Facial

Nose skin is separated from its supporting skeleton, composed of bone and cartilage, by using different surgical techniques, which allows accessing to reshape the nose structure. Different maneuvers are then performed to re-shape this bone-cartilaginous structure. The skin is finally redistributed on this new support. If it is performed by closed approach, incisions are made inside the nostrils, but, if it is done by opened approach; an incision is made at the columella base.

There are two approaches for rhinoplasty:

• Open or external approach: a small incision is made in the columella to raise widely the skin from the tip to the nasal dorsum.
• Closed or endonasal approach: based on internal incisions (endonasal).

The closed approach allows the surgery being carried out faster, and with lower risk of inflammation and edema, producing a less visible scar because it is located at the vestibular level. On the other hand, the external approach consumes more time but allows correcting deformities and being more thorough in the treatment of the nasal tip, as this is easier to manipulate.

The technique must be chosen by your surgeon according to different factors (kind of problem to be solved, patient’s clinical history, etc.), because different techniques are indicated depending on the case. Communication with your surgeon is vital in any treatment. During the first visit, your case will be evaluated, and the surgeon will explain you how is going to be the complete process, including the surgical technique.

It can be done from early ages (14-15 years in girls and a little older in boys), because in the puberty, the nose is almost completely developed.

The procedure lasts from 1 to 3 hours, although it depends on the case complexity. It may be longer.

Patients will usually spend one night after the surgery, being discharged the following day. However, it will depend on the type of anesthesia used (local with sedation or, more frequently, general anesthesia) and the evolution of the patient.

A splint is usually placed in order to help maintain the new shape of the nose. Dr. Tarragona usually does not place plugs. Nevertheless, they may be necessary in cases of associated septoplasty, or when obtaining septal cartilages for a nasal reconstruction. The patient should remain at rest with the head elevated during the first day. Local cold should be applied. Bruises will disappear in about 2 weeks. Nasal splint and stitches will be removed in about 1 week.

Most of patients who undergo rhinoplasty feel good in 2 days, being able to make normal life in about a week.

Yes. Improvement is progressive and gradual. Nevertheless, a minimum swelling can be maintained for few months, especially at the nose tip, and between the eyebrows for few weeks. The final result is obtained in 1 year approximately.

When rhinoplasty is performed by a qualified plastic surgeon, the complications are infrequent and, if there are, they are usually minor. However, it is very important to be in good hands, as the nose is the most prominent and visible structure of the face, and any defect will be perceived by the patient and the others.

As a surgical procedure, complications may occur such as bruising, nose bleeding, asymmetries, contour irregularities, or reactions to anesthesia.

In prior sessions to the intervention, the patient should inform the surgeon about the reasons for undergoing the treatment, as well as his wishes and expectations. Dr. Tarragona will inform you about the impact that this procedure can have on your life.

If the intervention is due to an aesthetic purpose, your surgeon, according to his experience and knowledge, will evaluate if your expectations are real, taking into account the nasal structure, texture, and thickness of the skin, which are different in each patient. Therefore, bidirectional communication between patient and surgeon is essential. The objective will be to achieve a harmonious result with the patient’s own features.

In the first visit, Dr. Tarragona will evaluate the quality of your vision, the tear production, and your general health status. Your facial anatomy will be evaluated thoroughly. The doctor will decide which procedures are the best to improve your appearance.

If it is performed in the 4 eyelids, the surgery will start with the upper ones.

In cases in which it is necessary to remove the skin, the incisions are made in the natural lines of the upper eyelids, just below the lashes in the lower ones. Therefore, scars are hidden inside the natural structures of the eyelid. Through these incisions the skin is separated from the fat and the muscle, extracting the excess of fat, skin and muscle.

In cases in which there are only excess of fat, the procedure can be carried out through a transconjunctival approach, producing a non-visible scar.

The incisions are closed with very fine sutures that produce a minimum scar.

The duration of the intervention ranges from 1 to 2 hours.

It will depend on the type of anesthesia applied (it can be general or local), although it is usually done under local anesthesia and sedation, thus hospitalization is usually not necessary.

After the procedure, the surgeon will recommend you apply an eye ointment to avoid corneal injuries, cold compresses or local ice, and to sleep with the head elevated in order to reduce the edema.

The stitches are removed between 5 and 7 days after the surgery. Your surgeon will tell you which medications you should have topically and/or orally.

Normally, the excess of skin on the eyelids is a sign of aging. The loss of elasticity in the skin and muscles (as a result of the passage of time, the accumulation of fat, and in some cases, certain type of diseases), causes bags in both upper and lower eyelids that produce a more aged or tired appearance. For this reason, patients who undergo this procedure are usually above 35 years old.

In some patients with family history, or with some heart or kidney disease that causes bags in eyelipids, the surgery can be performed at a younger age.

Most of patients who undergo a blepharoplasty can start reading or watching TV in 2-3 days. However, you would not be able to use contact lenses. It may take a while to use them, up to 2 weeks, and even then, you may feel uncomfortable. Normally, after a week or 10 days you will be able to go back to work.  You should maintain a relative rest for 3 to 5 days and avoid strong activities for 3 weeks.

The result of the surgery is very favorable and long-lasting, and, in general, the bags of the eyelids do not usually reappear.

When the intervention is performed by a qualified plastic surgeon, the complications are infrequent and minor. However, as a surgical procedure, usual complications may occur such as hematomas, swelling, etc.

After the intervention, minor complications may appear such as double or blurred vision, temporary edema of the eyelids, and slight asymmetries in healing. Sometimes, after blepharoplasty, there is some difficulty in focusing the images, i.e. images may look somewhat blurred. This disappears in 2 or 3 weeks after the intervention. Conjunctivitis and subconjunctival hematoma (red eye) may also occur, which improve with appropriate treatment. In the first days, it is normal if, during the sleep, the eyelids do not close completely.

It usually lasts between 1 and 2 hours, although in severe cases it can last more time.

It is frequently performed as an outpatient procedure. Depending on the technique used, the duration of the surgery and the degree of difficulty of the reconstruction may require hospitalization.

During the intervention, Dr. Tarragona will place a bandage that will be removed after 24 hours. Once it is removed, the patient should apply ointment impregnated gauzes daily and keep them for 3 days, protected with a band without pressure. It is necessary to sleep a month with this band and not to practice sports for at least 30 days after surgery. The stitches will be removed in 10 days and after 3 months, the recovery will be complete.

In the previous sessions, Dr. Tarragona will evaluate the problem and will recommend the most appropriate technique for you. This ensures that patient and doctor will decide together the shape and the size of the ears.

By correcting protruding or prominent ears, the incision is generally made on the back surface of the ear, producing an imperceptible scar. Then, the auricular cartilage is reduced by its weakening, permanent sutures, or partial resection of cartilage, leading to folding in adequate locations and producing a natural appearance. A bandage is placed in order to maintain the new location of ears and allow them healing properly. All incisions are made at retroauricular groove level; thus, scars are not visible.

You should avoid sun exposure or excessive cold, so the best time is at the end of summer or winter.

Structures of the auditory pavilion are much more moldable in childhood, thus this is the optimal time for the intervention, and also because they have no complete social awareness for this issue. However, during adolescence, or reached maturity, these procedures can also be performed with equally satisfactory results.

Usually, patients can return to normal life in a week, being careful with physical activities.

The result is permanent. A retouch is rarely necessary.

Complications are minor such as hematoma, ecchymosis, recurrence of deformity, and asymmetries.

It usually lasts between 3 and 6 hours, depending on the procedure.

It depends on the type of anesthesia used, but you will usually spend one night after the surgery, being discharged the following day. The type of anesthesia will depend on the complexity of the surgery.

Compressive bandage during the first 6-10 hours postoperatively, local cold, and a compression garment for neck and cheeks during the first 10 days. The stitches will be removed every week. You must take analgesics and have your blood pressure well controlled. It is convenient to keep the head elevated for a few days after the surgery in order to reduce the inflammation.

In the first evaluation, your surgeon will explain you in detail the processes of intervention and recovery.

Patients are usually between 40 and 60 years old, women and men, whose face and neck begin to “fall or drop down” but whose skin still retains some elasticity. It is also performed successfully in patients aged between 70 and 80 years old.

You usually will feel a little discomfort after the surgery. The feeling of numbed skin disappears in a few weeks or months. The appearance of the face will be normal after a few weeks. Most of patients are well after 2 days, however resting should be maintained during the first week. The majority of patients return to work between 10 days and 2 weeks after the intervention.

Lifting is a long-lasting treatment; however, the passage of time will continue affecting your features. Therefore, some patients will undergo a new lift after 5 or 10 years.

When lifting is performed by a qualified plastic surgeon, the complications are infrequent and minor. Some complications may occur such as hematomas, temporary or permanent damage to the nerves controlling facial muscles (very rare), infection, and anesthesia reactions. Scarring problems are more common among smokers.

In the first visit, the face, including the skin and the underlying bony structures, will be evaluated. Surgical possibilities will be then discussed.

You should consider that lifting does not stop the aging process.

The placement of the incisions and the steps of the surgery vary greatly depending on the degree of involvement of the structures of the face and the technique preferred by your surgeon. The initial incisions are usually done at the temples, hidden in the hair; they are extended following the natural line in front of the ears and on the neck. A small incision can also be made behind the chin. Then, the skin is separated from the fat and underlying muscles. The fat is removed; the underlying muscles are tightened, and finally, the excess of skin is eliminated.

• Implant: silicone, Medpor®, etc.
• Fatty tissue infiltration of the patient himself, achieving permanent results.
• Advance or reduction on the chin bone.

It depends on the type of anesthesia. If the procedure is performed with local anesthesia and sedation, hospitalization is not necessary. Nevertheless, if the surgery is done with general anesthesia, hospitalization is required for one day.

It may be necessary to immobilize the area after the surgery, by using a bandage, which will be removed few days later.

The surgeon may recommend a chin surgery or procedure to a patient who undergoes a rhinoplasty, to achieve better facial proportions, since the size of the chin can increase or minimize the perceived size of the nose. The facial profile is improved too. It can also be agreed how many millimeters of advance will be achieved, and to perform a simulation prior the surgery.