small cannula and a gentle vacuum system, fat is selectively removed
from prominent areas of the abdomen, thighs, flanks, face, arms,
breasts, or calves to produce as natural and as streamlined apprearance
as desired. Patient selection is the key to a superior result as are
new advances in wetting solutions, cannula size, and vacuum devices.
Most liposuction can be performed under sedation and local anesthesia
or general anesthesia if necessary.
abdominoplasty is designed to enhance the contour of the torso.
Typically this requires assessment of the muscle, fat and skin of the
abdomen. A combination of muscle tightening, fat sculpturing either by
liposuction or direct excision, and removal of excess skin is
customized depending on the anatomy and desires of the patient.
What To Expect:
general anesthesia is the most common approach to abdominoplasty
although local anesthesia supplemented with intravenous sedation or
even epidural anesthesia can be used. The operation lasts between 1 and
3 hours, and post-operative pain, similar to a C-section or extreme
abdominal work-out, is expected to last for approximately one week.
Recovery is either in a post-operative facility or hospital. If just
liposuction or a mini-abdominoplasty is performed, recovery may take
place at home. A drain may be used and removed within the first few
most common type of patient for abdominoplasty has gone through
multiple pregnancies or C-sections, or has experience large shifts in
weight. Congenital or developmental contour problems related to
maldistribution of fat, skin laxity, or abdominal wall weakness can be
corrected. Ideally, the patient will have a stable weight, have a
reasonable and healthy diet, participate in regular exercise or sports,
and be well-motivated. Pre-operative exercises may be prescribed to
help tone the muscles or attempt to achieve spot toning. A liquid diet
for a couple of days before surgery will help reduce bloating,
constipation, and simplify the immediate post-operative recovery.
Assistance with ambulation is necessary for the first few days. The
patient is instructed to fast for 8 hours pre-op.
is in a post-operative facility or hospital for the initial day or two.
The patient is allowed to shower once any drains present are removed.
Assistance with ambulation is required for the first 2-3 days. Most
sutures are absorbably. A compressive and supportive garment is used
for the first week and up to six weeks post-op to aid in edema control,
patient comfort, and abdominal wall support. Full recovery occurs
between 2 and 6 weeks depending on the actual extent of surgery.
lip and palate is a congenital condition resulting in a discontinuity
of the upper lip and/or roof of the mouth. It can occur as a unilateral
or bilateral condition and to varying degrees of severity. Repair is
performed in consultation with a multidisciplinary team at the
Cedars-Sina Craniofacial Clinic of which Dr. Yuan is a founding member
and plastic surgical coordinator. The repair is performed in stages
with the lip being operated on between birth and three months and the
palate between 8 and 18 months.
What To Expect:
is performed under general anesthesia at Cedars-Sinai Medical Center
with the lip usually an out-patient procedure and the palate requiring
1 or 2 days of hospitalization. Feedings are resumed immediately
post-op and pain is usually easily controlled with oral medication.
Each procedure last approximately an hour.
infant patient is seen either at Dr.Yuan's private office or at the
monthly multidisciplinary meetings at the Cedars-Sinai Craniofacial
Clinic. A comprehensive treatment plan is designed by a number of
specialists led by Dr. Yuan. If pre-surgical manipulation of the
palatal segments is possible using an intraoral orthopedic appliance,
this will be inserted at a surgical procedure by the team's pediatric
orthodontist. An otolaryngologist will exam the ears and determine need
for myringotomies and tubes to assist drainage of the inner ear and
prevention of ear infections. Infants should be fasting for 6 hours
prior to surgery.
cleft lip patients will have a protective metal guard taped across the
lip and have arm restraints to prevent finger-sucking and injury to the
suture line. A liquid diet is begun using a spoon or syringe and a
bottle is allowed within 2-3 days.
The cleft palate patient will
be observed in the hospital for 1-2 days with attention to
post-operative bleeding, breathing difficulty, and feeding problems. A
liquid diet is continued for 3 to 4 days and regular feedings resumed
at 4-5 days after the first office visit. Full recovery is expected in
as well as environmental factors such as smoking and prolonged sun
exposure, can produce flaccid, thin, and wrinkled lips with downward
slant to the corners of the mouth giving a sad, tired expression. The
lip can be made fuller by a variety of surgical methods including
lifts, implantation of biological filers, and skin resurfacing with
lasers and peeling agents producing a rejuvenated, fuller, less sad
What To Expect:
lip surgery can be performed under local anesthesia supplemented with
sedation. Surgery usually takes only an hour or so and post-operative
discomfort is minimal.
specific pre-operative preparation is necessary. However, a careful and
complete review of the options, alternatives, and risks is undertaken
with the patient to ensure an individualized solution. If laser or
other peels are recommended, pre-treatment with a gentle exfoliative
agent and bleaching agent may be recommended for 2-6 weeks. Oral
antibiotics and anti-viral medications are prescribed.
is minimal but swelling may be pronounced and last for a couple of
weeks. Frequent application of ice-cold compresses is important.
Scarring is minimized. Palpability of implants usually resolve after a
number of weeks and the lips can be presentable within 2 weeks with
some make-up. A liquid diet recommended until the majority of swelling
subsides. Pigmentation changes usually resolve within a few weeks but
may last for months or even be permanent.
incision in the natural crease is utilized to remove excess skin and
fat of the upper eyelid producing a more youthful and less tired
appearance. The lower eyelid can be recontoured by removing or
repositioning fat, tightening or tailoring the muscle, and smoothing
out the wrinkles and excess skin through a combination of hidden
incisions and selective use of a resurfacing laser. Bags and wrinkles
are diminished allowing for the rejuvenation of the orbital region.
Congentially baggy lower lids can be similarly treated with great
effect and minimal risk and recovery time.
What To Expect:
may require examination by an ophthalmologist or optometrist to screen
for eye diseases, document visual acuity and visual fields, and test
for tearing irregularities. Surgery is most often performed under local
anesthesia with light sedation and recovery is uniformly quick and
Forehead and Brow Lift
techniques using endoscopic instrumentation allow for the softening of
wrinkles of the forehead and frown lines as well as elevation of the
eyebrows, if necessary, through small (< 1 inch) incisions hidden
within the hairline of the scalp. An aging, tired, and heavy look may
be altered to varying degrees depending on the patient's desires.
Occasionally, incisions at the frontal hairline may be preferable,
especially in those patients with a high forehead. This procedure is
often used in combination with a facelift and/or eyelid correction.
What To Expect:
forehea/brow lift may be performed under sedation with local anesthesia
to aid in quicker recovery. The procedure lasts 1 1/2 hours and
post-operative recovery requires a week or so of swelling, bruising
around the eyes, and some discomfort, usually described as like a
headache or tight band around the scalp.
are meticulously examined for appropriateness of this procedure as some
eyelid surgery may be necessary or even substituted. Eye examination
may be requested to screen for visual problems and to document visual
acuity and visual fields. No other special pre-operative preparation is
care is minimal with cold compresses on an hourly basis serving the
best remedy for swelling, bruising, and discomfort. Pain medication is
prescibed as necessary. The limited incisions are cleaned and ointment
applied daily. The patient is allowed to shower and shampoo 24 hours
after surgery. Sutures are removed at 7 days. Patients are generally
presentable at 7-10 days although full recovery may require 2-3 weeks.
Yuan believes that treatment of breast cancer is best performed in a
multidisciplinary setting . The choice between lumpectomy with
radiation versus mastectomy with reconstruction cannot adequately be
made without information regarding plastic surgical options. With
current techniques using implants or autogenous tissues reconstruction,
rebuilding the breast has as its attainable goal symmetric, natural,
and aesthetic breasts. Treatment of the cancer with an eye on survival
as well as long-term quality of life is enhanced by plastic surgical
evaluation. Once a reconstruction is proposed, concerns about the
opposite breast, patient's feelings towards implants (saline, silicone
gel, or combination) and desires regarding shape, contour and size will
permit customization of treatment. Immediate reconstruction is often
recommended using an implant, expander, or autologous flap. Two or
three stages are necessary for complete reconstruction including the
What To Expect:
reconstruction means that an implant, expander or tissue flap is used
at the time of mastectomy to begin the building of a new breast.
Coordination and cooperation between general surgeon and Dr. Yuan is
paramount to a superior result. General anesthesia is required and a
procedure may last between 2 and 8 hours. Discomfort is often no more
than with mastectomy alone.
comprehensive, multidisciplinary team evaluation with active input by
Dr. Yuan results in a treatment plan. Instructions will be given by the
general surgeon and supplemented by the plastic surgeon depending on
the method of reconstruction. Markings are made at a pre-operative
office visit and all questions are answered including a discussion of
risks and benefits. The patient is prepared for hospitalization which
lasts from 2 to 7 days.
recovery from reconstruction may follow that of mastectomy alone.
Drains are usually used and may be removed prior to discharge from the
hospital within 2 days. The patient is ambulatory by the first day and
pain is variable but should be expected. A self-administered pain
medication pump may be used for patient comfort while hospitalized.
Some sutures may be removed prior to discharge but all are usually
removed within 7-10 days. The patient is allowed to shower once the
drains are discontinued. Full recovery at home may take 2-3 weeks with
implants and up to 4-6 weeks with a flap reconstruction.
variety of approaches and techniques are combined to produce a
customized rejuvenation of the face, forehead, and neck. With input
from the patient, the individual anatomical features and desires of the
patient will determine the most appropriate surgical techniques to
produce a natural and effective restoration of youthfulness without
necessarily altering the individual character of a particular patient.
Often, the facelift will be used in combination with forehead/brow
surgery, eyelid correction and skin resurfacing (chemical or laser
peels) procedures to provide a uniform, harmonious and comprehensive
What To Expect:
in a fully-accredited and fully equipped private surgicenter, a caring
and experienced staff of nurses and physicians provide a safe and
comforting environment. The facelift procedure, and its attendant
ancillary procedures of the heand and neck region, is usually performed
under sedation and local anesthesia or general anesthesia. Lasting
between 2 and 5 hours depending on the pre-operative planning, safety
and a superior result is the primary focus. No discomfort should be
felt during the procedure.
full history and physical exam precedes the surgery to ensure a safe
experience. Customized skin conditioning with selected topical creams
or ointments (Retin A, Kinerase, glycolic acid, hydroquinone) may be
prescribed to enhance the overall effect and to treat the texture and
quality of the skin itself, especially if a resurfacing procedure is
head dressing may be applied and is usually removed within 1-2 days
after surgery. Recuperation may occur at home or in a specialized
post-operative care facility recommended by Dr. Yuan where skilled
nursing care is available. Patients are allowed to shower and shampoo
the day after surgery. Discomfort may persists for a few days although
is usually minimal. After about of week of healing, most patients are
able to go about usual daily activities that do not involve significant
exertion. Most sutures are removed within a week of surgery. A minimal
amount of make-up will allow the majority of patients to return to work
or regular activities in 7-10 days. Office visits are scheduled weekly
for the first three weeks post-op.
short (less than 1 1/2 inch) incision is used to insert a saline or
silicone gel implant to achieve enlargement of the breast. With
important input from the patient, the most appropriate incision,
location, type, style, shape, and size of implant is chosen to produce
a customized augmentation with maximum naturalness and minimum risk.
Attention to patient desires, anatomy, and concerns, as well as
meticulous surgical techniques will allow for maximum patient
satisfaction. Choices between various incision (transaxillary,
periareolar, or infra-mammary), location (sub- or pre-pectoral muscle),
type of implant (smooth or textured, round or anatomically-shaped) and
size of implant will be made cooperatively between Dr. Yuan and the
What To Expect:
is performed under general anesthesia in a comfortable, private,
accredited, fully-equipped surgicenter and lasts approximately 1 1/2
hours. Pain following the procedure can range from minimal to severe
depending on the patient's pain tolerance. By day 3 or 4, pain is
nearly gone and exercises to maintain softness of the implants can
history and complete physical examination by an internist will ensure a
patient's suitability for breast surgery. A series of pre-operative
office visits with photos will allow the patient and Dr. Yuan to make
judicious choices regarding incisional approach, location, type, and
size of implants to fit the patient's individual anatomy and desires.
All risks are discussed in detail and surgery does not proceed until
the patient and Dr. Yuan are in full agreement with all aspects of the
Prior to surgery, the patient is given
prescriptions for prophylactic antibiotic, pain, sleep, and anti-emesis
medication. The patient is instructed to have a light supper, refrain
from oral intake for eight hours prior to surgery, and encouraged to
enjoy a good night's sleep.
is at home or in a special post-operative care facility with skilled
nursing care available if desired. Showering is permitted the following
day and sutures are removed within 4-5 days. Pain is controlled with
medication and rest and usually subsides by the fourth day.
Displacement exercises to maintain implant softness are begun at that
time if appropriate. Normal daily non-strenuous activites and driving
can be resumed at one week post-op. Full activities including exercise
is begun at 2-3 weeks and complete recovery to pre-op status and level
of exercise is expected by 4-6 weeks post-op.
are weekly for the first 3 weeks, then 6 weeks, 3 months, 6 months, and
one year post-op. A baseline mammogram may be recommended at 6 months
for medical reason relating to discomfort, pain, rash, or skin ulcers,
or cosmetic concerns with size, breast reduction is a highly satisfying
procedure that can quickly provide patients with symptomatic relief and
attractive cosmetic enhancement of the female figure. Patient selection
is important as regards appropriateness and timing of surgery. A stable
weight and lifestyle are ideal. Attention to individual anatomy and
concerns with size, shape, scars, and risk factors, will allow for a
customization of the technique to produce the desired cosmetic contour
with mimimal risk and scars. Patient satisfaction is among the highest
of all plastic surgical procedures.
What To Expect:
breast reduction procedure is typically performed in an out-patient or
hospital setting using general anesthesia, although under special
circumstances, intravenous sedation and local anesthesia may be
possible. The procedure may last between 2-4 hours and the
post-operative recovery is generally 7-10 days with minimal pain or
discomfort. Patient usually report that recover is not nearly as
painful as anticipated.
complete history and physical examination ensures a patient's
suitability for surgery. Weight should be stable. Criteria for possible
insurance coverage will be noted and authorization process begun prior
to scheduling surgery. Options for various methods and magnitude of
reduction with discussion of resultant scars and risks will be
undertaken to fully inform the patient. Patients may be requested to
have a pre-operative mammogram. Often, the breasts are marked for
surgery the day before the procedure in order to save time in the
operating room. Prescriptions to aid in healing and control pain will
be given to the patient pre-operatively.
miniml amount of dressings are usually applied to the incisional sites
and a patient may shower within 1 or 2 days of the surgery. A simple
post-surgical bra is worn for the first few weeks and sutures are
removed in stages during this time period.
Recovery to resume
driving and daily non-strenuous activites is approximately one week
while full recovery to pre-operative status may take up to 3 or 4
weeks. Pain is quite minimal and easily controlled with oral
medications. Follow-up office visits occur weekly for the first three
weeks, then 6 weeks, 3 months, 6 months and 1 year post-op. A baseline
mammogram may be recommended at 6 months post-op.