What is Botulinum Toxin?

Botulinum Toxin is the drug that has preoccupied, perhaps more than any other, digital and print media for its aesthetic results, especially in the facial area. In fact, Botox (by the Allergan company) and Dysport (by the Ipsen company) are the main commercial names of botulinum toxin type A, otherwise known as botulinum. It is a bacterial exotoxin produced by Clostridium botulinum.

What are the uses of Botulinum Toxin?

Botulinum toxin type A has been used for over 30 years to treat diseases such as involuntary muscle disorders, stiffness, strabismus, blepharospasm and hemifacial spasm.

In the last 20 years, however, it is used for the non-surgical treatment of facial wrinkles, and its widespread dissemination lies in the fact that it is a minimally invasive method that gives spectacular results immediately. Specifically, Botulinum toxin can correct:

• Forehead wrinkles
• The glabellar wrinkles around the eyes (crow's feet)
• Lift the angle of the eyelids
• The wrinkles of the nose (bunny lines)
• The oval of the face
• Neck wrinkles
• The bodice (bust area)

We have to mention that Botulinum toxin is also used successfully in the treatment of primary hyperhidrosis, mainly in the armpits, palms, and soles of the feet.

What is the right age to start Botulinum Toxin?

The need for Botulinum toxin is more related to the activity of the muscles rather than age. However, the younger the person, the more spectacular and natural the results.

There are expressive people with strong muscles that need Botulinum toxin from 18 to 20 years old, and others without intense muscle activity that don’t develop wrinkles until the age of 30-35 years.

However, it is true that early initiation of therapy is proactive in the appearance of wrinkles. Frequently, nowadays, the use of small doses of Botulinum toxin is applied to younger ages that have either inherited predisposition or are experiencing wrinkles due to hypertonic muscles. This treatment is also known as “Baby Botox.”

How long does it last? How often can I do Botulinum Toxin?

The average duration of Botulinum toxin is about 4-6 months. After the third month, a small movement of the region may begin to appear. In the first few applications, the period may be slightly shorter. However, if done regularly, studies have shown a greater duration of effect that can reach up to seven months.

There is no limit to the number of treatments, but usually, re-application is necessary about 2-3 times a year.

What is the procedure and what do I need to know?

Treatment involves injections of botulinum toxin in accordance with the needs of the patient and after discussion regarding the desired results. Given that botulinum toxin reduces muscle contractions that move the skin, Botox must be injected in the correct anatomical area, at the right doses, to have the best possible result. The effect of the drug begins to appear after 2-5 days, and the final result will be visible at 10-14 days.

Botulinum Toxin is probably the best non-surgical facial treatment, with undeniable outcomes, resulting in a rested, refreshed and smooth face. However, its application by physicians not specialized in the anatomy of the region or even worse by non-medical personnel can lead to complications such as an expressionless gaze, asymmetry, and ptosis.

Choosing a qualified Surgeon is of the utmost importance to achieve correct results and avoid complications.

What is Hyaluronic acid?

Hyaluronic acid is a glycosaminoglycan, which are natural and major structural components of the human body. It is prepared in a laboratory for the needs of Medical science.

The hyaluronic acid used in our clinic (Restylane, Juvederm) is approved by the Health and Drug Organization. It is perfectly safe, slowly absorbed by the body and by retaining water, helps the skin to remain hydrated and youthful.

What are the uses of Hyaluronic acid?

Hyaluronic acid belongs in the category of fillers, and its main feature is to moisturize and ''fill'' deep facial wrinkles, such as:

• Nasolabial folds
• Wrinkles around the lips (smokers lines)
• Wrinkles around the mouths’ edges (marionette lines)
• Wrinkles of the forehead, eyes or glabellar (usually after Botox)
• Dark circles under the eyes
• Acne Scars
• Increase the volume or contouring lips
• Improvement of volume to cheekbones

What is the procedure and how long do the effects of Hyaluronic acid last?

Hyaluronic acid is injected under the skin thus filling facial wrinkles or giving volume to areas needed, such as the cheeks and lips. The treatment is fast (the application usually takes 15-30 min), painless (under local anesthetic), secure and is performed as an office-based procedure.

The results are immediately visible, and their duration ranges from 6 months to 1.5 years, depending on the injection site, the type of hyaluronic acid used and the rate of its degradation by the human body.

How many types of Hyaluronic acid are there and which do I choose?

Depending on the effect you want to achieve, hyaluronic acid of different densities is used. Generally, the subtler the wrinkles, the less condensed the hyaluronic acid used. In fine wrinkles, like those of smokers or around the eyes, thinner hyaluronic acid is applied. In areas with deep wrinkles, denser hyaluronic acid is applied.

In cases we want to provide volume, such as the cheeks and chin, denser concentrations of hyaluronic acid are also used.

The selection of the suitable formulation will be made by your surgeon.

What is Mesotherapy?

Mesotherapy, nowadays, is one of the most popular non-invasive facial and body treatment worldwide. The treatment takes its name from the mesoderm, i.e., the middle layer of the skin, where the intradermal injection of anti-aging and regenerating substances takes place. Its beneficial effects have given mesotherapy the title of "biological revitalization."

What are the results of Mesotherapy?

Depending on the area of the body where it is applied and the infusion substances used, mesotherapy helps to address the following problems:

• Deep hydration and skin firming
• Smoothing of wrinkles (face, neck, chest)
• Glowing, healthy appearance and skin regeneration
• Improve dark circles and eye wrinkles
• Reduction of pores and improvement of acne scars
• Reduction of stretch marks
• Cellulite and gentle firming activity with specific clamping solutions
• Reduction of postoperative scars and wounds

How do the Mesotherapy products work?

With age, there is a decrease in collagen production by fibroblasts by about 1% per year, as well as its gradual destruction by factors such as smoking, overexposure to sunlight (especially without the use of sunscreen) and stress.

Mesotherapy is the most effective method of direct penetration of vitamins, amino acids and pharmaceutical substances under the epidermis, which is the most important part of the skin. It is the one that nourishes and supports all other layers of the skin.

During Mesotherapy treatments, we administer peptides, vitamins and hyaluronic acid serum, which hydrates, maintains natural moisture, improves and prevents skin aging.

Simultaneously, regenerating firming agents such as DMAE and silicium or substances that combat cellulite like caffeine or phosphatidylcholine can be added, depending on the aesthetic effect we want to achieve.

How is Mesotherapy performed?

Injectable Autologous Mesotherapy (needling):

The injectable mesotherapy acts directly on the affected area through a very thin needle (30G), to achieve the desired therapeutic effect. The solution is injected directly into the subcutaneous tissue of choice and is specifically configured according to the treatment needs.

Non-injection Mesotherapy (Pen):

This is a relatively new method, similar to the injectable treatment, but covers the entire face/neck/chest, so that the solution is injected evenly throughout the skin at the area where treatment is applied.

During the technique, an apparatus in pen form, with 12 thin needles, is used. These penetrate the skin up to 100 times per second with a regulated speed and a depth of 0.25 to 2.5 mm, depending on the area being treated. This technique minimizes skin damage, pain and recovery time, while the likelihood of bruising is reduced. The desired results are achieved due to the enhanced production of collagen and elastin on the surface of application, in conjunction with the mesotherapy products we use.

When will I see results and how many sessions are needed?

On average, patients notice improvement after two to three sessions. However, the results can be visible from the first session, depending on the condition being treated, the severity of the problem, age, etc.

An average of 5 to 10 treatments is applied at intervals of about two weeks. Maintenance sessions may be needed depending on each case’s needs.

What is Autologous Mesotherapy (PRP) and how does it work?

Autologous Mesotherapy, also known as Platelet-Rich Plasma Therapy, is an innovative and effective method for facial regeneration and glow. The treatment utilizes and exploits the properties of our blood with the use of growth factors (such as PDGF, VEGF, TGF-b, and EGF). The release of growth factors as well as other platelet components is accelerated from plasma. The mixture is enriched with substances such as calcium chloride and nucleotides. Collagen production will result in skin regeneration of natural, as well as, long-term effects.

Where is Autologous Mesotherapy (PRP) applied?

The main applications of Autologous Mesotherapy (PRP) relate to:

• Deep hydration and skin firming
• Smoothing of wrinkles (face, neck, chest)
• Glowing, healthy appearance and skin regeneration
• Reduction of pores and improvement of acne scars
• Improvement of dark circles and eye wrinkles
• Treatment of stretch marks
• Smoothening of postoperative scars

The combination of Autologous Mesotherapy (PRP) with Er: YAG nonablative Laser treatment is a clear indication and gives an excellent result by multiplying the rate of regeneration of the skin through enchased collagen production.

What are the main advantages of this method?

The main advantages of the Autologous Mesotherapy (PRP) are:

• Uses the patient's growth factors, and thus the mode of action is natural
• Safe and easy application. Since the plasma is taken from the patient, the probability of allergy is virtually non-existent
• The duration of the results
• Enhances collagen production and simultaneously rejuvenates the skin.
• Restructures wrinkles naturally.

How is Autologous Mesotherapy (PRP) performed?

Initially, blood is taken from the patient (5-15ml). Then, the blood is placed in the centrifuge to isolate the rich in platelets plasma from other blood components. After separation, the plasma is activated by the addition of a nucleotide solution (DNA Activator) and calcium ions (Ca ++). The multivalent plasma mixture is precisely injected, same as way as Heterologous Mesotherapy. Specifically:

Injectable Autologous Mesotherapy (needling):

Injectable Autologous Mesotherapy acts through a very thin needle (30G) to achieve the anticipated therapeutic effect. The solution is directly injected into the subcutaneous tissues to have the desired results.

Autologous non-injection Mesotherapy (Pen):

This is a relatively new method, similar to the injectable treatment, but covers the entire face/neck/chest, so that the solution is injected evenly throughout the skin where the treatment is applied.

During this technique, a pen form apparatus with 12 thin needles is used. These needles penetrate the skin up to 100 times per second with a regulated speed and a depth of 0.25 to 2.5 mm, depending on the area being treated. The enhancement in the production of collagen and elastin fibers on the surface of application, in conjunction with the polyvalent plasma mixture we inject, will provide the desired results. Simultaneously, skin damage, pain, bruising and recovery time is minimized.

The procedure:

The shape of the nose is determined by the underlying bony as well as its cartilage framework. This framework has to be altered to achieve the new shape of the nose, depending on the patient`s expectations about his/hers current features. Hump removal, narrowing and shortening of the nose, elevation or reduction of the tip; there may be many different steps to achieve the desired result. Often cartilage grafting might be necessary. Airway problems caused by a crooked septum can also be addressed within this aesthetic operation.

At what age can a nose correction be performed?

Correction of the shape of the nose (rhinoplasty) is one of the most frequently performed procedures in aesthetic plastic surgery. There is a big range in the age of our patients, but we usually perform rhinoplasties only to individuals over the age of 16.

How long does the surgery take?

Depending on the specific needs of the procedure, a rhinoplasty takes between 1 and 4 hours.

Do I have to stay in the hospital, what form of anesthetic is used?

Usually, general anesthesia is necessary for rhinoplasty. We recommend staying overnight in the hospital for a major procedure, especially when nasal bones have to be reshaped or cartilage grafting was performed.

Bruising, that is most visible under your eyes, will be gone after five days. The visible swelling will have gone down after two weeks, but it can take up to almost a year before it disappears completely.

How do I have to prepare for a nose correction?

Take no Aspirin or drugs that influence the blood-clotting system, get yourself cool pads that you can put on after the operation to cool your nose.

What dressings will I have afterward and when will it be removed?

• When nasal bones have to be reshaped, a cast protects the nose for ten days.
• Afterward your nose will be taped for four days.
• Packs, if used, will be removed after 1-2 days.
• Ointment to keep the inside of your nose smooth will be administered, together with normal saline for washing the interior of the nose.
• Stitches, if used externally, will be taken out after four days.

Do I have a lot of pain afterward?

There is usually no pain after a rhinoplasty, but you will feel some pressure and discomfort that is generally due to the nasal packs. When these are removed (after two days), you feel a lot better.

What are the potential risks and complications?

Fortunately, major complications are seldom. After a rhinoplasty, there will be some bruising and swelling, most of it will be gone down a few days after the operation. The nose, as well as the upper lip, might feel a little numb for a few weeks. You will have a pack in your nose against bleeding, which is removed one to two days after the operation.

Important information for the time after the operation

• sleep only on your back (that should be slightly raised)
• don`t touch or remove the cast or dressing
• if you have to sneeze, open your mouth wide and release the pressure through your mouth and not through your nose
• take a week off work
• no sports or heavy physical work for four weeks, also no sun or solarium
• try not to smoke for two weeks before and after the operation
• you should cool your nose and face the first two days after surgery
• take the drugs prescribed (usually an antibiotic and a pain-killer)
• healthy food (vitamins) and Arnica supports the healing process

A clear look is an essential part of one’s emotional expression. Sagging eyelids, on the other hand, leave the eye looking small and tired. By removing sagging skin and excess fat tissue from the eyelids, the eyes receive a younger and fresher appearance. They appear more open and larger, and the tired look disappears.

The procedure

One of the most common and noticeable signs of aging is loose and saggy eyelid skin. On the upper eyelid, the excess skin might even lead to impairment of vision. It can create the impression of a small and sad looking eye. The main reason for “drooping eyelids” is a real excess of eyelid skin or a descending of the forehead tissue and eyebrows, pushing the skin of the upper eyelid downward. In the lower eyelid bulging of the fat may cause a serious esthetic consideration.

In most cases, the correction of loose eyelid skin is performed under local anesthetic.

On the upper eyelid (upper blepharoplasty) the cut is made in the natural creases of the eyelid. In most cases underlying muscle is tightened and excess fat is removed. On the lower eyelid, the incision is made 2mm below the eyelashes or inside the lower eyelid. Fat is also removed with the use of electrocautery to prevent hematoma.

Do I have to stay in the hospital, what form of anesthetic is used?

For a blepharoplasty, we normally use a local anesthetic. However many patients prefer to be asleep during the operation. You don’t have to stay in the hospital; eyelid corrections are usually outpatient procedures.

When will I be back to normal?

• Bruising and most of the swelling will be gone after one week.
• You should not do any physical exercises for three weeks (like jogging and aerobic)
• You can be back to work 3 – 5 days after the operation

How do I have to prepare for the operation?

No Aspirin or drugs that influence the clotting system

Do I have a lot of pain afterward?

There is usually no or just a little pain following eyelid – surgery.

What are the potential risks and complications?

You will have bruising and swelling that goes mostly down 7 – 10 days after the blepharoplasty procedure. Major complications after upper eyelid surgery are infrequent.

Important information for the time after the operation

• sleep only on your back (that should be slightly raised)
• don`t touch or remove the dressing
• take 3 – 5 days off work
• no sports or heavy physical work for four weeks, use a sun blocker- cream to protect the scars for six months.
• you should cool your eyes the first two days after surgery
• don`t forget to take the drugs prescribed by us (usually an antibiotic and a pain-killer)
• healthy food (vitamins) and Arnica supports the healing process

Ear surgery (otoplasty) is usually performed to set prominent ears back closer to the head. Protruding ears is the most frequent deformity of the ear. However, there is a huge variety of other ear deformities (“constricted ear,” “cup- ear,” “lop-ear”) that can be corrected by plastic surgery. Ear deformities can be very obvious and lead to a high degree of self- consciousness.

The procedure:

An incision is made at the back of the ear where a small strip of skin is removed. Special stitches are placed into the cartilage of the ear. By tightening these stitches, the ear is pinned back into a normal position. It should stand away from the head at an angle of approx. 25 – 30 degree. The skin is closed, and the surgical scar is on the backside of the ear.

At what age is an ear correction performed?

Ear corrections can be performed in nearly every age; however, the operation should be done before starting school, to avoid unpleasant reactions of classmates.

How long does the operation take?

The procedure takes between 1,5 to 2 hours.

Do I have to stay in the hospital, what form of anesthetic is used?

The surgery is usually performed under local anesthetic, but if you prefer to be completely asleep, general anesthesia can be provided as well. You don`t have to stay in the clinic; ear corrections are usually outpatient procedures.

When will I be back to normal?

Bruising and most of the swelling will be gone after one week.

What about dressings and when will it be removed?

You have to wear a circular bandage around your head for two days. After that, you have to wear a sports band continuously for two weeks and only at night for an additional two weeks.

What are the potential risks and complications?

Some bruising and swelling will be evident. Bleeding, asymmetry and infection are rare complications. If somebody pulls your ear within the first weeks after the operation, it may stick out again.

Important information for the time after the operation

• sleep only on your back (that should be slightly raised)
• don`t touch or remove the dressing
• take 3 – 5 days off work
• no sports or heavy physical work for four weeks
• try not to smoke for two weeks before and after the operation
• don`t forget to take the drugs prescribed by us (usually an antibiotic and a pain-killer)
• healthy food (vitamins) and Arnica supports the healing process

Aging, although a natural process, leaves some signs-wrinkles. Many people would choose to eliminate the sign of the aging process. Modern-day Plastic Surgery, which boasts a vast range of specialized forms of treatment, is being increasingly regarded as the obvious way forward.

A wonderful method of removing the signs of aging from the face, or, at least, of making them less severe, is the facelift (as a rule, this will include the neck as well). It will make sagging cheeks disappear, straighten up the chin-line and tauten up loose face and chin-skin. Wrinkles become smooth, the contour of the face come across as being much younger. If the procedure is carried out properly, a facelift should not be readily identifiable as such for the observer, even if the individual looks younger afterward.

Facelift incisions usually begin above the hairline at the temples, extend in a natural line in front of the ear and continue behind the earlobe to the lower scalp. Afterward, the underlying layer of tissue, called the Superficial Musculo Aponeurotic System (SMAS) is tightened, to create a natural and youthful undersurface of the face and to enable a long-lasting result. Excess skin of the face and neck is removed. Stitches secure the layers of tissue and close the incisions. Small tubes will be temporarily placed under the skin behind both ears to drain blood and fluids. They will be removed the day after surgery. Liposuction or lipostructure, sometimes are combined with a facelift that allows precise modeling of facial contour.

There are many different ways of a facelift procedure. Which one is the right for you can only be decided after an examination in a personal consultation. Whatever procedure or technique is chosen to rejuvenate your face, it is important to maintain your facial features and not to create a “tight facelift- look.“

At what age should a facelift be done?

Most facelifts are performed between 45 and 70 years. But age is not important in the consideration; more importantly are signs of aging, especially sagging skin, the formation of jowls or marionette lines (lines between the corner of the mouth and the chin).

What are the potential risks and complications of a facelift?

You will have bruising and swelling that goes down 7 – 10 days after the operation. Major complications after a facelift are fortunately very seldom. There will be some temporary numbness in your cheeks. Wound healing problems with damage and loss of skin, infection or the injury of important anatomical structures like nerves and vessels are also seldom.

What anesthetic will be used?

During a facelift, you will be completely asleep.

How long does a facelift last?

Usually, you gain ten years by a facelift. You carry that benefit your entire future life.

How long does the operation take?

The time for surgery depends on the technique involved and the additional procedures performed (liposuction, lipostructure) and usually takes between 3 to 5 hours.

How do I prepare for the surgery?

• take no drugs that influence the blood clotting system (e.g., aspirin) two weeks before the operation
• do not smoke. Smoking impairs the blood flow to the skin and raises the risk of skin and tissue damage.
• wash your hair the day before surgery

How should I take good care of myself after the surgery?

• Avoid any vigorous activities (like bending down) for five days after surgery because you might cause post-operative bleeding. Move or turn your neck and head slowly.
• Your sleeping position should be on your back in a slightly upright, sitting position
• Cooling might be necessary
• You will have to wear a circular bandage around your head for four days.
• Drains will be removed the day following the operation.
• Be careful when washing your face and hair. Don`t lean your head backward during the first five days to avoid bleeding.
• There should be no direct sunlight (UV-light) on your face for six months. Sunlight might cause large and red scarring. Protect yourself with a strong sun-blocker cream or with a hat.
• No sports or exhausting activities for eight weeks after the procedure.
• Massage your scars with your fingertips, applying some pressure. The best way to treat small scars is pressure.

How long until I am back to normal?

Take two weeks off work. This is the necessary time for the swelling and bruising to go down, and you can get back to normal. In some rare cases, bruising can last a little longer.

What is the Brow Lift?

The area of the upper facial tertile (forehead and eyebrows), with time, loses its youthful appearance, starting to look tired as wrinkles appear.

The Brow Lift essentially corrects three problems in the upper facial tertile:

• The excess skin and feeling of heaviness of the upper outer eyelid and the lower surface of the forehead. Patients typically describe this as the tired gaze. This is due to gravity, causing the sagginess of the skin from the upper part of the orbit, sometimes resulting in soft tissues restricting the patients’ vision.
• The wrinkles between the eyes caused by contraction of the strong muscles in the area.
• The transverse wrinkles of the forehead caused by muscle activity, in particular, the frontalis muscle.

A Brow Lift will probably improve "crow’s feet" on the outside surface of the eyelid, but not eliminate them.

In general, the procedure can be done in two ways:

• The Open Brow Lift
• The Endoscopic Brow Lift

The open method tends to be replaced today by the endoscopic procedure, mainly because of its disadvantage relative to the surgical scars, although its results are, normally, of a longer duration. The advantages and disadvantages of each method will be discussed in detail with your surgeon during your visit to the clinic. However, both methods, offer a long-lasting effect that, if combined with eyelid surgery, provide an even more youthful face.

Who are candidates for Brow Lift surgery?

Candidates for Brow Lift are people with:

• Sagginess of the skin of the forehead and eyebrows leading to secondary dermatochalasis (excess skin in the eyelid area) limiting the field of vision.
• Sagginess of the skin of the forehead and eyebrows combined with significant dermatochalasis of the eyelids (necessary to combine Brow Lift and blepharoplasty).
• Sagginess and forehead wrinkles
• Significant sagginess of the skin on the forehead and eyebrows creating tired, sad or harsh eyes,
• Restoration in cases of facial nerve paralysis

During your visit to the clinic:

During your visit to the clinic, we will discuss:

• What is of concern to you and if the Brow Lift is the best-indicated treatment.
• Medical history, whether you take medications, vitamins and herbal supplements, any allergies and previous surgeries you had in the past.
• Your smoking habits.

Then, the surgeon:

• Will assess your general health status and identify any risk factors
• Will clinically examine you to estimate the quantity of excess skin on both sides, the degree of regional muscle relaxation, which may exacerbate the problem, as well as the quality of your skin.
• Pre-surgical photos will be taken for further evaluation.
• All possible surgical options will be discussed, depending on each case’s needs.
• The expected aesthetic outcome of the procedure, as well as any associated risks and complications, will also be analyzed.
• Anesthesia options will be explained.

Pre-operatively:

The pre-operative evaluation includes some blood tests, a chest X-ray, a cardiogram and sometimes further workup, depending on each case.

You will also need to stop smoking before and for a period of time after surgery, as to avoid getting aspirin and anti-inflammatory drugs since they increase the risk of bleeding.

The Operation:

The operation is performed under general anesthesia.

The Endoscopic Brow Lift may be done as a sole operation or in combination with other facial interventions (facelift, blepharoplasty). Through small incisions (about 1cm) on the scalp, the deep layer of the fascia is identified, which must be suspended around the cut, providing the desired aesthetic correction of the forehead and eyebrows. Sometimes, a small part of the frontalis muscle is removed, if there is major slackness.

The open Brow Lift has the same objectives as the endoscopic procedure. The results, in general, are rather more permanent and predictable, although the size of the incision is a major disadvantage. Patients with baldness or thinning hair will have visible incisions scars and usually prefer the endoscopic method.

These incisions are closed with small sutures, which will be removed in about seven days. Drains will not be used unless a combination of procedures has been performed such as facelift and Brow Lift.

Post-operatively:

After the surgery, you will have few stitches, which will be removed in 7 days. The small incisions were placed on the scalp so that they are inconspicuous. The bruising and swelling will subside in 7-14 days. The use of cold compresses can be used to help this.

The patients return home the same day. The surgeon will give you specific instructions on how to take care of the cuts directly after surgery, which medications to take and when you will be seen again.

Brow Lift operation risks and safety information:

In general, a Brow Lift is a safe procedure with great success. However, like any surgery, it has some risks and possible complications that each patient must be informed of and must be fully understood before entering the operating room.

The possible complications are:

• Bleeding, hematoma or bruising
• Infection
• Poor healing of incisions
• Numbness of the forehead and scalp which may last several months
• Relative asymmetry
• The need for re-operation
• General risks of anesthesia

Our team will explain in detail the whole process and will answer any questions you may have related to the procedure.

The chin occupies a great portion of the lower part of the face. Any isolated chin deformity can be corrected by a procedure called genioplasty. Surgery of this kind is usually performed in cases where the chin is recessive, protruding, vertically excessive or deficient, or shifted towards one side. The goal is to correct the facial imbalance and provide good facial esthetics. There will be no alteration of your bite. A thorough cephalometric and clinical facial analysis is performed as a part of the preoperative evaluation. In some cases of a recessive chin, instead of cutting and repositioning the bone itself, we may use some prefabricated polyethylene implants to augment the chin’s volume.

The procedure

Genioplasty is performed under sedation or general anesthesia. The surgeon will make an incision inside your mouth, below your lower front teeth. Following this, the area or the chin will be reached, and the bone underneath your teeth will be cut. The surgeon is then able to move the chin segment and place it in the appropriate position. According to the abnormality, the surgeon can move the segment forward, backward, align it with the midline, or reduce its vertical height as well as augment its vertical height if necessary. Then the chin segment will be fixated in its final position with plates and screws. In cases of implant placement, the bone will not be cut. The implant will be positioned in place and fixated with screws. The result is immediately visible in all cases.

Do I have to stay in the hospital?

A genioplasty is performed under sedation or general anesthesia. The patient will have to recover for some hours at the hospital and usually is discharged the same day.

When will I be back to normal?

• Most of the swelling will be gone after ten days.
• Some residual swelling (10-20%) may take a month to subside
• You should not do any physical exercises for three weeks (like jogging and aerobic)
• You can be back to work 3 – 5 days after the operation

How long does the operation take?

A genioplasty takes 1,5 – 2 hours to be completed.

How do I have to prepare for the operation?

No Aspirin or drugs that influence the clotting system

Do I have a lot of pain afterward?

There is usually minimal pain following a genioplasty, which is easily controlled with regular pain medications.

Swelling will mostly go down 7 – 10 days after the genioplasty.
Some bruising may also be evident.
In rare cases, you may experience numbness of your lip which is temporary.
In rare cases, an infection of the surgical wound may be noted.
No severe pain is anticipated.

Important information for the time after the operation

• sleep only on your back (that should be slightly raised)
• don`t touch or remove the dressing
• take 3 – 5 days off work
• no sports or heavy physical work for four weeks
• you should place ice packs for a day after surgery
• don`t forget to take the drugs prescribed (usually an antibiotic and a pain-killer)
• healthy food (vitamins) supports the healing process.

When the prominence of the cheekbones is defective, a cheek augmentation procedure can be performed. In cases of lack of definition, flat face or due to the aging process patients can benefit from cheek augmentation procedures. Polyethylene cheek implants are used. They come in various shapes and sizes, and your surgeon will choose the one that fits better according to each case’s needs. Cheek surgery is simple and a very good esthetic solution when indicated.

The procedure

Cheek augmentation is performed under sedation. The surgeon will make an incision inside your mouth, above your upper teeth on both sides. Following this, the area or the cheekbones will be reached. The surgeon will be able to place the cheek implants in the appropriate position and fixate them with screws. The result is immediately visible.

Do I have to stay in the hospital?

The patient will have to recover for few hours at the hospital and will be discharged the same day.

When will I be back to normal?

• Most of the swelling will be gone after 7-10 days.
• Some residual swelling (10-20%) may take a month to subside
• You should not do any physical exercises for three weeks (like jogging and aerobic)
• You can be back to work 2-3 days after the operation

How long does the operation take?

A cheek augmentation usually takes 1 hour to be completed.

How do I have to prepare for the operation?

No Aspirin or drugs that influence the clotting system

Do I have a lot of pain afterward?

There is usually minimal pain following a cheek augmentation, which is easily controlled with regular pain medications.

What are the potential risks and complications?

Swelling will mostly go down 7 – 10 days after the procedure.
Some bruising may also be evident.
In rare cases, you may experience numbness in the area of your cheeks which is temporary.
In rare cases, an infection of the surgical wound may be noted.
No severe pain is anticipated.

Important information for the time after the operation

• sleep only on your back (that should be slightly raised)
• take 2 – 3 days off work
• no sports or heavy physical work for three weeks.
• you should place ice packs for a day after surgery
• don`t forget to take the drugs prescribed (usually an antibiotic and a pain-killer)
• healthy food (vitamins) supports the healing process.

In cases of excess submental fat, jowl fat, and loss of the visible contour of the mandible a submental liposuction procedure can be performed. Although fat deposit in the submental region is usually the result of obesity, it may be present even in individuals of normal weight. During the aging process, the skin loses elasticity and begins to hang.

Accumulation of fat in the submental region causes the loss of normal facial contour. Additionally, jowls as well as the decreased definition of the lower jaw borders are characteristics of aging faces.

Candidates for this type of surgery are patients with submental and jowl fat who request an aesthetic improvement. Skin elasticity should be good to fair to maintain good retraction of the skin. In cases of smoking, diabetes, or other medical problems where extensive facelift procedures may be contraindicated, submental liposuction may be an alternative. Patients who require more rapid recovery than a facelift allows may also be candidates for liposuction.

The procedure

Submental liposuction is performed under sedation. The surgeon will make very small incisions in the submental crease and at the junction of the ears and cheeks. Following this, a solution of an anesthetic with a vasoconstrictive agent will be infiltrated to the area. After 10 minutes the microcannulas will be inserted through the incisions, and the fat will be suctioned out. In some cases, a platysmaplasty may also be performed for better esthetic results. After the procedure is completed a compression garment is placed.

Do I have to stay in the hospital?

Submental liposuction is performed under sedation and local anesthesia. The patient will have to recover for few hours at the hospital and will be discharged the same day.

When will I be back to normal?

• Most of the swelling will be gone after 7-10 days.
• Some residual swelling (10-20%) may take a month to subside
• You should not do any physical exercises for three weeks (like jogging and aerobic)
• You can be back to work 5-7 days after the operation

How long does the operation take?

Submental liposuction usually takes 1 hour to be completed.

How do I have to prepare for the operation?

No Aspirin or drugs that influence the clotting system

Do I have a lot of pain afterward?

There is usually minimal pain following a submental liposuction procedure, which is easily controlled with regular pain medications.

What are the potential risks and complications?

Swelling will mostly go down 7 – 10 days after the procedure.
Some bruising may also be evident.
There is a low risk of an expanding hematoma (collection of blood)
There is a possibility of seroma formation.
You may experience increased sensitivity at the suctioned area.
Perforation of the skin is rare and may result in scaring.
Removal of too much fat may result in adherence of the skin to the platysma.
Damage to the branch of the facial nerve that runs parallel to the lower jaw is very rare.
In rare cases, an infection of the surgical wound may be noted.
No severe pain is anticipated.

Important information for the time after the operation

• keep the head elevated
• soft diet is advisable for several days
• sleep only on your back (that should be slightly raised)
• you may begin showering the following day
• take 5-7 days off work
• no sports or heavy physical work for three weeks.
• you should massage the area to avoid blood collection or lump formation
• you should wear the garment for two weeks
• don`t forget to take the drugs prescribed (usually an antibiotic and a pain-killer)
• healthy food (vitamins) supports the healing process.

Some people have round faces and are seeking for a better definition of their cheekbones. One way to achieve this is to slim the cheeks of the face by performing a surgical procedure which is called buccal fat pad reduction. A facial space containing fat is located in the cheek between the corner of the mouth and the nostril. When fat deposits in the cheeks are excessive, the result can be a full, round face, which may be aesthetically unpleasing.

Patients with chubby cheeks may frequently request this procedure to improve facial appearance.

The procedure

Buccal fat pad reduction is performed under sedation and local anesthesia. The surgeon will make very small incisions on the inside of the cheeks. The fat is located easily, and it is protruding into the mouth once the space is entered. The amount of fat to be removed is determined, and the fat pad is removed using a cautery. This is important as it seals the blood vessels and prevents bleeding. We never remove the whole fat from the space. After the fat is removed the small incisions are closed with dissolving sutures.

Do I have to stay in the hospital?

Buccal fat pad reduction is performed under sedation and local anesthesia. The patient will have to recover for few hours at the hospital and will be discharged the same day.

When will I be back to normal?

• Most of the swelling will be gone after 5-7 days.
• Some residual swelling (10-20%) may take a month to subside
• You should not do any physical exercises for two weeks (like jogging and aerobic)
• You can be back to work the 2-3 days after the operation

How long does the operation take?

A buccal fat pad reduction usually takes 40-50 minutes to be completed.

How do I have to prepare for the operation?

No Aspirin or drugs that influence the clotting system

Do I have a lot of pain afterward?

There is usually minimal pain following a buccal fat par reduction procedure, which is easily controlled with regular pain medications.

What are the potential risks and complications?

Swelling will mostly go down 5-7 days after the procedure.
Some bruising may also be evident.
There is a low risk of an expanding hematoma (collection of blood)
Removal of too much fat may result in future esthetic considerations.
Damage to the branch of the facial nerve is extremely rare.
In rare cases, an infection of the surgical wound may be noted.
No severe pain is anticipated.

Important information for the time after the operation

• keep the head elevated
• soft diet is advisable for several days
• sleep only on your back (that should be slightly raised)
• take 2-3 days off work
• no sports or heavy physical work for two weeks.
• don`t forget to take the drugs prescribed (usually an antibiotic and a pain-killer)
• healthy food (vitamins) supports the healing process.