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.

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.

2) What’s the difference between laser, dermabrasion, and chemical peel?

Chemical peels offered range from mild no downtime peels to moderate TCA (trichloroacetic acid peels).

Sometimes people get confused between dermabrasion and microdermabrasion. Dermabrasion, which is considered a surgical procedure, is typically more effective on raised scar tissue, acne and chicken pox scars and some of the deeper forehead wrinkles. Dermabrasion can be used alone or in combination with other skin resurfacing techniques.

Microdermabrasion is a mini-peel achieved by projecting aluminum micro-crystals onto the skin. “Power Peel”, “Euro Peel”, “Parisian Peel” and “Derma Peel” are all forms of microdermabrasion. Microdermabrasion is safe for all skin types.

Lasers make it possible to change tissue without making an incision. Lasers can be used to vaporize tumors, close blood vessels, selectively reduce pigmentation, or even treat skin wrinkles. Dr. Lopez can treat birthmarks or damaged blood vessels, remove port-wine stains, and shrink facial “spider veins” without major surgery.

After Dr. Lopez has indicated that a laser can be helpful in the surgery, he will explain the laser of choice and what can be accomplished. Dr. Lopez will decide on the appropriate method, dictated by the nature and extent of the surgery. Dr. Lopez will give you his best judgment for the particular procedure.

3) Are there different kinds of lasers? Yes. It is important for you to realize that lasers have specific applications. The choice of the laser depends upon many factors, including the surgeon’s experience, acceptable healing time, the size of the area to be treated, and the expectations of the patient. Dr. Lopez will decide if a laser is appropriate, and which laser is best for the situation.

4) Which laser is best for me? The only way to know for sure is a consultation with a board certified facial plastic surgeon such as Dr. Lopez that specializes in all of the above skin resurfacing techniques. It is not uncommon to use a combination of approaches to achieve an optimal result. At the time of your consultation Dr. Lopez will examine your skin to assess factors that could affect the outcome of the surgery and to determine the proper procedure for your condition.

For example, a patient who wants improvement in the lines around the lips might benefit from a simultaneous procedure of laser resurfacing and dermabrasion. A patient with acne scars may achieve the best result with optimal blending from a full-face laser combined with dermabrasion of the deepest acne scars and a TCA peel of the neck. The choice of which approach is right for you depends on many factors including the nature of the defect (traumatic scar, premature aging, pigmentary changes, acne scarring, etc.), the anatomical location, skin type, medical history and more.

5) What can you treat with laser surgery? Facial plastic surgeons are experienced in the use of the laser and are the best source of information as to whether laser surgery is appropriate for your condition. Here are a few applications for lasers.

Dr. Lopez often uses the minimum laser intensity possible. The low intensity requires many treatments. However, the low intensity also preserves as much of the healthy tissue as possible. This produces an aesthetically pleasing result and minimizes the recovery time.

6) Why isn’t all surgery performed with lasers? Many procedures can achieve the best results only with the use of laser. Likewise, some procedures are better performed without the laser. The laser is not always the best tool for surgery. The choice of using a laser or other surgical methods is carefully made Dr. Lopez, who has to consider the results, the possible complications and the alternatives. Always remember that there are very few “right” and “wrong” answers with laser surgery.

7) Will laser skin resurfacing help with my deep, pitted acne scars? It depends on the scars. Sometimes combining a full face laser resurfacing with dermabrasion of the deepest acne scars is the best approach. Other times, resurfacing by itself is not enough. Preparatory surgery such as scar excision or the use of fillers such as fat injections prior to dermabrasion may be needed to achieve an optimal result. Excision of multiple deep, pitted acne scars may be performed over several sessions. These must be evaluated on an individual basis.

Will laser surgery lift my sagging skin? Laser and all skin resurfacing techniques are employed to change the surface texture. Laser resurfacing is not performed to correct sagging skin.

9) What kind of results can I expect from laser resurfacing? It depends on what we’re working with and what the patient is trying to achieve. Laser is not a perfect science. Even in the best of hands, one can not expect 100% improvement. However, after reviewing realistic expectations, most surgical outcomes make patients very happy.

10) When will I look “normal” after laser resurfacing? You will be presentable at one to two weeks. You may put make-up on two weeks following laser surgery and resume most all daily activities. The lasered areas are quite pink and this pinkness lasts for eight to twelve weeks. You will look great at three months and even better at six months. Your final result is evaluated at one year.

11) Does my history of a cold sore on my lip affect my laser resurfacing? Cold sores are actually a viral infection. All patients are pretreated with an antiviral medication to prevent the recurrence and spread of cold sores while the lasered area heals.

12) Can you laser all skin types? Yes! However, careful selection for blending reasons must be done. Some patients can very easily be more prone to post laser hyperpigmentation (variations in skin color). This can be managed with bleaching creams and agents, however, sun avoidance and judicious use of sunscreen is most important.

13) Will I still look like “me” after surgery? Many of my patients report that when they return to their normal life, their friends comment, “You look great. Are you getting more sleep?” or “You look less stressed and tired”. Dr. Lopez will not change the way you look, just enhance it.

14) Will laser resurfacing get rid of these deep frown lines between my eyes? Several modalities exist to treat frown lines, one of which is laser. Some patients opt for a less invasive treatment such as Botox or fillers, which achieve temporary results. Other patients want more permanent correction such as a browlift with permanent treatment of those muscles that cause the deep frown lines.

15) Will I be awake during laser resurfacing? For most patients, a limited anatomical area such as around the mouth (perioral) or one or two scars, patients remain awake. For full-face skin resurfacing, patients are generally asleep.

16) How much pain will I have with laser resurfacing? Understandably, after any surgical procedure, some discomfort can be expected. All patients are provided with prescriptions for pain medication. Pain is well managed with medications. Patients who undergo full face skin resurfacing complain much more about wanting to have a clean face and keeping the face moist with ointments or dressings than they do about pain.

17) What does it feel like after surgery? It depends on the amount of skin resurfacing you have done. Lasered skin is covered with a moist jelly-like dressing. Patients complain more about wanting to wash their face than discomfort. If you are asleep for the procedure, our nurses will be right by your side as you wake up to attend to any needs you have.

18) Do I go home after surgery? Skin resurfacing is 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.

19) How long will pinkness and swelling last? Postoperative swelling begins to resolve at the end of the first week. Full resolution of swelling may take two to three weeks. The pinkness associated with skin resurfacing can last six to eight weeks. For that reason, patients use make-up to camouflage the pinkness until it settles.

20) 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.

21) 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.

22) When can I exercise? Dr. Lopez prefers that aerobic activities be avoided for two weeks after surgery. In addition, heavy weight lifting 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.

23) 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.

LASER RESURFACING PREOPERATIVE INSTRUCTIONS

24) 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.

25) 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.

26) 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 impetus to quit smoking.

27) 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.

28) 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 on order to minimize bruising. He also asks you to start Vitamin C before surgery. You will also be placed on an antiviral medication to start the day before your surgery.

LASER RESURFACING POSTOPERATIVE INSTRUCTIONS

29) What should I expect after laser surgery? After the surgery, you will probably experience some swelling and skin redness for several days. Antibiotic ointments may be used during the healing process. It is important for you to follow all the post-operative directions, particularly in using sunblock and avoiding sun exposure.

30) What do I look like 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.

31) 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.

32) Tell me more about the treated area after laser surgery. Dressings vary depending on the size of area that is lasered. You will notice a gel like substance on the dressings that we will change for you the day following the procedure. You will be asked to switch to an ointment about three days following surgery. You will be asked to return to the office about seven days from the surgery date for evaluation of healing and to switch to a moisturizer with sunscreen. It is uncommon for patients to complain of significant pain.

33) 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 one week following surgery to promote healing 6- Arnica- place under the tongue three tabs three times a day before meals for two weeks. 7- Antiviral medication- generally Valtrex which is started the day before surgery and is taken for two weeks

34) When do I start taking these prescriptions? Patients take their pain medication as needed. Begin taking vitamin C one week before surgery. You can begin taking Arnica and Valtrex 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.

35) When can I shower? As long as you keep your head dry, you may bathe at any time following the procedure. Approximately two days following laser surgery, one may shower and gently wash the hair.

36) 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.

37) When is my first postoperative appointment? You will be asked to see Dr. Lopez the next day following laser surgery for removal of head wrap. You will need someone to drive you to this appointment.

38) Are there any instructions about 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.

39) How long does healing take? The full impact of the laser may not be apparent for a month or two, especially with vascular deformities. Healing and evaluation of the final result takes one full year. However, after three months, most patients have about 90% of their final result.

2) Will I look like someone else after surgery? Many of my patients report that when they return to their normal life, their friends comment, “You look great. Are you getting more sleep?” or “You look less stressed and tired”. Dr. Lopez will not change the way you look, just enhance it.

3) Will my incision be visible? All upper eyelid lifts require a skin incision that is extremely well hidden in the upper eyelid crease.

Dr. Lopez performs two types of lower eyelid lifts. The method that he chooses depends on your individual deformity. If you have a significant amount of excess skin and redundant muscle, he may make an incision just under your lashline to remove the excess skin, muscle and fat.

An alternative technique involves making the incision on the inside of the lower eyelid to remove the fat that is causing the puffy, tired appearance. Dr. Lopez is extremely well versed in both procedures and will individualize the surgery to your needs.

Occasionally Dr. Lopez combines a blepharoplasty with some kind of skin resurfacing such as laser or peel to remove any fine textural face lines in the skin.

4) Will an eyelid lift take away the crows feet and all the fine wrinkles? Many patients are not only concerned about the baggy eyelid skin, but also would like improvement of the fine wrinkles that have developed with time around the eyes. The crow’s feet are most often significantly improved with the addition of a skin resurfacing procedure combined with Botox.

5) Will I be asleep during surgery? Dr. Lopez performs most of his upper eyelid lifts using an oral medication to relieve the anxiety that is normal when one undergoes a surgical procedure along with numbing medicine (local anesthetic) that is administered with a very small needle.

Patients that are having a lower eyelid lifts often prefer IV sedation (medicine administered through a vein in your arm) and a local anesthetic. Patients often fall asleep during surgery and do not hear or feel anything during surgery.

6) Is the surgery painful? Fortunately, most procedures on the face cause mild discomfort. However, Dr. Lopez does provide all patients with prescriptions for pain medication. Most patients may use the prescription medication for one to two days after surgery and then switch to Extra Strength Tylenol.

7) Do I need a ride home after surgery? Yes. Surgery around the eyes can cause swelling that can restrict your field of vision and make driving dangerous. In addition the effects of anesthesia can disorient patients for a variable time, so patients are not able to drive themselves home after the surgery.

Do I go home after surgery? Most patients that have an eyelid lift are able to go home that same day. Dr. Lopez does require that an adult stay with you overnight and to drive you to his office for your first postoperative appointment. Patients having surgery must stay in the San Antonio area overnight

9) How long do I stay in the San Antonio area? Most patients stay in San Antonio about seven to ten days following surgery for postoperative care to include suture removal. After that it’s ok to fly or travel long distances.

10) 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.

11) 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

12) 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.

EYELIFT PREOPERATIVE INSTRUCTIONS

13) 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.

14) 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.

15) What else can I 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.

16) 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.

17) 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 bruising. He also asks you to start Vitamin C before surgery.

BROWLIFT POSTOPERATIVE INSTRUCTIONS

18) What do I look like the day of surgery? After the procedure, you will have cold packs on your eyes with antibiotic ointment on your incisions. The antibiotic ointment may partially blur your vision. Your eyelids may be swollen. The swelling along with the bruising will continue to increase with the maximum occurring around 24-48 hours after the procedure.

19) How will I feel after surgery? Most patients that have IV sedation will feel groggy after the procedure. Once the numbing medicine wears off you may experience some mild discomfort that is usually well controlled with the pain medicine that Dr. Lopez prescribes. After 1-2 days most patients are taking Extra Strength Tylenol for the mild discomfort.

20) When can I drive after surgery? You can resume driving when you are no longer taking prescription pain medicine and your visual fields are not restricted from swelling. The usual time period is 3 to 4 days.

21) Can I be home by myself overnight the night of surgery? No. For your safety, Dr. Lopez requires that a responsible adult stay with you the first night following surgery.

22) Are there any foods 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.

23) 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 one week following surgery to promote healing. 6- Arnica place under the tongue three tabs three times a day before meals for two weeks.

24) How long does the bruising and swelling last? Most patients experience swelling that lasts about a week. Patients that bruise easily, can have the bruises persist up to two weeks, however, this is uncommon.

25) How can I minimize the swelling and bruising? Most of Dr. Lopez’s patents 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.

26) When can I shower? Dr. Lopez prefers that you do not get the incisions wet for 48 hours following the procedure. A shower from the neck down is acceptable while using a washcloth to cleanse for face.

27) When is my first postoperative appointment? Dr. Lopez will see you 6-8 days after your procedure for suture removal and postoperative evaluation.

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

2) Will I have a “surprised” look if I have a browlift? The goal of a browlift is not to raise the brows as high as possible. Dr. Lopez elevates the brows to a more youthful position. In women the position is generally just above the bony arch above the eyes with its highest point near the outside of the eye. The ideal brow position for a man is just at the bony arch above the eye with minimal to no arch in the brow.

3) What is an “endoscopic” browlift? An endoscopic browlift is done by making small incisions behind the hairline and using a telescope to perform the surgery. When the telescope is inserted under the skin, the area is displayed on a television screen.

In the right patient, endoscopic browlifts can have several advantages. Along with the advantage of smaller incisions, browlifts performed endoscopically have fewer sensation changes (less numbness and itching), less wound care and fewer side effects following surgery. Also, with endoscopic browlifts there is no compromise to the hair.

4) What other types of browlift procedures are there? Dr. Lopez uses various techniques to lift the brows. Patients with high hairlines may benefit from a pretrichial browlift where an incision is made just at the anterior hairline and the position of the hairline can be lowered along with lifting the brows. In males with deep forehead wrinkles, a direct or mid-forehead browlift can be done where the incision is placed right in a wrinkle that hides the incision extremely well.

Dr. Lopez no longer performs coronal browlifts where an incision is made about 4-6 inches behind the hairline and the brows are elevated by removing excess skin. The endoscopic browlift has replaced the coronal browlift to Dr. Lopez’s practice because of the many advantages discussed above.

5) Should all browlifts be done endoscopically? Absolutely not. Dr. Lopez individualizes the procedure to each patient. Factors that determine what kind of browlift is best for the patient include heaviness of the brows, gender, position of the hairline and severity of forehead wrinkles

6) How long does a browlift last? The longevity of the benefits of a browlift is dependent on many factors to include general health, sun exposure, tobacco use, and genetics. In general the brows will always be at a higher position for the rest of your life than if you had not had the surgery.

7) What’s the difference between endoscopic browlift and midfacelift? Endoscopic browlifts have the ability to raise or lower the brow and address the upper eyelids and part of the lower eyelids, stopping at the bony rim below the eyes. When Dr. Lopez performs a midfacelift he is able to provide middle face rejuvenation -including any remaining portion under the eyes and the area of the face level with the nose down to the teeth. With the addition of a midfacelift, the cheek is elevated; it pads the bony rim of the lower eyelid thus necessitating less fat removal. This improves his ability to treat lower eyelid “bags” and rejuvenate the bony orbital rim by precisely treating the droopiness and bagginess about the eyes in the manner that it ages.

Will I still look like “me” after surgery? Many of my patients report that when they return to their normal life, their friends comment, “You look great. Are you getting more sleep?” or “You look less stressed and tired”. Dr. Lopez will not change the way you look, just enhance it.

9) Will a browlift get rid of these deep frown lines between my eyes? Frown lines are a common reason that patients seek browlifts.. Frown lines are more often the effect of the corrugator and procerus muscles. Dr. Lopez will treat these muscles during the browlift surgery in order to improve the frown lines. Some of the deepest lines may not completely resolve, however they will be significantly improved. Dr. Lopez can add a finishing touch with a filler or a resurfacing option to provide an optimal result.

10) Will a browlift get rid of the horizontal wrinkles in my forehead? A browlift is most often performed to relocate the brow and restore it to a more youthful position. A browlift will not remove fine lines and wrinkles. To improve the horizontal wrinkles Dr. Lopez often recommends Botox after the browlift is done.

11) How much pain will I have? Most patients who have browlift 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.

12) If I have a browlift will it also lift my face? When combined with a midfacelift suspension, which can be performed through the same incisions, the procedure does lift some sagging in the face. A midfacelift will not, however, address one of the most common concerns of cosmetic patients which is the “turkey wattle”,redundant skin of the neck, to tighten the neckline.

13) Where are the incisions for endoscopic browlift? The beauty of the endoscopic browlift is that the incisions are all hidden above the hairline. Because of incision placement, browlift incisions heal very well and most patients and family members will not notice them after a few weeks.

14) 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.

15) 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.

16) Do I go home after surgery? Most browlifts 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.

17) 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.

18) 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.

19) 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.

20) 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.

BROWLIFT PREOPERATIVE INSTRUCTIONS

21) 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.

22) 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.

23) 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.

24) 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.

25) 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.

BROWLIFT POSTOPERATIVE INSTRUCTIONS

26) 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.

27) 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.

28) How 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.

29) 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.

30) 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.

31) 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.

32) 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.

33) 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.

34) 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.

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

36) What 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.

37) 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.

38) 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.

39) 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.

40) 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.

2) At what age should my child have an otoplasty? Typically Dr. Lopez likes to see the child when he is around 5 years old. By this age ear development has neared maturity. Another important factor is the psychological effect of teasing, which can start as early as 4 to 5 years old. If the otoplasty is performed prior to the onset of peer pressure yet timed when the cartilage is mature enough to be reshaped, your child is not as adversely affected by the teasing of unknowing classmates. The child also needs to have matured enough to participate in the postoperative healing. A noncompliant child can cause suboptimal results.

3) Will I still look like “me” after surgery? Many of Dr. Lopez’s patients report that when they return to their normal life, their friends comment, “You look great. Are you getting more sleep?”, “Did you change your hairstyle” or “You look less stressed and tired”. Dr. Lopez will not change the way you look, just enhance it. Ultimately the preoperative degree of protrusion of the ears will determine how much of a change occurs.

4) How long does my surgery take? The length of surgery depends on several factors including the complexity of each person’s ears. In general the surgery takes one to two hours. Revision otoplasty can take a little longer because of corrections that need to be made as a result of the initial surgery.

5) How much pain will I experience? Fortunately, most procedures on the face cause mild discomfort. However, Dr. Lopez does provide all patients with prescriptions for pain medication. Most patients may use the prescription medication for one to two days after surgery and then switch to Extra Strength Tylenol.

6) Will I be awake during surgery? You will have the choice to have general anesthesia or IV sedation (medicine administered through an IV) and a local anesthetic (numbing medication administered in the operating room). In both situations, patients are asleep during surgery. Patients do not hear or feel anything and are comfortable during the operation. Patients wake up very soon after the surgery is completed.

7) Do I go home after the surgery? Yes, most facelifts 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. Your first appointment is usually the day after surgery. Patients having surgery must stay in the immediate San Antonio area overnight.

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.

9) 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.

10) 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.

OTOPLASTY PREOPERATIVE INSTRUCTIONS

11) 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.

12) 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.

13) 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.

14) 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.

15) 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. He also asks you to start taking Vitamin C 1 gram per day for 1 week before surgery to continue for 2 weeks after surgery.

OTOPLASTY POSTOPERATIVE INSTRUCTIONS

16) What will I feel when I wake up from surgery? Most patients report only mild to moderate discomfort associated with some tightness or pulling. This pulling sensation, most noticeable under the chin, subsides after about three weeks. Dr. Lopez will make sure you are not nauseated or queasy.

17) How will I look like 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 morning. A second dressing may 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.

18) How can I prevent bruising? Most patents will have a little bruising. We can try to minimize bruising by using Arnica before and after the procedure. Arnica is a natural “herb” that helps prevent bruising.

19) How do I take care of the incisions? The areas that are sutured will require some simple care. Dr. Lopez asks that you use a Q-tip to cleanse the sutures 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 cared for will slide out easily.

20) When can I shower? You can shower 48 hours after the surgery. Make sure that you pat dry the incisions well after the shower and apply the antibiotic ointment.

21) 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 1 gram for 1 week before and two weeks following surgery to promote healing 6- Arnica- place under the tongue three tabs three times a day before meals for two weeks.

22) When do I start taking these prescriptions? Patients take their pain medication as needed. Begin taking vitamin C 1 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.

23) Are there any foods 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.

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

25) What about my regular daily activities? Sleep with head of the bed elevated or use two to three pillows for one week. Absolutely no bending, lifting or straining for two weeks. If you have little children, bend at the knees or sit on the floor and let them climb on to your lap.

26) How can I minimize the swelling and bruising? Most of Dr. Lopez’s patents 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. 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.

27) 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.

28) 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.

2) I have a large hump on my nose, can that be fixed? The hump (convexity) on your nose is usually made of bone and cartilage. Dr. Lopez is able to lower both the cartilage and bone if necessary. Again, your nose must be in harmony with your face as well as the rest of your body. Tall individuals look better with a small convexity or straight profile rather than a scooped out appearance. Shorter individuals can look better with a bit of scoop to the nose. Men in general also look better with a bit of a convexity, i.e. the “Grecian Nose”.

3) If my nose is made smaller, where does the extra skin go? Over time the skin will contract and take the shape of the underlying bony/cartilaginous structure.

4) My nose is crooked, can that be fixed? A crooked nose can be because the bone has been broken and is no longer in the midline, or because the cartilage in the middle of the nose (middle vault) has a concavity or both are off. To fix crooked nasal bones, Dr. Lopez makes cuts in the bones to reset the bones in the midline. In order to straighten out the middle part of the nose, Dr. Lopez may need to use cartilage to fix the concavity.

5) My nose ticks out too far and I have a weak chin, will fixing my nose make my chin look stronger? In general no. A weak chin that does not project out enough usually can be made to look much better with a chin implant. This will also improve the rhinoplasty result as the face will be in better harmony.

6) Will I still look like “me” after surgery? Many of my patients report that when they return to their normal life, their friends comment, “You look great. Are you getting more sleep?” or “You look less stressed and tired”. Dr. Lopez will not drastically change the way you look, just enhance it.

7) Where are the incisions for a rhinoplasty? In an open rhinoplasty Dr. Lopez makes a very small incision in the skin at the base of the nose in the midline. This incision heals extremely well and is nearly imperceptible once healed. The remainder of the incisions are within the nose.

What is an open (external) rhinoplasty? An open (external) rhinoplasty involves making a small inverted V-shaped skin incision in order to raise the nasal tip skin up and be able to visualize the tip cartilages. The advantage of the open approach is the increased exposure that Dr. Lopez is able to get in order to produce your optimal result. The disadvantage is that the nose will be swollen longer when compared to the closed (endonasal) approach.

9) What is a closed (endonasal) rhinoplasty? In a closed (external) rhinoplasty there are no external skin incisions. Dr. Lopez will use this technique when a lot of work does not need to be done to the tip or middle vault. The advantage of the closed approach is that the swelling subsides quicker. The disadvantage is the decreased exposure the surgeon attains when trying to manipulate the middle vault or tip.

10) How much pain will I have? Most patients who have a rhinoplasty 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.

11) Will I be awake during surgery? Patients are asleep during the surgery with general anesthesia. Patients do not hear or feel anything and are comfortable during the operation. Patients wake up very soon after the surgery is completed. All patients must have a responsible adult to stay with them through the night following surgery. Patients may not drive for following their procedure if they are taking pain medicine or their vision is impaired.

12) Do I go home after surgery? Most rhinoplasties 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 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 weight lifting 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.

17) At what age can I have a rhinoplasty? You should not have a rhinoplasty until your face and nose have stopped growing. Usually the age is around 16 for a female and 17-18 for a male. Once your shoe size has been stable for a year, that is a good indication that you can have a rhinoplasty.

18) When can I have a revision rhinoplasty? Dr. Lopez performs a lot or revision rhinoplasty operations to correct or enhance the work of the previous surgeon. In general the nose will continue to change over the first year following a rhinoplasty, so Dr. Lopez prefers that patients wait a year after their original surgery to have a revision.

19) Is revision rhinoplasty more difficult? In general yes. Once the nose has been worked on scar tissue distorts the normal tissue planes. In addition, grafting material such as the nasal septum may have already been used. Often times ear cartilage or even rib cartilage is necessary to correct the deformity. Make sure that the surgeon you choose has a lot of experience with revision rhinoplasty.

20) What is the septum? The nasal septum is a cartilaginous and bony structure that divides the nose into two nasal cavities. Dr. Lopez often uses the septal cartilage to strengthen the nose and improve the appearance and function of the nose.

21) If you take ear cartilage will that change the shape of my ear? Dr. Lopez uses ear cartilage often and it does not change the shape of your ear or the function of your ear. At 6 months from surgery even with your hair up nobody will know that you had ear surgery.

RHINOPLASTY PREOPERATIVE INSTRUCTIONS

22) 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.

23) 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.

24) 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 impetus to quit smoking.

25) 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.

26) 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 bruising. He also asks you to start Vitamin C before surgery.

RHINOPLASTY POSTOPERATIVE INSTRUCTIONS

27) What does it feel like when I wake up from surgery? When you wake up you will have a small cast on your nose and small packs within your nose. The packs will not allow you to breathe through your nose. We will make sure you are not nauseated or queasy. Our nurses will be right there with you as you wake up from surgery.

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 medicince- 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 1 gram for 1 week before and two weeks 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 foods 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 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.

32) When is my first postoperative appointment? You will be asked to see Dr. Lopez on the second day following your rhinoplasty. At that appointment Dr. Lopez will remove the nasal packing. Some patients describe the packing removal as a mild discomfort, but Dr. Lopez still recommends taking a pain pill 1 hour before your appointment. You will need someone to drive you to this appointment.

33) What happens after the first postoperative visit? After your first visit, take your medications as directed and keep your incision clean and moist. 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. Dr. Lopez will want to see you 6-8 days after the surgery for removal of the cast and suture removal. Suture removal may be uncomfortable, so Dr. Lopez recommends taking a pain pill 1 hour before your appointment. You will need someone to drive you to this appointment if you are taking pain medication.

34) Are there any instructions about 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.

35) When can I blow my nose? You are not allowed to blow your nose for one week. Avoiding nose blowing minimizes bleeding and swelling following surgery.

36) Can I wear my glasses or contacts after rhinoplasty? It’s best to allow a day or so before using your contact lenses following rhinoplasty. It’s not uncommon for patients to tell us that giving their eyes a temporary rest from the contact lenses feels good for the first two to three days following rhinoplasty. It’s OK to rest your glasses on the nasal cast. However, one week following rhinoplasty the cast is removed. At that time we will show you how to use the Frame-Ups® to prevent your eyewear from resting directly on your nose. We strongly recommend that you use the frame-ups for postoperative week #2 – which is the week following cast removal.

37) How long does the healing take? Healing and evaluation of the final result takes one full year. However, after three months, most patients have about 90% of their final result.

38) How can I minimize the swelling and bruising? 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.

39) 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.

40) 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.

2) Does Dr. Lopez tighten the neck muscles? Yes, the relaxed muscles are “tightened” under the skin and the excess skin is removed. Tightening the muscles of the neck eliminates the saggy skin in the midline of the neck, often termed the “turkey wattle” which results in a more youthful appearance. Successful facial rejuvenation involves manipulating both muscles and skin.

3) How long does a necklift last? You will continue to age after the surgery, but for patients who do not smoke, do not abuse the sun, are in good general health and have good genetics, a necklift can last upwards of 10 years. For patients who elect to abuse their skin and body, the improvement one see with a necklift will not last as long.

4) How can you tell if I need a chin implant? For patients with weakly projecting chins, a chin implant can greatly improve their facial harmony and enhance the ultimate outcome after a facelift. Dr. Lopez will assess your overall facial anatomy in order to determine if a chin implant is indicated.

5) I have a double chin and jowls. Can Dr. Lopez fix them? Each patient will have different anatomy which dictates the degree of improvement that is possible: however, the primary goal of a necklift is to improve the double chin.

6) Does a facelift get rid of wrinkles? A necklift is performed to remove sagging tissues in the midline of the neck. There is usually some improvement in wrinkles around the neck; however, facial resurfacing, Botox, and dermabrasion are more appropriate procedures for elimination of wrinkles.

7) How much pain will I experience? Fortunately, most procedures on the face cause mild discomfort. However, Dr. Lopez does provide all patients with prescriptions for pain medication. Most patients may use the prescription medication for one to two days after surgery and then switch to Extra Strength Tylenol.

Will I be awake during surgery? You will have the choice to have local anesthesia, general anesthesia or IV sedation (medicine administered through an IV) and a local anesthetic (numbing medication administered in the operating room). In the latter two situations, patients are asleep during surgery. Patients do not hear or feel anything and are comfortable during the operation. Patients wake up very soon after the surgery is completed.

9) Do I go home after the surgery? Yes, most necklifts 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. Your first appointment is usually the day after surgery. Patients having surgery must stay in the immediate San Antonio area overnight.

10) 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.

11) 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 cover-up.

12) 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.

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.

NECKLIFT PREOPERATIVE INSTRUCTIONS

14) 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.

15) 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.

16) 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.

17) 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.

18) 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. He also asks you to start taking Vitamin C 1 gram per day for 1 week before surgery to continue for 2 weeks after surgery.

NECKLIFT POSTOPERATIVE INSTRUCTIONS 19) What will I feel when I wake up from surgery? Most patients report only mild to moderate discomfort associated with some tightness or pulling. This pulling sensation, most noticeable under the chin, subsides after about three weeks. Dr. Lopez will make sure you are not nauseated or queasy.

20) How will I look like 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. You may have some bruising, however, this typically is more pronounced 24-48 hours after the procedure.

21) How can I prevent bruising? Most patents will have a little bruising. We can try to minimize bruising by using Arnica before and after the procedure. Arnica is a natural “herb” that helps prevent bruising.

22) How do I take care of the incisions? The areas that are sutured will require some simple care. Dr. Lopez asks that you use a Q-tip to cleanse the sutures 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 cared for will slide out easily.

23) When can I shower? You can shower 48 hours after the surgery. Make sure that you pat dry the incisions well after the shower and apply the antibiotic ointment.

24) 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 1 gram for 1 week before and two weeks following surgery to promote healing 6- Arnica- place under the tongue three tabs three times a day before meals for two weeks.

25) When do I start taking these prescriptions? 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.

26) 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.

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

28) What about my regular daily activities? Sleep with head of the bed elevated or use two to three pillows for one week. Absolutely no bending, lifting or straining for two weeks. If you have little children, bend at the knees or sit on the floor and let them climb on to your lap.

29) How can I minimize the swelling and bruising? Most of Dr. Lopez’s patents 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. 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.

30) 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.

31) 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.

Midfacelifts are state of the art technology that not all plastic surgeons are skilled in performing. Therefore, it is vital that your screening process includes a review of Before and After Photographs of the doctor’s midfacelift results.

2) Am I a candidate for a midfacelift? Best candidates for a midfacelift are people with hollowed out eyes, sagging cheeks, deep smile lines and a fallen brow. Typically the midface (cheek area) starts to drop in the mid thirties and becomes more apparent in our 40′s and 50′s. A midfacelift helps Dr. Lopez address the lower eyelid better by padding the bony rim. He removes less fat and is able to remove more skin without eyelid changes.

3) How do I know if I need a midfacelift or a facelift? Many factors including age, genetics, previous sun exposure, tobacco abuse, skin type and skin elasticity all play a role in assessing if a midfacelift would be the right way to go. The only way to know for sure is a consultation with Dr. Lopez.

4) Where are the incisions for a midfacelift? Since midfacelifts can be performed endoscopically, incisions measure generally about one half to one inch. These smaller incisions are placed behind the hairline so they are well camouflaged. If Dr. Lopez feels that a pretrichial browlift is indicated, then the midface lift can be done through the same incision.

5) When can I return to work? Patients typically return to work and activities anywhere from seven to ten days although restrictions limiting heavy lifting, bending and straining along with aerobic activity remain for two weeks following the procedure.

6) What is an endotyne? Dr. Lopez uses a state of the art device called a midface endotyne to elevate your cheeks (midfacelift). The endotyne is made of a resorbable material that goes away 6-9 month after placement.

MIDFACELIFT PREOPERATIVE INSTRUCTIONS

7) 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.

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.

9) 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 impetus to quit smoking.

10) 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.

11) 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. He also asks you to start taking Vitamin C 1 gram per day for 1 week before surgery to continue for 2 weeks after surgery.

MIDFACELIFT POSTOPERATIVE INSTRUCTIONS

12) What does it feel like when I wake up from surgery? Most patients report only mild to moderate discomfort associated with some tightness or pulling. This pulling sensation, most noticeable under the chin, subsides after about three weeks. 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.

13) What do I look like 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.

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

15) How do I care for the incisions? The sutures/staples 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/staple removal, sutures that have been lubricated glide out easily.

16) 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.

17) 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 – Anti-swelling medication- for patients that are not diabetic a Medrol dosepak will be given 5 – Vitamin C 1 gram for 1 week before and two weeks following surgery to promote healing. 6 – Arnica- place under the tongue three tabs three times a day before meals for two weeks.

18) When do I start taking these prescriptions? Patients take their pain medication as needed. Begin taking vitamin C 1 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.

19) Are there any foods 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.

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

21) Are there any instructions about regular daily activities? Sleep with head of the bed elevated or use two to three pillows for one week. 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.

22) How can I minimize the swelling and bruising? 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.

23) 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.

24) 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.

2) Does Dr. Lopez tighten the neck muscles? Yes, the relaxed muscles are “tightened” under the skin and the excess skin is removed. Tightening the muscles of the neck eliminates the saggy skin in the midline of the neck, often termed the “turkey wattle” which results in a more youthful appearance. Successful facial rejuvenation involves manipulating both muscles and skin.

3) How long does a facelift last? You will continue to age after the surgery, but for patients who do not smoke, do not abuse the sun, are in good general health and have good genetics, a facelift can last upwards of 10 years. For patients who elect to abuse their skin and body, the improvement one see with a facelift will not last as long.

4) How can you tell if I need a chin implant? For patients with weakly projecting chins, a chin implant can greatly improve their facial harmony and enhance the ultimate outcome after a facelift. Dr. Lopez will assess your overall facial anatomy in order to determine if a chin implant is indicated.

5) I have a double chin and jowls. Can Dr. Lopez fix them? Each patient will have different anatomy which dictates the degree of improvement that is possible: however, the primary goal of a facelift is to improve the jowls and the double chin. Neck liposuction is often performed with a facelift to further improve the neck results.

6) Does a facelift get rid of wrinkles? The medical term for a facelift is a rhytidectomy which translates into “removal of wrinkles”. A facelift is performed to lift sagging tissues especially around the jaw line and neck. There is usually some improvement in wrinkles; however, facial resurfacing, Botox, and dermabrasion are more appropriate procedures for elimination of wrinkles.

7) I had a facelift somewhere else and I don’t like my result. Can Dr. Lopez “fix” it? Most often the answer is yes. It’s not uncommon for patients who have previously had facelifts to be referred to see Dr. Lopez for revision surgery. Upon the initial consultation Dr. Lopez will determine if your original facelift result can be improved. In general, patients should wait one full year before undergoing revision facelift.

Why is a revision facelift more difficult? All surgery causes scar formation. The scarring that results after a facelift appears as a thick, tough layer that can be more difficult to work with than tissue that has not been operated on. Also the original location of landmarks has been altered such that correcting them may prove to be difficult. In general, revision facelifts can take a little longer because of corrections that need to be made as a result of the initial surgery. Fortunately, Dr. Lopez is one of a few surgeons in the country that performs a deep plane facelift. When doing revision facelifts, this allows him to work in a plane of tissue that has normally not been dissected.

9) How much pain will I experience? Fortunately, most procedures on the face cause mild discomfort. However, Dr. Lopez does provide all patients with prescriptions for pain medication. Most patients may use the prescription medication for one to two days after surgery and then switch to Extra Strength Tylenol.

10) Will I be awake during surgery? You will have the choice to have general anesthesia or IV sedation (medicine administered through an IV) and a local anesthetic (numbing medication administered in the operating room). In both situations, patients are asleep during surgery. Patients do not hear or feel anything and are comfortable during the operation. Patients wake up very soon after the surgery is completed.

11) Do I go home after the surgery? Yes, most facelifts 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. Your first appointment is usually the day after surgery. Patients having surgery must stay in the immediate San Antonio area overnight.

12) 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.

13) 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.

14) 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.

15) 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.

FACELIFT PREOPERATIVE INSTRUCTIONS 16) 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.

17) 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.

18) 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.

19) 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.

20) 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. He also asks you to start taking Vitamin C 1 gram per day for 1 week before surgery to continue for 2 weeks after surgery.

FACELIFT POSTOPERATIVE INSTRUCTIONS 21) What will I feel when I wake up from surgery? Most patients report only mild to moderate discomfort associated with some tightness or pulling. This pulling sensation, most noticeable under the chin, subsides after about three weeks. Dr. Lopez will make sure you are not nauseated or queasy.

22) How will I look like 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 morning. 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.

23) How can I prevent bruising? Most patents will have a little bruising. We can try to minimize bruising by using Arnica before and after the procedure. Arnica is a natural “herb” that helps prevent bruising.

24) How do I take care of the incisions? The areas that are sutured will require some simple care. Dr. Lopez asks that you use a Q-tip to cleanse the sutures 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 cared for will slide out easily.

25) When can I shower? You can shower 48 hours after the surgery. Make sure that you pat dry the incisions well after the shower and apply the antibiotic ointment.

26) 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 1 gram for 1 week before and two weeks following surgery to promote healing 6- Arnica- place under the tongue three tabs three times a day before meals for two weeks.

27) When do I start taking these prescriptions? 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.

28) 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.

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

30) What about my regular daily activities? Sleep with head of the bed elevated or use two to three pillows for one week. Absolutely no bending, lifting or straining for two weeks. If you have little children, bend at the knees or sit on the floor and let them climb on to your lap.

31) How can I minimize the swelling and bruising? Most of Dr. Lopez’s patents 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.

32) 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.

33) 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.