Norman Surgical Arts Center ~ Yukon Maxillo-facial Surgery Center
Oral Surgery
Norman, OK
(405) 364-6777
Many factors cause the skin to wrinkle and sag (i.e., exposure to the sun, genetics, as well as the natural aging process). Children and young adults have smooth, round faces due to fatty tissue that is evenly distributed throughout the contours of the face. As you age, the skin sags and fits more loosely. These folds become prominent, especially around the chin, the jaw line, and along the neck.
Dr. Braly performs rhytidectomies, or facelifts, to enhance your appearance and correct these conditions. A facelift involves tightening of the facial and neck muscles as well as the removal of any excess skin. The procedure is often performed in conjunction with additional cosmetic surgeries such as blepharoplasty (eyelid surgery), forehead lift, chin augmentation, liposuction, and/or rhinoplasty (nasal surgery). These procedures can be performed any time after signs of aging appear in order to attain a more youthful appearance.
We will evaluate your medical history in order to determine your overall health. Dr. Braly will discuss with you how your face can look and what you can expect from surgery. Our objective is to create a natural appearance that is pleasing to you. Photographs are performed to determine the amount of improvement after surgery.
We will provide you with preoperative instructions that may include the elimination of specific drugs containing aspirin several weeks before surgery to minimize excess bleeding. Antibiotics may also be prescribed to prevent infection. You may be instructed to shampoo your hair the night before surgery. A small amount of hair may be shaved around your ears and temples.
A rhytidectomy can be performed under IV sedation or general anesthesia in our state-of-the-art surgical facility. These options will be discussed in detail with you. Incisions are made inside the hairline at the temple, running in front of the ear then around the earlobe and behind the ear, ending in the hair of the scalp. The loose skin is separated from underlying tissue and is pulled up and back. Excess skin is removed. Sagging muscles and connective tissues are tightened. In some cases, fatty deposits are removed from beneath the chin and neck. Small sutures are used to close the incisions.
Bandages are applied to the area of surgery and are removed within a few days. Pain is moderate and controlled with oral medications. Your sutures are removed within the first five to ten days. In order to minimize scarring, the doctor may remove the sutures in stages. Scarring fades quickly. Swelling and discoloration decrease within two weeks. Tightness in your face will be present for several weeks and there may be slight changes in your hair pattern around the incision.
It is recommended that you avoid the sun for several weeks after surgery. Healing is gradual so you will not notice final results for up to six months. Improvement varies, depending on the your initial condition. In most cases, a single procedure achieves the desired results. Most patients who have had facelifts are pleased with their new, more youthful appearance.
Although standard face-lift techniques can address many of these changes of lower facial aging, many patients are looking for alternatives to this "all-or-nothing" surgical approach. Busy patients demand more immediate results, little (if any) down time, smaller incisions, and less visible scars.
The S-Lift is an ideal alternative to traditional face-lifts. This wonderful procedure gets its name from the "S" shape of the small skin incision just in front of each ear. Patients like to call this procedure the "weekend face lift." The S-Lift provides an overall lift to the lower third of the face and cheeks. Compared to a conventional face-lift, it is a much quicker, safer, more affordable operation with fewer complications and a much shorter recovery time. The S-Lift can also be combined with other minimal incision procedures.
What does the S-Lift involve?
This small-incision alternative to the conventional face-lift is performed in our state of the art surgical facility under local anesthesia with mild sedation. A special anesthetic solution is gently injected into the area forward of the ears. This fluid gently lifts the skin from the underlying tissue. A narrow "S" shaped section of skin is excised from just in front of each ear so that the incision lies in a natural crease. The skin is lifted and the underlying muscles are tightened. Excess fat may be removed with a tiny instrument designed for facial liposculpture. The incisions are then closed using fine sutures.
Following surgery, the normal aging process resumes. Your life-style choices, bone structure, skin type, sun exposure, and heredity all play a part in determining how many years can be removed by an S-Lift, and for how long. In general, younger patients enjoy longer-lasting results.
As one of the most exciting and innovative scientific achievements to date, laser technology is being utilized throughout the health care community. Dr. Braly use one of the newest lasers, the ultrapulse carbon dioxide laser, to treat sun-damaged skin, facial wrinkles, and scars in a procedure called laser skin resurfacing.
The word "laser" is an acronym, which stands for light amplification by the stimulated emission of radiation. A surgical laser, such as the CO2 laser, is a beam of light capable of removing unwanted tissue, such as scarred, lined, wrinkled, and otherwise imperfect skin. The laser vaporizes skin cells by emitting bursts of radiation that are absorbed by water in these cells. Laser light penetrates to a very precise, controlled depth, making the procedure safe and predictable, while reducing the risk of scarring or pigmentation problems. Laser skin resurfacing is bloodless, and is performed in our office under light sedation. As a result of this treatment, you are left with more youthful looking skin.
The laser is used to reduce tiny wrinkles, acne scars, and other minor skin imperfections, especially around the mouth and eyes. It can improve sun-damaged and acne-scarred skin problems that often cause concern to both men and women.
Prior to surgery, Dr. Braly will discuss the goals for facial improvement. After determining the most appropriate procedure, we will fully describe the procedure, what results to expect, and the costs. The skin is usually pretreated prior to surgery to improve the healing time.
A local anesthetic is given to ensure that you are comfortable throughout the procedure. The area is cleansed and draped. Dr. Braly directsthe laser beam toward your skin imperfections. The laser quickly and accurately vaporizes the outermost layers of skin just four or five cells in thickness.
In most cases, only one treatment is needed. The initial redness fades in a few weeks to a light pink, which can be camouflaged with cosmetics. The discoloration usually disappears in one to three months. The goal of laser resurfacing is to enhance facial appearance. Expectations by the patient must be realistic and results should be anticipated as improvements rather than total corrections. Results of the surgery depend on many factors such as the size, shape, and location of the imperfection and the patient's heredity, age, and general skin condition.
Dr. Braly performs rhinoplasties in order to reshape the nose. Appearance can be improved for those people who are dissatisfied with the shape and size of their nose. Nasal reconstruction was one of the first cosmetic procedures ever developed and is among those most frequently performed today. Rhinoplasty is a surgical procedure in which deformities of the nose are corrected by removing, rearranging, or reshaping bone or cartilage.
Reasons include reducing the size of the nose, removal of bumps as well as improving the angle of a nose. Conditions may be natural or due to external trauma to the face. This operation will also help patients who have difficulty breathing. The operation can be performed on all age groups, including teens and the elderly.
A medical history along with a careful examination is conducted in order to evaluate your general health. We will discuss with you the way your nose can look in relation to your other facial features. Preoperative instructions may include eliminating certain drugs that contain aspirin to minimize the possibility of excess bleeding. Antibiotics may be prescribed before surgery to prevent infection.
Surgery is usually performed under general anesthesia. In most cases involving a reduction in shape or size of the nose, angle, or removal of a hump, the skin of the nose is separated from the underlying skeleton of bone and cartilage. The bone and cartilage are then reshaped and the skin redraped over the surface. Patients who have a deviated septum may benefit by correction of this problem. The incisions are placed inside the nose, unless the surgeon uses an open approach, in which case the incisions are made across the columella (the tissue between the nostrils). In cases where the nostrils flare, the surgeon may make an incision at the junction between the nose and the skin of the upper lip to narrow the flared appearance. It is not unusual to combine rhinoplasty with chin augmentation to improve the profile.
The recovery takes one to two weeks. Most people resume their normal activities within a week or two. Following surgery, a lightweight splint is applied to maintain the new shape of the nose. The splint is removed within a week. Nasal packs may be inserted at the time of surgery to protect the septum. These are removed within a week. There is always some stuffiness of the nose, especially when work has been done on the nasal septum.
Pain is minimal and is controlled with medications. Bruising occurs around the eyes and begins to fade within a few days. Discoloration usually disappears in two weeks.
Your insurance company may pay for all or part of the costs associated with your surgery if it is performed as a result of nasal obstruction. It is recommended that you check with your carrier to determine if there is coverage.
Dr. Braly performs brow and forehead lifts to raise eyebrows and reduce ridges and furrows on the forehead, 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.
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 two weeks after surgery. You can proceed with your normal daily activities within one to two weeks. A final evaluation may occur within several months from the initial surgical procedure.
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.
As we all know, the eyes are a prominent facial feature. Although the eyes are expressionless structures, the surrounding skin conveys emotion. The tissue, muscle, fat, hair, and lashes all contribute to the wide array of expressions. Unfortunately, wrinkles and deep lines as well as puffiness under the lids develop as you age. In addition, exposure to the sun, as well as hereditary factors contribute to the aging process, all resulting in changes of expression. In many cases, people may look fatigued, worn out, and older than their true age. Beyond possible visual impairment, these changes in your appearance can cause stress and anxiety.
Dr. Braly is trained in several surgical procedures, such as blepharoplasty, forehead lift, and brow lift in order to eliminate the majority of these problems.
To better understand your overall health, we will evaluate your medical history prior to surgery. In addition, a complete examination of your eyes and face is made in order to take the most effective surgical approach. The amount, distribution, and type of excess skin to be removed are carefully reviewed.
Dr. Braly will provide you with preoperative instructions that may include the elimination of specific drugs containing aspirin several weeks before surgery to minimize excess bleeding. Antibiotics may also be prescribed to prevent infection.
The areas that will be excised are marked and digital photographs are performed in order to determine the amount of improvement after surgery.
We can perform blepharoplasty to correct sagging eyelids, bags or pouches beneath the eyes, as well as excess folds around the eyes. This surgical procedure involves the removal of excess skin and fat on upper and lower eyelids and is often performed in conjunction with other surgical procedures including facelifts, eyebrow, and forehead lifts. Blepharoplasty can be done under general anesthesia (with you asleep) or under IV sedation. Both are very comfortable options. Premedication is utilized prior to surgery to decrease swelling after the operation.
Dr. Braly will trace the natural lines and creases of your face and make incredibly fine incisions from the inner to the outer edge of the eyelid. Surgery on the upper eyelid is performed first with the incision made in the fold of the lid. The incision is made below the eyelash on the lower eyelid. Any excess fat and skin are removed from the underlying compartments. The amount of fat excised is determined by the degree of protrusion of fat when pressure is applied to the area. Small sutures are used to close the incision and special ointments and dressings may be applied. The surgery can take up to two hours. In certain cases, lower eyelid incisions are made inside the lid. Laser may be used at the same time to reduce wrinkles.
Initially, drying of the eyes can occur after blepharoplasty. This condition can be alleviated with medication. In addition, you may be sensitive to bright light and wind for a period of time. Numbness and itching may also occur during the healing process. A final evaluation may occur within several months from the initial surgical procedure.
Your insurance company may pay for part 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.
BOTOX� Cosmetic treatment is a revolutionary approach to reversing the affects of facial wrinkles. Crow's 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� Cosmetic into the tiny facial muscles that create the wrinkles.
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.
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.
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.
Facial liposuction is a very common and popular procedure. It is designed for the permanent removal of fatty tissue from your cheeks, chin, and neck. It is an elective procedure that allows the surgeon to remove undesirable, subcutaneous fat in specific areas that do not respond to diet and exercise.
Patients with good skin tone who have fatty deposits receive the best results from facial liposuction. It is not a treatment for obesity. If weight gain occurs following liposuction, the fat will be deposited in areas that have not been treated. The procedure can be repeated, if necessary. To maintain the safety of the procedure, there is a limit on how much can be done at one time. A variety of factors can affect the results: physical condition, genetic makeup, diet, exercise, smoking, alcohol intake, and skin elasticity.
Facial liposuction is performed under general anesthesia on an outpatient basis in a hospital or surgical center. The surgeon makes small (less than 1/2 inch), discreet incisions in the face or neck. A cannula is inserted in a small incision and attached to a suction machine. The procedure may take an hour or more.
The results of liposuction are permanent. If you were to gain a large amount of weight, you might note rippling in the treated areas, depending on your skin elasticity.
Following liposuction, the scar will go through a maturation process. During the first eight to twelve weeks, they may be red and possibly raised. The scars will mature over six to twelve months and become pale, flat, and soft. You may experience numbness, burning, and/or tingling around the incision site. These symptoms are almost always temporary. Please let us know if you are prone to keloid scars.
In cases of protruding or over-developed ears, the procedure of otoplasty may be an option. Otoplasty is commonly referred to as "pinning back" of the ears. It is available for children once their ears have stopped developing around the age of six. Over-developed ears can be the cause of psychological stress and trauma and should be treated at a young age before it becomes a serious issue. Dr. Braly is trained in several surgical procedures that eliminate the majority of the problems related to protruding ears.
To better understand your overall health, we will evaluate your medical history prior to surgery. In addition, a complete examination of your ears is made in order to take the most effective surgical approach. All issues such as shape and types of anesthesia used will be discussed.
Dr. Braly will provide you with preoperative instructions that may include the elimination of specific drugs containing aspirin several weeks before surgery to minimize excess bleeding. Antibiotics may also be prescribed to prevent infection.
The areas that will be excised are marked and digital photographs are taken in order to document the amount of improvement after surgery.
The procedure can be performed under IV sedation or general anesthesia and the doctor will discuss this option with you. Dr. Braly has the option of either folding the cartilage located on the back of the ear or removing excess cartilage. Sutures are placed and bandages applied to speed the healing process. The procedure typically takes only a few hours.
After the operation patients should expect bruising around the area that fades in two to three weeks. Pain associated with operation is minimal and can be easily treated with oral medication. The bandages are only needed for a few days and should be replaced with a lighter dressing. Refraining from sleeping on the ears is required and patients are advised to use a very soft pillow. Showering and shampooing may begin after a few days. Expect two to three days of recovery before normal activities can be performed. Consult with Dr. Braly before attempting any athletic or precarious activities that may affect the healing process.
Chin and Cheek Implants
Facial implants can dramatically improve the look of your face. Chin and cheek implants can create a more natural look.
A chin implant can augment the jaw-line to correct a weak or retrusive chin and improve the overall harmony of the face and the neck-chin angle. The surgery is done through a small incision under the chin and is associated with relatively quick healing with minimal bruising.
Cheek implants can dramatically improve the look of your face. It can offer the look of defined and higher cheekbones. It can also rejuvenate the face by replacing the fat that in youth was present in the cheeks.
If cheek implants are the only procedure being performed, the incision is typically made in the mouth and then placed in the cheek. This avoids visible scarring. If you are having a facelift in addition to a cheek implant, the cheek implants can be put in the face through the same incisions.
Featherlift
The FeatherLift is the most in non-surgical facial lifting. This new procedure is a minimally invasive technique that requires no incisions with little to no downtime. This newly emerging trend in face lifting is achieved by placing Aptos Threads, or anti-drooping suturing threads, underneath the skin's surface.
These serve as a truss to elevate a drooping brow, cheek, or neckline. This non-surgical face "lifting" is for patients with facial aging who are eager to improve their appearance without going through a facelift surgery.
Fillers
WHAT ARE RESTYLANE AND PERLANE?
Restylane and Perlane are long-lasting gels that, when injected into the skin with an ultra-fine needle, lift and add volume to the areas being treated. Restylane and Perlane are essentially the same product; Perlane is simply more concentrated. They are similar to one of the body's own natural substances (hyaluronic acid) so reactions are exceedingly rare. The hyaluronic acids in Restylane/Perlane simply supplement the body's age-depleted hyaluronic acid to plump up the lip or to raise the skin and 'fill in' the particular wrinkle being treated.
WHAT ARE RESTYLANE AND PERLANE USED FOR?
Restylane and Perlane are excellent treatments for:
* wrinkle correction
* lip enhancement
* smile lines (correcting thin, superficial lines around the eyes, mouth and forehead)
* deep folds
* shaping facial contours (such as cheeks and chin correcting)
* volume augmentation of the lips
HOW LONG WILL THE TREATMENT LAST?
The effect of both Restylane and Perlane treatment will vary from individual to individual. Results depend on factors such as the person's age and lifestyle, the structure of the skin, and the degree of perfection required. Most patients elect to receive an additional treatment within a year since the hyaluronic acid in both products, being a natural substance, dissolves over time. Being larger in size, Perlane takes longer to dissolve than Restylane.
SUMMARY
Restylane and Perlane treatments are quick, safe and effective. Since neither product is extracted from animals, there is no risk of an allergic reaction. As one of the main components of both products (hyaluronic acid) occurs naturally within the body, no 'patch test' is required. Treatment may begin immediately after consultation and results are immediate.
Genioplasty (chin surgery)
When a chin is small, it may undermine the entire face making a nose look larger and more conspicuous. A genioplasty is a surgical procedure carried out to reshape or change the size of the chin. Using specialized instruments, the bone of the chin is reshaped to balance your profile in relationship to the nose, jaws and lips.
The surgical reshaping of the chin is carried out either as an isolated procedure or as part of other facial surgery (e.g. orthognathic surgery, rhinoplasty or facelift). A genioplasty may have dramatic positive affects on your profile and shape of the lips.
Scar Revision
Because of its location, a facial scar is frequently considered a cosmetic problem. There are several ways to make a facial scar less noticeable.
Often it is simply cut and closed with tiny stitches, leaving a thinner, less noticeable scar.
If the scar lies across the natural skin creases, Dr. Braly may be able to reposition it to run parallel to these lines, where it will be less conspicuous.
Some facial scars can be softened using a technique called microdermabrasion, a controlled scraping of the top layers of the skin. Microdermabrasion leaves a smoother surface to the skin, but it won't completely erase the scar.
Z-Plasty
Z-plasty is a surgical technique used to reposition a scar so that it more closely conforms to the natural lines and creases of the skin, where it will be less noticeable. It can also relieve the tension caused by contracture.
In this procedure, the old scar is removed and new incisions are made on each side, creating small triangular flaps of skin. These flaps are then rearranged to cover the wound at a different angle, giving the scar a "Z" pattern. The wound is closed with fine stitches, which are removed a few days later. Z-plasty is usually performed as an outpatient procedure under local anesthesia.
While Z-plasty can make some scars less obvious, it won't make them disappear. A portion of the scar will still remain outside the lines of relaxation.
As you heal, keep in mind that no scar can be completely removed. The degree of improvement depends on the size and direction of your scar, the nature and quality of your skin, and how well you care for the wound after the operation.
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