Facial Cosmetic Surgery

For more information on surgical or non-surgical aesthetic cosmetic treatment, visit our sister-practice at: www.lynchburgaesthetics.net

Endoscopic Browlift

Dr. Carvajal performs brow and forehead lifts to raise eyebrows and reduce ridges and furrows on the forehead, thus creating a smoother, more youthful appearance. This procedure can be performed in conjunction with other surgeries.

An incision is generally made across the top of the head from the front of one ear to the front of the other ear. The forehead and brows are elevated and excess skin is removed. The flap is then sutured. Newer techniques now allow us to perform Forehead Lifting through small incisions in the scalp by using an endoscope and specialized instruments. This accelerates the healing process.

Post-Operative Information

Antibiotics may be prescribed for several days following surgery. Sutures are generally removed within one week. Swelling and some bruising may occur, which should subside within a few weeks. Our doctors will prescribe ice compresses and eye exercises to reduce swelling and regain mobility. Women will be allowed to use eye cosmetics up to two weeks after surgery. You can proceed with your normal daily activities within 1-2 weeks. A final evaluation may occur within several months from the initial surgical procedure.

Insurance

Your insurance company may pay for part or all of the cost of surgery if the procedure is performed as a result of visual impairment. Because every insurance carrier is different, it is recommended that you check with your own insurance company to determine the level of coverage.

Forehead Lift

Dr. Carvajal performs Brow and Forehead Lifts to raise eyebrows and reduce ridges and furrows on the forehead, thus creating a smoother, more youthful appearance. This procedure can be performed in conjunction with other surgeries.

An incision is generally made across the top of the head from the front of one ear to the front of the other ear. The forehead and brows are elevated and excess skin is removed. The flap is then sutured. Newer techniques now allow us to perform Forehead Lifting through small incisions in the scalp by using an Endoscope and specialized instruments. This accelerates the healing process.

Post-Operative Information

Antibiotics may be prescribed for several days following surgery. Sutures are generally removed within one week. Swelling and some bruising may occur, they should subside within a few weeks. Our doctors will prescribe ice compresses and eye exercises to reduce swelling and regain mobility. Women will be allowed to use eye cosmetics up to two weeks after surgery. You can proceed with your normal daily activities within 1-2 weeks. A final evaluation may occur within several months from the initial surgical procedure.

Insurance

Your insurance company may pay for part or all of the cost of surgery if the procedure is performed as a result of visual impairment. Because every insurance carrier is different, it is recommended that you check with your own insurance company to determine the level of coverage.

Eyelid Surgery (Blepharoplasty)

Eyes are a prominent facial feature. It is the surrounding skin, rather than the eyes themselves, that conveys emotion. The tissue, muscle, fat, hair and lashes all contribute to the wide array of expressions. Age, sun exposure and hereditary factors all contribute to wrinkles, deep lines and puffiness around the eyes.

The aging process can cause unwanted changes in expression, causing us to look permanently fatigued and older than we really are. These changes in appearance can cause emotional distress and sometimes even visual impairment. An eyelid lift, or blepharoplasty, is designed to restore a more youthful appearance to your eyes. It may involve the upper lids, the lower lids, or both.

New and Traditional Techniques

Traditional Blepharoplasty: An incision is made in the crease of the upper lid toward the temples. Once healed, it is not noticeable when the eye is open. On the lower lid, the incision is made along the lash line toward the temples, and is hidden by lashes when healed.

The Transconjunctival Approach: This is a newer technique for lid blepharoplasty, involving an incision inside the lower lid. Fat can be removed through this incision, but excess skin cannot be eliminated.

Laser resurfacing of the eyelids is a non-surgical alternative that may delay the need for a surgical blepharoplasty. It results in significant tightening of the skin around the eyes, but will not effect the fat around the eyes and may even accentuate it.

Please ask your doctor if you have any questions about which procedure is right for you.

The Surgery

Local anesthesia is given around the eyes. An intravenous line is started so that sedation may also be given. During the procedure you will be awake but comfortable and relaxed. General anesthesia is rarely used.

This procedure is performed on an outpatient basis at our surgical center. It is important to arrange for care after the surgery. Someone must drive you home and be available to care for you for the first 24 hours.

Complications are unlikely when performed by a surgeon with experience in blepharoplasty. These include: bleeding and swelling, delayed wound healing, infection, drooping of eye upper or lower eyelid, asymmetry, double vision and dry eyes.

Recovery: What to Expect

The area surrounding the eyes will remain swollen in the days following the surgery. It should begin to subside after the first day. Some vision blurring is normal.

The stitches will be removed in 4-5 days. Swelling and bruising will persist for about 10 days, but you can begin wearing makeup to help conceal these concerns. You may expect to resume normal activity within a week to 10 days, and start enjoying your new look within approximately 10-14 days. It may take about 6 months for the scars to lose their redness.

Wrinkling will recur later in life, however it is unlikely that the bags will recur because the fat has been removed. Deeper wrinkles around the outer eye extended onto the temple are not greatly affected by the eyelid lift. These areas may be treated with laser resurfacing.

Restylane/JuvedermTM

Restylane and JuvedermTM are gels that are injected into the skin that adds volume to the lips and lifts up and fills out wrinkles and folds. Restylane and JuvedermTM are made of Hyaluronic Acid, which is a natural substance already present in your body that provides volume and fullness to the skin. Restylane/JuvedermTM temporarily diminishes depressions and acts as a filler for a period of time, often longer than that of Collagen. It is NOT a replacement for BOTOX Cosmetic, since it does not alter the muscle activity. While there exist patient differences, most patients experience an improved effect for three to five months. Repeating the Restylane/JuvedermTM within three to five months is recommended to maintain the effect and diminish wrinkling.

The amount and location of Restylane or JuvedermTM injected corresponds with your initial desires. Treatment is performed on a unit dose of prepackaged syringes of 0.4 or 1.0 ccs. Syringes cannot be stored. The number of syringes used determines the cost of the treatment.

While every effort is made to optimize results, patients may experience incomplete results. If ones treated region does not have adequate resolution, retreatment may be necessary. A large portion of the cost of the procedure lies in the cost of the material. Therefore, retreatment of regions will be charged at the normal rates. Every effort is made to minimize the cost of the procedure and the need for retreatment.

After your injection, keep your head elevated for one hour. Ice packs may be used for one to two days for pain and swelling. Additionally, over the counter ibuprofen may be used for discomfort and swelling.

Before Procedure

To better understand your overall health, we will evaluate your medical history prior to the procedure. In addition, a complete examination of your face is done in order to decide the most effective injection sites. All issues and concerns will be discussed.
The areas that will be treated are marked and digital photographs are taken in order to determine the amount of improvement after the procedure.

Commonly asked questions

Is Restylane and JuvedermTM FDA approved?
The U.S. Food and Drug Administration (FDA) has recently approved Restylane and JuvedermTM, an injection for the correction of moderate to severe facial wrinkles and folds, such as nasolabial folds, the lines between the nose and mouth.

How does Restylane and JuvedermTM work?
Restylane and JuvedermTM gels are injected into the skin in tiny amounts to add volume, lifting up and smoothing out unwanted wrinkles. The gel integrates into the dermal tissue then attracts and binds to water molecules to help maintain volume. It is gradually broken down by the body and disappears without any residue.

Is there an allergy test required?
No pre-test is needed.

Which areas of the face can be treated with Restylane or JuvedermTM?
Restylane and JuvedermTM can be used for smoothing out folds and wrinkles, lip enhancements and shaping facial contours. The most common areas are the glabellar lines (between the eyebrows), the nasolabial folds (from the root of the nose to the angle of the mouth) and the lips, although other sites can also be treated. Very superficial or very deep wrinkles may be difficult to correct and may require a formal face lift or laser resurfacing.

What will I look like after the treatment?
The treatment takes about 15 minutes and immediately after the treatment, you can expect slight redness, swelling, tenderness or an itching sensation in the treated area. This is a normal result of the injection. The discomfort is temporary and generally disappears in a few days. After a lip treatment, the lips may become swollen and look somewhat uneven. This can persist for a few days (up to a week).

Is the treatment painful?
Every effort is made to minimize any discomfort you may feel. Local anesthesia is given prior to the treatment making the area numb prior to the injection of Restylane or JuvedermTM. Complimentary Nitrous Oxide may be used as well.

What precautions will I need to take after treatment with Restylane or JuvedermTM?
During the first 48 hours after your treatment, do not massage or rub the treated area. If you have had a lip enhancement, avoid puckering your lips for the first two days after the treatment. Until the initial swelling and redness have resolved, do not expose the treated area to intense heat (e.g. in a solarium or by sunbathing) or extreme cold.

Are there any side-effects associated with Restylane or JuvedermTM?
Injection-related reactions such as swelling, redness and tenderness might occur. Other types of reactions are very rare, but about 1 in 2000 treated patients have experienced localized reactions thought to be of a hypersensitive nature. These have usually consisted of swelling or redness at the injection site, sometimes affecting the surrounding tissues.

Is Restylane or JuvedermTM Safe?
Yes. Because of Restylane and Juvederm’sTM careful design, it works with your body, not against it. It is a naturally occurring substance that has been used safely by physicians since 1996 worldwide. Restylane and JuvedermTM are non-animal based and fully compatible with the body; therefore allergy testing is not required. Restylane and JuvedermTM have minimal side effects, the most common of which is bruising. Some experience temporary localized swelling at the injection site.

Is Hyaluronic Acid safe?
Hyaluronic acid is a natural substance that is found throughout your body. It gives volume to the skin, lubricates the joints and gives the eyes their shape. The hylaluronic acid in Restylane and JuvedermTM are stabilized for long duration and is not of animal or human origin.

How long do the results last?
It has been shown in clinical trials that Restylane is effective for up to six months, but individual results may vary. JuvedermTM may last longer than 6 months.

BOTOX Cosmetic

BOTOX Cosmetic treatment is a revolutionary approach to reversing the effects of facial wrinkles. Crows feet, worry lines and laugh lines can all be a thing of the past. These are referred to as dynamic wrinkle lines and all are treatable with this procedure. Cosmetic denervation is the process of injecting botox into the tiny facial muscles that create the wrinkles.

Before Surgery

To better understand your overall health, we will evaluate your medical history prior to surgery. In addition, a complete examination of your eyes is made in order to decide the most effective injection sites. All issues and concerns will be discussed.

The areas that will be treated are marked and digital photographs are taken in order to determine the amount of improvement after surgery.

The BOTOX Cosmetic Procedure

BOTOX Cosmetic injections are performed without anesthesia because they are virtually painless. Only a very small sting is felt when the injections are made. The effects are not permanent and may need to be repeated two to three times per year to retain the effects. Research has suggested, however, that long term use of the injections leads to a longer duration of each treatment’s effect. Patients over the age of 65 may not experience such dramatic results. BOTOX Cosmetic is only useful in treating expression lines and cannot be used to repair sagging skin caused by aging.

Post-Operative Information

After the operation patients may experience slight bruising around the area that quickly fades. Normal activities can be performed immediately. Possible side effects are temporary weakness of nearby muscles or in rare cases an eyelid may droop. BOTOX Cosmetic is completely reversible so any side effect is only a temporary condition. The doctor will explain all risks associated at the time of your consultation.