is or whatever its called. Can anyone do this?

There are a number of rhinoplasty options, for someone who has a crooked nose secondary to trauma.  These options include cutting the nasal bones (osteotomy), onlay grafts of one's own cartilage, and nasal implants to hide the defect.  Seek out a board certified plastic surgeon in your area who routinely performs rhinoplasty.

Vincent D. Lepore, MD

San Jose Plastic Surgeon

Tummy Tuck Recovery

What is tummy tuck recovery generally like? If I get it done, what can I expect post-op care, checkups, pain? How long does complete recovery from a tummy tuck take?

Mini Abdominoplasty:

Mini tummy tucks are recommended if only a small lower abdominal skin excess is present. A mini tummy tuck has a quicker recovery. After a mini tummy tuck procedure, moderate discomfort can be treated with oral pain medication. Patients can usually return to work a week after surgery.

Standard Abdominoplasty:

After standard abdominoplasty patients should take care in movement for the first week, walking in a somewhat forward flexed position at the waist. Pain is handled with ibuprofen and a narcotic pain pill as needed.  Patients can expect more freedom of movement during the second week. Most are able to drive and move about fairly normally in 8-10 days, and should anticipate ten to fourteen days off work. No aerobic exercise is permitted for six to eight weeks. Additionally, home assistance is required for two full days. Home help should be available twenty-four hours a day for the first three days, and some patients may prefer a professional aftercare facility instead of home recovery. A pain pump which administers a small amount of long-acting anesthetic continuously for three days under the skin of the abdomen can be very helpful. The majority of my patients choose to stay at home after their procedure, and the pain pump helps make this more comfortable.

Extensive Abdominoplasty:

An extensive abdominoplasty usually requires the patient to take two weeks off work and social activities. Home help will be needed for the first 2-4 days, and it is often best to stay in an aftercare facility for the first 1-2 days. An extensive abdominoplasty would be a patient who had significant liposuction of the waist, flank area, and started with a relatively larger amount of fat and skin. When abdominoplasty is combined with breast surgery, such as augmentations or lifts, an overnight stay might be recommended as well.

Endoscopic Abdominoplasty - this is an operation done through a minimal incision hidden in the pubic hair that is designed to tighten lower abdominal bulging without removing any skin. It may be combined with liposuction. The recovery is the same as a mini tummy tuck.

I will see my patients 3-5 days after the surgery. We keep in touch by phone during that time to monitor their recovery. If a drain has been used, it is usually removed between 3 and 6 days after the procedure. It is possible to remove drains this early because I use special Quill quilting sutures to close off the space that has been created in elevating the flaps. The quilting sutures prevent accumulation of fluid that could lead to a persistent collection called a seroma. Before the use of quilting sutures it was necessary to leave the drains in for up to two weeks.

Patients are then seen weekly, and the belly button sutures removed around two weeks. Since the knots are tied on the inside of the belly button, and they attach to the abdominal side underneath the skin, there are never any visible stitch marks.  Most patients return to normal activity and work, depending of course on what they do, between seven and twelve days after surgery.  Although I have had patients run on a treadmill against doctor's orders at two weeks, I recommend that they avoid strenuous activity for six weeks, giving all the internal repairs time to heal properly.

The feeling of tightness that goes along with a nice tummy tuck gradually relaxes during the first month, and most patients are standing up, stretching and comfortable by the time of their second or third post-operative week.

Studies show that swelling starts to go down between three and six months, so you have to be patient. The lower abdominal swelling is what is most noticeable, and the incision line is the last area to soften and flatten between three and six months.  Studies have also shown that there can be some increase in swelling between six and twelve months, and after that it returns to its final healed state.

Robert M. Lowen, MD

Bay Area Plastic Surgeon

Tummy Tuck Scars

I imagine that you can have tummy tuck scars hidden below your underpants but is this true? can i wear a bikini 1 year after tummy tuck?

  You want what every woman having this procedure wants, a minimally visible, well-healed incision scar that will allow you to wear whatever you want, including a bikini. We have all seen before and after pictures of tummy tucks on the Internet that show the scar is way too high, and visible in underwear, let alone a bikini.  The distance between the scar and the belly button is too small and the result leaves much to be desired.

    The key to keeping the scar in the bikini line is in the surgical planning. I have the patient wear their bikini or narrow underwear to the pre-operative marking. The skin of the thigh is then pulled up in the direction of the belly button and the outline of the underwear is marked. By doing this first, the incision will be hidden under the bikini line. If this is not done, it is a foregone conclusion that when tension is placed on the closure, the laxity of the front of the thigh will allow  the incision to rise into a visible area.  The pubic area is also gently elevated and marked, just enough to take out the laxity. It is not overly elevated, because you do not want the pubic area too high, just restored to its youthful position.  If there is a C-section scar, the incision is always marked below that.
    The closure is done with permanent interrupted sutures places close enough together that a finger will not fit between them.  This is the first layer and brings the deep tissues together under tension without allowing tension to be transmitted to the upper layers of the skin where the visible scar forms. The tension across the groin area gives you a sleek, youthful look, but the tension and incision placement are controlled. Therefore, the scar does not ride up, and the scar has the greatest chance of healing as a fine, flat line.
     In addition there are slowly dissolving sutures that go from the abdominal wall just next to the belly button up to the underside of the skin of the hole where the belly button will be placed.  When these are tied, the skin flap is further secured at the level of the belly button, preventing tension from being transmitted to the pubic area and pulling that area up.

    Careful pre-operative planning and secure closure of the incision will predictably result in a low and well-hidden scar.  

Robert M. Lowen, MD

Bay Area Plastic Surgeon