OTHER SPECIALTIES
Hyperhidrosis, Lip Augmentation, Scar Revision, Dermabrasion, Gluteal Augmentation, Fat Transfer, Hand Rejuvenation, Facial Implants, Skin Lesions and Labioplasty
- Hyperhidrosis (Excessive Perspiration)
Men and women whose lifestyles or careers require being in close proximity with clients or shaking hands frequently know the embarrassment that sweaty palms or underarm odor can cause. Thankfully, in addition to reducing lines on the face, BOTOX® is extremely effective in treating excessive perspiration, or hyperhidrosis. Excessive sweating of the forehead, armpits, palms of the hands, or soles of the feet is a common problem with no permanent solution, but BOTOX injections provide a temporary solution. When used for hyperhidrosis, BOTOX can effectively reduce perspiration for approximately one year. Laser-assisted lipolysis devices are also being used as an FDA off-label application to try to permanently treat axillary (underarm) sweating. However, published studies on the effectiveness of these new treatments are still pending.
- Lip Augmentation
Lip augmentation creates fuller, plumper lips and reduces fine wrinkles around the mouth. Patients who request lip augmentation either want fuller lips than they were born with or want to restore the fullness they enjoyed when younger. Augmentation can enhance the red part of the lips (vermillion) and accentuate the thin white roll of tissue surrounding the lips.
Most patients choose injected tissue fillers for lip augmentation. The most popular fillers contain either natural materials (collagen) or synthetic biocompatible materials (Juvéderm™ and Restylane®). Alternatively, fat from another site in the patient’s own body can be used. One treatment is usually sufficient to produce the desired result, but the amount of augmentation diminishes over time. The amount of time the result lasts varies with different injectable materials.
Tissue filler injections are done in the office and typically have little downtime, though there may be some redness, mild swelling, or itching. Most patients leave the office and continue their normal daily activities. Injections with Restylane and fat are more likely to cause lip swelling, which typically diminishes after one or two days with Restylane and within a week after fat injection.
Another option for lip augmentation is to use a longer-lasting material that is implanted, rather than injected, into the lips. These materials gradually become integrated into the surrounding tissue. Products such as AlloDerm® and Surgisis® are a natural collagen matrix processed from donated human skin or animal tissue. The most commonly used synthetic implants, like SoftForm™ and Advanta™, are made from expanded polytetrafluoroethylene (ePTFE). These implantable products come in the form of a tube that Dr. Centeno inserts with a small, specialized tool. The procedure is done in the office under local anesthesia and mild sedation.
Proper placement of an implanted material is important and requires skill to reduce the chance of lip asymmetry. Because AlloDerm and Surgisis are natural products, the risk of developing a foreign-body reaction or rejection is extremely low. Synthetic implants are usually well tolerated by the body but may become infected. Any implanted material may shift its position, become palpable, or extrude through the skin, though these problems are extremely rare.
Patients undergoing a facelift who also desire lip augmentation can have both procedures completed at the same time. A good option in this case is to take residual subcutaneous tissue removed during a facelift and implant it in the lips. The results are long-lasting and the tissue is especially useful for adding volume to the vermillion (red part of the lips).
Recovery after lip augmentation with an implant is usually four to five days until swelling and redness disappear. The lips will be tender and stiff for a few weeks, especially if synthetic products are used.
- Excision of Skin Lesions
Many people are born with moles or develop skin growths as they age. Most of these, such as skin tags or lipomas (soft, moveable nodules beneath the skin) are unsightly or uncomfortable, but otherwise harmless. If you find these types of lesions bothersome, Dr. Centeno can easily remove them in our office, in most cases. Dr. Centeno biopsies all excised skin growth to provide a definitive diagnosis and to make sure it is not cancerous.
Unfortunately, the frequency of skin cancer caused by sun exposure is increasing. Any type of new skin growth, change in a mole, or other skin lesion should be checked by a physician to help you decide whether it should be excised. A skin condition called actinic keratoses is a relatively common, precancerous condition that is easily treated in our office. Other common forms of skin cancer are squamous cell and basal cell carcinoma, which Dr. Centeno sees frequently. The most serious form of skin cancer, melanoma, requires additional treatment by a cancer specialist (oncologist) following its removal.
Skin cancers tend to form on the face or other visible parts of the body that are frequently exposed to the sun. By employing a plastic surgeon to remove these lesions, you can be assured that it will leave the least visible scar. A biopsy will determine if all the malignant growth has been removed. If not, additional excision will be necessary. The longer you wait to get a skin lesion removed, the larger it may become. A larger excision is more likely to leave a larger scar.
- Hand Rejuvenation
Hands can reveal age even more readily than the face. Some patients choose to undergo hand rejuvenation at the same time they have a facelift or other facial procedure so that their hands better match the youthful look of the face. Saint Croix Plastic Surgery & MediSpa offers you several levels of treatment for rejuvenating your hands. Our MediSpa offers products that can improve dark spots, or hyperpigmentation, caused by sun damage. More severe sun damage may require a TCA (trichloracetic acid) chemical peel or laser pulsed light phototherapy treatment. Injections of a tissue filler (such as Sculptra™) or fat transferred from another area of the body effectively restores lost volume and helps conceal veins and tendons that become more noticeable as we age. Additionally, the prominent veins of the hands can be treated with a laser to make them less visible.
- Scar Revision
Dr. Centeno is experienced in revising scars to make them less noticeable, regardless of whether the scar resulted from injury or a surgical procedure. Not all scars can be improved by revision, but most can, with either minor surgery or another type of treatment.
- Facial Implants and Chin Enhancement
Chin surgery, also known as mentoplasty, is a surgical procedure that reshapes the chin either by enhancing it with an implant (chin augmentation) or reducing and recontouring the bone (chin reduction). Because the size of the chin may magnify or minimize the perceived size of the nose, a chin procedure is sometimes recommended in combination with nose reshaping to achieve better facial proportions.
In addition to being used in the chin, facial implants can refine the line of the jaw, produce higher cheekbones, and recontour the nose. They can be implanted for cosmetic or reconstructive purposes. In either case, carefully shaped implants change the basic contour and balance of the face by building up a receding chin, adding prominence to cheekbones, reshaping the nose, or creating a stronger jaw line. The result is a more harmonious balance to your facial features. Facial implants in a range of sizes and styles, and manufactured with a variety of materials have been approved by the FDA for many decades. Dr. Centeno can help you decide which implant type is right for you.
Insertion of an implant is similar for all facial areas. Dr. Centeno makes a small incision near where the implant will be placed, either in a natural facial crease or inside the mouth or nose. A pocket is made in the facial tissue, the implant is inserted, and the incision is closed with stitches and then bandaged or taped. Many patients choose to have facial implants placed at the time of another procedure, such as a facelift. In these cases, implants can usually be inserted through the same incision(s) required for the other facial surgery.
Following surgery, you will experience some discomfort and swelling in the affected area for several days. It’s normal to experience some temporary difficulty with smiling and talking, and bruising may be visible around the implanted area. Dr. Centeno will instruct you about restrictions related to diet, dental hygiene, or activities.
Facial implants can produce some remarkable changes, and you may not be able to accurately evaluate your results for weeks, or perhaps even months. Give yourself plenty of time to get used to your new look. You may be surprised to find that most people won’t realize that you had facial implant surgery, but they will notice a positive change.
- Dermabrasion
Dermabrasion is a procedure used to make flaws in the skin less visible. It is most often performed to improve the look of facial skin left scarred by accidents, acne or previous surgery, or to smooth out fine facial wrinkles, such as those around the mouth. It can also remove pre-cancerous growths called keratoses. Dermabrasion involves a mechanical abrasion of the top layers of skin using a high-speed rotary wheel to “refinish” the skin’s surface. The abrasion continues until the surgeon reaches the safest level needed to achieve the desired result. Small areas of skin or an entire aesthetic unit may be treated. Dermabrasion can be done alone or in conjunction with other procedures such as a facelift or scar revision.
Dermabrasion usually takes from a few minutes to one hour, depending on the size of the area being treated. It is not uncommon for the procedure to be performed more than once, in stages, especially when scarring is deep or a large area of skin is involved.
Immediately after the procedure, your skin will be red and swollen, and eating and talking may be difficult. You will probably feel some tingling, burning, or aching, all of which can be controlled with medications prescribed by your Dr. Centeno. The swelling will begin to subside in a few days to a week.
As with all skin abrasions, a scab or crust will form over the treated area as it begins to heal. This will fall off as a new layer of tight, pink skin forms underneath. Your face may itch as new skin starts to grow, and your surgeon may recommend an ointment to help you to be more comfortable. If ointment is applied immediately after surgery, little or no scab will form.
Your new skin will be a bit swollen, sensitive, and bright pink for several weeks. During this time, you can gradually resume normal activities and return to work after about two weeks. The pinkness of your skin will take about three months to fade. Sun protection is very important until pigment has returned to your skin, which may take as long as six to twelve months.
- Labioplasty (Labial Reduction)
Labioplasty (also called labial reduction or labiaplasty) recontours the labia–the folds of skin or “lips” that surround the entrance to the vagina. Although this procedure has just recently received more coverage in the popular press, it has been around for decades and is growing in popularity. Labioplasty is not likely to be a topic of much conversation because the appearance of one’s genitalia is extremely private and personal. However, women who have enlarged or uneven labia are thrilled to learn that a relatively simple procedure can reduce the size, improve the symmetry, and improve the contour of the labia.
Large and/or irregular genital labia sometimes develop naturally, but deformities also can result from the stretching of childbirth or sexual intercourse, as well as aging and hormonal changes. Most women who seek labial reduction have enlarged labia minora (the “lips” nearer the vaginal opening), which may be larger or longer than the labia majora (outer “lips”). Others have labia that are unequal in size or contour (asymmetry).
Enlarged or uneven labia can cause self-consciousness and discomfort during sex or even sexual avoidance. Difficulty keeping the genital area clean and irritation caused by the two “lips” rubbing together are other problems reported by some women. Rarely, oversized labia may be visible in tight-fitting clothing or swimsuits. More often, overly large or long labia are uncomfortable when wearing certain types of pants or participating in activities such as biking or jogging. Every woman’s external genital anatomy differs somewhat, so the type of labioplasty procedure needed will depend on your unique issues, what you hope to achieve, and your anatomy.
Several techniques are available for labial reduction, and the most appropriate one will depend on your genital anatomy. All the techniques involve removing excess tissue through a small incision that permits the labia minora size and contour to be trimmed. Any existing asymmetry will be corrected at the same time.
An incision is typically made along the outer edge of the labia minora (the edge furthest away from the vaginal opening). If both the right and left labia are recontoured, two incisions are required. Once the excess tissue is removed, the incision is closed with absorbable sutures that do not have to be removed.
Only mild to moderate discomfort follows labioplasty for a day or two, and a quick recovery from this outpatient procedure is typical. You will be able to walk and bathe immediately, though some swelling should be expected. The swelling usually peaks two or three days after surgery and then begins to disappear. By three weeks after surgery, swelling should be gone. Labial sensation should not be altered by labioplasty.
Most women are able to drive and return to work two or three days after labial reduction. Strenuous activity should be avoided for three weeks, or about the time when all swelling has diminished. After three weeks, you can resume all your normal activities, including sexual intercourse and exercise. During the three-week period of healing, do not use tampons or douches in order to make sure the surgical area heals properly.
- Gluteal (Buttock) Augmentation
While many people would rather have smaller buttocks, others wish to enhance their flat or sagging “behinds” or improve the contour and projection of the gluteal area. At Saint Croix Plastic Surgery & MediSpa, Dr. Centeno can create either smaller or larger butts, depending on your preference.
Gluteal augmentation has gained popularity in the last decade to reflect changing tastes in body types. Curvier models have replaced the ultra thin, and fashions that emphasize a shapely and rounded backside are now mainstream.
Enhancement of the gluteal region is requested by a variety of people, including younger women and men who are unhappy with flat buttocks, women in their 30’s and 40’s who have noticed their buttocks sagging or drooping as gravity takes it toll, and people who have lost a significant amount of weight and are left with unnaturally flattened buttocks and excess skin. With gluteal augmentation, additional volume gives the buttocks better proportion with the rest of the body. Your shape is curvier and clothes fit better.
Four options are available for augmenting the buttocks:
- gluteal implants
- fat transfer from another body area
- shaping your existing buttock tissue into a more pleasing contour
- liposuction of surrounding areas
Gluteal Implants. A variety of shaped implants are available. The principle is the same as with breast augmentation, but these implants are solid rather than having a saline or silicone gel filler. Gluteal implants can add the greatest volume, projection, and defined shape to the buttocks. However, because gluteal implantation has a higher rate of complications, this technique is reserved for select patients.
Fat Transfer. Another option for gluteal augmentation is fat transfer, which is especially attractive for people who have excess fat in other areas of the body, like the abdomen or thighs. In a single surgery, excess fat from selected areas is removed with liposuction, concentrated and processed with special equipment, and then injected into the buttocks to add volume and better contour. Because 30% to 50% of the transferred fat will be reabsorbed by the body, more fat than is needed is initially transferred to the buttocks to compensate for what will be lost. After two to three months, the final result of the gluteal augmentation should be apparent. If additional volume is still needed, touch-up fat injections can be performed in Dr. Centeno’s office. Fat transfer is the safest method of gluteal augmentation, but is only available for patients who have sufficient fat deposits that can be transferred.
Tissue Recontouring. The third method of gluteal augmentation is creation of a tissue flap taken from the buttock region and shaped to enhance gluteal projection. Dr. Centeno has been an innovator in gluteal flap techniques and has developed new procedures that are being adopted by other surgeons around the world. A flap procedure uses your own tissue, called autologous tissue, as a sort of implant. It is moved from a part of the buttocks where you don’t need it, then molded and secured into a location where it will enhance rather than detract from the gluteal contour and back regions that can be pulled down to cover the tissue flap. For this reason, augmentation with autologous tissue is especially useful in massive weight loss patients.
Gluteal augmentation can be done as a separate procedure or in combination with other body contouring surgery. Patients who have a complete circumferential body lift or a thigh and buttock lift may choose to undergo gluteal augmentation at the same time. Recontouring of the gluteal region is sometimes needed when a lifting procedure produces unnaturally flat buttocks. This does not happen because too much tissue was lifted; instead, less tissue volume remains after a lift and the skin has been tightened and repositioned, which leaves the buttocks with less projection.
Details for each type of gluteal augmentation vary depending on the individual. If you are interested in learning more about these options (implants, fat transfer, or a tissue flap), ask Dr. Centeno. After evaluating your anatomy, he will explain which option(s) are best suited to your body type, discuss the advantages and disadvantages of each method, and help you decide which type of gluteal augmentation will best meet your goals.
Liposuction of Surrounding Areas. The aesthetics of the gluteal region has increasingly been studied from a scientific standpoint. As in other areas of Plastic Surgery, anatomical areas of the body are divided into various aesthetic units. The units that make up the area can be enhanced or reduced to improve the overall appearance of the original area. Liposuction can be used very effectively to improve the appearance of the buttock region. By removing excess fat on the “curve” of the back, the “love-handle” area or the thighs, the buttock’s appearance can be enhanced considerably.
- Fat Transfer
Autologous fat transfer, the re-injection of fat removed from the body by liposuction, is an area receiving a significant amount of clinical and laboratory research. Over the last decade, it has become an extremely popular treatment among patients and surgeons alike. Many different anatomical areas can benefit from fat transfer. It can be used for facial rejuvenation and reconstruction, breast reconstruction and augmentation, buttock augmentation, and the correction of defects of the body and extremities caused by trauma, injections, infection, or radiation.
In a single surgery, excess fat from selected areas is removed with liposuction, concentrated and processed with special equipment, and then injected into the affected area to add volume and better contour. More fat than is needed is initially transferred since 30% to 50% of it will be reabsorbed by the body. After two to three months, the final result of the fat transfer procedure should be apparent. If additional volume is still needed, touch-up fat injections can usually be performed in the office.
Fat transfer is a very safe procedure and typically results in a smooth contour correction with your own tissue. Dr. Centeno has received specialized training in autologous fat transfer from one of the foremost leaders in this field, Dr. Sydney Coleman, and is currently conducting a clinical trial evaluating the use of fat transfers to correct breast deformities after lumpectomy and radiation for breast cancer and for breast reconstruction after mastectomy.