Top Plastic Surgeon Subhas Gupta, MD, PhD, FRCSC, FACS

Subhas Gupta, MD, CM, PhD, FRCSC, FACS - Loma Linda Plastic Surgery

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General Information

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Aesthetic Plastic Surgery Terms

Sometimes after multiple pregnancies or large weight loss, abdominal muscles weaken, and skin in the area becomes flacid. Abdominoplasty can tighten the abdominal muscles and, in some instances, improve stretch marks. In both men and women, the procedure will remove excess skin and fat. Generally, an incision is made across the pubic area and around the umbilicus (navel). When skin laxity and muscle weakness is confined to the lower part of the abdomen, a modified abdominoplasty that limits tissue removal and muscle repair to the area below the umbilicus may be performed. This usually leaves a shorter scar and no scarring around the navel.

Alpha Hydroxy Acids

Alpha hydroxy acids are derived from foods, such as fruits and milk, and can improve the texture of skin by removing layers of dead cells and encouraging cell regeneration.

Augmentation Mammoplasty (see Breast Augmentation)

Blepharoplasty (see Eyelid Surgery)

Breast Augmentation (Augmentation Mammoplasty)

Breast augmentation is typically performed to enlarge small breasts, underdeveloped breasts or breasts that have decreased in size after a woman has had children. It is accomplished by surgically inserting an implant behind each breast. An incision is made either under the breast, around the areola (the pink skin surrounding the nipple) or in the armpit. A pocket is created for the implant either behind the breast tissue or behind the muscle between the breast and the chest wall.

Breast Lift (Mastopexy)

Frequently, a woman elects this surgery after losing a considerable amount of weight, or losing volume and tone in her breasts after having children. The plastic surgeon relocates the nipple and areola (the pink skin surrounding the nipple) to a higher position, repositions the breast tissue to a higher level, removes excess skin from the lower portion of the breast and then reshapes the remaining breast skin. Scars are around the areola, extending vertically down the breast and horizontally along the crease underneath the breast. Variations on this technique, in some cases, may result in less noticeable scarring.

Breast Implants (Textured-Surface)

The shell of textured-surface breast implants are made with the same silicone elastomer that is used for the shell of other types of breast implants, but a special manufacturing process creates a textured surface.

Breast Reduction (Reduction Mammoplasty)

Breast reduction is normally classified as a reconstructive procedure, since oversize breasts interfere with normal function and physical activity. However, there is an important aesthetic component to the operation, since the plastic surgeon can improve the shape of the breasts and nipple areas. Breast reduction involves removing excess breast tissue and skin, repositioning the nipple and areola (the pink skin surrounding the nipple) and reshaping the remaining breast tissue.

Buccal Fat Pad

Buccal fat pads are located above the jawline near the corner of the mouth. They can be removed in individuals with excessively round faces to give a more contoured look, sometimes referred to as the "waif look." However, plastic surgeons warn that, in some individuals, removal of the buccal fat pads can lead to a drawn, hollow-cheeked look as aging progress.

Cannula

A hollow tube attached to a high-vacuum device used to remove fat through liposuction. The plastic surgeon manipulates the cannula within the fat layers under the skin, dislodging the fat and "vacuuming" it out.

Capsular Contracture

Capsular contracture is the most common problem associated with breast implants. It occurs when naturally forming scar tissue around the implant shrinks and tightens, making the breast feel firmer than normal and sometimes causing pain and an unnatural appearance of the breast.

Cellulite

Cellulite is the dimpled-looking fat that often appears on the buttocks, thighs and hips. While there is no treatment that will eradicate this problem, aesthetic plastic surgeons are exploring new techniques which may improve the condition. One method is to cut the fibrous tissue that binds the fat down in these areas and creates the lumpy appearance, and then to inject fact withdrawn from elsewhere in the body to smooth out the unevenness. Another technique, called the cellulite lift, surgically removes excess skin and fat, leaving a thin scar that may extend around the full circumference of the abdomen but is placed discreetly within bikini lines.

Chemical Peel

Fine lines and wrinkles around the mouth and on the forehead and cheek areas may be improved with a wide range of skin treatments. A chemical peel solution is applied to the entire face or to specific areas to peel away the skin's top layers. Several light to medium-depth peels can often achieve similar results to one deeper peel treatment, with less risk and shorter recovery time. Peel solutions may contain alpha hydroxy acids, tricholoracetic acid (TCA) or phenol as the peeling agent, depending on the depth of peel desired and on other patient selection factors.

Chin Augmentation (Mentoplasty)

Chin augmentation can strengthen the appearance of a receding chin by increasing its projection. The procedure does not affect the patient's bite or jaw. There are two techniques: one is performed through an incision inside the mouth and involves moving the chinbone, then wiring it into position; the other approach requires insertion of an implant through an incision inside the mouth, between the lower lip and the gum, or through an external incision underneath the chin.

Collagen Injections

Collagen is an injectable protein that can be used to treat facial wrinkles. Patients to be treated with collagen should first be tested for any allergic reaction. The results of collagen injections are not permanent, and treatments must be repeated periodically to maintain results.

Earlobe Reduction

A simple, 30-minute procedure, earlobe reduction can be performed in a plastic surgeon's office or at the same time as a facelift operation. The earlobe should not comprise more than 25 percent of the total length of the ear. In cases where it exceeds this dimension, an L-shaped wedge is cut away, the earlobe edges are brought together and sutured.

Eyelid Surgery (Blepharoplasty)

Aesthetic eyelid surgery can brighten the face and restore a more youthful appearance by reducing the fat that causes bags beneath the eyes and removing wrinkled, drooping layers of skin on the eyelids. Blepharoplasty is often performed along with a facelift or with other facial rejuvenation procedures. Incisions follow the natural contour lines in both upper and lower lids, or can be done through the lining of the lower eyelid, providing access to skin and fatty tissue. The thin surgical scars are usually barely visible and blend into the eyes' natural lines and folds.

Facelift (Rhytidectomy)

A facelift can reduce sagging skin on the face and neck. Incisions are placed in the hairline and then pass in front of and behind the ears; the exact design of incisions may vary from patient to patient and according to the surgeon's personal technique. For younger patients, more limited incisions may be appropriate. When necessary, removal of fatty deposits beneath the skin and tightening of sagging muscles is performed. The slack in the skin itself is then taken up and the excess removed. Scars can usually be concealed by hair and makeup.

Fat Injections

Fat withdrawn from one body site can be injected into another -- for example, to smooth lines in the face or build up other features such as the lips. In most cases, a percentage of injected fat is resorbed by the body, and the procedure must be repeated. Injection of fat to enlarge the breasts is a dangerous procedure and is not recommended because of the possibility of dense scarring that may seriously hinder accurate interpretation of both breast self-exams and mammograms.

Forehead Lift (Brow Lift)

The forehead lift is designed to correct or improve skin wrinkling, as well as loss of tone and sagging of the eyebrows that often occurs as part of the aging process. The procedure may also help to smooth horizontal expression lines in the forehead and vertical frown lines between the eyebrows. Incisions are placed behind the hairline above the ear and pass over the top of the head. In some cases, incisions may be placed in front of the hairline. Some patients may have the procedure performed with the use of an endoscope, requiring much shorter incisions. Improvements are made beneath the skin and on the deep muscles; skin and muscle are then tightened to give a fresher, more youthful appearance.

Lasers

Lasers can be effectively used to eliminate surface blood vessels on the face that become reddened and enlarged due to sun exposure. The problem is most often seen in fair-skinned individuals who cannot tan or have difficulty tanning. The use of lasers for skin resurfacing is effective in reducing the effects of sun damage. Laser resurfacing is an alternative to chemical peel for some patients.

Lip Augmentation

A permanent method of augmenting the lips is accomplished by surgically advancing the lip forward, with incisions placed inside the mouth. A dermal-fat graft, taken from the deeper layers of the skin, may then be positioned under the mucosa (the lining of the lip) to add additional "plumpness." Injecting fat collagen or other substances for lip augmentation is another alternative. The correction is not permanent, and injections must be repeated periodically to maintain results.

Lip Lift

A technique that surgically lifts the corners of the aging mouth can eliminate the pronounced droop and unhappy facial expression that often develops with advanced age. By cutting away small diamonds of skin just above the corners of the mouth, the vermilion (border of the lips) is raised into a slight smile.

Lip Reduction

To reduce the lips, a small strip of the mucosa (the lining of the lip) is surgically removed to narrow the lips to the desired proportion. The small scars on the outside of the lips are barely noticeable.

Lipoplasty (Liposuction)

Lipoplasty allows the plastic surgeon to remove localized collections of fatty tissue from the legs, buttocks, abdomen, back, arms, face and neck using a high vacuum device. The procedure leaves only minute scars, often as short as one-half inch in length or less. The use of refined equipment allows removal from delicate areas such as calves and ankles. Lipoplasty removes fat, but it cannot eliminate dimpling or correct skin laxity. If a patient's skin has lost much of its elasticity, the plastic surgeon may recommend a skin tightening procedure such as a thigh lift, buttock lift or arm lift, all of which leave more extensive scars.

Malar (Cheekbone) Augmentation

The cheekbones may be built up by placing an implant over them. This is usually performed through an incision within the mouth, but it may be done through a lower eyelid or brow lift incision.

Mastopexy (see Breast Lift)

Otoplasty (Ear Surgery)

The ears are positioned closer to the head by reshaping the cartilage (supporting tissue). This is usually accomplished through incisions placed behind the ears so that subsequent scars will be concealed in a natural skin crease. Otoplasty can be performed on children as early as age five or six.

Phenol

The chemical phenol is sometimes used for full-face peeling when sun damage or wrinkling is severe. It can also be used to treat limited areas of the face, such as deep wrinkles around the mouth, but it may permanently bleach the skin, leaving a line of demarcation between the treated and untreated areas that must be covered with makeup.

Platysma

The muscle which, when tight and firm, gives the neck underneath the chin and jawline its youthful contour. The platysma muscle can be tightened during a facelift or as a separate procedure.

Reduction Mammoplasty (see Breast Reduction)

Retin-A

Retin-A cream or lotion may be applied to enhance the overall texture of the skin and is often prescribed as a pre-treatment prior to a facelift or chemical peel.

Rhinoplasty: Open

The open rhinoplasty technique can sometimes benefit patients who need more complex correction or are undergoing a secondary rhinoplasty procedure. A small incision is made outside the nose across the columella (the tissue that divides the two nostrils). This enables the plastic surgeon to turn the outer tissue of the nose back, providing visualization of the structures inside. Additional incisions, like those used in the traditional closed approach, are made inside the nose as well. The scar resulting from the incision on the outside of the nose eventually becomes barely visible.

Rhinoplasty (Nose Reshaping)

Rhinoplasty is usually performed to alter the size and shape of the bridge and tip of the nose. Reshaping is generally done through incisions inside the nose, but there may also be an incision passing across the central portion of the nose between the nostrils. It is sometimes necessary to narrow the base of the nose or reduce the size of the nostrils, which involves removing small wedges of skin at the base of the nostrils. The nose is reduced, or sometimes built up, by adjusting its supporting structures, which is done either by removing or adding bone and cartilage. The skin and soft tissues then redrape themselves over this new "scaffolding."

Rhytidectomy (see Facelift)

SMAS

The superficial musculoaponeurotic system (SMAS) is a layer of tissue that covers the deeper structures in the cheek area and is in continuity with the superficial muscle covering the lower face and neck, called the platysma. Some facelift techniques lift and reposition the SMAS as well as the skin.

TCA

Trichloroacetic acid is used for peeling of the face, neck, hands and other exposed areas of the body. It has less bleaching effect than phenol, and is excellent for "spot" peeling of specific areas. It can be used for deep, medium or light peeling, depending on the concentration and method of application.

Transconjunctival Blepharoplasty

Transconjunctival blepharoplasty (eyelid surgery) is performed by making an incision from inside the lower eyelid. It avoids any scarring on the lower lid. It is a useful technique when only fat, and not skin or muscle, needs to be removed from the eyelid area.

Source: American Society of Plastic Surgeons