The decision to have plastic surgery, whether cosmetic or reconstructive, is an important one for an individual. In the following sections, we have provided a wealth of additional information to help you make an informed choice—a choice that you can be comfortable with. The initial topics are general in nature, with more specific subjects addressed further below.

General:

How should I select a surgeon?
What should I know about anesthesia?
What are the risks?
How long will my recovery be?
How are fees determined?
Why should I schedule an initial consultation?
Why are pictures taken before and after surgery?
What is Informed Consent?

procedural specific:

Breast Augmentation
Liposuction
Eyelid Lift
Facial Rejuvenation

skincare:

Microdermabrasion
Chemical Peels
Skincare Products
Chirality
Facials

 

General FAQs

How should I select a surgeon?

It is important to establish rapport with your plastic surgeon and have total confidence in that doctor's ability. Select a surgeon who compares alternatives, explains clearly what will be done for you and the rationale for the approach selected. Be sure he discusses convalescence and possible risks. Choose a surgeon who communicates and has a clear understanding of your desired result.

You should carefully evaluate the proposed surgery and the surgeon himself before proceeding. Insist on certain threshold qualifications. Ask specific questions about the doctor's training: Is the surgeon Board Certified? Has he fellowship training or specialized training in the procedures you want performed?

All other things equal, a specialist performs the same procedures far more frequently and, therefore, has a greater level of experience and skill than general surgeons. It is also essential to consider whether the surgeon has an aesthetic taste compatible with yours. This can be determined through referrals from other patients and physicians.

What should I know about anesthesia?

Many procedures can be performed using intravenous conscious sedation and local anesthesia administered by Dr. DeWeese. When necessary, twilight sleep or light general anesthesia is administered by a competent anesthetist or anesthesiologist. The level of anesthesia will vary with procedure and patient.

The type of anesthetic is clearly described at the time of consultation and is tailored to the patient's needs for surgery. After surgery, the patient will remain in the recovery area until able to be discharged or transferred to their hospital room. Your surgeon will ask you to have a friend or family member to drive you home after the operation, or upon discharge from the hospital. It is recommended that someone stay with you at home for the first night following the procedure or discharge from the hospital.

What are the risks?

Although complications arising from a plastic surgery operation are possible, they are very rare. A full description of every possible complication is beyond the scope of this text, but risks specific to each procedure will be discussed at the consultation. Patients then have a chance to ask questions so that they make an informed decision whether or not to undergo the proposed procedure. Most patients accept the risks after consultation and consideration.

How long will my recovery be?

The period of recovery depends on the surgery performed. After surgery, strenuous physical activities are limited. You can resume normal activities within a few days depending upon the surgical procedure. In some cases there will be temporary swelling, bruising and discomfort. The most common concern is an uncomfortable feeling, not pain. Pain is surprisingly minimal and easily controlled with medication. Mild analgesics are used in most cases, but stronger medication is given, when necessary.

During your consultation, Dr. DeWeese will outline a schedule of post-operative visits for removal of dressings and sutures. Special arrangements are made for patients who are from out of town, or choose to spend a few days after surgery away from their families.

Care is taken to place incisions inconspicuously in natural skin creases or along skin folds so they are not visible when the healing process is completed. An incision may be pink for several weeks postoperatively, but may be easily camouflaged with makeup the day after suture removal. Complete maturation of the surgical area takes more than one year; though, in most cases, after one or two weeks, only the patient and physician can detect the surgical incision. Time is the single most important factor in the healing process.

How are fees determined?

In general, cosmetic surgery is not covered by insurance. Insurance will only pay when a surgery is done for reconstruction of deformities caused by accidents, or when surgery improves body functions impaired by a physical deformity, such as rhinoplasty (nasal surgery) correcting a septal deviation. If an insurance company is to be billed for the surgery, the doctor's office staff will typically submit the insurance claim forms and documents to your insurance company for payment.

Fees are generally determined based on each patient's needs. The exact cost of a procedure varies depending on the extent of the procedure. The surgery package price includes the surgeon's fee, the anesthesiologist's fee, and the hospital and operating room expenses. All surgical fees also include post-surgery visits. Fees are clearly explained to the patient at the time of the first consultation.

At Looking Glass, the initial consultation fee is $100. If another consultation is needed or the patient has additional questions that were not discussed during the first consultation, no additional charge is applied.

Why should I schedule an initial consultation?

A consultation helps to clarify the patient's desires and the surgeon’s plan. At the time of your visit, the extent of your surgery will be carefully discussed and an evaluation made. There is no standard operation that applies to every patient. An operation will be designed specifically for you during this consultation and all details will be explained.

The most important goal of the consultation is clear communication. Caution is advised in looking at before and after photos. These can often be misleading and may not reflect your particular needs. To help bridge the gap, some surgeons have begun using simulation software to give patients an idea of what they will look like after surgery. These simulations represent an approximation based on past experiences with multiple patients and are in no way a guarantee of final results for any given patient.

In general, the consultation helps the patient understand what can and cannot be achieved. It helps the doctor understand the patient's desires and, most importantly, it gives the patient an opportunity to ask valuable questions and decide if surgery is right for them.

Why are pictures taken before and after?

Pictures are taken prior to surgery to help plan the procedure. They are useful guides which surgeon will use in planning and preparing for your procedure. In addition, post-operative photos are taken to enable you and the surgeon to evaluate the results of the procedure.

What is Informed Consent?

You will be asked to review and sign a form that clearly describes your desired operation. This “informed consent” is a legal document, and your authorization allows the surgeon to perform the surgery. The main purpose of the document is to educate the patient on the particular procedure—including risks, possible complications and alternative treatments—so that the patient can make an informed decision whether or not to undergo the procedure.

Frequently Asked Questions about Breast Implants

How long do I need to be off work?

It is recommended that you take one week off work after breast augmentation surgery, and continue to avoid strenuous activity and heavy lifting for four weeks after the surgery. Driving is not advisable for two weeks after surgery.

What age is too old to get a breast augmentation?

Breast augmentation can be performed from the age of 18. You are NEVER too old to improve the appearance of your breasts.

Is it necessary to wait until after having children before having breast augmentation surgery? Do breast implants interfere with breastfeeding?

It is a matter of choice for each woman. More than half of patients perform the surgery before having children and the majority of them have no problems breastfeeding afterwards. The incisions are small and the surgeon attempts to minimize the amount of disruption of the glands in the nipple/areola. The underlying breast implant does not harm the breastfed baby in any way.

Do breast implants interfere with mammography?

Yes. Breast implants, regardless of their location in the sub-muscular or sub-glandular location, can interfere with a mammogram. Generally, breast implants placed in the sub-muscular position tend to interfere with mammography less than those placed below breast tissue. Mammography centers are accustomed to performing mammography displacement techniques on patients with breast implants.

How do I decide what size implants to get?

The size that a patient decides to achieve is a very personal decision. Often the patient wishes to achieve a “natural look” to simply improve the proportionality of the upper and lower body. Some patients, however, want a “round” look. For these patients a natural look is not a priority and they are not concerned if other people know that they have had a breast augmentation.

In making this decision, it helps to discuss your goals with your surgeon. Pictures are often helpful as a form of communication between the patient and the surgeon. Often, discussing “cup size” is useful, but one must be careful since “cup size” can vary depending on bra manufacturers. Furthermore, implant sizes are measured by volume (cc), which does not directly translate to cup size.

How do I decide on the incision (or, “approach”) to be used during breast augmentation?

Several incision options are available to perform the breast augmentation. These include:

• Around the areola - this incision tends to heal very nicely and becomes barely visible with time.
• Under the breast (just above the intramammary fold) - this incision is good for patients who have some excess skin under the breast. An incision can be hidden in this area
• In the axilla (armpit)

The choice of the incision is made by the patient and the surgeon. In general, surgeons try to use the approach that will be best hidden from view after surgery. Often, the decision is guided based on the patient's particular anatomy.

How do I decide to go over or under the muscle with the breast implant?

The decision to do a sub-muscular (under the muscle) or sub-glandular (under the breast tissue) breast augmentation is based on several factors - including the patient’s preference and anatomy. Each type of augmentation has its pros and cons.

All things being equal, a sub-muscular breast augmentation is preferable. This type of augmentation is associated with less chance of seeing or feeling the breast implant. This operation is also associated with a decreased risk of breast implant hardening (capsular contraction or scar tissue formation). Sub-muscular breast augmentation also interferes with the performance of mammography less than sub-glandular breast augmentation.

On the other hand, sub-muscular breast augmentation is generally associated with more patient discomfort and a longer period of time to achieve the final cosmetic results, as compared to the sub-glandular breast augmentation. Weighing the pros and cons of each type of augmentation, Dr. DeWeese prefers to perform a sub-muscular augmentation to achieve an end result with fewer complications and a better aesthetic look.

What is capsular contracture?

This term refers to scar tissue that occasionally forms around the breast implants, causing the breasts to harden. This hardening may lead to tenderness and pain. Capsular contracture is the most common complication following breast augmentation. Sub-muscular breast augmentation helps to deter capsular contracture. Massage may also prove a useful deterrent, especially for implants placed above the muscle. If severe capsular contracture occurs, it may be necessary to remove the scar tissue and replace the implant (preferably in a sub-muscular position).

If I develop a capsular contracture and the implants have to be removed, will I be able to have them put back again?

Most of the time, patients wish to have implants replaced after removal of capsules (capsulotomy), and are able to.

Can sensation of the nipple/areola be lost after breast augmentation surgery?

Yes, a small percentage (less than 5%) of patients have permanent nipple/areola sensation loss after breast augmentation surgery. Many patients have temporary loss or, alternatively, experience hypersensitivity of the nipple/areola complex. The surgeon takes great care during the operation to avoid injury to the nerve supply to the nipple/areola complex.

What is the difference between textured and smooth implants?

“Textured,” in this context, refers to the surface of the breast implant. Textured implants are given a rough surface in an attempt to prevent contracture formation (especially when the implants are placed above the muscle). This does not appear to be relevant in the sub-muscular position. Textured implants may be associated with visible skin rippling more than smooth implants.

What do the implants feel like?

In general, implants feel firmer than your own breast tissue. Also, the appearance and feel of augmented breasts depends on how much breast tissue the patient has before surgery. The more tissue the patient already possesses, the more natural the look and feel of the breast after implants.

Who should perform my breast augmentation surgery?

The physicians most qualified to perform breast augmentation surgeries are board certified plastic surgeons. It is important to get information regarding your surgeon’s training and experience. Important questions include: Can the surgeon perform this procedure in a major hospital in your city? What do other patients say about the surgeon’s ability to communicate and his level of post-operative care?

What medications should I stop before surgery?

Do not take any medication containing aspirin or ibuprofen. Herbs or weight loss medications should also be stopped at least two weeks before surgery.

What can I expect post-operatively?

Most patients experience a moderate to significant discomfort. This seems to be increased with sub-muscular breast augmentation compared to sub-glandular breast augmentation. Many patients are unable to sleep because they are not used to sleeping on their backs. Soreness of the back and neck may be related to this difficulty finding a comfortable sleeping position. Some patients choose to use two pillows and sleep in a reclined position. Nausea may also occur in the days after surgery.

How do I reduce post-operative nausea?

Unfortunately, nausea is a common problem after many surgical procedures. Many medications can be used intra-operatively in an attempt to reduce this problem. Post-operative nausea can be reduced by minimizing the use of narcotics and taking any medication with some food in the stomach. If nausea is not relieved by these measures, anti-nausea medication may be prescribed.

How do I know if I need a breast lift?

A breast lift (mastopexy) is an operation used to treat ptotic (sagging) breasts. A consultation with a board certified plastic surgeon can help you answer this question. In general, evaluating the position of the nipple/areola complex in relation to the fold under the breast (infra-mammary fold) will help determine the need for lifting.

Different types of breast lifting operations are available, depending on the severity of the sagging. Reviewing pictures of patients who have had a breast lift may be helpful.

What is symmastia?

This is when the two breasts come together in the midline (cleavage area), and may occur with implants that were placed either over or under the muscle. A correctable problem, cleavage can be “increased” through a procedure that divides the soft tissue or muscle fibers at the medial edges of the breast.

What is a “tubular breast”?

Tubular breasts, otherwise known as constricted breasts, are associated with some breast tissue deficiency, especially medially (around the cleavage area). The appearance of the breasts can vary greatly from a very severe deficiency of breast tissue to mild deficiency. Often, the patient will have different size and shape between the right and left breast. This assymetry is a correctable condition. Implants can be used to improve the size, shape and symmetry of the breasts.

When do the stitches come out?

The stitches are absorbable: they usually do not need to be removed because they dissolve naturally on their own.

When can I take a shower again after surgery?

After the initial dressing has been changed, you are allowed to shower.

What are expanders? Will I need expanders to achieve the size I want?

Tissue expanders are like implants with a fill port for use in stretching tissue. Expanders are not usually necessary.

Do you make over-sized pockets to house the implants?

Pockets are slightly larger than the implants used, which allows for some movement and makes the augmented breasts resemble natural breasts as much as possible.

What guarantees are offered with the implants?

The implants are under lifetime warranty by the implant manufacturer. For a small fee, additional insurance also provides a stipend to return to the operating room if an implant leak occurs within the first 10 years.

Who prescribes the painkillers and may I get them prior to surgery?

All necessary prescriptions will be prescribed by the doctor one or two weeks prior to surgery (at the pre-op appointment).

How long do I have to wear the special bra or "bandeau"?

The amount of time depends on your specific situation. On average, a bandeau is worn by our cosmetic surgery patients for two to four weeks after the procedure. This garment helps press the implants down. Wearing the bra is also important. Remember, each patient is different and the recovery time will also be different. Following Dr. DeWeese’s directions will give you the best possible results.

When can I start to exercise?

Dr. DeWeese does not recommend heavy weight lifting or strenuous exercise until at least six weeks after the procedure. Patients may walk and do leg exercises as soon as it feels comfortable.

How long is the recovery?

Every patient’s recovery time and process is different. Most patients are able to resume the majority of their normal activities six weeks after the procedure.

 

Frequently Asked Questions about Liposuction

Are there different types of liposuction?

Some plastic surgery offices use different names for liposuction: you may hear terms such as “lipoplasty,” “liposculpture” or “suctioning lipectomy”—these all mean the same thing. Recent advances include Ultrasound Assisted Lipectomy, which involves the use of a cannula—a tube that vibrates with ultrasonic energy, liquifying the fat so it can be more efficiently removed.

Can liposuction be used as a weight loss method?

No. Liposuction is used to get rid of isolated areas of fat that have proven to be diet and/or exercise resistant, NOT for weight loss.

Who is a good candidate for liposuction?

The best candidates for liposuction are people at their normal weight who have isolated areas of fat. Firm, elastic skin allows for a better outcome. The patient’s age is not a factor; however, older patients have less skin elasticity and may not achieve the same results as younger patients.

How long do I need to be off of work?

Dr. DeWeese suggests that you take off work for three to five days, but continue to avoid strenuous activity for one month.

 

Frequently Asked Questions about Eyelid lift Surgery

How do I get rid of the “puffiness” under the eyes?

A lower blepharoplasty (lower eyelid surgery) will get rid of the pockets of fat that often cause puffiness.

Is there any way to alleviate the heavy feeling that makes it difficult to hold the eyes open?

Yes, upper eyelid surgery can alleviate the “heaviness” that some people feel around their eyes when the excess skin accumulates on the eyelid.

Where is the incision made for different eyelid surgeries?

The incision for upper eyelid surgery is hidden in natural fold of the upper eyelid and extends slightly beyond the outside corner. For the lower eyelid, the incision is hidden just below the lower eyelashes.

How long do I need to take off work after eyelid surgery?

It is suggested that you take two weeks off work after eyelid surgery and refrain from strenuous activity for up to one month.

 

Frequently Asked Questions about Facelifts/Facial Rejuvenation

What is a good age to have a facelift?

There is no specific age recommended for having a facelift. The results of a facelift can be subtle or very dramatic, depending on the patient’s appearance before surgery. There is a trend towards doing less drastic surgery sooner: you don’t have to live with the aged appearance as long and fewer people will notice you have “had work done.”

Are the incisions visible after facelift surgery?

No, if done correctly, all of the incisions associated with facelift surgery can be hidden in normal creases/folds of the face or in the hairline.

How long does a facelift last?

The effects of a facelift are permanent. The patient will always look better than if she or he never had a facelift. However, a facelift does not stop time, just sets the hands of the clock back a little. Some patients will reach a stage when they will benefit from a second facelift - typically this is ten or more years after the initial procedure.

 

Frequently Asked Questions about Microdermabrasion

How does microdermabrasion work?

This mild technique uses a controlled jet of fine mineral crystals to gently remove the upper most layer of the skin—the stratum cornea—resulting in a smoother and softer looking skin. The non-toxic aluminum oxide crystals are sprayed across the skin and are simultaneously vacuumed away, removing both dead skin cells and the crystals. This treatment stimulates the collagen beneath the skin surface, which firms the skin.

Is this new technology?

No. Microdermabrasion had been performed in Europe for a full five years before the FDA approved this procedure in the US.

How does it compare to other peels?

Although microdermabrasion cannot produce the same benefits of chemical peels, it requires less recovery time and patients can see an instant result after the treatment. In contrast, some chemical peels can take a week to a month for patients to see results.

How long does each treatment take?

The actual microdermabrasion takes 20 to 25 minutes, but the a treatment session can take as much as an hour if other procedures like extractions or a masking are performed.

Is the treatment painful?

It is virtually painless. Some clients do experience a little discomfort from the abrading pressure of the crystals and the pulling from the vacuum, but this feeling usually diminishes after the first treatment.

Who should avoid this treatment?

This treatment is not for those with Cuperose (broken capillaries), thin skin, active acne (pustules, open sores), skin cancer, herpes simplex, eczema, psoriasis or dermatitis. Those with diabetes, hepatitis or allergies should consult with their physician before undergoing microdemabrasion.

How does Microdermabrasion help age spots?

Regular exfoliation by microdermabrasion will help to smooth and reduce the thickened stratum cornea that results in many benign age spots, such as actinic or seborrheic keratoses.

Is there a risk that Microdermabrasion can create cancerous cells by increasing cell turnover?

No. The external process of microdermabrasion does not increase internal cell activity. To the contrary, regular exfoliation helps remove the dead skin cells, which allow greater production of healthy cells.

 

Frequently Asked Questions about Chemical Peels

How often should I get a peel?

The frequency of peels depends on the patient’s skin and the depth of the peel. Superficial peels can be done once a month, medium-depth peels can be done every two to three months depending on the skin type, and deep peels like the TCA should be done no more than one time a year.

Why is sun exposure not good for the skin during a peel?

When the skin is peeling, it is sloughing of the top layer of skin, called the stratum cornea. During this process, the skin underneath is sensitive and can easily hyper-pigment (form dark spots) from the sun. This occurs when melanocytes (cells that produce pigment) in the skin are stimulated by the sun’s ultraviolet rays, leading to the increased production of melanin, our skin’s natural protection against these rays. Major sun exposure during a peel, or the two weeks immediately after a peel, can result in hyper pigmentation.

 

Frequently Asked Questions about Skincare Products

What are the basic skincare products to maintain the health of my skin?

For daily skin maintenance, you should have five skincare products: a cleanser, an exfoliator that can be used on the skin daily or every other day, a sun block, an eye cream and a moisturizer for the evening. Other products may also be used, but these are the main products you should have on hand as part of your home care regimen. For optimal effectiveness and minimal irritation, you should make sure all products are chirally correct.

 

Frequently Asked Questions about Chirality

What is Chirality?

“Chiral” is the Greek word for hand. In the same way that our hands mirror each other, most skincare ingredients are chiral, meaning they have a left or right chemical orientation. All body cells including skin receptors recognize and prefer a specific orientation of an ingredient. An ingredient attaching to a receptor is like a hand fitting in a glove. For example, Vitamin C is 50% left handed (L-ascorbic acid) and 50% right handed (D-ascorbic acid). Research has shown that only the “L” version is an effective antioxidant, while the D version is irritating and ineffective. Looking Glass recommends and uses the Cosmedix line of products, as it contains only chirally correct ingredients, ensuring that each product is its most effective and least irritating.

Is Chirality New?

Louis Pasteur discovered chirality in 1848 while studying tartaric acid from wine making. He found two tartaric acids on the mirror image of the other like our hands.

Why have I not heard of Chirality before?

Chirality is the fastest growing investment by drug companies. Drug companies admit to past mistakes of ignoring chirality for so long, due to of the expense it takes to make ingredients chiral. The FDA now mandates that all pharmaceutical medications are chirally corrected, and research has also demonstrated that chirally correct skincare products also have a better effect for the skin.

How does Chirality Impact Skincare?

The body’s receptors are all chiral. They are like gloves made to fit only over the correct hand. Skincare products need to be chirally correct for the proper fit onto the skin’s receptors. This results in the most effective product with the fewest side effects.

 

Frequently Asked Questions about Facials

Do facials help the health of your skin?

Yes, the goal of a facial is to clean and exfoliate the skin. Healthy skin exfoliates every 28 to 30 days, but because of many outside factors, like pollution, and internal factors, like diet and nutrition, some people’s skin needs help exfoliating. Depending on the situation, facials can be used to maintain the skin or can be used to treat particular skin conditions like acne, oiliness, hyper pigmentation and dryness.

How often should I get a facial?

This depends on the goals of the patient and the patient’s skin type. Clients looking to maintain their skin should get a facial every four weeks. Clients seeking treatment for more serious conditions, like acne, may need to get a skincare treatment every two to three weeks. Your particular skincare regimen depends on your goals is for your skin.

Who is allowed to perform skincare treatments?

A licensed, State Board Certified aesthetician or cosmetologist is qualified to administer skincare treatments.