Brought to you by Dr. Thomas D. McKim, M.D., F.A.C.S., expert(s) at Cosmetic Surgery.

Get the basics on breast augmentation and facelifts

Plastic surgery is a very personal choice, regardless of the procedure. Here’s a rundown of things to consider for those considering two common operations, breast augmentation and facelifts.

Breast augmentation

Breast augmentation, technically known as augmentation mammoplasty, is a surgical procedure to enhance the size and shape of a woman's breast for a number of reasons, including enhancing body contour, balancing a difference in breast size and as a reconstructive technique following breast surgery.
The best candidates for breast augmentation are women who are looking for improvement, not perfection, in the way they look. If you're physically healthy and realistic in your expectations, you may be a good candidate.

Breast augmentation has been available in the United States for over 40 years. During breast augmentation, implants are inserted through an incision — usually made just above the breast crease, around the pigmented skin surrounding the nipple, or in the armpit — and placed into a pocket created by the surgeon behind the breast tissue or the chest muscle to add volume and enhance shape to small or underdeveloped breasts, or to restore volume lost as a result of weight loss, childbirth or aging.

Types of implants

A breast implant is a silicone shell filled with either silicone gel or a salt-water solution known as saline.

The Food & Drug Administration has determined that new gel-filled implants should be available only to women participating in approved studies. Some women requiring replacement of their implants may also be eligible to participate in these studies.

Saline-filled implants continue to be available on an unrestricted basis, pending further FDA review.
Risks

Breast augmentation is relatively straightforward. But, as with any operation, there are risks associated with surgery and specific complications associated with this procedure.

The most common problem, capsular contracture, occurs if the scar or capsule around the implant begins to tighten, causing the breast to feel hard. It can be treated in several ways, including removal or scoring of the scar tissue, or removal or replacement of the implant.

Excessive bleeding can follow the operation, causing some swelling and pain. If excessive bleeding continues, another operation may be needed to control it.

Some women develop an infection around an implant, usually within a week after surgery. In some cases, the implant may need to be removed for several months until the infection clears.

Some patients report that their nipples become oversensitive, undersensitive or even numb. These symptoms usually disappear within time, but may be permanent in some patients.

Occasionally, breast implants may break or leak. Rupture can occur as a result of injury or even from the normal compression and movement of your breast. If a saline-filled implant breaks, the implant will deflate in a few hours, and the body will absorb the salt water.

If a break occurs in a gel-filled implant, two things may happen. If the shell breaks but the scar capsule around the implant does not, you may not detect any change. If the scar also tears, silicone gel may move into surrounding tissue, collecting in the breast or migrating to another area of the body. There may be a change in the shape or firmness of the breast.

Both types of breaks may require a second operation and replacement of the implant. In some cases, it may not be possible to remove all of the silicone gel in the breast tissue if a rupture should occur.
Breast implants are not designed to last a lifetime. Women with breast implants should have an annual examination by a board-certified plastic surgeon to check to see if their implants need to be replaced.

After surgery

You're likely to feel tired and sore for a few days following your surgery, but you'll be up and around in 24 to 48 hours. Most of your discomfort can be controlled by medication prescribed by your doctor.

Within several days, the gauze dressings will be removed, and you may be given a surgical bra. Your stitches will come out in a week to 10 days, but the swelling in your breasts may take three to five weeks to disappear.

You should be able to return to work within a few days, depending on the level of activity required for your job.

Follow your surgeon's advice on when to begin exercising and normal activities. Your breasts will probably be sensitive to direct stimulation for two to three weeks, so you should avoid much physical contact.

Your scars will be firm and pink for at least six weeks. Then they may remain the same size for several months, or even appear to widen. After several months, your scars will begin to fade, although they will never disappear completely.

Facelifts

As people age, the effects of gravity, exposure to the sun and the stresses of daily life can be seen in their faces. A facelift (rhytidectomy) can set back the clock, improving the most visible signs of aging by removing excess fat, tightening underlying muscles and redraping the skin of your face and neck.

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.

Risks

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.

Planning your surgery

Facelifts are very individualized procedures. Your surgeon will evaluate you to determine if you are a good candidate for cosmetic surgery and will be able to recommend the procedures that are best for you.
Your surgeon should 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 your surgeon if you smoke or are taking any drugs or medications, especially aspirin or other drugs that affect clotting.

The surgery

A facelift usually takes several hours or longer if you're having more than one procedure done. For extensive procedures, some surgeons may schedule two separate sessions.

Incisions usually begin above the hairline at the temples, extend in a natural line in front of the ear and continue behind the earlobe to the lower scalp. If the neck needs work, a small incision may also be made under the chin.

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 surgery

Any discomfort after surgery is usually insignificant and can be lessened with pain medication perscribed by your surgeon. Some numbness of the skin is quite normal; it will disappear in a few weeks or months.

Your 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 five 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.

Most of your stitches will be removed after about five days. Your scalp may take longer to heal, and the stitches or metal clips in your hairline could be left in a few days longer.

You should be up and about in a day or two, but plan on taking it easy for the first week after surgery.

Your surgeon will give more specific guidelines for gradually resuming your normal activities. They're likely to include avoiding strenuous activity, including sex and heavy housework, for at least two weeks, avoiding alcohol, steam baths and saunas for several months.

Information provided by the American Society of Plastic Surgeons and BreastImplantSafety.org