The Thermage procedure was developed to help the signs of aging skin. It works by tightening tissue. It is currently used for treating periorbital (around the eye) wrinkles. The Thermage procedure is also known as ThermaLift, Thermal Lifting, Therma Plasty, and Thermoplastic contouring. The Thermage technology is being studied for other aesthetic uses on the face.
The radiofrequency (RF) energy uniformly heats the dermis while cooling and protecting the epidermis. It is designed to cause immediate collagen contraction followed by new collagen production which occurs over a period of time. The Thermage procedure is the only non-invasive method to tighten loose skin.
Depending on the size of the area treated, the procedure itself may take anywhere from a few minutes to an hour. The doctor may require that you arrive an hour before your procedure for administration of an anesthetic cream. The patient below had her forehead skin treated in about 25 minutes. Note the change in the appearance of her eyes (photo on right).
You may return to your normal activities immediately, as there is usually no “downtime”. Minimal redness is seen in some patients but it usually disappears shortly after treatment. Heat-related complications can occur but are uncommon. There is no special care needed after treatment. As a part of good skin care, sunscreen is recommended.
In most patients, results appear gradually over 2-6 months, although some patients see an earlier response.The patient below (photo on right) represents treatment results after 4 weeks.
A single treatment has produced good results in a significant number of patients. However, the doctor will assess the number and frequency of treatments required to achieve optimal results for your skin.
Recently published studies show that improvements continue for at least six months after a single treatment session. Other studies show that thermal collagen changes can last several years, depending on the rate of the aging process.
The Thermage procedure is very safe. Although it is possible that skin damage can occur, this advanced treatment has been studied carefully in hundreds of patients with minimal reports of lasting adverse effects.
Dr. Dennis Monteiro would like to bring to your attention a NEW, recently FDA approved gradual, long-lasting collagen stimulator called Sculptra® Aesthetic. In as little as 2-3 applications, this product offers 2+ year duration providing a very natural, youthful and relaxed appearance. Below are before and after photos.
• If a gradual, long-term result is your treatment goal, this may be the solution you have been waiting for.
• If you are not satisfied with the duration of your current filler, Sculptra Aesthetic might be right for you.
Please ask Dr. Monteiro more about it!
Please ask Dr. Monteiro about anything you don’t understand. To find out more about Sculptra, click the link below to visit their website at:
Sometimes ear surgery is performed on a mature adult; other times it is performed on a child.
If performed on a child, most surgeons recommend that parents stay alert to their child’s feelings about protruding ears; don’t insist on the surgery until your child wants the change. Adults who desire this surgery are prepared for a successful outcome that often increases their self-confidence. Children who feel uncomfortable about their ears and want the surgery are generally more cooperative during the process and happier with the outcome.
Please ask Dr. Monteiro about anything you don’t understand in the information contained below.
When ear surgery is performed by a qualified, experienced surgeon, complications are infrequent and usually minor. Nevertheless, as with any operation, there are risks associated with surgery and specific complications associated with this procedure. A small percentage of patients may develop a blood clot on the ear. It may dissolve naturally or can be drawn out with a needle. Occasionally, patients develop an infection in the cartilage, which can cause scar tissue to form. Such infections are usually treated with antibiotics; rarely, surgery may be required to drain the infected area.
If your child is young, your surgeon may recommend general anesthesia, so the child will sleep through the operation. For older children or adults, the surgeon may prefer to use local anesthesia, combined with a sedative, so you or your child will be awake but relaxed.
Dr. Monteiro usually performes otoplasty as an outpatient procedure in a hospital, his office-based surgical facility, or a freestanding surgery center. Occasionally, the doctor may recommend that the procedure be done as an inpatient procedure, in which case you can plan on staying overnight in the hospital.
Creating a fold in the cartilage makes the ear lie flatter against the head and appear more normal.
In most cases, ear surgery will leave a faint scar in the back of the ear that will fade with time. Even when only one ear appears to protrude, surgery is usually performed on both ears for a better balance.
Nasal Surgery (Rhinoplasty)
Because your face is one-of-a-kind, your nasal surgery needs to be customized to address your particular needs. Dr. Monteiro will beautify your nose and correct breathing difficulties.
Please ask Dr. Monteiro about anything you don’t understand.
About deviated septum…
The condition named above is usually associated with a deviated septum (or a bent internal framework of the nose.) Most of the time this results from trauma such as a broken nose but many patients with this condition cannot recall an episode where this might have occurred. The condition described in this question however, could also result from allergies or the two conditions can exist simultaneously. Careful examination is needed before surgery to separate the two conditions. While individual insurance policies can vary, in general, functional surgery to improve breathing is considered a covered benefit in many group policies. If additional correction of a cosmetic deformity of the nose is done at the same time the cost of this part of the procedure is usually not covered by insurance.
All surgery carries some uncertainty and risk.
When nasal surgery is performed by a qualified plastic surgeon, complications are infrequent and usually minor. Still, individuals vary greatly in their anatomy, their physical reactions, and their healing abilities, and the outcome is never completely predictable.
Poor healing of the skin is most likely to affect smokers. You can reduce your risks by closely following Dr. Monteiro’s advice both before and after surgery.e.
Preparing for your surgery…
Dr. Monteiro will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications. Carefully following these instructions will help your surgery go more smoothly. If you smoke, it’s especially important to stop at least a week or two before and after surgery; smoking inhibits blood flow to the skin, and can interfere with healing.
Whether your rhinoplasty is being done on an outpatient or inpatient basis, you must arrange for someone to drive you home after your surgery, and to care for you for a day or two if needed.
Where your surgery will be performed?
A rhinoplasty may be performed in Dr. Monteiro’s office-based facility, at an outpatient surgery center, or in a hospital. It’s usually done on an outpatient basis, but some patients may be hospitalized for a day when general anesthesia is used. Certain conditions such as diabetes or high blood pressure should be monitored after surgery, and may also require a short inpatient stay.
Types of Anesthesia
Most nasal surgeries are performed under local anesthesia, combined with a sedative to make you drowsy. You’ll be awake but relaxed, and your nose and face will be insensitive to pain. Dr. Monteiro may choose to administer a general anesthesia, depending on the extent of the procedure. In that case, you’ll sleep through the operation.
Rhinoplasty usually takes one to two hours – or somewhat longer if the procedure being done is more complex. During surgery the skin of the nose is separated from its supporting framework of bone and cartilage and is then sculpted into the desired shape. Incisions are ususally made within the nostrils. Dr. Monteiro will discuss your particular procedure with you in advance of your surgery.
|1. Incisions are made inside the nostrils or at the base of the nose, providing access to the cartilage and bone, which can then be sculpted into shape.|
|2. Dr. Monteiro can remove a hump using surgical instruments.|
|3. Cartilage is trimmed to reshape the tip of the nose.|
|4. Trimming the septum improves the angle between the nose and upper lip.|
|5. If the nostrils are too wide, Dr. Monteiro can remove small wedges of skin from their base, bringing them closer together.|
|6. To improve the nasal airway, the shape or position of the septum may be altered. Or, the deviated protion of the septum may be partially removed.|
|7. A splint bandage made of tape and an overlay of plastic, metal, or plaster will be applied to help the bone and cartilage of the nose maintain its new shape.|
After your surgery…
After surgery – particularly during the first twenty-four hours – your face will feel puffy, your nose may ache, and you may have a dull headache. Pain can be controlled with medication. Plan on staying in bed with your head elevated. You’ll notice swelling and brusing around your eyes, reaching a peak after two or three days. A little bleeding is common for the first few days following surgery, and you may experience some stuffiness for several weeks.
Getting back to normal…!
You should be up and about in a day or two, but plan on taking it easy for the first week after surgery. Be especially gentle with your face and hair, since your skin will be both tender and numb, and may not respond normally at first. Dr. Monteiro will give more specific guidelines for gradually resuming your normal activities. They’re likely to include these suggestions: Avoid strenuous activity, including exercise, sex, and heavy housework, for at least two weeks.
At the beginning, your face may look and feel rather strange. Your features may be distorted from the swelling. Some bruising may persist for two or three weeks. Most patients are back at work about ten days to two weeks after surgery.
After surgery, patients have a straighter bridge, a well-defined nasal tip, and an improved angle between the nose and upper lip.
The chances are excellent that you’ll be happy with your rhinoplasty -especially if you realize that the results may not be immediately apparent. Even after the swelling and bruises are gone, your nose will continue to heal for several months.
In general, most or all of the incisions in rhinoplasty are hidden in the inside of the nostril. While external incisions hidden in the creases where the nose meets the cheek can be used to narrow the nose, incisions on the bridge or tip are not usually used in cosmetic surgery of the nse, and scars will not be apparent.
Because your face is one-of-a-kind, your facelift procedure needs to be fully customized to address your unique needs. Dr. Monteiro will create an individualized approach to correct the effects of aging on your face. His techniques can refresh your look and soften wrinkles without appearing tight or unnatural.
Please ask Dr. Monteiro about anything you don’t understand in the information contained below.
As people age, the effects of gravity, exposure to the sun, and the stresses of daily life can be seen in their faces. Deep creases form between the nose and mouth; the jawline grows slack and jowls develop; folds and fat deposits appear around the neck. It is now common for both women and men to opt for facelifts.
A facelift (technically known as rhytidectomy) can’t actually stop the normal aging process. What it can do is “set back the clock,” improving the most visible signs of aging by removing excess or replacing deficient fat, tightening underlying muscles, and redraping the skin of your face and neck. A facelift can be done alone, or in conjunction with other procedures such as a forehead or brow lift, eyelid surgery, or reshaping the nose or chin
The best candidate for a facelift is a man or woman whose face and neck have begun to sag, but whose skin still has some elasticity and whose bone structure is strong and well-defined. Most patients are in their forties to sixties, but facelifts can be done successfully on people in their seventies or eighties as well.
A facelift will make you look younger and fresher, and it may enhance your self- confidence in the process. But it can’t give you a totally different look, nor can it restore the health and vitality of your youth. Before you decide to have surgery, think carefully about your expectations and discuss them with Dr. Monteiro.
A facelift can improve the cheeks, jowls, and neck
If you smoke, it’s especially important to stop at least a month before and after surgery to minimize your risks; smoking inhibits blood flow to the skin, and can interfere with the healing process.
A limited facelift may occasionally be performed in our office with just local anesthesia, but more commonly in an outpatient surgery center, or a hospital. It’s usually done on an outpatient basis, but some surgeons may hospitalize patients for a day when using general anesthesia for longer and combined procedures.
When a facelift is performed by a qualified plastic surgeon, complications are infrequent and usually minor. Still, individuals vary greatly in their anatomy, their physical reactions, and their healing abilities, and the outcome is never completely predictable.
Complications that can occur include: hematoma (a collection of blood under the skin that must be removed by the surgeon), injury to the nerves that control facial muscles (usually temporary), infection, and reactions to the anesthesia. Poor healing of the skin is most likely to affect smokers. You can reduce your risks by closely following your surgeon’s advice both before and after surgery.
Facelifts are very individualized procedures. In your initial consultation Dr. Monteiro will evaluate your face, including the skin and underlying bone, and discuss your goals for the surgery.
The doctor will check for medical conditions that could cause problems during or after surgery, such as uncontrolled high blood pressure, blood clotting problems, or the tendency to form excessive scars. Be sure to tell Dr. Monteiro if you smoke or are taking any drugs or medications – especially aspirin – or certain vitamins,or other drugs that affect clotting.
If you decide to have a facelift, Dr. Monteiro will explain the techniques and anesthesia he will use, the type of facility where the surgery will be performed, and the risks and costs involved. Don’t hesitate to ask him any questions you may have, especially those regarding your expectations and concerns about the results.
The doctor will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications. Carefully following these instructions will help your surgery go more smoothly. If you smoke, it’s especially important to stop at least a month before and after surgery; smoking inhibits blood flow to the skin, and can interfere with the healing of your incision areas. If your hair is very short, you might want to let it grow out before surgery, so that it’s long enough to hide the scars while they heal.
Whether your facelift is being done on an outpatient or inpatient basis, you must arrange for someone to drive you home after your surgery, and to help you out for a day or two if needed.
A facelift may be performed in a surgeon’s office-based facility, an outpatient surgery center, or a hospital. It’s usually done on an outpatient basis, but some surgeons may hospitalize patients for a day when using general anesthesia. Certain conditions such as diabetes or high blood pressure should be monitored after surgery, and may also require a short inpatient stay.
Some facelifts are performed under local anesthesia, combined with a sedative to make you drowsy. You’ll be awake but relaxed, and your face will be insensitive to pain. (However, you may feel some tugging or occasional discomfort.) Dr. Monteiro may choose to administer a general anesthesia. In that case, you’ll sleep through the operation.
A facelift usually takes several hours or somewhat longer if you’re having more than one procedure done. The exact placement of incisions and the sequence of events depends on your facial structure and your discussions with Dr. Monteiro and the technique that he feels is best for you.
Incisions usually begin above the hairline at the temples, follow the natural line in front of the ear, curve behind the earlobe into the crease behind the ear, and into or along the lower scalp. If the neck needs work, a small incision may also be made under the chin.
Facial, neck tissue and muscle may be separated; fat may be trimmed or suctioned and underlying muscle may be tightened. In general, the surgeon separates the skin from the fat and muscle below. Fat may be trimmed or suctioned from around the neck and chin to improve the contour. The surgeon then tightens the underlying muscle and membrane, pulls the skin back, and removes the excess. Stitches secure the layers of tissue and close the incisions; metal clips may be used on the scalp.
After deep tissues are tightened, the excess skin is pulled up and back, trimmed and sutured into place Following surgery, a small, thin tube may be temporarily placed under the skin behind your ear to drain any blood that might collect there. The surgeon may also wrap your head loosely in bandages to minimize bruising and swelling.
There isn’t usually significant discomfort after surgery; if there is, it can be lessened with the pain medication prescribed by Dr. Monteiro. (Severe or persistent pain or a sudden swelling of your face should be reported to your surgeon immediately.) Some numbness of the skin is quite normal; it will disappear in a few weeks or months. The doctor may tell you to keep your head elevated and as still as possible for a couple of days after surgery, to keep the swelling down.
If you’ve had a drainage tube inserted, it will be removed one or two days after surgery. Bandages, when used, are usually removed after one to two days. Don’t be surprised at the pale, bruised, and puffy face you see. Just keep in mind that in a few weeks you’ll be looking normal. Your stitches may dissolve, or may be removed in about a week. Your scalp may take longer to heal, and the stitches or metal clips in your hairline could be left in a few days longer.
Most of the scars will be hidden within your hair and in the normal creases of your skin.
You should be up and about in a day or two, but plan on taking it easy for the first week after surgery. Be especially gentle with your face and hair, since your skin will be both tender and numb, and may not respond normally at first. Dr. Monteiro will give more specific guidelines for gradually resuming your normal activities. They’re likely to include these suggestions: Avoid strenuous activity, for at least two weeks (walking and mild stretching are fine); avoid alcohol, steam baths, and saunas for at least a month. Above all, get plenty of rest and allow your body to spend its energy on healing.
At the beginning, your face may look and feel rather strange. Your features may be distorted from the swelling, your facial movements may be slightly stiff and you’ll probably be self-conscious about your scars. Some bruising may persist for two or three weeks, and you may tire easily. It’s not surprising that some patients are disappointed and depressed at first. By the third week, you’ll look and feel much better. Most patients are back at work about ten days to two weeks after surgery. If you need it, special camouflage makeup can mask most bruising that remains.
The chances are excellent that you’ll be happy with your facelift – especially if you realize that the results may not be immediately apparent. Even after the swelling and bruises are gone, the hair around your temples may be thin and your skin may feel dry and rough for several months. Men may find they have to shave in new places-behind the neck and ears-where areas of beard-growing skin have been repositioned.
You’ll have some scars from your facelift, but they’re usually hidden by your hair or in the natural creases of your face and ears. In any case, they’ll fade within time and should be scarcely visible. Most of the scars will be hidden within your hair and in the normal creases of your skin. Most of the scars will be hidden within your hair and in the normal creases of your skin.
Having a facelift doesn’t stop the clock…your face will continue to age with time, but you should continue to look younger than if you had not had the facelift at all. You will likely want to continue with other treatments in the years following your surgery such as skincare, fillers, or botox injections to maintain your best appearance, and you may want to repeat the procedure at some point in the future
Eyelid Surgery (Blepharoplasty)
Blepharoplasty can be performed for cosmetic or reconstructive reasons, or for a combination of both – and is designed to improve both shape and function of the upper and lower eyelids. It is a very common plastic surgery procedure, and in recent years it has become as popular with many male patients as well as female patients
Before surgery….what are the goals of blepharoplasty?
A properly performed blepharoplasty procedure will brighten the face and restore a more youthful appearance. In some patients the procedure will improve vision by removing the excessive skin of the upper eyelids which can hang down and interfere with peripheral vision.
What are the risks involved with this procedure?
Fortunately, when performed by a competent plastic surgeon, complications are infrequent and minor. All patients will experience some bruising and swelling for a few days after the surgery. In addition, a temporary problem with closure of the eyelids is usually seen. Some may have temporary blurring of their vision, usually due to the ointments applied to the incisions postoperatively. In rare instances, the lower eyelid may be pulled down causing an ectropion. If this does not resolve on its own, further surgery may be necessary. The theoretical complications of any surgical procedure, such as bleeding, infection, wound disruption and heavy scarring are also possible, but rare.
A properly performed blepharoplasty procedure will brighten the face and restore a more youthful appearance. In some patients, the procedure will improve vision by removing the excessive skin of the upper eyelids which can hang down and interfere with peripheral vision. The best patients for eyelid surgery are those who are healthy, psychologically stable and well-motivated. Some medical conditions may increase the risk of blepharoplasty surgery such as thyroid disease, high blood pressure, and patients who do not make sufficient tears to keep their eyes well lubricated. Dr. Monteiro will discuss your particular needs with you in detail, and he will customize your eyelid lift to your specific needs and desired outcome. Cosmetic eyelid surgery is often performed in conjunction with facelift, or brow and forehead lift surgery.
Scars are a result of any surgical procedure. However, the incisions made to accomplish the goals of the procedure are barely visible after several months as they are placed within the normal creases and folds of the upper and lower eyelids. In patients who only need removal of fat from the lower eyelids, the incision can be made on the inside of the eyelid, and will, therefore, result in an invisible scar.
The blepharoplasty procedure will not eradicate the wrinkles around the eyes (“crow’s feet”) nor will it elevate a droopy eyebrow. Other procedures such as laser skin resurfacing, a chemical peel, or injectable treatments such as Botox®, Juvederm, or collagen may help to alleviate lines and grooves adjacent to the eyes. Dark circles under the eyes may improve somewhat if related to excess fat pads and excess skin, but often the darker appearance of the lower eyelid skin can be related to other factors, including skin pigmentation and visibility of blood vessels under the skin, and remains despite surgery.
After any swelling or bruising and redness is gone, you will see a dramatic reduction and a noted improvement in the appearance of your upper and/or lower eyelids. Bruising and redness/swelling usually resolves in about 7 to 10 days. Using clean, soft icepacks (that fit the contour of your eye area) regularly during the first days after the procedure help healing along and help reduce brusing and swelling. Both women and men noticeably benefit from this procedure, and results generally last for years to come.
Eyelid surgery is usually performed using local anesthesia and light intravenous sedation. It is commonly done in the doctor’s office, outpatient surgical center or, in some cases, in a hospital. The procedure is most often performed on an outpatient basis.
Plastic Surgery Specialists
1288 Valley Forge Road, Suite 65
Valley Forge, Pa
If you have further questions, please send an email to: email@example.com
Expect to see the following benefits (see photos, below):
Skin more toned and firm
Less “dimpling” on problem areas
Clothes fit better
Shaping and contouring of hips and thighs
Increased sense of well-being
What is Endermologie…?
Endermologie is a non-invasive FDA approved device that uses rollers and intermittent suction to break up fat cells trapped in the subadjcent soft tissues, also known as cellulite. Numerous clinical studies have shown its effectiveness in reducing cellulite appearance. For over a decade, stars and models have known about this secret to combat cellulite. Not only will you see an improvement in those unwanted “dimple” areas, but you will visibly witness your skin gaining firmness, smoothness and tone. Contouring and reshaping of problematic areas, such as hips and thighs, will become noticeable. If you are tired of that ” orange peel” effect then Endermologie may very well be the solution you’ve been seeking.
A French engineer named Louis Paul Guitay was receiving physiotherapy to soften scars he had from an accident. To standardize treatment and help the therapist he developed a computer driven hand held massaging device to deliver consistent pressure and suction to his scars. While initially a therapeutic massage device, it was shown, unexpectedly, to produce improvement in cellulite.
– 6 sessions 360.00
– 8 sessions 450.00
– 10 sessions 500.00
Endermologie will not eradicate cellulite, but it will dramatically reduce the appearance of it, and isn’t that what we’re concerned about? Your skin will become more firm and toned also improving the cellulite. There are numerous American and European studies documenting Endermologie’s effectiveness.
Prices for treatments are as follows:
– 5 Sessions 550.00
– 10 Sessions 1000.00
– 20 Sessions 1800.00
For monthly maintenance sessions you can save with package pricing:
– 1 mo (2 sessions) 150.00
– 2 mo (4 sessions) 260.00
– 3 mo (6 sessions) 360.00
Dermabrasion and dermaplaning help to “refinish” the skin’s top layers through a method of controlled surgical scraping. The treatments soften the sharp edges of surface irregularities, giving the skin a smoother appearance. Dermabrasion and dermaplaning left scarred by accidents or previous surgery, or to smooth out fine facial wrinkles, such as those around the mouth. It’s also sometimes used to remove the pre-cancerous growths called keratoses. Dermaplaning is commonly used to treat deep acne scars.
Please ask Dr. Monteiro about anything you don’t understand in the information contained below.
If you’re considering surgery to refinish the skin, this information will give you a basic understanding of the procedure-when it can help, how it’s performed, and what results you can expect. It can’t answer all of your questions, since a lot depends on your individual circumstances.
Both dermabrasion and dermaplaning can be performed on small areas of skin or on the entire face. They can be used alone, or in conjunction with other procedures such as a facelift, eyelid surgery, light scar removal or revision, or chemical peel.
If you’re planning “surface repairs” on your face, you may also be considering chemical peel, an alternative method of surgically removing the top layer of skin. However, dermabrasion and dermaplaning use surgical instruments to remove the affected skin layers, while chemical peel uses a caustic solution.
Dr. Monteiro performs all three procedures, selecting one or a combination of procedures to suit the individual patient and the problem. In general, chemical peel is used more often to treat fine wrinkles, and dermabrasion and dermaplaning for deeper imperfections such as acne scars. A non-chemical approach may also be preferred for individuals with slightly darker skin, especially when treating limited areas of the face, since dermabrasion and dermaplaning are less likely to produce extreme changes and contrasts in skin color. If you’d like more information on chemical peel, click on the link at left to go to that section of our website on that topic.
Dermabrasion and dermaplaning can enhance your appearance and your self-confidence, but neither treatment will remove all scars and flaws or prevent aging. Before you decide to have a skin-refinishing treatment, think carefully about your expectations and discuss them with Dr. Monteiro.
Men and women of all ages, from young people to older adults, can benefit from dermabrasion and dermaplaning. Although older people heal more slowly, more important factors are your skin type, coloring, and medical history. For example, black skin, Asian skin, and other dark complexions may become permanently discolored or blotchy after a skin-refinishing treatment. People who develop allergic rashes or other skin reactions, or who get frequent fever blisters or cold sores, may experience a flare-up. If you have freckles, they may disappear in the treated area.
In addition, most surgeons won’t perform treatment during the active stages of acne because of a greater risk of infection. The same may be true if you’ve had radiation treatments, a bad skin burn, or a previous chemical peel.
Dermabrasion and dermaplaning are normally safe when they’re performed by a qualified, experienced board-certified physician. The most common risk is a change in skin pigmentation. Permanent darkening of the skin, usually caused by exposure to the sun in the days or months following surgery, may occur in some patients. On the other hand, some patients find the treated skin remains a little lighter or blotchy in appearance.
You may develop tiny whiteheads after surgery.These usually disappear on their own, or with the use of an abrasive pad or soap; occasionally, the surgeon may have to remove them. You may also develop enlarged skin pores; these usually shrink to near normal size once the swelling has subsided.
While infection and scarring are rare with skin-refinishing treatments, they are possible.Some individuals develop excessive scar tissue (keloid or hypertrophic scars); these are usually treated with the application or injection of steroid medications to soften the scar.
Dr. Monteirowill give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, and on avoiding aspirin and other medications that affect blood clotting. You may also be given special instructions regarding the care and treatment of your skin prior to surgery. If you smoke, you’ll probably be asked to stop for a week or two before and after surgery, since smoking decreases blood circulation in the skin and impedes healing.
While you’re making preparations, be sure to arrange for someone to drive you home after your surgery, and to help you out for a day or two if needed.
Your treatment may be performed in the doctor’s office-based facility, an outpatient surgery center, or a hospital. It’s usually done on an outpatient basis, for cost containment and convenience. However, if you’re undergoing extensive work, you may be admitted to the hospital.
Dermabrasion and dermaplaning can be performed fairly quickly. The procedures usually take from a few minutes to an hour and a half, depending on how large an area of skin is involved. It’s not uncommon for the procedure to be performed more than once, or in stages, especially when scarring is deep or a large area of skin is involved.
1. In dermabrasion, the surgeon scrapes away the top layers of skin using an electrically operated instrument with a rough wire brush or diamond-impregnated burr, attached to a motorized handle. The scraping continues until the surgeon reaches the safest level that will make the scar or wrinkle less visible.
2. This cross section shows how dermabrasion smooths irregularities in the outermost layer of skin.
3. In dermaplaning, the surgeon uses a hand-held instrument called a dermatome. Resembling an electric razor, the dermatome has an oscillating blade that moves back and forth to evenly “skim” off the surface layers of skin that surround the craters or other facial defects. This skimming continues until the lowest point of the acne scar becomes more even with the surrounding skin.
Your new skin will be a bit swollen, sensitive, and bright pink for several weeks. During this time, you can begin gradually resuming your normal activities.
You can expect to be back at work in about two weeks. Your surgeon will probably advise your to avoid any activity that could cause a bump to your face for at least two weeks. More active sports-especially ball sports-should be avoided for four to six weeks. If you swim, stick to indoor pools to avoid sun and wind, and keep your face out of chlorinated water for at least four weeks. It will be at least three to four weeks before you can drink alcohol without experiencing a flush of redness.
Above all, it’s important to protect your skin from the sun until the pigment has completely returned to your skin – as long as six to twelve months.
A chemical peel is most commonly performed for cosmetic reasons: To enhance your appearance and your self-confidence. A chemical peel may also remove pre-cancerous skin growths, soften acne facial scars and even control acne.
Please ask your provider about anything you don’t understand in the information contained below.
Chemical peel uses a chemical solution to improve and smooth the texture of the facial skin by removing its damaged outer layers. It is helpful for those individuals with facial blemishes, wrinkles and uneven skin pigmentation. Phenol, trichloroacetic acid (TCA) and alphahydroxy acids (AHAs) are used for this purpose. The precise formula used may be adjusted to meet each patient’s needs. Although chemical peel may be performed in conjunction with a facelift, it is not a substitute for such surgery, nor will it prevent or slow the aging process. Some patients choose to have a chemical peel in conjunction with other procedures such as a forehead lift, eyelid surgery, or a facelift.
Alphahydroxy acids (AHAs), such as glycolic, lactic, or fruit acids are the mildest of the peel formulas and produce light peels. These types of peels can provide smoother, brighter-looking skin for people who can’t spare the time to recover from a phenol or TCA peel. AHA peels may be used to treat fine wrinkling, areas of dryness, uneven pigmentation and acne. Various concentrations of an AHA may be applied weekly or at longer intervals to obtain the best result. Your provider will make this decision during your consultation and as the treatment proceeds. An alphahydroxy acid, such as glycolic acid, can also be mixed with a facial wash or cream in lesser concentrations as part of a daily skin-care regimen to improve the skin’s texture.
Trichloroacetic acid (TCA) can be used in many concentrations, but it is most commonly used for medium-depth peeling. Fine surface wrinkles, superficial blemishes and pigment problems are commonly treated with TCA. The results of TCA peel are usually less dramatic than and not as long-lasting as those of a phenol peel. In fact, more than one TCA peel may be needed to achieve the desired result. The recovery from a TCA peel is usually shorter than with a phenol peel. Phenol is the strongest of the chemical solutions and produces a deep peel. It is used mainly to treat patients with coarse facial wrinkles, areas of blotchy or damaged skin caused by sun exposure, or pre-cancerous growths. Since phenol sometimes lightens the treated areas, your skin pigmentation may be a determining factor as to whether or not this is an appropriate treatment for you. Phenol is primarily used on the face; scarring may result if it’s applied to the neck or other body areas.
Smooths rough, dry skin
Improves texture of sun-damaged skin Aids in control of acne
Can be mixed with bleaching agent to correct pigment problems
Can be used as TCA pre-treatment.
Chemical peel is especially useful for the fine wrinkles on cheeks, forehead,
and around the eyes, and the vertical wrinkles around the mouth.
Chemical peel is normally a safe procedure when it is performed by a qualified, experienced plastic surgeon. However, some unpredictability and risks such as infection and scarring, while infrequent, are possible.
In some states, no medical degree is required to perform a chemical peel – even the strongest phenol peels. Many states have laws that permit non-physicians to administer certain peel solutions, but regulate the strengths which they are permitted to apply. You should be warned that phenol and TCA peels have been offered by inadequately trained practitioners claiming “miracle techniques” to rejuvenate the skin.
It is very important that you find a physician who has adequate training and experience in skin resurfacing. Your provider may offer you a choice of peel techniques or suggest a combination of peels to obtain the best result for you.
During your initial consultation, it is important that you discuss your expectations with your provider. Don’t hesitate to ask any questions or express any concerns that you may have. Expect your plastic surgeon to explain the planned procedure in detail, including its risks and benefits, the recovery period and the costs. If you have a history of cold sores (herpes), you should inform your provider prior to the procedure. Remember, chemical peel treatments are usually not covered by medical insurance unless they are performed for medically related problems.
will instruct you on how to prepare for your peel treatment. Sometimes Retin A – a prescription medication derived from Vitamin A – is used to pre-treat the skin. This thins out the skin’s surface layer, allowing the TCA solution to penetrate more deeply and evenly. If your skin won’t tolerate Retin-A pre-treatment, an AHA cream may be used instead. Hydroquinone, a bleaching agent, is sometimes used in conjunction with Retin-A or AHA pre-treatment, especially if you have blotchy skin areas or pigmentation problems. You may have to spend a month or more in the pre-treatment phase before your provider will schedule your actual peel. You will need to arrange for someone to drive you home and help you out for a day or two if you are having a phenol or deeper TCA peel. You probably won’t need any extra assistance if you’re having an AHA peel or superficial TCA peel. It is very important that you find a physician who has adequate training and experience in skin resurfacing. Dr. Monteiro may offer you a choice of peel techniques or suggest a combination of peels to obtain the best result for you.
Most chemical peels may be safely performed in your provider’s office or outpatient surgical center. The doctor may want you to stay overnight in a facility or hospital if other cosmetic procedures are performed simultaneously.
Anesthesia isn’t required for phenol or TCA peels because the chemical solution acts as an anesthetic. However, sedation may be used before and during the procedure to relax you and keep you comfortable.
No anesthesia is needed for AHA peels since they cause only a slight stinging sensation during application. Your provider can answer any questions you may have concerning sedation during a chemical peel.
AHA peels/treatments: Your provider will apply the AHA solution to your cleansed facial skin, a process that usually takes no more than 10 minutes. No “after-peel” ointment or covering is required. Depending on the strength of the peel, periodic treatments may be necessary until the desired effects are achieved.
For some patients, the application of an AHA-based face wash or cream once or twice a day at home will be sufficient to accomplish the desired goal. Your provider may add Retin-A or a bleaching agent to your at-home treatment schedule. After several weeks of at-home use, Dr. Monteiro will examine your skin to determine if your regimen needs adjustment.
Phenol and TCA peels: Typically, the skin is first thoroughly cleansed. Then, the doctor will carefully apply the phenol or TCA solution. You may feel a stinging sensation as the peel solution is applied, but this feeling will quickly pass. A full-face TCA peel usually takes no more than 15 minutes. Two or more TCA peels may be needed to obtain the desired result, and those may be spaced out over several months. Mild TCA peels may be repeated as often as every month.
If phenol solution has been used, your plastic surgeon may coat the treated area with petroleum jelly or a waterproof adhesive tape. With lighter peels, no covering is necessary. A full-face phenol peel generally takes one or two hours to perform, while a phenol peel to a smaller facial region (perhaps the skin above the upper lip) may take only 10 or 15 minutes. A single treatment usually suffices.
1.The chemical solution can be applied to the entire face, or to a specific area – for example, around the mouth. Sometimes a peel is done in conjunction with a facelift.
2. At the end of a phenol peel, a thick layer of petroleum jelly may be applied to the treated area.
3. A darker protective crust may form over the new skin. As it sloughs off naturally, the skin underneath will be a bright pink.
After an AHA peel, it is common to experience some temporary flaking or scaling, redness and dryness of the skin. However, these conditions will disappear as the skin adjusts to treatment.
For some patients, the application of an AHA-based face wash or cream once or twice a day at home will be sufficient to accomplish the desired goal. Your provider may add Retin-A or a bleaching agent to your at-home treatment schedule. After several weeks of at-home use, your provider will examine your skin to determine if your regimen needs adjustment.
A TCA peel may also cause significant swelling, depending on the strength of the peel used.
After a phenol or TCA peel, your provider may prescribe a mild pain medication to relieve any tingling or throbbing you may feel. If the tape was used to cover your face, it will be removed after a day or two. A crust or scab will form on the treated area. To help your face heal properly, it is essential that you follow your provider’s specific post-operative instructions.
If you’ve had a phenol peel, your face may become quite swollen. Your eyes may even be swollen shut temporarily. You will need someone to help care for you for a day or two. You may also be limited to a liquid diet and advised not to talk very much during the first few days of recovery.
4. After healing, the skin is lighter in color, tighter, smoother, and younger-looking.
With an AHA peel, the temporary redness, flaking and dryness that you experience will not prevent you from working or engaging in your normal activities. A fresher and improved skin texture will result in continued AHA treatments. Remember, protecting your skin from the sun is also important following these mild acid peels. Ask your provider to recommend a sunblock with adequate UVA and UVB protection and use it every day.
With a TCA peel, the moderate discomfort and mild swelling you may experience will subside within the first week. In about a week to ten days, your new skin will be apparent and you should be healed sufficiently to return to your normal activities. It is best to avoid sun exposure unless you are adequately protected.
With a phenol peel, new skin will begin to form in about seven to ten days. Your face will be very red at first, gradually fading to a pinkish color over the following weeks to months. During this time, it is especially important that you use a sunblock or blotchy, irregular skin coloring may result.
About two weeks after treatment, you may return to work and resume some of your normal activities. Your skin will be healed enough for you to wear makeup. (For makeup tips, ask your plastic surgeon for the ASPS brochure on camouflage cosmetics.)
Improvements from AHA peels may be very subtle at first. You may detect a healthier glow to your skin. With continued treatments, you will notice a general improvement in the texture of your skin.
The results of a TCA peel are usually not as long-lasting as those of phenol peel. However, your skin will be noticeably smoother and fresher-looking.
If you’re planning a phenol peel, you can expect dramatic improvement in the surface of your skin – fewer fine wrinkles, fewer blemishes and more even-toned skin. Your results will be long-lasting, although not immune to the effects of aging and sun exposure.
Botox® and other brands of neurotoxin injections and injectable fillers, such as Restylane®, Juvederm®, Belotero® and Radiesse® are popular treatments for wrinkles, fine lines, mild acne scars and furrows or small depressions on the face. Fillers are also ideal for lip enhancement, for restoring volume lost due to the aging process and are a good choice for reshaping and contouring of the face, and also the hands. Each of the fillers we offer has unique properties, and may be customized and combined to address your particular needs. Duration of effect is variable, depends upon the product and location used, and may range from 6 to 18 months. The first step is a consultation with one of our providers, all of whom are expert injectors. Our practice will work with you to determine your goals, whether you desire a long range plan or would like to look your best for a special life event.
Some wrinkles are specifically formed as a result of the actions of muscles. The contraction of small muscles under the skin results in grooves being worn into the skin. BOTOX® works by preventing these muscles from contracting, thereby allowing the skin to relax and assume its non-wrinkled appearance. Although BOTOX® is a neurotoxin, it has been safely used in small amounts to improve the appearance of wrinkles and lines. BOTOX® is most commonly injected into the frown lines, horizontal forehead lines and crow’s feet. In some patients, injection into the neck muscles is performed to provide a more youthful appearance. Side effects may include mild swelling and bruising, and rarely, eyelid heaviness, which is temporary. Both women and men noticeably benefit from these injections, and results generally last three to six months. With continued use, the duration of Botox may be longer and the amount needed may be less.
Patients seeking BOTOX® or collagen need not prepare in any special way for the treatments.
Some redness or some slight bleeding at injection sites may occur; temporary swelling may also be present. These side-effects vary from individual to individual and usually disappear within a few days to a week.
Most patients will see immediate improvement. Often the improvement is dramatic and patients will elect to continue treatments over time to ensure a continuity of care from the treatment
Some patients elect to enhance the effects of a facelift, or eyelid surgery with BOTOX® or collagen treatments.
After any minute swelling or slight redness is gone, you will see a dramatic reduction and a noted improvement in the appearance of lines and wrinkles on your skin. Both women and men noticeably benefit from these simple treatments and results generally last from three to six months.