Sciton SkinTyte™ 2 is the 2nd generation SkinTyte Technology that uses Intense Pulsed Light and Infrared technology to deeply heat dermal collagen while protecting the entire treated area with sapphire contact cooling. This process promotes contraction of the collagen, initiating the body’s natural healing process. Following treatment, a new foundation of collagen is created leading to increased skin firmness.

How does Sciton Skintyte 2 work?

Sciton SkinTyte™ 2 utilizes infrared energy to deeply heat dermal collagen while protecting the entire treated area with sapphire contact cooling. This process promotes contraction of the collagen, initiating the body’s natural healing process. Following treatment, a new foundation of collagen is created leading to increased skin firmness.

What conditions can be treated with Sciton SkinTyte 2?

• Facial skin

• Neck skin

• Abdominal skin (especially after pregnancy or liposuction)

• Sagging arm skin

What will happen during the procedure?

A numbing cream will be applied to the areas to be treated, after which you will wait 20-30 minutes for the cream to take effect. Your eyes will be protected with safety shields or glasses.  You will feel a warming sensation as the light is absorbed by the targeted areas. Your procedure may take a few minutes to half an hour depending on the size of the area to be treated and the type of procedure performed. We will discuss all of your options with you.
What areas can be treated?

Any area of your body can be treated. The most common areas are those that appear to be sagging and have lost the natural collagen and elastin fibers that keep the skin firm and resilient. The most popular treatments are on the face, neck, back of the hands, chest and abdomen.

How many treatments will I need?

The number of treatments needed will vary from patient to patient and we will personalize a treatment plan based on the level of improvement you desire. We may also combine your treatment with other popular aesthetic procedures to further personalize your treatment.  Typical patients need 4 treatments spaced 2-4 weeks apart, but most patients will see results of tightening right after the first treatment, but results can take up to 3 treatments to see.

Will it be uncomfortable?

The procedure is gentle, noninvasive and safe. The Sciton SkinTyte procedure has minimal discomfort associated with it.

What should I expect after the treatment?

You may experience some redness that should resolve within a few hours.

How long will it take to recover?

This is a noninvasive and gentle procedure with virtually no downtime. In most cases, you are able to return to work, apply makeup, and resume most of your activities immediately.

What aftercare do I need?

It is important to follow your our instructions. You may be given some skin care products and instructions on how to use them. You will be sensitive to ultra-violet light and you must avoid direct sun exposure until completely healed. Fully cover your skin or use a good sunscreen whenever you go outdoors.

A MicroLaserPeel removes a thin layer of damaged skin to improve texture and provide a more youthful appearance. It provides superior results because it can be administered with great precision of depth. The procedure is performed in our center and can be custom tailored to your specific skin conditions and desired outcome.

How does MicroLaserPeel work?

The MicroLaserPeel’s beam is scanned over a treatment area to remove a very thin layer of the skin. Removing the top layer eliminates some of the damaged cells that can give skin a tired, aged look. As the skin heals, fresh cells grow and resurface the treated area. The result is healthier-looking skin, often with reduced wrinkles and improved color evenness. Patients often say that it looks like their skin went from looking tired to vibrant.

What conditions can be treated with MicroLaserPeel?

• Mild wrinkles

• Scars

• Keratosis

• Sun damage (e.g., freckles)

• Pigment irregularities

What areas of the body can be treated?

Most skin areas can be treated. Popular treatment areas are the face and neck, though some people also treat the chest and hands.

How many treatments will I need?

Excellent results can be obtained in just one treatment; however the number of treatments needed may vary from patient to patient. We can personalize a plan based on your specific needs and may choose to combine MicroLaserPeel with other aesthetic procedures to further personalize your treatment.

What will happen during the procedure?

Your skin will be cleaned in the treatment area and your eyes will be protected with safety shields. We will position the laser handpiece above the skin and will hold it in place as the computer-guided scanner moves the laser beam around the treatment area. Depending on the size of the area being treated, the procedure usually lasts 15 to 30 minutes.

Will it be uncomfortable?

One of the primary advantages of MicroLaserPeel is that it causes little pain because it does not penetrate very deep into the skin. At its most shallow settings, most people can tolerate treatment with no anesthetic at all. At deeper settings, a topical numbing cream is typically used.

What should I expect immediately after the treatment?

Immediately after the treatment you will notice that the skin has a frosty appearance. This is the dehydrated skin that will peel away within next few days following the treatment. You may experience some skin redness and a sensation resembling sunburn, as well as mild swelling.

How long will it take to recover?

Depending on the depth of treatment, most patients feel comfortable enough to return to work within 3 to 4 days; an attribute that has given rise to the nickname the “weekend peel”.

What aftercare do I need?

You may be given skin care products and instructions on how to use them. Your skin will be sensitive to ultra-violet light after the procedure, so you must avoid direct sun exposure until fully healed. It is recommended that you always use some level of solar protection to avoid sun damage and premature aging of your skin.

When should I expect results?

Because only the outer layer of skin is treated, most patients notice an obvious improvement in tone, texture and color evenness once the skin heals in approximately 3-4 days.

ClearScan employs laser energy that can selectively target microstructures, such as hair follicles. With its targeted absorption by melanin, it gives the optimal balance between safely treating all skin types and effectively removing unwanted hair. The ability to safely treat sun-tanned skin makes this the treatment of choice for active individuals.

How does ClearScan work?

The ClearScan laser selectively targets your hair follicles and heats them with laser energy. Unlike other treatments, the laser beam treats many hairs at once, making treatment of large areas practical. The ClearScan utilizes a unique computer-guided scanning system that automates the treatment, ensuring your skin is rapidly and evenly treated. The computer places the beam in an optimum pattern for your skin to experience a safe, effective and gentle treatment.

Can all skin colors be treated?

Yes, all skin types from light to dark can be treated.

Can tanned skin be treated?

Yes, tanned skin can be treated safely. However, always inform us if you have been tanning, using tanning products, or have experienced prolonged exposure to the sun within the last three weeks.  We will then adjust your treatment regimen accordingly to give you the safest and most effective experience.

Can in-grown hair be treated?

Yes, laser energy delivered by ClearScan can be used to remove all types of hair. When shaving bumps cover follicles, the laser energy can still penetrate to the hair follicle for a safe and effective treatment.

How many treatments will I need?

The number of treatments needed will vary from patient to patient and your physician will personalize a treatment plan based on the level of improvement you desire. We may also combine your treatment with other popular aesthetic procedures to further personalize your treatment.  Typically, patients need 6 treatments spaced 4-6 weeks apart.  The Sciton Clearscan ND:Yag laser hair removal laser only kills the hairs that are currently growing.  It cannot kill the hairs that are in the dormant or asleep state.  Our hair grows in cycles and every month a new cycle of hairs turn from the dormant state to the growing state.

What will happen during the procedure?

We will discuss the treatment of the Sciton Clearscan ND:Yag laser hair removal laser with you and decide if you need a topical anesthetic cream. The area of your skin that is to be treated will be scanned with laser light. Treatment time will depend on the size of the area to be treated. The continuous cooling feature will ensure your comfort and safety during treatment. Since the sensation varies from individual to individual, a topical anesthetic can be provided. Let us know if you are very sensitive.

Is there a risk of complications?

Temporary pigmentation changes are possible but seldom occur. Always discuss your concerns with us prior to treatment.

What should I expect after treatment with the Sciton Clearscan ND:Yag laser hair removal laser?

Some redness and slight swelling may be present in the area that has been treated. However, this should subside within a few hours. If any prolonged redness or swelling occurs, please consult us immediately. Keep the treated area clean, use at least SPF 15 sunscreen when going outdoors, and follow physician instructions carefully.

ProFractional™ & ProFractional-XC™

Dramatic results with minimal down time

What is ProFractional Therapy?

ProFractional Therapy is a quick and comfortable laser procedure with little downtime, used for improving the overall appearance of your skin. The procedure is performed in our center and can be custom tailored to your specific skin conditions and desired outcome.

How does ProFractional work?

ProFractional uses a tiny laser beam to treat thousands of pinpoint areas of your skin. Because only a fraction of your skin is directly treated with the laser, the surrounding untreated tissue promotes rapid healing. This skins wound healing response creates new collagen which adds firmness and resilience to the skin.

What is the primary application of ProFractional?

Based on an assessment of your skin condition and cosmetic goals, we may choose to use ProFractional whenever a combination of resurfacing with minimal downtime is desired.

What areas of the body can be treated?

Most skin areas can be treated. Popular treatment areas are the face and neck, though many people also treat the chest and hands.

How many treatments will I need?

Excellent results can be obtained in just one treatment, though the number of treatments may vary from patient to patient. We can personalize a plan based on your specific needs and may even choose to combine ProFractional Therapy with other aesthetic procedures to further personalize your treatment.

What will happen during the procedure?

Your skin will be cleaned in the treatment area and your eyes will be protected with safety shields. A laser handpiece will be positioned gently on the skin. When the laser energy is applied, you will hear a rapid succession of snapping sounds. The handpiece will be moved around to adjacent locations until the entire treatment area has been covered. The procedure normally takes 15 to 30 minutes.

Will it be uncomfortable?

ProFractional therapy is widely regarded as a comfortable procedure, usually tolerated with the use of a topical numbing cream or a local anesthetic, depending on the depth of treatment.

What should I expect immediately after the treatment?

Immediately following the procedure you may experience mild redness and a sensation resembling sunburn. We will advise you on specific after-treatment care recommendations, which may include analgesics and application of an ointment to keep the skin moist.

How long will it take to recover?

Complete healing typically occurs within a few days and most patients usually feel comfortable enough to get back to work and apply makeup a day or two after the treatment. There will likely be some swelling that will subside within several days following the treatment.

What aftercare do I need?

You may be given skin care products and instructions on how to use them. Your skin will be sensitive to ultra-violet light after the procedure, so you must avoid direct sun exposure until fully healed. It is recommended that you always use some level of solar protection to avoid sun damage and premature aging of your skin.

When should I expect results?

As your skin heals in the days following your treatment, you may notice a general tightening effect. However, the true benefit of ProFractional is the collagen remodeling that occurs during the 4 to 6 months following your treatment.

BBL is an innovative technology that sets new standards for skin conditions associated with aging, active life-styles and sun damage. BBL energy allows us to precisely treat age and sun spots, small facial veins, and many other skin conditions. Your treatment will be tailored to match your skin type and your desired results.

How does BBL work?

The light energy delivered by the BBL will gently heat the upper layers of your skin. The heat absorbed by the targeted areas will stimulate your skin cells to regenerate new collagen. This process will restore your skin to its natural beauty, blending its natural colors and making it smoother, vibrant and younger looking. In addition, the photothermal energy will eliminate fine vessels that cause redness and reduce unwanted melanin that produces pigmented lesions.

What conditions can be treated with BBL?

• Pigmented Lesions (e.g., freckles, age spots)

• Vascular Lesions (e.g., small blood vessels)

• Acne

• Skin Firmness

• Uneven Skin Texture

• Unwanted Hair

What areas can be treated?

Any area of your body can be treated. The most common areas are those most exposed to the damaging effects of sunlight. The most popular treatments are on the face, neck, back of the hands, chest and shoulders.

How many treatments will I need?

The number of treatments needed will vary from patient to patient and we will personalize a treatment plan based on the level of improvement you desire.  We may also combine your treatment with other popular aesthetic procedures to further personalize your treatment.

What will happen during the procedure?

Your eyes will be protected with safety shields or glasses. You may briefly feel a warm or rubber band snap sensation as the light is absorbed by the targeted areas. Your procedure may take a few minutes to half an hour depending on the size of the area to be treated and the type of procedure performed.

Will it be uncomfortable?

The procedure is gentle, noninvasive and safe. Generally, there is no need for a topical anesthetic, however, we may choose to use it on more sensitive areas.

What should I expect after the treatment?

You may experience some redness that should resolve within a few hours. For some pigmented lesions, you will see a darkening of the treated areas followed by fading and flaking off at a later stage. Your treated skin will feel smoother, fine lines and pores will be less noticeable, and sunspots or uneven pigmentation will fade. Results depend on your condition, the number of treatments, and the area treated. We will provide you with complete information about the post treatment care and results.

How long will it take to recover?

This is a noninvasive and gentle procedure with virtually no downtime. In most cases, you are able to return to work, apply makeup, and resume most of your activities immediately.

What aftercare do I need?

It is important to follow our instructions. You may be given some skin care products and instructions on how to use them. You will be sensitive to ultra-violet light and you must avoid direct sun exposure until completely healed. Fully cover your skin or use a good sunscreen whenever you go outdoors.

LATISSE® solution is a prescription treatment for hypotrichosis (inadequate or not enough eyelashes) used to grow eyelashes, making them longer, thicker and darker.

How was LATISSE® discovered?

It’s a story of how one great product led to another. In 2001, Allergan developed a medicated eye drop used to treat ocular hypertension. Then, a side effect was discovered.  Patients began growing longer, fuller and darker lashes. This led Allergan to study the active ingredient in this other product, and after a clinical trial, LATISSE® was born, earning its FDA approval in December 2008.

How does LATISSE® work?

LATISSE® is believed to affect the growth (anagen) phase of the eyelash hair cycle in two ways: first, it increases the length of this phase; and second, it increases the number of hairs in this growth phase. The exact way it works is unknown.

How soon will I see results?

LATISSE® users may start to see longer lashes at 4 weeks, with full growth at 16 weeks. The growth is gradual over time.

How do I apply LATISSE®?

LATISSE® solution is a once-a-day treatment you apply yourself each evening to the base of the upper eyelashes. DO NOT APPLY in your eye or to the lower lid, because excess hair growth outside the treatment area may occur. See the full instructions in How to Apply, and apply as instructed by us.

What if I forget to apply one night? Or a few nights?

If you miss an application, or a few, don’t try to catch up. Just apply the LATISSE® treatment the next evening and stay on schedule.

Could LATISSE® cause the color of my eyes to change?

Increased brown iris pigmentation has occurred when the same formulation of bimatoprost ophthalmic solution was instilled directly into the eye to treat elevated intraocular pressure. Although iris pigmentation was not reported in clinical studies with LATISSE®, patients should be advised about the potential for increased brown iris pigmentation which is likely permanent.  In other words, the formulation can change the eye color in a very small percentage of patients (1-2%) if it is put directly into the eye, but has not shown to change eye color if it is brushed on the roots of the eye lashes.

What are the possible side effects of LATISSE®?

The most common side effects after using LATISSE® solution are an itching sensation in the eyes and/or eye redness. This was reported in approximately 4% of patients. LATISSE® solution may cause other less common side effects which typically occur on the skin close to where LATISSE® is applied, or in the eyes. These include skin darkening, eye irritation, dryness of the eyes, and redness of the eyelids.

If you develop a new ocular condition (e.g., trauma or infection), experience a sudden decrease in visual acuity, have ocular surgery, or develop any ocular reactions, particularly conjunctivitis and eyelid reactions, you should immediately seek your physician’s advice concerning the continued use of LATISSE® solution.

Do I need to refill my LATISSE® prescription every month?

To achieve the full effect of LATISSE® longer, fuller, darker lashes you will need to use the product daily for 16 weeks.

Juvederm® (made by Allergan, the makers of Botox Cosmetic) is made of cross-linked hyaluronic acid, a type of sugar naturally found in your skin and connective tissues. What makes Juvederm® so special is that once it is injected into the body, Juvederm® starts absorbing water like a dry sponge and plumps up the area in which it was injected.  Juvederm® is FDA approved for the treatment of moderate to severe nasolabial folds (smile lines from the nose to around the mouth), but is also often used to plump up the lips and to lessen the appearance of tired bags under the eyes.

How long does Juvederm®?

Juvederm® has been shown to last for up to 12 months.  After injection the body naturally starts breaking Juvederm® down into simple sugars and this process may take a total of 6-12 months or more to complete.  In the meantime, you enjoy the benefits of decreased lines and wrinkles and increased fullness in the lips.

Does Juvederm®?

Juvederm® is  well tolerated by most patients. Numbing creams can help with any discomfort and a local anesthetic injection is always done for sensitive areas like the lips at no extra cost.

How will I look post-treatment?

Post-treatment injection sites will have some redness and swelling.  Most patients can return to work the next day without any problems.  Lip augmentation with Juvederm® will look grossly enlarged for the first 24-48 hours with a return to normalcy in 3-5 days.  It is recommended that you do lip augmentation with Juvederm® on a Friday, thus being able to return to work by Monday.

Can I do Juvederm® and Botox® at the same visit?

Yes.  Botox® Cosmetic and dermal fillers such as Juvederm® are often  used together to give the total non-surgical rejuvenation.  Most patients choose to undergo both treatments at the same time to reduce the inconvenience of coming back.  Others choose to do them separately for financial or other reason.

Botox® Cosmetic is the protein Botulinum Toxin A made by Allergan, a world leader in prescription cosmetic medicines including Botox Cosmetic and Juvederm.  Botox Cosmetic is FDA approved to reduce the appearance of glabellar lines (frown lines between the eyebrows), but has also been used successfully to treat forehead lines, crows feet, blepharospasms (excessive blinking), hyperhydrosis (excessive sweating in the underarms, hands, and feet), migraine head aches, and other physicial ailments.

How does Botox® Cosmetic Work?

When injected into the muscle or tissue, Botox Cosmetic impairs the nerves from telling the muscles to contract or the sweat glands to produce sweat.

How will I look post treatment?

You will notice some initial redness and swelling in the treated area that will subside in the next hour.  Within 3-5 days, you will start to notice a more rested appearance, with the best effects noticed in 2 weeks.  Contrary to popular belief, you can have a full range of facial expressions with Botox Cosmetic treatments.

How long does Botox® Cosmetic Last?

The effects of Botox Cosmetic typically last 3-4 months and up to 6 months.  Individual results will vary depending on the strength of the underlying muscles.  Your lines will return to the pre-treatment appearance as the Botox® Cosmetic wears off.

Do Botox® Cosmetic injections hurt?

Most people compare the injection sensation to a bug bite.  Overall discomfort is minimal and temporary.

Where is Botox® Cosmetic administered? 

Traditionally it is used to treat frown lines between the eye brows, forehead creases, crows feet around the eyes and fine lines above the lips.

Are Botox® Cosmetic injections safe? 

Botox® has safely treated a variety of medical conditions since its FDA approval in 1989.  Botox® Cosmetic was FDA approved in 2002.  As of 2007, Botox injection is the most common cosmetic procedure, with 4.6 million procedures in the United States, according to the American Society of Plastic Surgeons.

1. What is Juvederm? Juvederm is an injectable filler for facial folds, lip augmentation, and wrinkles that is made up of hyaluronic acid. It instantly restores your skin’s volume and smoothes away facial wrinkles and folds like your “smile lines” or “parentheses” (nasolabial folds—the creases that run from the bottom of your nose to the corners of your mouth).

2. What is hyaluronic acid? Hyaluronic acid is a naturally occurring substance found in all mammals that helps to hydrate and add volume to your skin. In addition to its use as an aesthetic treatment, hyaluronic acid has also been used for more than 20 years for injection into arthritic joints to aid movement as well as for eye surgeries and wound repair.

3. Why does Dr. Lopez use Juvederm instead of Restylane? Restylane is a great filler. However, Dr. Lopez has found that Juvederm is a little longer lasting and in his practice the risk of palpable areas has been less with Juvederm. Juvederm is also the only hyaluronic acid (HA) filler FDA approved to last up to 1 year.

4. What is Juvederm used for? Dr. Lopez uses Juvederm to fill areas of the face that have thinner skin such as the lips and the lower eyelids.

5. Can Juvederm work for me? You should not use Juvederm if you are allergic to any ingredient of Juvederm. You should also not choose Juvederm if you desire very short-term results.

5. How does Juvederm work? Once injected, Juvederm immediately adds fullness to your face giving you a visible result at the first treatment session.

6. Do injections of Juvederm hurt? As with any injection, injections with Juvederm may hurt. Juvederm is injected in small amounts using a very fine needle. Dr. Lopez uses advanced techniques to minimize the discomfort.

7. Does the correction last forever? No. Correction is temporary; therefore, touch-up injections as well as repeat injections are usually needed to maintain optimal corrections.

8. Are skin tests needed before treatment with Juvederm? No skin testing is required prior to use.

9. Can people with different skin tones/colors be treated with JUVÉDERM™? Yes. Juvederm injectable gel is the first FDA-approved hyaluronic acid dermal filler that has proven its safety and effectiveness in persons of color. Studies with Juvederm showed no increased risk of hyperpigmentation or hypertrophic scarring in patients of color.

10. Should I tell Dr. Lopez what medications I am taking? Yes. You should tell Dr. Lopez about all the medicines you are taking, even over the counter medicines or treatments. If you are taking blood thinners or medications that may interfere with clotting of the blood, such as aspirin, you might be more likely to have bruising or bleeding at the injection site. There have been no studies of possible interactions between Juvederm and drugs or other substances or implants.

11.What can I expect to happen at a treatment session?

12. What are possible side effects of treatment with Juvederm? The most common side effects are redness, bruising, or swelling. These side effects generally last for a short time and are mild in nature. As with all procedures that involve an injection through the skin, there is a risk of infection.

13. How quickly can I get back to my daily activities? Most patients feel comfortable going back to their normal activities immediately after treatment with Juvederm.

14. How many treatments are required? Generally, significant changes may be achieved in a first treatment. An enhancement procedure may be required to achieve optimal results.

15. What to expect after your Juvederm treatment. Dr. Lopez will inject the optimal amount of Juvederm during your treatment. You will then have your maximal amount of swelling 48-72 hours after your treatment after which your final result will take shape. In Dr. Lopez’s experience, Juvederm lasts about 9 to 12 months.

Radiesse – Frequently Asked Questions

1. What is Radiesse? Radiesse is an injectable filler for facial folds and wrinkles that is made up of calcium hydroxylapatite.

2. What is Radiesse used for? Dr. Lopez uses Radiesse to fill moderate to severe facial wrinkles and folds in the areas of the face that have thicker skin such as the nasolabial folds– the creases that extend from the corner of your nose to the corner of your mouth.

3. Can Radiesse work for me? You should not use Radiesse if you are allergic to any ingredient of Radiesse. You should also not choose Radiesse if you desire only short-term results.

4. How does Radiesse work? Once injected, Radiesse immediately adds fullness to your face giving you a visible result at the first treatment session. Radiesse contains microspheres made of a natural material called calcium hydroxylapatite in a water based gel carrier.

5. Do injections of Radiesse hurt? As with any injection, injections with Radiesse may hurt. Radiesse is injected in small amounts using a very fine needle. Dr. Lopez uses advanced techniques to minimize the discomfort.

6. Are skin tests needed before treatment with Radiesse? No skin testing is required prior to use.

7. Should I tell Dr. Lopez what medications I am taking? Yes. You should tell Dr. Lopez about all the medicines you are taking, even over the counter medicines or treatments. If you are taking blood thinners or medications that may interfere with clotting of the blood, such as aspirin, you might be more likely to have bruising or bleeding at the injection site. There have been no studies of possible interactions between Radiesse and drugs or other substances or implants.

8. What can I expect to happen at a treatment session?

9. What are possible side effects of treatment with Radiesse? The most common side effects are redness, bruising, or swelling. These side effects generally last for a short time and are mild in nature. As with all procedures that involve an injection through the skin, there is a risk of infection.

10. What can I expect after treatment? Immediately following a treatment session with Radiesse redness, bruising or swelling may occur in the treatment area. These signs usually go away in a short period and are generally mild in nature. An ice pack may be applied to the treatment area to help reduce swelling.

For approximately 24 hours after treatment:

After you leave the office, you may experience redness, bruising or swelling for a few days. Not all patients experience these, but please note that such effects can occur and are not out of the ordinary for such a treatment.

You may be able to feel the area where Radiesse was injected for some period after injection. Over time, the injected area will feel more and more like your own tissue.

11. How quickly can I get back to my daily activities? Most patients feel comfortable going back to their normal activities immediately after treatment with Radiesse.

12. How many treatments are required? Generally, significant changes may be achieved in a first treatment. An enhancement procedure may be required to achieve optimal results.

13. What other things do I need to know? The Microspheres in Radiesse can be seen in X-rays and CT Scans. It is very important that you inform your doctor and other health care professionals that you have Radiesse injected in your face. Even though Radiesse can be seen in X-Rays and CT Scans, there is not a high risk that it would cause your doctor concern, as long as s/he knows that you have had Radiesse injected in your face.

2) What is the difference between a facial paresis and a payalysis? A facial paresis implies that there is some facial nerve function. The nerve is stimulating some of the facial muscles to contract. The prognosis for a facial nerve paresis that is not caused by a tumor is generally very good. A facial paralysis implies that the nerve is completely not functioning. There is no movement of facial muscles. The prognosis for a facial paralysis is generally not as good.

3) I have a facial paralysis and my face sags. Why? When the facial nerve is paralyzed there is no nerve conduction to the facial muscles. When muscles don’t contract they atrophy so that nothing counteracts the force of gravity. The longer the duration that a facial paralysis is present; the more severe the sagging of the facial tissue.

4) How does a gold weight help close my eye? When a patient has a facial paralysis, the eye is unable to close because the facial nerve is responsible for innervating the orbicularis oculi muscle that closes the eye. When the eye is unable to close, the cornea is left exposed which can lead to irritation, infection and possibly blindness. Dr. Lopez places a gold weight in the upper eyelid which help close the eye and protect the cornea.

5) What treatment does Dr. Lopez use for the lower eyelid? Facial paralysis causes the lower eyelid to pull down because of the lack of muscular tone of the face. Dr. Lopez performs a lower eyelid recession with placement of a graft that helps raise the lower eyelid and in combination with a gold weight in the upper eyelid help to protect the eye.

6) Why do I need a browlift and/or a midfacelift when I have facial paralysis? Facial paralysis causes the facial muscles to atrophy (decrease in size and strength) such that the side of the face that is paralyzed over time will settle at a very noticeable lower position than the normal side, causing an obvious asymmetry. Dr. Lopez performs a browlift and/or midfacelift to restore the symmetry that was there before the paralysis.

7) What is a temporalis tendon transfer? One of the most disfiguring and functionally disturbing sequelae of a facial paralysis is the drooping of the corner of the mouth on the paralyzed side of the face. Patients often complain of drooling that can be professionally and socially disruptive. Dr. Lopez performs a temporalis tendon transfer to elevate the corner of the mouth and enable the patient to have some voluntary movement to the corner of the mouth, i.e. smile. The temporalis tendon transfer was recently described by a colleague of Dr. Lopez at Johns Hopkins. The operation involves transferring the tendon of the temporalis muscle (which is innervated by the trigeminal nerve and not the facial nerve) to the muscles around the mouth. A small incision is used in a naturally occurring crease of the face. By elevating the corner of the mouth and giving voluntary movement, the patient’s face is more symmetric, and there smile is more natural appearing.

8) Will I still look like “me” after surgery? After facial reanimation surgery you will look more like the former you before the facial paralysis occurred.

9) How much pain will I have? Most patients who have facial reanimation surgery say how surprised they are that the pain is less than they anticipated. Understandably, after any surgical procedure, some discomfort can be expected. All patients are provided with prescriptions for pain medication. Patients sometimes use the prescription medication two to three days after surgery and then switch to Extra Strength Tylenol. Patients undergoing a midfacelift will have some pain on chewing for about 48 hours. It is uncommon for patients to report unmanageable pain after surgery.

10) What if I have a history of bad scars? If you have pierced ears, the way you healed there is a good indication of how you will heal from facial plastic surgery. Scars on the rest of the body typically are not an indication for how patients heal following facial plastic surgery. At the time of your consultation, it’s important to show Dr. Lopez any previous scars that are of concern to you so he can give you a realistic assessment of your healing potential following facial plastic surgery.

11) Will I be awake during surgery? Patients are asleep during the surgery either with general anesthesia or using IV sedation (medicine administered through an IV) and a local anesthetic (numbing medication administered in the operating room). Patients do not hear or feel anything and are comfortable during the operation. Patients wake up very soon after the surgery is completed. Intravenous sedation is a type of anesthesia; therefore all patients must have a responsible adult to stay with them through the night following surgery. Patients may not drive for seven days following their procedure and this time may be longer, depending on the procedure.

12) Do I go home after surgery? Most facial reanimation procedures are done on an outpatient basis. Because you will go home after receiving sedation, you will need to make arrangements for a responsible adult to drive you home, to stay with you overnight and to drive you to our office for your first postoperative appointment. Patients having surgery must stay in the immediate San Antonio area overnight.

13) Will I bruise and swell afterwards and how long will it last? Unfortunately it is impossible to do surgery without causing swelling. Dr. Lopez does everything possible to minimize the amount of swelling that occurs. Generally, postoperative swelling begins to resolve at the end of the first week. Bruising is extremely variable. Patients that have a tendency to bruise will generally bruise for about 10 days. Patients that don’t tend to bruise may have minimal if any bruising. Complete resolution of bruising and swelling may take two to three weeks. However, bruises may be camouflaged fairly easily at seven to ten days with a concealer stick.

14) How long should I stay in San Antonio following surgery? Most patients stay in San Antonio about seven to ten days following surgery. After that it’s ok to fly or travel long distances.

15) When can I return to work? Most of Dr. Lopez’s patients take about two weeks off of work. After two weeks, most of the residual bruising and swelling can easily be camouflaged with make-up.

16) When can I exercise? Dr. Lopez prefers that aerobic activities be avoided for two weeks after surgery. In addition, heavy weightlifting or more strenuous workouts should be avoided for three weeks postoperatively. It’ is extremely important to avoid bending, lifting or straining during the early postoperative period as these activities can increase swelling and delay healing.

FACIAL REANIMATION PREOPERATIVE INSTRUCTIONS

17) Should I do anything before to prepare for surgery? You will have a preoperative appointment with Dr. Lopez and his staff to go over the preoperative instructions.

18) Why do I need a preoperative appointment? This is an essential appointment to prepare you for your upcoming surgery. Dr. Lopez will take preoperative photographs at the visit as well as go over the procedure again to ensure that everyone is on the same page. All questions that you have will be answered on that visit as well. You will often times be given your prescriptions on the preoperative visit day. If you are having a T3, Dr. Lopez will teach you how to do exercises that you will do before the surgery as well as after to learn how to make a symmetric smile.

19) What else can I do to do to prepare for surgery? Dr. Lopez likes to have patients that have well controlled blood sugar to drink three eight ounce glasses of pineapple juice for at least one week before surgery. Pineapple juice can help minimize the postoperative swelling. Patients that use tobacco will be asked to stop for six weeks before and six weeks following surgery. Tobacco has properties that impede wounds from healing. Dr. Lopez will encourage tobacco users to not resume smoking at all after surgery; in fact many of his patients have used the surgery as their motivation to quit smoking.

20) What about my daily medications before surgery? In general you will be allowed to take most of your daily medications. Medications that thin the blood such as ibuprofen, vitamin E, and herbal supplements need to be stopped two weeks before surgery. You can continue to take a multivitamin. Aspirin needs to be stopped three weeks before surgery. Dr. Lopez will provide a “Medication List” that reviews all medications and supplements to avoid prior to surgery.

21) Do I need any special prescriptions before surgery? Dr. Lopez will generally give you a prescription for an antibiotic, a pain medicine, antibiotic ointment, as well as an anti-swelling medication. Dr. Lopez does prefer patients to start Arnica, a natural herbal substance, the day before surgery in order to minimize brusing. He also asks you to start taking Vitamin C before surgery.

FACIAL REANIMATION POSTOPERATIVE INSTRUCTIONS

22) What does it feel like when I wake up from surgery? Most patients report only mild to moderate discomfort, which may be associated with some numbness, itching, tightness or a pulling sensation. These postoperative symptoms subside with time. We will make sure you are not nauseated or queasy. Our nurses will be right there with you as you wake up from surgery to give you special attention.

Patients initially experience numbness for the first six to twelve months following surgery. About two months after surgery, it is common to have itching or “pins and needles” as the sensation returns. This itching is significantly less with an endoscopic browlift than a traditional browlift. This is actually an important point because patients who scratch or “itch” their hairline can thin the hair.

23) Tell me more about the incision. The head wrap will be removed in the office the day following surgery. After the head wrap dressing is removed, you will notice little clips in your hair. Apply antibiotic ointment to the incision sites three times a day. You will be asked to return to the office about seven days from the surgery date for removal of clips. Because most patients tell us their forehead is temporarily numb the removal of clips is usually not too uncomfortable.

24) What do I look when I wake up from surgery? Following the procedure, you will have a soft head wrap around your head and under your chin. This helps minimize swelling. The head wrap will be removed in the office the following day. A second dressing will be gently applied for 48 hours to minimize swelling. You may have some bruising, however, this typically is more pronounced 24-48 hours after the procedure.

25) Can I do anything to prevent brusing? Most patents will have a little bruising. We can minimize bruising by using Arnica before and after the procedure. Arnica is a natural “herb” that helps prevent bruising.

26) Tell me more about the sutures. If there are sutures near your ears they will require some simple care. We will ask you to use a Q-tip to cleanse them with peroxide once a day and apply an antibiotic ointment three times a day to keep the sutures soft. In six to eight days, when the time arrives for suture removal, sutures that have been lubricated glide out easily.

27) When can I shower? You can shower once the second dressing is removed. Make sure that you pat dry the incisions well after the shower and apply the antibiotic ointment.

28) What medications do I take following surgery? Dr. Lopez will ask you to take the following medications starting the day of surgery: 1- An antibiotic – generally Keflex for one week. 2- Pain medicine – Vicodin or Percocet to take as needed. 3- Antibiotic ointment- to place on the incision sites at least three times a day. 4- Antiswelling medication- for patients that are not diabetic a Medrol dosepak will be given. 5- Vitamin C for 1 week following surgery to promote healing. 6- Arnica- place under the tongue three tabs three times a day before meals for two weeks.

29) When do I begin taking the medications? Patients take their pain medication as needed. Begin taking vitamin C one week before surgery. You can begin taking Arnica the day before surgery. The antibiotic and swelling medications begin when you arrive home following surgery. Unless you are notified otherwise, resume all daily medications when you arrive home from surgery.

30) Are there any food to avoid following surgery? No. Dr. Lopez encourages you to eat a well-balanced diet. You may notice that saltier foods can cause you to swell for a longer period of time.

31) When is my first postoperative appointment? You will be asked to see Dr. Lopez on the first day following your facial reanimation procedure for removal of head wrap dressing. You will need someone to drive you to this appointment.

32) Are there any instructions about my regular daily activities? Sleep with head of the bed elevated or use two to three pillows for one week. Facial fullness, headache and disrupted sleep are very normal postoperative symptoms and will decrease as the healing process occurs. Absolutely no bending, lifting or straining. If you have little children, bend at the knees or sit on the floor and let them climb on to your lap.

33) How long does the healing take? As numbness wears off patients experience a “pins-and-needle” sensation. At about two months postoperatively patients experience an itchy scalp. It is important not to scratch as scratching can thin the hair. These sensations can take up to a year to dissipate completely. Medications are available to be used on an as needed basis to ease any significant sensations. Healing and evaluation of the final result takes one full year. However, after three months, most patients have about 90% of their final result.

34) How can I minimize the swelling and brusing? Most of Dr. Lopez’s patients will have a little bruising. He minimizes bruising by having patients stop all blood thinners well ahead of surgery as well as using Arnica before and after the procedure. The cold packs around the eyes should be used every 20 minutes while awake after surgery to help prevent swelling and bruising. The cold packs should be used for the first 72 hours. You do not need to wake up to use the cold packs. A good night’s sleep is vital to healthy healing. Patients are also asked to sleep with their head at least at 45 degrees to minimize the swelling.

35) When will I look normal? You will be presentable at two to three weeks. You will look great at six weeks and even better at six months as things settle and expressions become more natural. At three weeks you know you are well on the way to recovery and most patients resume routine activities around two to three weeks following surgery. Final results are evaluated at one year.

36) How often do I need to return for postoperative visits? Dr. Lopez likes to see his patients 3, 6, and 12 months after the procedure to ensure that the healing is going as expected.