Q: What is Plastic Surgery?
A: Plastic surgery is a surgical specialty dedicated to reconstruction of facial and body defects due to birth disorders, trauma, burns, and disease. The art and science of plastic surgery is also involved with the enhancement of the appearance of a person through such operations as facelift, rhinoplasty, breast augmentation, and liposuction.

Q: What is the difference between cosmetic and reconstructive surgery?
A: Cosmetic surgery is performed to reshape normal structures of the body in order to improve the patient's appearance and self-esteem. Cosmetic surgery is usually not covered by health insurance because it is elective.

Reconstructive surgery is performed on abnormal structures of the body, caused by congenital defects, developmental abnormalities, trauma, infection, tumors or disease. It is generally performed to improve function, but may also be done to approximate a normal appearance. Reconstructive surgery is generally covered by most health insurance policies although coverage for specific procedures and levels of coverage may vary greatly.

There are a number of "gray areas" in coverage for plastic surgery that sometimes require special consideration by an insurance carrier. These areas usually involved surgical operations which may be reconstructive or cosmetic, depending on each patient's situation. For example, eyelid surgery (blepharoplasty) - a procedure normally performed to achieve cosmetic improvement may be covered if the eyelids are drooping severely and obscuring a patient's vision.

Q: What is the Recovery from Plastic Surgery Like?
A: Each patient will tolerate pain post-operatively in a different way, and we consider this. While some patients may describe the pain as an ache, others experience greater discomfort. Appropriate pain medications are prescribed for the post-operative patients, and these help minimize discomfort. Most facial cosmetic operations have minimal discomfort post- operatively. Liposuction is slightly more uncomfortable, and operations that require elevation or tightening of the muscles-such as an abdominoplasty or breast augmentation have discomfort equal to that of a C-section.

Q: How long is the recuperative period and when can I return to work?
A: The length of time it takes to recuperate after plastic surgery varies depending on the procedure performed and the person operated on. Most patients will require assistance for the first two days. Then most patients are able to care for themselves, but may still need assistance if they have small children to care for. The specific lengths of disability are outlined below by procedure. These are approximations, and do not include return to exercise.

Eyelid Surgery-Usually can get around independently by the second day. With the use of sunglasses, may feel comfortable going to the store by day 3-4, and with makeup could return to work by 5-7 days.
Facelift Surgery-Usually can get around independently by the second day. Usually do not feel comfortable going out in public for 5-7 days. Requires 10-14 days before returning to work if in the public eye.
Breast Surgery-Usually can get around independently by the second day. May return to work at 5-7 days if not required to lift more than 15 pounds.
Liposuction-Usually can get around independently by the second day, earlier if smaller number of areas treated. One can return to work and normal activities in 5-7 days.
Abdominoplasty-Patients may take between 2-4 days before getting around independently. The recovery is almost identical to C-section. One can return to a desk job at 5-7 days, other jobs 10-14 days.

Q: When can I resume regular exercise?
A: The time a patient resumes regular exercises varies based on the operation performed. All patients are encouraged to start a slow walking routine on the second postoperative day. Regular aerobic and more vigorous activities are not allowed during the first 2 weeks in order to decrease the risks of bleeding, swelling, and bruising. Weight lifting and contact sports are allowed at 1 month in most cases.

Liposuction

Q: There has been so much in the press about suction fat removal surgery. What exactly is it?
A: It is a procedure variously known as liposuction, lipolysis, suction assisted lipectomy (SAL), or lipoplasty.  The technique was developed in France for the permanent removal of cellulite and localized fat deposits.  This procedure is remarkable because of the surgical incision, about ¼ inch in length, and is often closed by only one stitch.

Because of early controversy surrounding the procedure, a "Blue Ribbon" study commission of plastic surgeons from the United States went to France late in 1982 to formally investigate the operation and its results. The committee issued a detailed report in January of 1983 which contained the following: "The committee unanimously agrees that suction lipectomy by the blunt cannula method is a surgical procedure that is effective and safe in trained and experienced hands, and offers benefits which heretofore hae been unavailable".  Dr. Gutstein began doing liposuction in 1981 and has one of the largest experiences with approximately 5,000 cases.

Q: Are there people who should not have this procedure
A: Lipolysis is most useful for the removal of localized fatty deposits from the "saddle bag" area, abdomen, hips, buttocks, and knees.  It is not useful for generalized obesity. This procedure is most useful in people under 55 years of age who have localized fatty deposits, but who are not themselves overweight or fat.  Liposuction cannot perform miracles on an overweight body.  Cosmetic plastic surgery is a combination of art and science.  Surgery is not an exact science and results are not always under the control of either Dr. Gutstein or the patient. It is impossible to guarantee or warrant any results.  The end result is dependent upon a  number of factors which are different in each individual patient, including among others, age, physical condition, elasticity of the skin, genetic makeup, heredity, diet, exercise, smoking, alcoholic intake, exercise and physical condition. No two persons, despite similar appearance, will have exactly the same result.

Q: How is liposuction done?
A: The surgery consists of a small incision, less than ¼ inch in length, injection of a solution into the fatty tissue, crosswise tunneling of the fat with an instrument, and suctioning out of the fat into each area you wish to have contoured.  The use of internal or external ultrasound to further loosen the fat is used in some clinics.

Q: How long does the operation take?
A: An average of one hour for each area treated including local, dissociative or general, anesthesia time.

Q: Is convalescence difficult?
A: In general, no.  There is a feeling of soreness, but rarely is there any sharp or severe pain involved in the recuperation period.

Q: Is hospitalization necessary?
A: Most of the operations of this type are performed under general or dissociative anesthesia and may be done in the office or the hospital as a day surgery procedure.  Smaller areas may be treated under local anesthesia.

Q: Is there an age limit for this operation?
A: Patients under 45 years of age usually get the very best result because their skin is tighter. However, the state of the skin remains the determining factor and many older patients obtain good results, too.  We have performed liposuction on selected patients to the age of 80.

Q: When can I become active again?
A: Walking and self-care is allowed at home on the day following the procedure and is encouraged.

Q: When can I return to work?
A: In general, three to five days after the operation for office work, and ten days for more active employment.

Q: When can I exercise?
A: Exercise and massage are encouraged ten days after the operation in order to modify and diminish the adhesion between the skin and deeper tissues.

Q: Should I follow a special diet?
A: No.  But in order to have the best results, it is good to have a well-balanced diet including fruits, vegetables, proteins, and not to over eat.

Q: When can I get in the sun again?
A: When all the bruising has disappeared, usually in 2 weeks.

Q: Are the results permanent?
A: In general, yes. However, if you gain a large amount of weight, the operated area will also slightly increase, but not as much as would have occurred before the operation. Rippling may also occur with large weight gain, and fat will be preferentially deposited in areas not operated upon.

Q: Can the operation be repeated?
A: Yes. It is preferable to operate in stages on some persons with exceedingly large fat deposits. Correction of minor irregularities can be done under local anesthesia.

Q: Can the operation cause complications?
A: A remarkably few serious complications have been reported: Infection, phlebitis, bruising and thickened scars are among these. Minor problems such as dimpling or rippling may be seen occasionally, especially if the skin is lax to begin with.

Q: What happens to the excess skin?
A: Due to its elasticity, the skin will shrink over the newly contoured area of the body. When the skin is loose due to age, or at times, on a hereditary basis, skin "tucks" may be advised at the same (or subsequent) time.

Q: Why is it important to have pre-operative pictures?
A: Pictures help in the analysis of the problem in preoperative planning and in comparing results, and are necessary in all plastic surgery procedures.