Nip This Tuck That

One of my cases today was a young woman who wanted fuller cheeks and lips.  She traveled here for a consultation, some months ago, from across the country.  Unsure of what she needed, she like many pf my patients was looking to me for specific suggestions on how she could be more attractive.  I evaluated her face using my “Palmer Beauty Principles” and showed her that she could benefit from an aesthetic improvement in 2 of the top three facial features.  Her cheeks were relatively flat and her lips were a bit thin.  She agreed and signed up for a day in the Operating Room….she wanted it right away but unfortuneately there were no OR openings for some months. 

 Today was her day and she showed up this morning just as bright, chipper and sweet as could be.  I can’t tell you how nice it is to operate on a person that is sweet, kind and appreciative.  Sometimes patients in this business can be demanding and hard to deal with….the power people with money that are used to always having things exactly their way.  More on this later.  Back to today’s patient.

 I did the Cheek Augmentation first.  I mark the outside of the face, after the patient is under anesthesia….using a purple surgical marking pen to trace the outline of each Cheek Implant as it should sit on top of her cheek bone.  There are several anatomical marks that I have used over the past 16 years that help exact Cheek Implant placement.  I then inject the area with a novacaine-like substance to control the bleeding and numb the area after the procedure.  I use a scalpel to make an incision on the inside of the upper lip close to the gums.  Using scissors, I dissect the tissue until I feel the Cheek Bone.  Dissection continues directly over the Cheek until the space inside is similar but slightly larger than what I have drawn on the outside of the cheek.  Antibiotic solution is placed inside the surgical opening and the Cheek Implant is placed inside the mouth on top of the Cheek.  Once I am satisfied that the Cheek Implant is in the proper position, I close the opening with dissolveable stitches from the inside out.  This prevents the front of the Cheek Implant from slipping downward or poking out into the mouth.  The inside lining (called mucosa) of the mouth (the incision) is closed in a water tight, double layered, running, locking, dissolveable suture.  Say that 5 times really fast!

 Then the same procedure is performed on the opposite Cheek.  I am right handed, so I tend to perform operations from the right side of the OR table and do the right side, of a procedure, followed by the left side.  The incision in the mucosa of the mouth is less than 1 inch long and the dissection goes about 4-6 inches deep…..so I wear a headlight on my head that has a high powered focused beam of light allowing me to see in deep surgical spaces.  Once the second Cheek is Augmented and the incision is closed, I use reinforced tape, on the skin, to secure the Cheek Implant.  This first set of tape (steri strips) goes over the entire Cheek and is removed after 1 week.  At that time, I place steri strips along the top, bottom and leading edge (by the nose) of the Cheek Implant to further secure the Cheek Implant for about 5-7 days.  It’s best to ice the area as much as possible for the first week but really there is not much discomfort, swelling or bruising.

 Once that’s done, I move on to the Lip Augmentation.  I use Alloderm for my Lip Augmentations and I believe that it’s the gold standard for soft, natural fuller lips.  I have had the residents at USC write several pappers about how my experience with Alloderm stating how great Alloderm is over the past 10 years, or so, that I have been using it for Lip Augmentation.  The Alloderm is rolled and then passed under the mucosa (red portion) of the lips through a small incision in the corner of the mouth.  The incision is closed with dissolveable stitches.  I tell patients that Alloderm Lip Augmenattaion lasts about 7 years and that I think it’s #1 in soft, natural looking lips.

She looked great when I was done…..I was happy and I’m sure she’ll be thrilled!  Just a glimpse at what goes on to make people look good…..and you thought that the beautiful people were just natural gorgeous, didn’t you?  Guess again!