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Vancouver Cosmetic Procedures
Abdominoplasty
Abdominoplasty or “tummy tuck” surgery is performed under a general anaesthetic. It is not a substitute for diet and exercise or as a weight loss strategy. Many women (and some men) are unable to tone up their muscles and skin despite diet and exercise. On occasion liposuction alone can be performed, but more commonly either a modified or full abdominoplasty is required to regain the most elegant abdomen. This sometimes involves some liposuction, but also involves tightening the loose abdominal muscles, creation of a more youthful navel, and removal of the skin from the lower abdomen. A garment is worn for 3 weeks post-operatively and light exercise can be resumed at 3 weeks. Heavy exercise stressing the abdominal muscles can be resumed 6 weeks post-operatively. Dr. Brown requests that the patients wear a bikini bottom on the morning of the surgery so the incision can be designed to fit within it.
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Asian blepharoplasty
During his post graduate training Dr. Brown had the opportunity of working with Tokyo’s top plastic surgeons to understand the nuances of Asian aesthetics. Most Asian patients don’t want a Caucasian “round eye” but rather seek a more elegant eyelid consistent with their ethnicity. The position of the eyelid fold largely depends on what part of Asia they are from, and this is thoroughly discussed before the procedure. With an office in Richmond, with its ever increasing Asian population, Dr. Brown has had extensive experience over the last 30 years of creating more refined Asian eyelids.
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Asian rhinoplasty
The embryology, anatomy and aesthetic considerations of the Asian nose are quite unique. In most cases the dorsal profile is flat and needs to be augmented. Often the tip is wide and lacks projection, and the base of the nose may be too wide. In addition the angle between the base of the nose and the upper lip is often too acute. Although Dr. Brown prefers silicone implants to augment the bridge, he prefers to use cartilage from the ear to define the tip. Not only does this look more natural, it also avoids the pointy shiny tip created by a silicone implant. The patient’s own cartilage can also be used to fill in the angle between the nose and the upper lip, and in some cases the base of the nose is narrowed. Most patients are able to return to work in 1 week, although heavy exercise should be avoided for 2-3 weeks.
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Asian facial rejuvenation
Dr. Brown has modified rejuvenation techniques developed by Professor Ohmori of Tokyo to apply to the large Asian community in Vancouver. As in noses and eyelids, there are subtle differences in the Asian facial anatomy that must be respected. Because of the wonderful resiliency of Asian skin, healing with all forms of facial rejuvenation tends to be quite fast.
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Blepharoplasty
Blepharoplasty, either upper, lower or both, is performed under IV sedation. Drooping and fullness to the upper eyelid is common to both men and women, and “bagging” of the lower lid endows the face with a tired look. Women often have trouble with makeup application with eyeliner and eyeshadow getting caked up in the redundant skin. Surgery is performed a little differently on the male eyelid and often a small amount of extra skin is left to leave a more natural look. Although fat is often preserved or only lightly modified on the upper lid, the excess fat of the lower lid is either sculpted or transferred to the hollow area beneath. Pain is minimal. Sutures are removed about 5 days after the surgery and with a little makeup the patient can resume work in 7-10 days.
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Body contouring/liposuction
Liposuction is not a substitute for a healthy lifestyle of diet and exercise. There are however, some areas that are resistant to even the most dedicated dieter. On men this is largely around the flank region (love handles). In women it is largely around the thighs, knees, hips, and flank areas.
Liposuction is usually carried out under general anaesthesia. Markings are made pre-operatively and then the patient’s body is sterilized and a general anaesthetic is given. A tumescent technique is used with the fat being evacuated through small 10-12 mm slits. It is very important not only to “feather” off the area around the liposuction, but to be conservative in the amount removed, as over resection is very difficult to treat. A garment is worn for 3 weeks post-operatively. Light exercise can be resumed in 1 week, and full exercise after 3 weeks.
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Botox
Botox has been used for several decades treating a wide variety of non-cosmetic problems. It is highly effective in the upper third of the face, especially the “crow’s feet” and forehead and frown wrinkles. The injection takes just a few minutes and then the patient can return to work. Although Botox can be used with variable success in the lower face, there are usually other techniques which are more effective. For patients whose jaws seem too wide, the muscle bulkiness can be reduced with judicious use of Botox. Although Botox at first lasts about 3 months, many patients find with continued use that the effect lasts longer. Dr. Brown’s staff are pleased to discuss this with you.
Brachioplasty
This refers to surgery to reduce the extra skin and fat from the upper arms. Surgery is performed under a general anaesthetic. The incisions are placed on the inside of the arm where they will be less noticeable. The operation does leave a visible scar and therefore patients who have only a modest excess of skin are not candidates for this procedure. On the other hand some patients, especially those who have sustained a large weight loss, can be very good candidates for brachioplasty.
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Breast augmentation/mastopexy
This surgery is carried out under a general anaesthetic. Some women have inadequate breast development, while others may have lost shape and volume after having children. Dr. Brown prefers to use either the inframamary approach or the periareolar approach. Depending on the anatomic condition, the implant may be placed either above or below the muscle. Most times a high profile implant is used as most women want to have better forward projection. Dr. Brown and his staff are sensitive to the patient’s aspirations of size and can help her determine what range of size would be ideal.
Depending on the position of the implant, light exercise such as stairmaster or lifecycle can be resumed after 1 week. Heavy high impact exercise should be delayed for 3 weeks.
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Facelifts
The facelift procedure varies significantly depending on the patient’s concerns. The modern facelift does not depend on simple skin tightening. Much of the effectiveness is generated by rebalancing deeper supporting structures of the face and neck to provide a more significant and natural improvement.
If only a modest rejuvenation is sought, then a “mini” or MACS facelift may be helpful. The more complete facelift is performed hiding the incisions in the hair and natural creases around the ear. The visible stitches are removed in 4 days and the hidden stitches are removed in 7 days. Usually a small incision is tucked beneath the chin if the neck fat and muscle have to be corrected. Although fat is often removed from the neck, it is very common to have fat (borrowed from the abdomen) grafted to the areas of the face that hollow out with aging. Other procedures such as blepharoplasty or forehead lifting can be carried out at the same time.
Pain is only modest, although a sense of firmness is noted where significant tightening of the loose neck muscles is carried out.
Although some patients feel comfortable returning to work in 10 days with makeup, others may want to wait 2-3 weeks before returning to their social activities. We suggest a “vacation” where you return looking remarkably refreshed.
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Fat grafting
With technical improvements over the last 10 years, the quality and longevity of fat has made it the filler of choice for many patients. Whereas Restylane may last 3-6 months and Juvederm 6-8 months, the patient’s own fat has much greater durability. Although some of the fat will remain as a permanent result, the average length of time between injections is 3-5 years. The fat is harvested, usually from the abdomen, sometimes from the flank or thigh, and then put in a sterile centrifuge to concentrate the fat cells. It is then placed with a series of passes in to the target areas, typically the nasolabial folds, lips, and prejowl area. As there is a little swelling and bruising, it is advisable for the patient to take a week off work.
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Forehead Lift
The forehead lift can be performed under either a general anaesthetic or IV sedation. Some patients who have heavy upper eyelids actually have more of a problem with ptosis or “drooping” of the forehead. Applying an upward pressure just above your eyebrows with your fingers can demonstrate the effectiveness of a forehead lift. Sometimes the lift can be performed with a shorter incision inside the hair at the side of the forehead. Sometimes a “transcoronal” incision made behind the hairline will render a better result. Many of the frown lines can be modified by the judicious resection of wrinkle producing muscles. Like other areas of cosmetic surgery, it is essential to avoid over elevation as this can result in a surprised and unnatural appearance.
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Gynecomastia
This condition in which the male breast is enlarged can be treated by a direct excision through a well camouflaged incision or by a modified liposuction technique through a slit on the side of the chest. With either procedure a feathering technique can be used to get a smooth transition zone around the resection site and thus have a smooth contour. Although a pressure garment is used 3 weeks postoperatively, resumption of physical activities takes 1-2 weeks. Summers are much more pleasant when it is possible to go bare chested once again.
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Injectables
Aside from using the patient’s own fat, Dr. Brown also uses Juvederm. This injectable is quite effective in certain areas of the face, and less so other areas. The nasolabial fold (the fold that runs from the corner of the nose to the corner of the mouth) which can have a masculinizing and aging effect as it deepens, can be softened with Juvederm. As we age, our lips get thinner and this too is an area where Juvederm has had great success. This filler is not permanent and has to be repeated to maintain its benefit. Dr. Brown’s staff are pleased to discuss these details with you.
Labioplasty
This procedure is designed to reduce the size and floppiness of the genital labia. The procedure is usually carried out under local anaesthesia, although it can also be carried out under sedation. Designs are made not only to avoid undue tension around the clitoris, but to reduce and rejuvenate the introitus. All sutures are self -dissolving, and activities involving the operative site must be forgone for 1 month.
Lip augmentation
This can be performed several different ways. Fillers such as Juvederm or fat can be used to provide a fuller more youthful look. It is essential to perform the injection in a way which looks balanced, rather than a “sausage look”. Dr. Brown often prefers to use Alloderm, a skin derivative without antigens, which can be shaped and inset into the lip through a small slit on each side. Sutures are removed at 4-5 days.
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Neck lifts (cervicoplasty)
Necklifts are usually performed using IV sedation. Through fine slits beneath the chin and behind each ear, excess fat can be removed and the floppy muscle tightened. A fine drain is sometimes used and removed after 24 hours. No dressings are required. Light physical activities can be resumed in 1 week, but rigorous physical exercise should be avoided for 2-3 weeks post-operatively. With the judicious use of makeup, patients can resume work in 7-12 days.
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Nippleplasty
This procedure is used to correct inverted nipples as well as decrease the size and projection of nipples which are too large. This is carried out under local anesthetics with the sutures being removed in 10-12 days.
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Otoplasty
The procedure for protruding ears usually entails setting the ear back as well as recreating the natural folds of the ear. To protect the result it is necessary to wear a headband for several weeks until the cartilage has become stable.
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Rhinoplasty
Although rhinoplasty can be performed under general anesthetic, 95% of Dr. Brown’s patients elect to have it done under IV or “twilight” anesthesia. There are several hundred steps performed in rhinoplasty, an operation in which experience is an important factor. Dr. Brown prefers to use a little light packing for 48 hours, and a cast which is removed after 1 week. Some noses benefit from a “touch up” procedure and the likelihood of this will be discussed at the initial consultation. Pain is very modest and easily controlled by painkillers for the first few days. In no other operation is it more true that it is “the art of the possible” and therefore a lengthy pre-operative discussion is required to ensure that the patient has appropriate expectations. This can be helped by a review of pre and post-operative photos of patients Dr. Brown has performed this surgery on.
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Skin Care Products
Not all aesthetic problems require surgery or injectables. Dr. Brown’s office carries a well researched and effective line of pharmaceutical grade skin care products from Obagi Medical to address all skin types and conditions. Dr. Brown’s nurse manager will help customize the right products for you and your skin whether your concerns are towards photo damaged skin, fine lines, hyperpigmentation or acne.
Visit Dr. Brown’s office to discover the benefits of using the Obagi Medical skin care system to transform your skin resulting in younger and healthier looking skin.