Procedure Description:
Using 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

Procedure Description:
An 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:
A 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 days.

Preprocedure:
The 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.

Postprocedure:
Recovery 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.

Cleft palate

Procedure Description:
Cleft 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:
Surgery 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.

Preprocedure:
The 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.

Postprocedure:
The 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 a week.

Lip Enlargement/Enhancement

Procedure Description:
Aging, 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 appearance.

What To Expect:
Most 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.

Preprocedure:
No 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.

Postprocedure:
Discomfort 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.

Blepharoplasty

Procedure Description:
An 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:
Patients 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 relatively painless.

Forehead and Brow Lift

Procedure Description:
New 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:
The 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.

Preprocedure:
Patients 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 normally required.

Postprocedure:
Post-operative 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.

Breast Reconstruction

Procedure Description:
Dr. 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 nipple.

What To Expect:
Immediate 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.

Preprocedure:
A 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.

Postprocedure:
The 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.

Facelift

Procedure Description:
A 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 result.

What To Expect:
Performed 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.

Preprocedure:
A 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 planned.

Postprocedure:
A 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.

Breast Augmentation

Procedure Description:
A 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 patient.

What To Expect:
Surgery 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 begin.

Preprocedure:
A 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 customized procedure.

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.

Postprocedure:
Recovery 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.

Follow-up visits 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 post-op.

Breast Reduction

Procedure Description:
Whether 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:
The 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.

Preprocedure:
A 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.

Postprocedure:
A 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.