Thomas E. Spicer MD

Plastic Surgery

1208 Hilltop - Suite 103 | Rock Springs, WY 82901 | P: (307) 362 - 8211 | F: (307) 382 - 3451

FAQs

Augmentation Mammaplasty (Breast Enlargement)
Blepharoplasty (Eyelid Surgery)
Carpal Tunnel Syndrome
Chemical Peel / Dermabrasion / Laser Abrasion
Face Lift
Liposuction
Rhinoplasty (Nose Surgery)
Tummy Tuck (Abdominoplasty)
Office Operating Room

Augmentation Mammaplasty
What is the strategy of breast enlargement?
The surgical strategy is to create a pocket in the tissues behind the breast into which is placed a breast implant to give the impression of a larger breast.

How should I decide how big an implant to place in the space?
Of course, bigger implants in general give the impression of a larger breast. To a degree, it depends on how big a breast you’d like to have. As with all things, though, there is some trade off. A small implant only makes the breast look a little larger, larger implants make the breast look progressively larger until there is no more stretch left in the breast tissues. At that point, a larger implant creates fullness that begins to be expressed higher on the chest at the top of the breast forming a shelf or roundness that peaks out above the bra line and is a “give-away” of having breast implants. That fullness is appreciated by some women who like this upper breast roundness; for others, it screams, “Breast Implant,” and they prefer not to give that secret away. Creating or avoiding this upper chest fullness is a function of both the size of an implant and the stretch-ability of the tissues. So how big you can be varies among women depending on the stretch-ability of your tissues and how much of this upper chest  fullness you are willing to tolerate.
[NEED A PHOTO]

Are breast implants a good way to treat a “droopy” breast?
When there is a modest degree of droopiness, a breast implant will tend to fill out the excess skin and help “lift” the breast. When the breast gets more droopy (as when the nipple location is significantly lower than the fold on the under side of the breast or begins pointing downward instead of forward), just putting in a breast implant is not enough and another procedure to reposition the nipples back up higher on the chest is required. That procedure is more extensive than just placing an implant and is called a mastopexy.

Should I choose silicone get implants or saline implants?
All breast implants have a silicone rubber shell or balloon. Silicone gel implants fill that silicone rubber balloon with a silicone rubber “gel” that is formulated to have a “breast tissue” feel; saline implants fill that silicone rubber balloon with salt water. Most plastic surgeons think that silicone gel implants give a modestly better result in terms of breast texture or “feel” but they don’t have the adjustability of saline implants. In addition, the FDA is recommending that you undergo an MRI every other year if you have gel implants to check to be sure they are intact; this adds considerably to their cost and convenience.

Is there any connection between breast implants and breast cancer?
Breast cancer is terribly common; breast cancer occurs in about 1 in 10 women in their lifetimes! Breast implants do not increase your chances of getting breast cancer nor do they reduce your chances. Most breast cancers are now found with mammograms before they are big enough to be felt. Breast implants make finding very small breast cancers with mammograms more difficult.

Blepharoplasty (Surgery for aging eyelids)
What is involved in surgery for aging around the eyes?
Aging around the eyes usually involves the accumulation of excess skin around the eyes and some contour problems that represent changes in the fatty tissue beneath the skin.
Surgery to correct these problems usually involves removing the excess skin and adjusting extra fullness by removing fat or adjusting hollowness by transplanting fat.

Can upper lids and lower eyelids be fixed at the same time?
Yes. Eyelid surgery is even combined with facelift surgery at times.

How long does it take to get over having eyelid surgery?
The sutures can usually be removed within a couple of days but there may be some bruising that lasts for 2-4 weeks. The amount of bruising is variable among patients and can be minimal or can be more extensive. Especially after working on lower eyelids, there is some lack of flexibility that gives them an “operated look” and takes several weeks to go away.

Carpal Tunnel Syndrome
What is Carpal Tunnel Syndrome?
There is a tight spot in the heel of the hand where a nerve passes through a very tight spot. The tight spot has potential to “pinch” the nerve creating a deep aching pain in the wrist and numbness to the thumb, index and long fingers. The things that pinch the nerve usually involve placing the wrist in extreme positions bent backwards or forwards or repetitive hand motions like turning a screw driver. It tends to hurt most at night because we sleep on our hands with the wrists bent and wearing a splint to keep the wrist straight at night often cures the problem. For most people, Carpal Tunnel Syndrome tends to come and go over a period of time with the overall trend to slowly get worse - - i.e. hurts more of the time and relief is less complete or short lived. To get prolonged relief, many people will require a surgery to open the space so the nerve is no longer pinched. Luckily, releasing the carpal tunnel usually gives dramatic relief to the pain at night and numbness of Carpal Tunnel Syndrome.

The numbness of Carpal Tunnel Syndrome goes away as the nerve heals after relieving the pressure. This healing tends to be slower and less complete in older folks, in diabetics and in those for whom the carpal tunnel syndrome is longstanding. This is one reason not to just let it go for long periods

 Chemical Peel / Dermabrasion / Laser abrasion
What problems are addressed by these skin surface procedures?
All of these involve causing a superficial injury to the skin and allowing it to heal to create a nicer skin surface. They are useful to treat any process that is superficial and affects primarily the skin surface, like fine texture wrinkling of the skin, sun damage spots that are pre-cancerous and splotchy pigmentation that often occurs years after sun exposure. Which of these procedures is used to cause the injury to the skin is less important; the depth of injury is MOST important to getting a good result. The deeper the injury, the better is the result unless it is too deep when permanent scarring to skin discoloration can occur.

What problems are not as well addressed by these skin surface procedures?
Skin wrinkles come in three variations:
1. Excess skin that hangs in folds (like a turkey gobbler neck or jowls),
2. Skin wrinkles that are caused by muscle action repeatedly bending or folding the skin (like the crow’s feet on the outside of the eyes, the frown creases between the eyebrows or radial lip lines) and
3. Skin texture lines that are fine wrinkles in the skin as it ages.
These skin surface procedures (dermabrasion, chemical peel and laser) work best for the skin texture lines (#3) and least well for treating the excess skin folds (#1). Treating excess skin folds usually involves removing the excess skin, typically involving face lift type surgery.

 Face lift
What issues are addressed by a face lift?
A classic face lift is an operation designed to remove the excess skin folds and fullness in the neck below the chin and along the jaw line. It involves an incision that comes down in front of the ear and goes into the hair behind the ear.

What if my concern is for deep smile lines or for lines around the eyes or across the forehead?
There are specific procedures to address each of these areas of concern including a mid-face lift for the smile lines, blepharoplasty for the eyelids as well as eyebrow or forehead procedures for the upper face.

How long does a face lift last?
About 25% of individuals who have a face lift will have a second one and usually the second will be done 5-10 years after the first.

How long does it take to heal from a facelift?
Healing is adequate to take out the sutures in 7-10 days. There typically is some bruising that lasts for 2-4 weeks. Most will be able to get back in their social circle within a few weeks but really looking good takes a couple of months.

 Liposuction
What is the strategy of liposuction?
Liposuction is an operation designed to suction or vacuum out some of the fat that resides just below the skin but above the muscles. That is done by inserting a long tube with a hole into that space and then moving it back and forth as suction is applied. It literally “vacuums” out the fat.

What problems does liposuction address?
Liposuction addresses problems of contour, especially where there is a localized accumulation of fat, like “Saddle Bags” or “Love handles” or “Double Chin”. It works less well as a weight reduction tool for someone who is heavy. Although it will help someone who has broader areas of fullness (like someone who has a very thick lower trunk, big hips and thighs), its help is not as dramatic as when the fatty fullness is more localized.

How do I know if liposuction or a tummy tuck is going to be better for me?
These procedures are often thought about as treating the same problem of tummy fullness but they actually treat different problems. Liposuction is used primarily to treat localized fatty fullness and it works great to reduce the lower tummy fullness that many women have just below their umbilicus but it is not a very good for treating “skin excess.” On the other hand, a tummy tuck is great for removing the excess skin fold that hangs as an apron from the lower abdomen after weight loss but it is not very good at treating the “fatty fullness” or contour treated by liposuction. In many instances, they can be combined to give the best result if there needs to be removal of excess skin as well contouring of excess fatty tissues.

What problems are associated with liposuction?
The most common problem is to be left with an irregular or lumpy surface in the areas where liposuction has been completed. This occurs as healing of the holes where the fat has been suctioned creates scarring and is most noticeable early after liposuction and tends to smooth out some over the first 9-12 months. Interestingly, it is much more severe when the liposuction has been aggressively employed in an area, a reason to not be too aggressive.

Other problems include infection that can occur as with any surgery. It is unusual but potentially serious if it happens. Also, there is often some numbness in the areas suctioned; usually the numbness resolves over a few months. As with any surgery, it is possible to get blood clots with liposuction; when these travel to the lungs they are called Pulmonary Emboli. While their occurrence is rare, they have potential to be fatal. Most of the serious problems of liposuction are more common with large volume suctions over multiple sites and when liposuction is done with general anesthesia.

Rhinoplasty (surgery to change the appearance of the nose)
What is the strategy of surgery to change the shape of the nose?
The shape of the nose is mostly determined by the shape of the underlying bone and cartilage. Altering the structure of that bone and cartilage will change the shape of the nose. In some individuals, the skin of the nose is very thick and doesn’t adapt to a new framework even when that framework is changed; this would be an issue your surgeon should discuss with you during your initial discussions about rhinoplasty. Exactly what is changed to modify the shape depends on what exactly the problem is; almost more than any other cosmetic surgery, rhinoplasty needs to be individualized to the precise problem at hand.

 Tummy Tuck
How do I know if liposuction or a tummy tuck is going to be better for me?
These procedures are often thought about as treating the same problem of tummy fullness but they actually treat different problems. Liposuction is used primarily to treat localized fatty fullness and it works great to reduce the lower tummy fullness that many women have just below their umbilicus but it is not a very good for treating “skin excess.” On the other hand, a tummy tuck is great for removing the excess skin fold that hangs as an apron from the lower abdomen after weight loss but it is not very good at treating the “fatty fullness” or contour treated by liposuction. In many instances, they can be combined to give the best result if there needs to be removal of excess skin as well contouring of excess fatty tissues.

Office Operating Room
In what facility are the surgeries done?
In the office I have a fully accredited (AAAASF) operating room. It allows the convenience and anonymity that is not present in larger facilities.

What anesthesia techniques are used?
We typically use a sedation and local anesthesia technique. That involves giving some sedation intravenously and actually numbing the area on which we’ll be operating using local anesthetic. From the patient’s viewpoint, though, it’s like having a general anesthetic - - you go to sleep at the beginning of the operation and awake when it’s over. The sedation allows us to administer the local anesthetic without discomfort.

What is the time line for a surgery in the office?
We would normally have you come to the office first thing in the morning. It is very important that you come without having anything to eat or drink since the previous evening - - safety requires that your stomach be empty. The surgeries that are completed in the office usually take about 2 hours and are followed by a period of awakening from the sedation that lasts another 2 hours. In most cases, you are ready to leave the office by noon. You do need to have someone available to drive you home (it would be unsafe to expect you to drive after having been deeply sedated)!

Can I take my usual medicines before surgery?
Usually you can but it is important to look at the list of medicines you are taking and discuss each. Some can result in discomfort during surgery (water pills), others can be a risk if not handled properly (insulin). On the preoperative visit, we will discuss all medicines you are taking and make the decision about each individually. It is important that you refrain from taking aspirin preferably for about 2 weeks before surgery. Aspirin tends to thin the blood making bleeding complications more common.

How much pain can I expect after surgery?
For almost all surgeries, there is some achy discomfort as the tissues awaken from the anesthetic. This usually starts when the anesthetic is wearing off and it lasts for an hour or two. This is the most important time to have pain medicine available. When you are going through this period you should realize that it doesn’t last too long and soon you will be much more comfortable. Once you get through that “achy” period, the pain is more “bruise” type pain and is much more tolerable. Just know that we will provide medication to help you through the “achy” period. The “bruise” soreness gradually dissipates but typically takes 3-4 weeks to be gone completely.