Thank you for your interest in plastic surgery. The Palm Harbor Plastic Surgery Centre, a group of three board certified plastic surgeons are dedicated to meeting your informational needs. Wading through the pool of terms associated with the profession of plastic surgery can be confusing. This resource guide is designed to help simplify your efforts.  Be sure to go to our what's new page for more detailed information as it relates to breaking news events in plastic surgery.

The Palm Harbor Plastic Surgery Media Department is also an excellent plastic surgery resource. It is comprised of our surgeons, highly specialized nursing and support staff who have been trained to assist you in developing your stories. Please contact our communications Department by telephone at 727-789-5711, via e-mail at media@phpsc.com or fax at 727-789-4098 if you would like to reach a member of our staff.

Definitions:

Cosmetic vs. Reconstructive Surgery
Although the outward effects may be similar or even identical, the terms cosmetic and reconstructive surgery are not interchangeable. The plastic surgeon performs cosmetic surgery to reshape normal structures of the face or body in order to improve the patient’s appearance and self-esteem. Reconstructive surgery is performed to correct abnormalities of facial or body structures caused by congenital defects, developmental abnormalities, injuries, previous or concurrent surgeries, infection, tumors or other disease. The purpose of reconstructive surgery is generally to improve function, but it may also be used to restore a normal appearance.

These distinctions have implications for insurance coverage. Nearly all insurance carriers cover reconstructive procedures for functional restoration, but not those performed purely for cosmetic reasons. In general, the classification as cosmetic or reconstructive depends upon the reason that the surgery is performed. For example, rhinoplasty to change the shape of the nose is considered cosmetic. However, rhinoplasty to change the shape of the nose following traumatic deformity is reconstructive.

Corrective surgery to remove or minimize the effects of scarring usually provides cosmetic improvement. Insurance carriers, however, may recognize these procedures as reconstructive in nature because scars are abnormal formations that develop on the body as a result of injury or illness.

Origins of Cosmetic Surgery
Cosmetic surgical techniques originally evolved from reconstructive procedures, and some techniques are the same, whether they are used for cosmetic or reconstructive purposes.

Suction-assisted lipectomy, commonly known as liposuction, is a procedure used to remove lipomas (fatty tumors), defat flaps and remove fatty deposits in various reconstructive procedures, but it has a much wider application as a cosmetic technique to streamline the body by suctioning away localized deposits of unwanted fat.

Many other procedures that today are more widely used to enhance appearance began as solutions to reconstructive problems. The relationship between the two types of procedures is so close that surgeons well-versed in reconstructive procedures are most likely to also have the background and training required for cosmetic surgery.

Background on Common Procedures
The following descriptions provide basic information on the most common reconstructive and aesthetic surgical procedures. 

Abdominoplasty (Tummy-Tucks)
A tummy-tuck is a major surgical procedure to flatten the abdomen by removing excess skin and fat from the lower abdominal region and tightening the muscles of the abdominal wall. The best candidates for tummy-tucks or abdominoplasty, are men or women who are in relatively good shape but who are bothered by large fat deposits or loose abdominal skin that won’t respond to diet or exercise. The surgery is particularly helpful to women who, through multiple pregnancies, have stretched their abdominal muscles and skin beyond the point where they can return to normal. Loss of skin elasticity in older patients, which frequently occurs with slight obesity, can also be improved.

Complete abdominoplasty usually takes two to three hours, depending on the extent of work required. Partial abdominoplasty may take an hour or two. Most commonly, the surgeon will make a long incision from hipbone to hipbone, just above the pelvic area. A second incision is made to free the navel from surrounding tissue. With partial abdominoplasty, the incision is much shorter and the navel may not be moved, although it may be pulled into an unnatural shape as the skin is tightened and stitched.

Next, the surgeon separates the skin from the abdominal wall all the way up to the ribs and lifts a large skin flap to reveal the vertical muscles in your abdomen. These muscles are tightened by pulling them close together and stitching them into their new position. This provides a firmer abdominal wall and narrows the waistline.

The skin flap is then stretched down and the extra skin is removed. A new hole is cut for the navel, which is then stitched in place. Finally, the incisions will be stitched, dressings will be applied, and a temporary tube may be inserted to drain excess fluid from the surgical site.

For the first few days after surgery, the abdomen will probably be swollen and some pain and discomfort may occur which can be controlled by medication. Depending on the extent of the surgery, the patient may be released within a few hours or remain hospitalized for two to three days.

The doctor will give instructions for showering and changing. And though it may be difficult to stand at first, walking as soon as possible is suggested.

Surface stitches will be removed in five to seven days, and deeper sutures will come out in two to three weeks. The dressing on the incision may be replaced by a support garment.

Breast Augmentation
Breast augmentation is performed to balance a difference in breast size, improve body contour or as a post-surgery reconstructive technique. Silicone shells filled with saline solution are implanted either directly under the breast tissue or beneath the chest wall muscle, giving breasts a fuller and more natural contour.

While a relatively straight surgical procedure, there can be discomfort associated with breast augmentation, such as scar tissue around the implant tightening over time. This tightening, known as capsular contracture, sometimes can be remedied by removing or scoring the scar tissue.

The methods for inserting and positioning implants depend on the patient’s anatomy and doctor recommendations. Incisions are made in an inconspicuous an area as possible – usually the armpit, around the areola (nipple area), or under the breast itself – to minimize visible scarring. Working through these incisions, the doctor lifts the breast tissue and inserts the implant. It is then centered beneath the nipple, either under or above the pectoral muscle. Possible risks include bleeding, infection, wound disruption, scarring, capsular contracture, sensory change or loss and implant rupture or failure.

After a post-surgical recovery period of 24 to 48 hours and an additional reduced-activity period of a few days, patients will likely experience soreness and swelling for a few weeks. Exercise and normal activity can resume at the direction of the surgeon.

Breast Reconstruction
Breast reconstruction is performed on mastectomy patients, allowing women who have lost breasts to cancer to preserve their natural profile and aid in their psychological healing. Breast reconstruction surgery is an effective way to rebuild the breast.

After the doctor assesses a patient’s situation, he or she explains surgical options appropriate for the patient’s age, health, and goals for appearance. Most cases of reconstruction will require more than one operation, but the process can begin right after the mastectomy has been performed. This can spare the patient some trauma associated with loss of the breast.

Depending on the surgeon’s evaluation of the many factors affecting a patient’s case, he or she can use a variety of techniques to reconstruct the breast. The most common technique combines gradual expansion of chest tissue (commonly called the tissue expansion technique) with the use of breast implants. With skin expansion, a balloon expander is inserted beneath the skin and is inflated with injections of salt-water solution over a period of weeks. After the breast area is sufficiently stretched, the expander is removed and replaced with a permanent implant. The nipple is then reconstructed in a subsequent procedure.

An alternative to skin expansion is the flap reconstruction technique. This involves creation of a skin flap using tissue taken from another part of the body such as the abdomen or back. The flap is attached to the chest area to create a pocket for an implant or used to build up an actual breast mound.

Flap surgery allows for single-stage breast reconstruction, which may allow some women to wake from their mastectomy surgeries with a fully reconstructed breast, rather than having to undergo several stages of reconstructive surgery.

After completion of the reconstruction process, doctors may recommend further operations on the healthy breast to match it to the re-built one. The ultimate result helps restore the patient’s physical appearance and improve her self-confidence.

Breast Reduction
Techniques for breast reduction vary, but the most common procedure involves an anchor-shaped incision that circles the areola, extends downward, and follows the natural curve of the crease beneath the breasts. The surgeon removes excess glandular tissue, fat, and skin, and moves the nipple and areola into their new position. He or she then brings the skin from both sides of the breast down and around the areola, shaping the new contour of the breast. Liposuction may be used to remove excess fat from the armpit area. In most cases, the nipples remain attached to their blood vessels and nerves. However, if the breasts are very large or pendulous, the nipples and areolas may have to be completely removed and grafted into a higher position. (This will result in a loss of sensation in the nipple and areolar tissue.)

Stitches are usually located around the areola, in a vertical line extending downward, and along the lower crease of the breast. In some cases, techniques can be used that eliminate the vertical part of the scar. And occasionally, when only fat needs to be removed, liposuction alone can be used to reduce breast size, leaving minimal scars.

After surgery, the patient will be wrapped in an elastic bandage or a surgical bra over gauze dressings. A small tube may be placed in each breast to drain off blood and fluids for the first day or two. Some pain might occur for the first couple of days--especially when moving around or coughing-- and some discomfort for a week or more. The surgeon will prescribe medication to lessen the pain.

The bandages will be removed a day or two after surgery, though the patient will continue wearing the surgical bra around the clock for several weeks, until the swelling and bruising subside. The stitches will be removed in one to three weeks.

Chemical Peel
The chemical peel is a non-invasive technique that is designed to restore wrinkled, blemished, unevenly pigmented or sun-damaged facial skin. Using a chemical solution usually of phenol, trichloroacetic acid or alpha-hydroxy (fruit acid), the skin’s top layers are peeled away, allowing for new cells to grow that produce a smoother, tighter, younger-looking skin surface.

Phenol -- Phenol is the strongest of the chemical peel solutions. It is mainly used to treat patients who have blotches on the skin caused by pregnancy, sun exposure, birth-control pills or illness, or on people with coarse facial wrinkles, severe sun damage or pre-cancerous growths. Because it lightens the treated areas of the skin, phenol is most often used for full-face peels. However, in patients with fair, unfreckled skin, phenol can be used on specific facial regions, where the contrast with the untreated areas won’t be obvious. Phenol is used primarily on the face, scarring may result if it is applied elsewhere.

Trichloracetic Acid (TCA) – TCA peels employ a milder chemical formula than phenol peels. A TCA peel is used primarily to treat fine surface wrinkles, superficial blemishes or pigment problems. Because TCA peels do not produce the same bleaching effect as phenol peels, they may be preferred by darker-skinned patients for partial peels on specific regions of the face. The results of a TCA peel are usually less dramatic and much shorter-lasting than those gained from a phenol peel. In fact, sometimes more than one TCA treatment may be needed to achieve the desired result. However, a TCA peel treatment requires less time than a phenol peel, and the recovery from a TCA peel is usually shorter than with a phenol peel.

Glycolic Acid -- Is the mildest of the peel formulas. This type of peel, sometimes called an alpha-hydroxy acid peel or “fruity” acid peel, can provide smoother brighter-looking skin in people who can’t spare the time needed to recover from a phenol or TCA peel. Patients who have glycolic acid peels are usually seeking only a fresher look and have only minor skin problems, such as fine wrinkling, areas of dryness or uneven pigmentation. When glycolic acid is applied to the face at a concentration of about 70 percent, it is considered a “peel,” even though the acid solution doesn’t penetrate the skin as deeply as it does for a phenol or TCA peel. Treatments are usually performed in a series – perhaps one peel a week for about six weeks. Glycolic acid can also be mixed with facial wash or cream at a concentration of about 10-14 percent and used as part of a daily skin-care routine to improve the skin’s texture.

Because chemical peels involve some risks and long-term considerations regarding exposure to the sun, prospective patients should take care to find a properly-trained plastic surgeon. After the patient’s preparation for surgery, which may involve several weeks’ use of Retin-A or fruit acid on the area to be treated, the doctor will apply the chemical solution to the skin area to be treated. The chemicals will usually cause a stinging sensation, depending on which solution is used. After the treatment, which can last up to two hours for a full-face treatment, the doctor applies petroleum jelly or another occlusive compound to help with the healing process.

After the peel, patients should expect considerable swelling. After seven to ten days the swelling subsides and new skin begins to form. Complete maturation of the new skin and lightening of the pinkness may take up to six months when using phenol, and patients must take care to avoid exposure to direct sunlight as it can cause blotching on the treated area. During recovery, patients maintain a regime of medication to speed healing and can apply makeup to camouflage the treated area.

Cleft Lip and Palate Surgery
A child born with a separation in the upper lip is said to have a cleft lip; a similar separation in the roof of the mouth is called a cleft palate. One of every 800 babies is born with one of these congenital deformities. Medical professionals have made great advances in treating children born with clefts, allowing patients to lead normal, healthy lives. In repairing a cleft lip or palate, plastic surgeons work with other specialists to address the medical and psychological concerns a patient can face. This cleft lip and palate team may consist of a plastic surgeon, a pediatrician, a dentist, a speech and language specialist, a social worker, a hearing specialist, an ear-nose-and-throat specialist, a psychologist, a nurse and a genetic counselor.

The most common initial difficulty of cleft lip or palate surgery is asymmetry, when one side of the mouth and nose does not align with the other side. The objective is to either close the separation in the patient’s lip or the opening in the roof of the mouth, allowing proper speech and eating while improving physical appearance.

Of prime importance in these surgical procedures is timeliness – most often, cleft lip surgery is performed when the child is about 10 weeks old. Cleft palate repairs are done before the child begins speaking. Repairs involve making incisions on either side of the cleft, then drawing the tissue together and stitching it into a normal position.

After surgery, the resources of the other cleft lip and palate team members are utilized by helping young patients with eating and speaking, monitoring their healing and ensuring a healthy recovery.

Endoscopic Plastic Surgery
Endoscopy is a surgical technique using a special instrument – an endoscope – which allows the surgeon to see inside the body via small incisions. A long-used technique in a number of medical procedures such as orthopedic surgery, endoscopy is now being successfully employed by plastic surgeons. While further testing is required to establish the effectiveness of endoscopic surgery, it is being used on a limited basis for both aesthetic and reconstructive procedures.

The endoscope, a tubular probe fitted with a small camera and tiny light, transmits video images of the body’s internal structures to a television monitor in the operating room. The endoscope is exclusively a viewing device, giving the surgeon a detailed look at the part of the body he or she will then operate on with special instruments such as scalpels or forceps.

Due to its minute entrance point, usually less that one inch in length, endoscopic surgery often means small, barely noticeable incisions and scars. Shorter incisions may also mean less risk of nerve damage, minimal bleeding and swelling and potentially quicker recovery time.

Some of the aesthetic procedures being performed today already benefit from the advantages of endoscopic surgery. These include abdominoplasty (tummy-tucks), breast augmentation, facelifts and forehead lifts. The technique also benefits reconstructive procedures such as flap surgery, placement of tissue expanders, sinus surgery and carpal tunnel release.

Eyelid Surgery (Blepharoplasty)
Eyelid surgery is a procedure to remove fat, and sometimes excess skin and muscle, from the upper and lower eyelids. It is used to correct drooping upper lids and puffy bags below the eyes that can make a prospective patient look older and tired. It is not, however, a corrective procedure for crow’s feet, other wrinkles, dark circles under the eyes or sagging eyebrows. It is simply used to remedy the sagging skin and weakened muscles that occur around the eyes over time. It is important that patients check with a qualified plastic surgeon and an ophthalmologist to evaluate possible surgical difficulties that could be caused by existing medical conditions such as low tearing, high blood pressure, glaucoma or a detached retina.

Patients can expect a one to three hour procedure consisting of the surgeon making incisions above and below the eye tissue. These incisions follow the natural folds of the eye and allow the surgeon to separate the underlying fatty tissue and muscle. The surgeon then removes the fat and often trims the sagging skin and muscle.
After surgery, the patient’s head is kept elevated and cold compresses are applied to the treated area to reduce swelling and bruising. Initial recovery takes anywhere from two weeks to one month, with discomfort subsiding gradually to reveal a youthful, more alert look after just a couple of weeks. The complete healing process takes up to six months as scars slowly fade to thin, nearly-invisible white lines.

Facelift
A facelift is a surgical procedure designed to reduce the visible signs of aging such as creases in the face, slackness in the jawline and accumulation of fat around the neck. Most patients who consider facelifts are in their 40s to 60s but it can be successfully performed on people in their 70s and 80s as well.

Surgeons have different approaches to facelift techniques, so it is important that the patient work with a qualified, experienced surgeon with whose technique they feel comfortable. A facelift usually takes several hours. The surgeon usually begins by making small incisions above the hairline at the temple, extended in a natural line in front of the ear and following down to the bottom of the ear, around the earlobe and into the hairline behind the ear. The skin is then separated from the muscle below and pulled back. The surgeon then trims the excess tissue and tightens the underlying muscle; stitches, then secures the layers of tissue and closes the incisions. Surgeons will also often wrap the head loosely with bandages to minimize bruising and swelling, although facelift surgery does not usually cause too much discomfort. Any resulting scars from the surgery can usually be hidden under the hairline or in the natural creases of the face so long-term evidence of the surgery is relatively invisible.

During the recovery, it is important to follow surgeon’s guidelines for appropriate activity, diet and exposure to the sun. Usually, the recuperation requires plenty of rest, and minimal time in the sun for several months is suggested. After one to five days, the bandages are removed. Stitches soon follow and, in a few weeks, swelling and puffiness subside to reveal a younger-looking face.

Hair Replacement Surgery
Whether due to aging, hormonal change, or circumstances such as burns or trauma, hair loss can often be remedied by hair transplants.

Performed for more than three decades on both men and women, hair replacement surgery utilizes existing hair to fill in bald areas. Several surgical sessions may be needed to achieve the level of hair fullness desired by the patient. The sessions may consist of grafting hair from the donor area to the thinning area, expanding hair-bearing tissue over the bald area directly or using tiny “plugs” of follicles to restore the hairline. It is essential that candidates for this procedure have healthy hair growth on other parts of the head to serve as donor areas. While many factors, such as hair texture or color can contribute to the aesthetic result of a transplant, there are several transplant techniques that can be used to improve the hair’s fullness and head coverage.

While hair replacement is normally a safe procedure, individual reactions to the techniques can vary. The outcome is never completely predictable, so it is essential that a prospective patient discuss the options with a qualified plastic surgeon in order to be certain of the most appropriate approach. Furthermore, the patient should find a doctor who is familiar with the many different replacement techniques to be certain he or she will find the one best-suited to satisfying his or her hair-replacement needs.

Surgeons watch patients closely during the recovery period, helping to ensure healthy scalp circulation and skin strength. While follow-up procedures are usually required, the ultimate result should be new hair growing in a previously bald area at the rate of about a half-inch per month.

Hand Surgery
A delicate and specialized surgical procedure, hand surgery has greatly advanced in recent years in part due to the expertise of plastic surgeons. Treatments for patients with injuries, degenerative disorders and birth defects of the hand have become increasingly improved, benefiting both the function and the appearance of the hand.

Techniques being used by surgeons in hand surgery include grafting (transfer of skin, bone or nerve tissue from other parts of the body), flap surgery (moving skin from a healthy site to a damaged site) and replantation (the restoration of accidental finger or hand amputations using microsurgery). All of these approaches are used to repair injuries to tendons, nerves, bones and damage caused by burns, cuts or other severe trauma.

Another increasingly common ailment remedied by hand surgery is carpal tunnel syndrome. When pressure builds up in the carpal tunnel of the wrist, nerves in the tunnel can be subject to tension that causes tingling in the hands. Cutting away the tissue and compressing the nerve can relieve the symptoms.

Rheumatoid arthritis, an inflammation of the hand’s joints, may also be repairable by hand surgery. Surgeons can repair or reconstruct almost any area of the hand or wrist by removing the inflamed tissue and repositioning tendons or even implanting artificial joints. This may result in a considerable improvement in hand function, appearance and comfort.

Surgery can also reverse the effects of Dupuytren’s contracture, a disorder of the hand’s skin that occurs when thick, scar-like tissue forms under the palm. If not treated, Dupuytren’s contracture can extend to the fingers, pulling them toward the palm and restricting motion. Surgeons can cut out the bands of thickened tissue, freeing tendons for better finger movement and may occasionally graft new skin over the repaired areas to restore normal appearance. Hand surgery can also correct birth defects of the hand such as fused, short or deformed fingers.

Because of the hand’s extreme sensitivity, surgeons will often recommend a regime of rehabilitation to speed healing and maximize hand function. The end result is a hand of maximally restored physical appearance and optimal dexterity.

Laser Skin Resurfacing
Men and women of all ages can benefit from laser resurfacing. The ideal patient for this procedure has fair, healthy, non-oily skin. Patients with olive skin, brown skin or black skin may be at increased risk for pigmentation changes no matter what type of resurfacing method is recommended. The plastic surgeon will evaluate the patient’s skin characteristics and make recommendations accordingly.

Also, individuals who have taken accutane in the past 12-18 months or are prone to abnormal (keloid-like) scarring, or those with active skin infections on the treatment area, may not be appropriate candidates for this procedure.

Having laser resurfacing can help enhance the patient’s appearance and self-confidence, but it won’t completely remove all facial flaws or prevent aging.

Laser surgery is a relatively quick procedure. It usually takes anywhere from a few minutes to one and a half hours, depending on how large of an area is involved. When the imperfections are especially deep, the surgeon may recommend that the resurfacing be performed in two or more stages.

During the procedure, the activated laser is carefully passed back and forth over the skin until the surgeon reaches the level that will make the wrinkle or scar less visible.

When the procedure is over, the surgeon may choose to treat the resurfaced skin with applications of protective creams or ointments until healing is complete. Some surgeons choose to apply a bandage over the treated areas, which will cover and protect the healing skin for the first five to ten days.

Liposuction
Liposuction is a technique to remove unwanted fat deposits from specific areas of the body such as the face, abdomen, buttocks, thighs, and elsewhere. It is not a substitute for weight reduction, but a way to remove localized fat that is unresponsive to diet and exercise.

In the procedure, surgeons make an incision in the area to be treated just large enough for the insertion of a hollow tube called a cannula. The cannula is attached to a machine that creates a strong vacuum and is then manipulated by the surgeon deep within the fat layers of the patient’s skin. The vacuum breaks up the fat and sucks it out from under the skin. Sometimes several incisions are made to allow the surgeon complete access to the fat deposits in the area being treated. Patients must realize that, in addition to fat deposits, they also lose body fluid in the procedure. Because of this, patients are given fluids intravenously during the operation; they may also need a blood transfusion.

After the operation, patients can expect a recovery period of up to three weeks. During this time, patients will likely have to wear a body-compression garment on the treated area; this helps minimize the swelling and fluid accumulation. The post-operative effects subside quickly, however, and the result is a slimmer physique that can increase a patient’s comfort and self-confidence.

Skin Cancer Removal
With more than 500,000 new cases reported each year, skin cancer is the most common form of cancer in the United States. More than 80 percent of these cases occur on the face, head or neck, where they can be disfiguring, as well as dangerous. Caused primarily by ultraviolet radiation, skin cancer can affect anyone, particularly those with fair skin, people with a family history of skin cancer and those who spend a lot of time outdoors.

The two most common types of skin cancer include basal cell carcinoma and squamous cell carcinoma, however if caught early enough they have a 95 percent cure rate. Malignant melanoma is the most dangerous and potentially deadly form of skin cancer. Other, non-cancerous skin growths include moles (heavily pigmented clusters of skin cells), and solar or actinic keratoses (rough, red or brown scaly patches of skin). While benign, these growths can become cancerous if subjected to constant irritants. The key to recognizing the various types of skin cancer and growths is regular examination of the skin; unusual changes should be checked by a doctor.

A doctor can diagnose skin cancer by removing samples of a growth and examining the cells under a microscope. Once determined to be cancerous, the growths can be surgically removed by a plastic surgeon. The procedure usually leaves no more than a thin, barely visible scar. Only in very extreme cases, such as a large tumor in a difficult to reach area or widespread growth to the lymph glands, is major surgery required in skin-cancer cases. After surgery, reconstructive techniques can repair scarred tissue or rebuild body parts to restore a patient’s physical appearance.

Surgery of the Ear
Ear surgery, or otoplasty, is usually done to set prominent ears closer to the head or to reduce the size of large ears. Ear surgery can also replace ears lost due to injury or correct ear problems such as awkward folding, unusual smallness or absence of natural folds and curves. When performed by an experienced, qualified surgeon, complications in ear surgery are infrequent and usually minor.

The operation usually takes two to three hours and requires the surgeon to make a small incision behind the ear to expose ear cartilage. The cartilage is then sculpted to bend the ear back toward the head. An alternative technique involves folding the cartilage back onto itself, allowing the ear to reshape itself without removal of the cartilage. To pin the ears back, surgeons can sew non-removable stitches concealed behind the ear.

Ear surgery does not usually require an overnight hospital stay, and patients can be up and around within a few hours after the procedure is completed. Patients might experience a mild ache for a few days after surgery, but it usually can be remedied with medication. The overall recovery time is about five days for adults and seven days for children. After this time, they can return to work or school, taking care to avoid bending their ears for about a month.

Surgery of the Nose
Nose surgery, or rhinoplasty, can enhance appearance and self-confidence, but it won’t necessarily change looks to match the ideal. The best candidates for rhinoplasty are people who are looking for improvement, not perfection, in the way they look. Age may also be a consideration. Many surgeons prefer not to operate on teenagers until after they’ve completed their growth spurt--- around 14 or 15 for girls, a bit later for boys.

Rhinoplasty usually takes an hour or two, though complicated procedures may take longer. During surgery the skin of the nose is separated from its supporting framework of bone and cartilage, which is then sculpted to the desired shape. The nature of the sculpting will depend on your problem and your surgeon’s preferred technique. Finally, the skin is redraped over the new framework.

Many plastic surgeons perform rhinoplasty from within the nose, making their incision inside the nostrils. Others prefer an “open” procedure, especially in more complicated cases; they make a small incision across the columella, the vertical strip of tissue separating the nostrils.

When the surgery is complete, a splint will be applied to help your nose maintain its new shape. Nasal packs or soft plastic splints also may be placed in your nostrils to stabilize the septum, the dividing wall between the air passages.

Tissue Expansion
Tissue expansion is a procedure that allows the body to produce extra skin for use in other operations. A silicone balloon expander is inserted under the skin near the part of the body to be repaired and gradually filled with salt water over a period of time. This causes the skin around the balloon to stretch and grow, restoring natural appearance to the reconstructed area.

The advantages of tissue expansion include: a near perfect match of the treated area’s color; texture and hair-bearing qualities; continuous connection to the donor area’s blood and nerve supply; and often less scarring. Tissue expansion’s initial drawback is that the balloon insertion is often visible for periods ranging from several weeks to several months (generally the amount of time required to successfully stretch the tissue).

Despite this short-term drawback, however, tissue expansion remains one of the best ways to reconstruct damaged tissue. The operation to insert the balloon expander takes less than two hours. After the balloon has been filled with salt-water injections, it is removed and the new tissue is put in place during a follow-up procedure. The temporary discomfort resulting from the insertion or removal from the final process usually occurs within one to two weeks.
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