Cosmetic and Plastic Surgery

To address the excess, often sagging upper or lower eyelid skin and “bags” around the eyes, upper or lower blepharoplasty may be recommended. The excess skin of the upper eyelids may be significant enough to impair a person’s vision or weigh down their eyelids enough to cause eye fatigue. In these cases, the problem goes beyond cosmetic to functional and insurance may sometimes cover upper blepharoplasty as a functional procedure. Both upper and lower blepharoplasty can improve the tired, worn out, aged appearance of the eyes.

During/after surgery

Blepharoplasty, or eyelid surgery is performed with general anesthesia at UT Health Tyler. If the procedure involves both upper and lower eyelids, the surgeon will typically manage the upper eyelid first. On average, it takes one to two hours to complete the operation. The patient will be sent home for recovery. For the first few days, there will be swelling and discoloration around the area. It is advised that the head is elevated for the first few days. Pain medications and antibiotics will be prescribed to manage the initial discomfort. Strenuous activities must also be restricted.

Schedule an appointment for a customized consultation with Dr. Perro to determine the cost of your procedure. In most cases, insurance will not cover cosmetic eyelid surgery. However, for some patients, insurance may be applicable. This is usually the case with patients who have their vision affected by a drooping upper eyelid.

Expected cost

Schedule an appointment for a customized consultation with Dr. Perro to determine the cost of your procedure. In most cases, insurance will not cover cosmetic eyelid surgery. However, for some patients, insurance may be applicable. This is usually the case with patients who have their vision affected by a drooping upper eyelid.

The purpose of a browlift is to address the age-related changes that affect the upper 1/3 of the face like eyebrow droop and deep forehead lines. Over time, as we age, the eyebrows descend and lines form in the upper face which may give the impression we are tired or angry. A browlift is a surgical procedure which elevates the eyebrows and softens the deeper lines of the forehead and area between the eyebrows to create a natural, rested appearance. 

Dr. Paul Critelli, board-certified plastic surgeon at UT Health East Texas Cosmetic Surgery Center in Tyler utilizes a brow lift with an incision made along the brow line to raise the brow and correct droopy upper eyelids that cause the patient to look tired, sad or angry. A brow lift helps men and women attain a more youthful appearance. It is often confused with a forehead lift because both use a lift technique to target the upper face. However, each lift is a distinct procedure using different techniques.

About the surgery

A brow lift is a surgical procedure to lift the brows and give a more refreshed, younger appearance. Over time the brows and forehead can begin to sag and wrinkle, causing patients to look tired or even angry. In some cases this causes obstruction of your vision which may be covered by insurance.

If the patient is a candidate for a forehead lift, the incision will be made endoscopically along the hairline, and the forehead will be pulled up which helps lift the brow at the same time. Patients report feeling younger with this procedure and remark that the aesthetic results are subtle, yet significantly noticeable.

The incision techniques used during a brow lift procedure depend on the severity of sagging, the skin condition and the hairline location. There are classic incisions, which may be located on the upper eyelid, or a coronal incision, which runs from ear to ear underneath the patient’s hair. A less invasive treatment is possible with an endoscopic brow lift.

Eyebrow incursion

This surgical technique places the incision along the natural upper eyelid crease or the brow’s hairline. The focus is to trim away excess skin and tighten the remaining skin and underlying tissues to create a rejuvenated facial appearance. The weak tissues will be reattached to the brow bone by sutures or attached with temporary tiny hooks placed internally where the muscles will cling and heal into a new position. This treatment doesn’t simultaneously resolve any issues of wrinkles on the upper forehead.

Coronal brow lift

An incision that hides the scar within the hair area is the coronal brow lift. The cut is made from one ear to the other, running along a few inches above the patient’s hairline. The eyebrows are then repositioned to correct the tired, aging appearance by pulling the muscles up. With this technique, the hairline is also positioned higher. The results are typically subtle, just enough to stretch the droopy eyelids, but not lifted too severely, which would result in a shocked, wide-eyed look.

Endoscopic brow lift

The use of endoscopes gives way to less invasive treatments. During an endoscopy procedure, several small incisions, no longer than an inch, are made close to the hairline. A tiny camera at the end of a thin tube will be inserted to allow the surgeon to operate via a monitor. Other tubes are inserted that will perform the necessary surgical steps to correct the cosmetic problem. Sutures are placed underneath the skin to help lessen the scars. The healing from this technique is quicker compared to the classic brow lifts.

During/after surgery

A brow lift is performed under general anesthesia at UT Health Tyler. It can last between 1 to 2 hours. Patients are sent home after surgery and advised to limit movement for up to 2 days. There will be some bruising and swelling that may be present on other areas of the face, such as the cheeks. Patients will be able to go back to a normal routine within a week. Strenuous activities must be avoided as it may affect healing. It is quite normal to feel as though the face is out of symmetry, but within 3-6 months, patients will see the optimized results, and look and feel younger with a positive outcome.

Expected cost

Schedule an appointment for a customized consultation with Dr. Critelli to determine the cost of your procedure. Because a brow lift is considered cosmetic in nature, insurance generally does not cover this procedure. However, in some cases where vision is affected because of sagging skin, insurance coverage may be a consideration. This is not guaranteed and varies by surgical case.

FAQ

Facelift vs brow lift?

The plastic surgeon will initially evaluate the problem areas on the face and recommend the best approach. A brow lift enhancement is confined within the upper area of the face while a facelift also improves the appearance of the lower area of the face including the chin and the cheeks. Depending on the severity of the wrinkles and the sagging, a full facelift may be a better approach.

Natural looks?

The ultimate aim for a brow lift procedure is to give the face an appearance that is fresh and youthful. With this surgery, the plastic surgeon is an expert who ensures that results are subtle enough so that it doesn’t look surgically treated. An experienced facial surgeon will have a thorough understanding of the internal structure of the face and will create results that are natural and prevent a wide-eyed or hyper-alert look.

Is BOTOX a better option?

BOTOX is a nonsurgical cosmetic treatment that targets forehead wrinkles. While it does an exceptional job of smoothing out lines and wrinkles on the forehead and around the eyes, it does not correct drooping of the skin folds around the eyes. Depending on the patient’s case, BOTOX is worth trying initially to see if this treatment satisfies the patient’s aesthetic goals. If BOTOX does little to the cosmetic issue, then a brow lift may be considered. Many patients benefit from a combination approach using surgery and BOTOX to attain the desired outcome.

Visible scarring?

Because the incisions are made in areas that can act as concealer, often the hair or natural crease of the face, scarring is generally not obvious. The doctor will make sure that the incisions are carefully placed to minimize the effects of scarring.

There are several non-surgical facial rejuvenation options, which may be used as stand-alone treatments or in conjunction with other procedures. Botox is a safe, popular and non-surgical treatment to improve the appearance of facial lines. It takes a few days to begin working, 1-2 weeks to reach maximal effect, and lasts typically about three months.

During/after the procedure

Injectable fillers are performed in Dr. Perro’s office at the UT Health East Texas Cosmetic Surgery Center in Tyler with the use of dental blocks and local anesthetic creams if necessary. Almost pain-free, your comfort and safety is our main concern. Patients will only feel a prick from the injection.

The substance will be injected gradually in even layers to make sure a natural looking result and contour is achieved. Sometimes, it may take more than one full syringe depending on how much volume is needed. There may be slight swelling, bruising and redness on the treated area but this usually subsides after a few days. Patients will be able to return to a normal routine a few hours after treatment.

Chin augmentation is a cosmetic procedure that enhances the contours of the chin while strengthening the jaw line. It is performed on patients who feel their chin is too small or weak in appearance, and can greatly improve the contours of the lower face. Dr. Paul Critelli, board-certified plastic surgeon at the UT Health East Texas Cosmetic Surgery Center in Tyler, offers chin implants to achieve a stronger jaw line.

About the surgery

Chin implants are usually made of silicone and are inserted within a chin pocket surgically created to hold the implant in place. There are also methods when an autologous approach can be taken, using bone from the rib or pelvic area and made to serve as an implant. Synthetic implants come in different sizes and shapes that can be matched to the patient’s preferences and aesthetic goals.

During chin augmentation, the implant is positioned over the bone below the lips. A pocket is created, which will hold the prosthesis in place. Sometimes the bone is shaved to create a groove for the implant. Incisions are commonly placed in two areas that can easily conceal scars on the underside of the chin or inside the lip, just between where the lower lip meets the gum. The results after this procedure are almost always positive for patients. An experience surgeon will create subtle results, yet dramatic enough to make a significant improvement to a person’s self-esteem.

During/after surgery

Chin implant surgery may use either a local anesthesia or general anesthesia depending on the surgical case. The procedure is performed at UT Health Tyler and could take up to two hours. A liquid diet is usually recommended in the first three days to avoid any pressure around the chin as the sutures are sensitive until healed. The patient is allowed only light activities until the second week. There will be numbness on the area surrounding the implant. While this is normal, the sensation will gradually improve as weeks pass. As with any implant surgery, it generally takes up to a full year for the implant to settle into position and create a final outcome that is soft, natural and normal in feeling.

Expected cost

Schedule an appointment for a customized consultation with Dr. Critelli to determine the cost of your procedure. Factors that affect cost are the type of implants used and any other cosmetic procedures done in conjunction with the augmentation.

FAQ

Fatty chin?

Chin augmentation is designed to emphasize the jaw line and create a balanced overall facial appearance. If there are excess fat deposits under the chin, which creates an impression of a double chin, liposuction may be performed. Before any cosmetic surgery, it is advised that the patient is close or already at their goal weight so it doesn’t compromise the positive results of surgery. Sometimes, liposuction is sufficient as it already defines the chin without ever needing an implant.

Temporary numbness?

Yes. With the implant and surrounding tissues adjusting to their new position, there will be a loss of sensation around the chin area and the skin around it will feel tighter than usual. This is an expected reaction post-surgery and shouldn’t be a cause of anxiety. Eventually, sensitivity will return to normal, but it may take several months before the patient can regain sensation. The improvement will be gradual during the course of a year.

Obvious scars?

The incisions made during a chin augmentation procedure are placed inconspicuously within the inside of the lip or under the chin, therefore, there is limited to no scarring that occurs with this procedure.

Mentoplasty vs genioplasty?

Mentoplasty is a procedure that adds fullness and shape to the chin. Genioplasty, on the other hand, is a surgical procedure that reconstructs the chin bone. Both procedures may be done at the same time as a combination surgery or as a single procedure, depending on the patient’s chin condition and aesthetic goals. Genioplasty is not always cosmetic in nature, as there are conditions in which the procedure resolves a patient’s bite or other medical concern.

As we age, we lose volume in our faces which contributes to more shadows falling on the face, leading to an older, less rested appearance. Dermal fillers like Juvederm and Restylane are used to restore lost facial volume and efface shadows on the face by filling lines and wrinkles. There are several types of fillers each with their own specific characteristics and benefits. Juvederm and Restylane are the most popular, mostly because they have a nice duration of effect but are dissolvable should the need arise.

Types of dermal fillers

Technological advances have made it possible to manufacture a variety of fillers. Most fillers are derived from natural substances (such as collagen) while others are artificially produced. The patient’s skin condition and aesthetic goals will decide which type of filler will be best to use.

Fat transfer

Fat transfer is the harvesting of excess fat from a donor site on the patient’s body. The fat is extracted using liposuction. These fat tissues are then purified and reinjected gradually into an area of skin with layering precision. The doctor will massage the skin and ensure that the intended contour is achieved. The body naturally absorbs fat and the results often last up to 6 months.

Collagen

Collagen is a naturally occurring protein in human and animals. Skin, bone, cartilage and teeth are rich in collagen. These are harvested and converted into a sterilized liquid form and used as a derma filler. It is a popular filler for lip augmentation procedures. Some collage is derived from animals. Patients using a derma filler of this nature will require allergy testing ahead of the procedure to ensure that they will not have any complications.

Calcium hydroxyapatite

Usually found in the bones and teeth of humans, calcium hydroxyapatite is also harvested and processed to use as a liquid filler. It is considered as one of the heavier substances and ideal in adding volume to deep creases. This particular filler product usually lasts longer than some of the others on the market.

Hyaluronic acid

Hyaluronic acid is another substance that is sourced from humans. Rich deposits of this substance are commonly found in ligaments and connective tissues. As with other natural substances, when used as a derma filler, the results are natural and effective, but they are not long lasting as the body reabsorbs the solution over time.

Polylactic acid

Polylactic acid is an artificial substance. When injected, it doesn’t just add volume underneath the skin, but it also triggers the production of collagen, which helps in skin renewal. The contours will be visible immediately and the skin quality will be evident after several months. This filler can last up to a year or longer for most patients.

During/after the procedure

Injectable fillers are performed in Dr. Critelli’s office at the UT Health East Texas Cosmetic Surgery Center in Tyler with the use of dental blocks and local anesthetic creams if necessary. Almost pain-free, your comfort and safety is our main concern. Patients will only feel a prick from the injection. The substance will be injected gradually in even layers to make sure a natural looking result and contour is achieved. Sometimes, it may take more than one full syringe depending on how much volume is needed. There may be slight swelling, bruising and redness on the treated area but this usually subsides after a few days. Patients will be able to return to a normal routine a few hours after treatment.

FAQs

How safe is it?

All derma fillers are FDA approved, meaning they have passed comprehensive testing to prove that the product is safe and effective to use. The majority of fillers are made with a natural substance so if the result is not as the patient desired, the good advantage is that the filler, at some point, will be reabsorbed by the body, and the results are temporary.

Do I need reinjection?

Most likely. Natural fillers are absorbed by the body in an average of 6 months to 12 months. When this happens, there will be a loss of volume similar to the condition prior to treatment. Reinjection is recommended to maintain the desired results. Some patients find this high maintenance but feel its worth the natural feel of their cosmetic treatment.

Is Botox better?

Injectable fillers help to decrease wrinkles by adding volume to smooth the skin’s surface. BOTOX, Dysport and Xeomin offer a result that looks and acts similar, but with a different approach. These treatments use a neurotoxic agent injected into the skin to temporarily freeze overactive muscles causing wrinkles. When the muscles relax, the visible wrinkles on the outer layer of the skin relax and soften, resulting in a smoother, younger appearance.

Otoplasty (ear surgery) is a cosmetic surgery that reforms misshapen ears to a normal appearance. There are a number of ear deformities that may be hereditary, or occur as a result from birth or a traumatic injury. The most common correction is among children to reshape ‘cup ears’ (ears that appears large and protruding) or ‘hidden ears’ (those that are underdeveloped and appear flattened to the skull).

The surgery reshapes the ear cartilages with splints in the cases of younger children. Dr. Paul Critelli, board-certified plastic surgeon at UT Health East Texas Cosmetic Surgery Center, performs otoplasty surgeries for patients and strives to create natural, normal looking ears.

In the cases of protruding ears, the cartilages are reformed and sometimes supported by splints. Soft tissues may also be trimmed away. The incisions are made behind the ear to reveal the ear’s confines. The ears will be repositioned by tightening the skin and then sutured. In cases of hidden ears, when cartilages are not fully developed, manipulations may include reshaping the cartilages by pulling or repositioning while splints are placed as supports. Sometimes, tissue grafting is also necessary to render volume.

Torn earlobe care

Ear surgery may also involve a torn earlobe. This can occur with heavy earrings or through other trauma. The surgical repair of a torn earlobe is generally straightforward. The skin cleft between the two sides of the tear is removed, and using either a skin graft or donated cartilage, a new lobe is reconstructed. Sutures are used that are placed in both the front and back of the ear and will remain intact for several weeks. Several post-operative visits may be required so that the sutures can be removed in several phases to ensure the lobe is strong and aesthetically appealing.

About the surgery

In the cases of protruding ears, the cartilages are reformed and sometimes supported by splints. Soft tissues may also be trimmed away. The incisions are made behind the ear to reveal the ear’s confines. The ears will be repositioned by tightening the skin and then sutured. In cases of hidden ears, when cartilages are not fully developed, manipulations may include reshaping the cartilages by pulling or repositioning while splints are placed as supports. Sometimes, tissue grafting is also necessary to render volume.

During/after surgery

Otoplasties are performed with general anesthesia at UT Health Tyler. This is an outpatient surgery and takes 1-2 hours. The ear will be bandaged to keep the new position and shape in place. This also helps so that children cannot touch or play with their ears, which may complicate healing. Activities must be limited, especially within the first week. Scars will remain hidden behind the ears or within the natural folds if the incisions are made in front of the ear.

Expected cost

Schedule an appointment for a customized consultation with Dr. Critelli to determine the cost of your procedure. Generally, health insurance does not cover cosmetic procedures such as otoplasty. However, there are rare exemptions especially if trauma occurred or if a birth defect is in question.

FAQ

Lasting results?

The results following an otoplasty procedure are long lasting. However, just like any other cosmetic procedure, aging and gravity may cause increased laxity. This could eventually affect the position of the ears. For the most part, the improvements made with this surgery are still significant.

When to have otoplasty?

On average, 5-6 year olds are ideal candidates for otoplasty as the ear will be already developed and the cartilage and tissues will still be soft, making it easy to reshape. This age is also recommended as it is a time before any schooling, which helps to avoid teasing.

One or two ears?

Usually, the condition is symmetrical to both ears. The final shape that the surgery will aim for will depend on the initial structure of the ear and how cartilages are placed. If the procedure is only for one ear, the shape will be patterned after the normally formed ear.

Dr. Paul Critelli is a board-certified plastic surgeon at UT Health East Texas Cosmetic Surgery Center and has created beautiful results for patients desiring an “awakened” facial appearance. Eyelid surgery (blepharoplasty) corrects cosmetic issues of the eyelids. This surgery targets and removes excess skin, fat and tissues from the upper and lower eyelids, and tightens the underlying muscles to create a rejuvenated facial appearance.

A loss of volume under the lower eyelid is one concern, and can cause male and female patients alike to look tired. In some individuals, a droopy upper eyelid is the issue. This occurs when excess tissue and skin collect on the eyelid causing a droopy look. Both of these are common facial concerns that can occur with aging (and in some cases, genetics) and can be corrected with blepharoplasty.

About the surgery

Eyelid surgery improves the appearance of the upper eyelids, lower eyelids or both. It targets excess skin and fat. As a person ages, the skin surrounding the eyes can become saggy or droopy. Eyelid surgery can also address drooping of the eyelid, called ptosis, which obstructs your vision. This is often covered by insurance, but your provider will be able to provide more information about that.

The procedure may either be performed on the upper eyelid only or the lower lid, or both. There will be a difference in approaches when it comes to the upper and lower eyelids but the method is similar; removing any loose skin or tissue, and extracting or repositioning the fat deposit. There will also be separate incisions spots. It is important to understand that this will not help with other cosmetic issues such as crow’s feet, wrinkles or dark circles. The results of an eyelid surgery are fairly isolated within the upper and lower lid section only. There are other procedures that can be combined, for example the use of BOTOX®, to create a maximized outcome.

Upper eyelid surgery

The most common problem with the upper eyelid is excess skin that droops and hangs over the eyes. Not only does this look unappealing, but it can also obstruct vision for a patient. The doctor will create an incision along the natural fold of the eyelid and extract any excess fat and tissue to remove any bulges. Once done, excess skin will also be trimmed and the cut will be closed with fine sutures. There are cases when fat tissues are only repositioned instead of excised.

Lower eyelid surgery

There are two options for incisions when it comes to lower eyelid surgery. This treatment will improve any appearance of bulging and sagging below the eye. Incisions may be made just slightly below the lash line and excess fat, tissue or skin will be excised. If the skin has retained good elasticity, a transconjunctival incision may be a better option as the cut is made inside the lower eyelid, which effectively makes any resulting scar concealed. A lower lid lift does not necessarily improve the dark circles that may occur under the eyes. The surgeon may recommend combining a lower blepharoplasty with another procedure such as a chemical peel or an injectable filler.

During/after surgery

Eyelid surgery is performed with general anesthesia at UT Health Tyler. If the procedure involves both upper and lower eyelids, the plastic surgeon will typically manage the upper eyelid first. On average, it takes one to two hours to complete the operation. The patient will be sent home for recovery. For the first few days, there will be swelling and discoloration around the area. It is advised that the head is elevated for the first few days. Pain medications and antibiotics will be prescribed to manage the initial discomfort. Strenuous activities must also be restricted.

Expected cost

Schedule an appointment for a customized consultation with Dr. Critelli to determine the cost of your procedure. In most cases, insurance will not cover cosmetic eyelid surgery. However, for some patients, insurance may be applicable. This is usually the case with patients who have their vision affected by a drooping upper eyelid.

Aging is a natural process, which results in weakening of the facial tissues and a depletion of volume under the skin that takes its toll on male and female patients alike. This creates a loss of skin elasticity leading to sagginess and droopy features that create a profile that looks tired and old. An individual may consider a facelift to improve these facial changes. A facelift reshapes and tightens displaced facial tissues and removes excess skin and fat.

Facelifts are generally invasive in nature, but the more recent methods use techniques that minimize incisions compared to traditional facelifts. This results in a faster recovery and a reduced risk for complications. Dr. Paul Critelli, board-certified plastic surgeon at UT Health East Texas Cosmetic Surgery Center, performs facelift procedure for patients at UT Health Tyler.

About the surgery

A facelift, or rhytidectomy, focuses on the bottom third of the face. This powerful procedure repositions facial fat and skin to improves the appearance of cheeks, jaw line and neck to give the patient a more youthful appearance.

The technique used during a facelift is dependent on the patient’s facial features and conditions. Most surgeons will always aim for the less invasive technique, but some patient cases are severe and will require internal tissues, fat and skin to be manipulated. Patients must also understand the procedure in detail, including the level of invasiveness, placement of incisions, what layers of tissues will be corrected, and what risks may be associated with the surgery before moving forward.

Skin-only facelift

Also referred to as the cutaneous facelift, this technique removes excess and loose skin to create a tightened look. The remaining skin is repositioned to lift sagging cheeks and jowls. It also improves the profile along the jaw line. With this facelift technique, the muscles or fat tissues are left untouched. As the treatment focuses on the skin only, recovery is quick. This is ideal for those who still have good tone muscle and distribution of fat, but find the skin losing elasticity in some areas.

Facelift and neck lift

Facelift/neck lift is a surgical procedure where the sagging skin and deeper soft tissues of the face and neck are elevated and suspended to provide a more youthful appearance. Facelift improves age related changes in the lower face and neck like jowling, neck banding, saggy neck skin, and fullness under the chin.

Dr. Perro strategically and discretely places his incisions for facelift so they are very well concealed. He also ensures the right balance is reached with his technique achieving a natural, non-operated look that never appears “pulled” or overdone.

Traditional facelift (SMAS)

SMAS is the superficial musculo-aponeurotic system, which is a muscle complex that is primarily active when it comes to facial expression. With normal wear-and-tear due to age, gravity and personal habits, muscle tissue loses its form and becomes displaced significantly for those over 50. This particular facelift is considered the standard when it comes to this cosmetic procedure. With lengthy incisions on the side of the face, from the temple to the lower hairline behind the ear, the skin will be peeled and lifted to reshape contours. If there is excess fat and skin, these will also be removed.

Deep plane lift

For those who have severe cases of drooping and skin folds that are normal with aging and extensive sun exposure, a deep plane lift may be the best approach. This is especially true for those whose facial profiles need extensive reshaping on areas that typically have the volume and tight contours. This involves a highly specialized skill set and the plastic surgeon must be carefully selected as the nature of procedure has a high chance of damage to the facial nerves. This particular technique can have many advantages over a traditional facelift.

Mini facelift

Also called as a short-scar facelift because of the shorter incisions made, a mini lift is a quick treatment that corrects the middle and lower face. Many patients initially consider this technique, but this doesn’t correct any severe issues and usually renders short-term results. Patients who undergo this procedure are most likely to also stage a full facelift as a final step to fully rejuvenate and reshape the face to its youthful curves.

During/after surgery

All facelift procedures are performed in our accredited surgical facility in Tyler with general anesthesia. Even though this is considered an outpatient procedure, there are some cases where the patient stays overnight for monitoring. It is normal to experience bruising and swelling after the surgery, and patients will feel as if their face is being pulled tight. This subsides within a couple of weeks. Optimal results will be evident after several months. It is important that activities are limited to help create a safe and quick healing.

Expected cost

Depending on the technique used and the invasiveness of the surgery, the fees vary. Schedule an appointment for a customized consultation with Dr. Critelli to determine the cost of your procedure.

Nonsurgical techniques?

Cosmetic surgery is constantly evolving and always finding ways to minimize the invasiveness of procedures. There are countless options that are considered less invasive than a facelift, including wrinkle relaxers such as BOTOX, injectable fillers, microdermabrasion and chemical/laser peels. These alternatives aim to correct signs of aging such as wrinkles, as well flatten and soften folds and contours. The effects, while effective, are often short-term lasting about 6 months to a year. Although these procedures can be safely repeated, for some, a facelift may be a better, more permanent option.

Is it natural?

Immediately following a facelift procedure, the patient will feel tightness and a pulling sensation. This is normal as the facial tissues, skin and muscle adjust to their new positions. It is important to choose a reputable plastic surgeon that has years of experience in facial cosmetic surgery. A doctor with experience in facial surgery will create natural, smooth results that will last for years to come.

Visible scars as a result?

A traditional facelift requires a long cut from the temple to the lower hairline, but the scars will be well concealed within the hairline and natural creases on the face. With the lesser invasive techniques, the scars heal pretty well and will almost be completely invisible to the naked eye.

Best age for a facelift?

Anyone can consider a facelift as soon as evidence of aging starts taking a toll on the skin. Generally, patients who are age 50 to 70 consider a facelift. Personal habits and environmental conditions can impact the skin and there are patients who are only 40 that are also good candidates for a facelift.

Of all cosmetic surgeries, one that can produce a striking improvement to an individual’s profile, is a neck lift. Board-certified plastic surgeon, Dr. Paul Critelli, offers this procedure for weight loss patients and for those who have loose, sagging skin in the neck area as the result of aging and gravity. A neck lift reduces excess fat and sagging skin to produce a more tightened, slimmer profile. It reduces what some refer to as the “turkey neck.”

In addition, this procedure treats the appearance of wrinkles and unsightly lines on the neck. The primary technique used during a neck lift is skin tightening. However, some patients may not necessarily need skin tightening, but instead could benefit from liposuction. During the consultation, the difference between a neck lift and neck liposuction will be discussed so that the best approach can be taken.

About the surgery

A neck lift is a cosmetic procedure that focuses on lifting sagging skin to achieve a contoured neck profile. This procedure reduces hanging skin and reshapes the neck. During the surgery, an incision is placed under the chin and/or behind or in front of the ears. If fat deposits are present and need to be removed, liposuction will be used during the surgery and performed first. The final steps of treatment will be to trim away excess skin, pull the remaining underlying tissue and muscle tight, and suture the incision.

During/after surgery

This procedure is performed under general anesthesia as an outpatient surgery at UT Health Tyler. The duration of the surgery usually takes around 2 hours, although it may vary depending on the case. Bruising and swelling will be visible after the surgery, but this will subside in the few short days following the procedure. Initially, patients will feel tightness and numbness. Once the neck adjusts to its new position, patients will notice a more relaxed feeling and a beautiful surgical result. It can take up to 6 months for the final results to appear.

Expected cost

Schedule an appointment for a customized consultation with Dr. Critelli to determine the cost of your procedure.

FAQ

Alternative to lift?

Surgery is the only way to remove loose skin, especially if it is loose enough to hang and droop. Therefore, a neck lift is the only solution when it comes to redefining an individual’s neck to create a strong contour. While there are some very good skin tightening laser treatments on the market today, surgery is still the best option.

Hidden scars?

There is minimal scarring with this procedure. Since the incision is placed under the chin and near the ears, the scarring is usually hidden. A skilled facial surgeon will take great effort to minimize scarring as much as possible.

Ideal age?

This depends on the situation and the amount of loose and sagging skin that is present. Some weight loss patients are young and may require a neck lift at a young age (for example, those between 20-30). For older patients who are combatting loose skin due to aging, the most common age is between 50-70.

Combination surgery?

During the initial consultation, it may be brought up that in addition to a neck lift, the patient may also benefit from another procedure, such as a facelift or a chin implant. It is common for these additional procedures to be combined to achieve the patient’s desired contours and aesthetic goals.

When someone refers to a “double chin”, in many cases, the problem may have nothing to do with the chin, but instead lie within the neck. This exists when there are excess fats deposits that settle below the chin creating the illusion of a secondary chin. Liposuction of the neck as a useful treatment to create a sleeker, slimmer neck and a stronger contour. Patients with loose, sagging skin undergo a neck lift using a skin removal and tightening technique to achieve their desired results.

Neck liposuction surgical technique

During a neck liposuction procedure, a tiny incision is made underneath the chin and a small cannula is inserted so that excess fat deposits can be suctioned. After the desired amount of fat has been removed, small sutures will close the incisions. This procedure leaves minimal scarring. The technique includes a numbing solution that is combined with a substance that helps control bleeding.

About the surgery

As a supplementary procedure with neck liposuction, a neck lift will correct any loose skin by removing the excess folds and tightening the underlying tissues and remaining skin with sutures. Incisions are placed on the underside of the chin or along the natural neck crease so that scars are not evident when the wounds heal. A neck lift reshapes the neck to create a stronger facial profile.

During/after surgery

Neck liposuction surgery is always performed at UT Health Tyler with the use of anesthesia. It is typically an outpatient procedure, but patients are advised to have someone stay with them for at least the first 24 hours. It is important to avoid putting any pressure on the neck and patients will be advised to sleep sitting up for a few days. A restricted diet will also be required to help aid healing. The results are often obvious immediately after surgery with optimal improvement seen after a few months.

Expected cost

Schedule an appointment for a customized consultation with Dr. Critelli to determine the cost of your procedure.

FAQ

Noticeable scars?

One of the advantages of liposuction of the neck is that it is minimally invasive and the incisions are just enough to insert a small cannula. Therefore, when the incision does heal, the scars are barely noticeable. Additionally, they are placed in areas where they can easily be concealed.

How much fat?

Neck liposuction generally targets smaller areas of fat compared to other parts of the body where liposuction is desired. The surgeon will continue to suction fat cells until the desired outcome as been attained.

Are results long-term?

The fat tissues removed by liposuction are reduced, however this does not mean that new fat tissues cannot develop. When proper diet and regular exercise are neglected, weight gain will most likely compromise the results of the liposuction. Results may be long term depending on the patient’s weight maintenance.

Rhinoplasty, commonly known as a nose job, is a cosmetic surgery for male and female patients that changes the appearance of the nose. Board-certified plastic and cosmetic surgeon, Dr. Paul Critelli, offers this procedure to his patients to provide a beautiful, subtle, natural outcome. The procedure is performed to correct a nasal dysfunction (such as a deviated septum), or cosmetically improve the appearance of the nose per the patient’s aesthetic goals. Some rhinoplasty surgeries are reconstructive in nature, which is the case for patients who have experienced trauma. The most common reason to have rhinoplasty is for cosmetic purposes.

There are many reasons a person might want a rhinoplasty procedure, otherwise known as a “nose job.” Rhinoplasty improves the shape of the nose and enhances facial balance. This also can be done to correct difficulty breathing by aligning the nasal structure to improve breathing. Using advanced techniques, Dr. Critelli can help patients achieve the look they’ve always desired and give patients the ability to breathe easily again. There are several techniques used for rhinoplasty. The approach taken will be based on the complexity of the surgical case and the overall goal of the patient.

Open rhinoplasty

With an open rhinoplasty, the incisions are made on the tissue between the nostrils or on the natural crease of the nose just above the lips. This allows for greater access and view of the confines of the nose. Surgeons prefer this as it is easier to manipulate the bones and cartilage. The skin is peeled back to reveal the internal structure of the nose and redraped once reshaping is completed. The scars associated with this approach are tiny – less than 5mm – so they are not easily noticeable once fully healed.

Closed rhinoplasty

During a closed rhinoplasty surgery, incisions are made to the inside of the nose through the nostrils. This is a common technique for patients who desire mild reshaping. This approach does not cause visible scarring. For severe reshaping cases, the open technique will be implemented.

Non-invasive rhinoplasty

For minor reshaping, some patients may opt to try an injectable filler to achieve results. These come in a variety of liquid substances, and sometimes a fat transfer can also be utilized. A filler can help add volume to hide small deformities, such as a bump or a bony appearance. It is important to note that fillers can only do so much in the reshaping process. For most patients, surgery is a better option and will offer a permanent solution.

During/after surgery

Rhinoplasty is performed at UT Health Tyler under general anesthesia. The procedure lasts up to 2 hours and is considered outpatient. After surgery, there will be swelling and soreness around the nose area. Bruising is also a side effect of surgery. The nose will be placed in a splint for additional support. During the first 7-10 days following surgery, the side effects will begin to disappear and the splint will be removed. Patients will be able to see their results immediately; however, it may take several months for the full results to appear.

Expected cost

Schedule an appointment for a customized consultation with Dr. Critelli to determine the cost of your procedure. For more complex cases, skin or fat grafting, or even cartilage reconstruction may be performed. If the procedure is purely cosmetic, the expenses are the patient’s responsibility. However, if reconstruction is performed to correct a deformity, trauma or medical condition, insurance may cover a portion of the expense.

FAQ

Is it risky?

All surgical procedures carry some form of risk. These risks can be greatly minimized if an experienced nose surgeon is chosen to perform the surgery. While rhinoplasty is one of the most commonly performed procedures in the U.S., surgeon skill is critical so that a beautiful, satisfactory outcome can result.

Broken nose?

Around half of all rhinoplasty cases will include some form of nose breaking in order to allow the surgeon to reshape the cartilage and bone. This is primarily intended for patients who have nasal asymmetry. The broken bone or cartilage will be reshaped and reattached, and then supported by splints during recovery.

What is a nasal pack?

Nasal packing is done to help with bleeding, especially if the surgery involves the septum. Gauze or cotton packs are inserted into the nasal chamber during this process. Patients find it uncomfortable, but the packing is only in for a short-term during the immediate recovery phase.

Surgical or nonsurgical?

This depends on the patient’s nose structure and what aesthetic result is trying to be achieved. For significant reshaping, the surgical approach will be performed as this allows the surgeon to manipulate the cartridges and bones. If the patient is looking for a subtle improvement, adding volume to the area may suffice.

Dr. Critelli, works with men around the East Texas area to achieve the “fit” look they desire. This includes attaining a “6-pack” with the help of surgery. Abdominal etching surgery enhances the definition of the abdominal muscles by removing excess fat and reshaping the abdominal region to create a sculpted ab appearance. This specialty surgery uses liposuction to accentuate the abdominal rippling effect many men desire. The best candidates for this procedure are men in relatively good shape who desire a more defined abdomen without intrusive scarring. With the help of an experienced surgeon, abdominal etching allows for the renowned “washboard abs” that are sometimes hard to get through diet and exercise alone.

About the surgery

Abdominal etching is done with a special tumescent liposuction technique. The procedure removes and sculpts fatty tissue residing under the skin. Before the procedure, detailed markings are made of the patient’s flexed abs. During the surgery, small incisions are made within the natural contours of the abdomen. This helps minimize scarring. Through these incisions, fat is removed in some areas, thinned in others, and rearranged to accentuate the abdomen (rectus) muscles and the linea alba (the line running down the center of the abdomen).

During/after surgery

All male abdominal etching procedures can be performed under general anesthesia as an outpatient procedure at UT Health Tyler or done under local anesthesia in the office. The surgery typically lasts about an hour. Following surgery, there will be some swelling and bruising in the abdomen. A compression garment should be worn for 3-6 weeks. Most patients are able to resume a normal work schedule within 1 week and incorporate exercise within 3 weeks. The full effect of surgery should be noticed within 6 months. This surgery allows men increased definition of their abdominals.

Expected cost

The cost of male abdominal etching surgery varies based on the extent of surgery. Schedule an appointment for a customized consultation with Dr. Critelli to determine the cost of your procedure.

FAQs

Will I have a “6 pack”?

For the ideal candidate, yes! Many people hope for a “6 pack” and work for years without attaining the desired results. This is caused by a layer of fat covering the muscle. Abdominal etching removes and sculpts this layer of fat, resulting in the desired “6 pack” for most candidates. Patients with muscle tone already present see the greatest results.

Who is the ideal candidate?

The ideal candidate for abdominal etching is a male with up to 20% body fat and preexisting muscle tissue, but who feels let down because he cannot attain “washboard abs”.

Is liosuction always needed?

In most cases, yes. The soft tissue and fat that collects in excess will need to be removed using a liposuction method. There are many liposuction techniques to consider. Some are less invasive and use a mechanism that can help the skin become tighter on the chest wall. These methods can be discussed during your consultation.

What about scarring?

Incisions for this surgery are well concealed. They are usually placed near the areola or in the lines between the abdominal muscles and are typically small enough that scarring is minimized. Over time, the incision lines will fade and become almost nonexistent for most men.

One of the most common cosmetic surgery procedures after a major weight loss is an arm lift, sometimes referred to as an arm reduction or arm reshaping. It is a skin removal/skin tightening procedure that treats the underside of the upper arms by trimming loose skin, tightening the underlying tissues and removing excess fat. During a significant weight loss, patients realize that the skin in some areas of the body doesn’t shrink as the body does. Loose, sagging skin is often the result. Body contouring procedures, such as brachioplasty, are popular and allow patients to complete their weight loss transformation. Dr. Paul Critelli is a body contouring surgeon and provides East Texas patients the opportunity to have shapelier arms with brachioplasty surgery.

About the surgery

The goal of an arm lift is to result in a toned upper arm appearance. The length of the incision varies depending on how much skin and fat are to be removed. Patients who have a fairly good skin tone may only require a minor incision. However, patients who have excessively loose, hanging skin will require an incision that may run from the armpit to the elbow. At this time, the excess skin is trimmed and the underlying muscles are tightened. In some patients, the armpit will also need to be addressed and surgically tightened.

During/after surgery

Patients undergoing brachioplasty are put under general anesthesia. It is an outpatient procedure that takes an average of two hours to complete. If the procedure is a part of an after weight loss surgery, which usually involves more than one body part, an overnight stay may be required. After surgery, the arm is protected with a compression garment and drain tubes may be present to avoid the risk of infection. Swelling and bruising are normal. Patients should keep the arm elevated to promote blood circulation and help with swelling. With proper care, the arm will return to normal function after several weeks.

Expected cost

Schedule an appointment for a customized consultation with Dr. Critelli to determine the cost of your procedure.

FAQs

Arm lift or lipo?

This depends on the amount of loose skin that is present. Patients who lose a significant amount of weight generally need the skin removed in order to attain a positive result. In fact, many times, arm lift patients do not even need liposuction because there’s no excess fat to be removed. On the other hand, patients who have relatively good skin elasticity may only need liposuction or minor tightening.

What about scars?

Any patient who undergoes an operation where skin is removed and incisions are made must understand that scarring is a part of the procedure, including brachioplasty. Doctors will make an effort to ensure that the scar will be as minimal as possible. For post-surgery care, topical ointments to assist in scar healing will be prescribed. It is also recommended that patients avoid sun exposure during the first year to protect the incisions from any additional discoloration. Most patients believe the benefits of a more toned arm overweigh the worry of scars.

Arm lift and other procedures?

It is common for arm lift patients to combine this surgery with another procedure. This is sometimes referred to as an upper body lift and may include liposuction, abdominoplasty (tummy tuck) and breast surgery (breast lift). During the consultation, each surgery will be discussed and recommendations will be made as to whether these procedures can be done at the same time.

How contoured will my arms be?

An arm lift is performed to remove hanging skin and fat. The only way to build actual muscle is through strength training. Following surgery, once the arms are fully healed, patients can begin weight training if they wish to do so. This is a great way to add shape to the arms by toning and strengthening them. Patients should maintain a healthy lifestyle that includes diet and exercise in order to avoid a recurring weight gain, which could compromise the surgical results.

Individuals who are in the process of losing weight, who are post-partum, or who are experiencing wrinkles and sagging skin due to aging may find themselves less confident as the skin loses its elasticity. Body contouring is a solution offered by board-certified plastic surgeon, Dr. Paul Critelli that can address certain problem areas by surgically trimming excess skin, tightening underlying tissues and removing pockets of fat. The physical change can be dramatic and life changing for many (especially for weight loss patients). Advances in medical technology and training allow plastic surgeons the ability to produce outstanding aesthetic results, which include a more toned and smooth appearance.

About the surgery

The process of body contouring is specifically designed to help patients reshape, tighten and firm up problem areas of the body where loose and sagging skin is present. Common areas addressed are the neck, arms, breasts, abdomen, hips, flanks, thighs, buttocks, and knees. It is likely that the doctor will consider a number of procedures to be combined into one surgery (where necessary). This typically involves the upper body parts or lower body parts that are staged together to minimize the risk of infection and shorten the recovery time.

During/after surgery

During surgery, Dr. Critelli will trim away and remove excess skin and the underlying tissues will be tightened. Liposuction is often a part of this process. All procedures are performed under general anesthesia. The duration of the surgery and the length of the hospital stay will depend on how many procedures were combined in a single operative setting. Recovery from this surgery is slow and challenging, but the improvements that are visible create a significant boost of self-confidence for the majority of patients.

Expected cost

Schedule an appointment for a customized consultation with Dr. Critelli. During the initial consultation, a customized surgical plan will be provided with the overall cost expectations outlined, which includes recommended treatments that meet the patient’s aesthetic goals.

FAQs

Procedures I can combine?

Procedures are combined and scheduled in stages depending on the overall physical health of the patient and the body areas that need to be addressed. Typically, the grouping will be staged with a combination of either the upper body parts (abdomen, breasts, arms, neck, face), or lower body parts (buttocks, thighs, flanks, knees). This staging helps reduce the risk of complications, such as blood loss and infection, since the surgery is limited to the area. This also shortens the length of time for recovery. The combination of procedures will be outlined during the initial consultation with the surgeon.

The ideal timing?

Individuals who have lost a significant amount of weight will need to be at or near their goal weight in order to proceed with a body contouring procedure. In addition, body contouring should also be reserved for those who have already had children and are not planning to become pregnant in the future. This is a recommendation only because it preserves the toned appearance created through surgery without compromising the surgical outcome.

Mommy makeover procedure?

A mommy makeover is a procedure that is in the same context of body contouring. It is a coined term for a group of body contouring procedures that address areas of the body specifically affected by pregnancy. These are the areas around the breasts, abdomen, hips and buttocks. Again, this is only a general term for body contouring reserved for those who have completed one or more pregnancies.

Will there be a lot of scars?

In general, body contouring procedures will result in scarring. Most patients report that once the incisions heal, the scarring is no longer a primary worry as the benefits of this life-changing surgery are so significant. An experienced plastic surgeon will make every effort to minimize the scars by carefully placing the incisions inconspicuously. Post-surgery care is also very important. Topical creams may be prescribed to help in the healing process. Over time, the scars will lighten and blend in with the patient’s natural skin tone.

A Brazilian butt lift is ideal for individuals who are looking for a slimmer waistline, shapelier and curvier buttocks. A flat or deflated butt may be a result of weight loss, pregnancy, aging or even gravity. This procedure begins by removing fat by means of liposuction. The fat tissue is harvested and grafted into the butt area to give it volume for a rounder, fuller look. One of the many benefits of this procedure, over other butt augmentation procedures, is that small to very large volumes of fat can be placed in each area of the hips and buttocks to tailor the results to the patient’s desires.

Candidates for this procedure must have good skin elasticity. If there is loose skin around the buttock area, a surgical butt lift may be initially necessary to trim away the excess skin and surgically lift the buttock. East Texas board-certified plastic surgeon, Dr. Paul Critelli proudly offers Brazilian butt lift surgery at the UT Health East Texas Cosmetic Surgery Center.

About the surgery

The body will be initially evaluated to make sure that the patient is a good candidate for the Brazilian butt lift method. It will also be assessed as to which areas the liposuction will be performed. Depending on the amount of fat necessary to fill up the buttocks area, multiple donor sites may be considered. After liposuction, the fat extracted will be purified. After purification, only a fraction of the fat is ideal for reinjection. Dr. Critelli will then reinstate the fat little by little to make sure that the layering is done properly.

During/after surgery

The surgery is considered an outpatient procedure and is generally performed with general anesthesia. Small to moderate volumes can be done under local anesthetic in the office setting. The surgery lasts an average of two hours depending on the number of donor sites and fat layering needed. After surgery, a compression garment is worn to help with the swelling and also assist in the contouring of the buttocks. The patient is advised not to put weight on the butt area for the first two to three weeks following surgery. Sitting or lying down must be done with the weight mostly on the thighs.

Expected cost

Schedule an appointment for a customized consultation with Dr. Critelli to determine the cost of your procedure. The cost depends on volume of fat grafted.

FAQs

Natural or synthetic?

Many patients nowadays opt for fat transfers as it feels more safe and natural. For some, they are not comfortable with implants or a foreign device stored in their buttocks. When choosing whether to go natural or implants, be sure to understand the pros and cons of each technique. The one disadvantage of fat transfers is that the injected fat maybe naturally reabsorbed into the body.

Multiple donor sites?

Multiple donor sites for the fat grafting may include the lower backside, abdomen, love handles and the thighs. Liposuction done in these areas may also help initially contour the surrounding areas of the buttocks. Depending on the amount of fat required to achieve the contour wanted, liposuction in the arms may also be performed.

What if I gain weight?

The ideal candidates for this procedure are those who are not too overweight. Both significant weight gain or loss will compromise the results of the surgery. Patients who have had this procedure must stick to a healthy lifestyle with proper diet and exercise.

Individuals who have loose skin around the buttocks due to significant weight loss, pregnancy or aging may consider a butt lift to achieve a tighter, shapelier look. This is a body contouring procedure that addresses excess and sagging skin on and below the buttocks. During a surgical butt lift, excess skin is removed and the remaining skin is pulled up for a tighter look.

Our plastic surgery office also offers the “Brazilian butt lift,” which can sometimes be confused with a surgical lift. During the Brazilian method, the surgeon does not “lift” the butt, but rather, fills it with volume via a fat transfer. Board-certified plastic surgeon, Dr. Paul Critelli consults with both men and women in Tyler who are contemplating having a gluteoplasty procedure.

About the surgery

In a traditional butt lift, incisions may be made under the butt cheeks, but in cases where a lower body lift is also being performed, the incisions may be placed near the waistline as well. Liposuction is usually a part of this procedure. Once the loose skin is trimmed away and the underlying tissues pulled tight, the surgeon will secure the incision with sutures. If the incisions were placed under the butt cheeks, the scarring will be able to be hidden with undergarments. A butt lift gives the buttocks a firmer look. The appearance of loose skin, cellulite dimples and wrinkling will be smoother and more toned.

During/after surgery

During a butt lift surgery, general anesthesia is used and is performed in an accredited surgical facility, most often as an outpatient procedure. If a combination surgery is performed with a butt lift, an overnight hospital stay may be required. Swelling and bruising will last several weeks as the area heals. Scarring is also unavoidable, but every effort is made to make the incision as inconspicuous as possible so that they can be concealed. In most cases, patients will be able to sit down after 2 weeks and will be able to return to their normal routine within six weeks.

Expected cost

Schedule an appointment for a customized consultation with Dr. Critelli to determine the cost of your procedure.

FAQs

Lift or liposuction?

It depends. Both of these procedures address different cosmetic issues. For individuals who have loose skin or wrinkles under the buttock area, a butt lift is necessary. This procedure may still include liposuction if there is excess fat to be removed. Patients with a healthy skin tone who simply want a smaller buttocks may see improvements with liposuction alone. These alternatives can be discussed during the initial body assessment and consultation.

Butt implants?

Butt augmentation is a procedure in which implants are used to give the buttocks volume and a shapelier curve. Another common procedure is the Brazilian butt lift, which gives the buttocks the same effect as butt augmentation except instead of using an implant, a fat transfer is performed. It is important to note that although a butt lift improves the firmness of the butt, it does not add volume. Some patients may benefit from a combined procedure that involves a butt lift with a fat transfer or implants.

Weight gain?

A butt lift is recommended for those who are close to or at their goal weight. When there is a significant weight gain after this surgery, the surgical results can be compromised. Similar to any body contouring procedure where the shape and contour of the body is enhanced, adhering to a healthy lifestyle with proper diet and regular exercise will help maintain the results for years.

How bad is the scarring?

As with most skin removal surgeries, there will be some scarring with a butt lift procedure. The plastic surgeon will make every effort to minimize scarring and their visibility by placing the incisions within the natural folds under the buttocks. Post-surgery care is very important for effective healing of the wound. Compression garments and topical creams will also help. Over the years, the scars will fade and flatten out.

Also known as fat grafting, fat transfer is a procedure that uses liposuction to remove fat from an area on the body where the fat layer is thick. These fats deposits are collected and purified, then reinstated into another part of the body that needs volume. Board-certified plastic and cosmetic surgeon, Dr. Paul Critelli, offers fat transfer surgery for patients throughout East Texas who desire a natural appearance.

Common areas on the body where a fat transfer may be performed include the breasts, buttocks, lips and face. Fat transfers are performed to meet an aesthetic purpose. While the results are natural, beautiful and can last for years, some of the fat may be absorbed back into the body over time. Patients who desire a permanent result may consider silicone implants instead.

About the surgery

During this procedure, fat is removed from the donor sites via liposuction. A cannula is inserted, which will remove the fat deposits so that they can be harvested and purified by a centrifuge device. During this process, only the healthy fat will be used for reinjection, which will then be prepared in syringes. The surgeon will slowly reinstate the fat into the body part where shape and contour are needed. During the injection process, the area will be slowly massaged so the fat deposits settle in compact layers for the best contour finish possible. Normally, multiple injections are necessary to create an even spread of fat and achieve an ideal outcome.

During/after surgery

Fat transfer treatment is performed with general anesthesia when it covers larger areas while local anesthesia is used if the area to be treated is small. A good example of this is lip enhancement. Both methods will be treated as an outpatient treatment at UT Health Tyler. The procedure will cause swelling and bruising on both the removal and injection sites. These side effects will subside in a few days. Recovery time depends on several factors, including how many body parts were involved in the surgery, as well as how much fat was transferred. Scarring is generally minimal with this procedure as the incisions made are just big enough for the cannula to be inserted.

FAQs

How long do results last?

A fat transfer procedure can give results that will last for years. While the concern of fat reabsorption is something to consider, a skilled surgeon will be able to maximize the outcome by using the tested techniques in terms of fat layering.

Loss of volume?

When properly performed, a fat transfer can last a long time. In areas where the fat does get resorbed, the area can continue to be tweaked. For patients who want to continue to have volume enhancement, but desire natural results (i.e., lip enhancement), this is an ideal procedure. This is especially the case for those who are not comfortable using an implant.

How about scarring?

Scarring is minimal during a fat transfer procedure. Any scars that remain will be small (either where the cannula or the syringe was inserted for the transfer). The incisions are usually placed in areas where they can be concealed by clothing.

Other treatments?

For loss of facial volume, there are treatments that may be considered that will also produce positive results. For wrinkle problems, an injectable filler may be suitable. These fillers may include collagen or hyaluronic acid. Every option can be discussed in detail during the initial consultation.

Facial fillers are a nonsurgical cosmetic solution to add volume under the skin to help soften the appearance of fine lines, wrinkles and hollow areas. An injectable filler uses a liquid substance to fill a facial pocket that has lost volume due to aging or weight loss, Liquid fillers reshape the natural contour of the skin, resulting in a younger appearance. They are commonly injected in the cheeks, chin, lips, under the eyes, in the nasolabial folds and other areas that require a “liquid lift.” It is common to combine a filler product with another facial cosmetic procedure. Fillers are noninvasive, do not leave scars and are highly effective in achieving natural results.

We offer the following types of injectables:

• Botox: Botox is a nonsurgical facial rejuvenation treatment that uses a neurotoxin to relax facial muscles, softening facial lines and wrinkles.
• Juvederm: Juvederm is a hyaluronic acid filler with multiple uses including adding volume to the lips, or cheeks, correct facial lines or smooth nasolabial folds.
• Radiesse: Radiesse is an injectable filler composed of calcium hydroxyapatite used commonly for cheek augmentation to correct loss of volume due to aging.
• Sculptra: Sculptra is a facial filler composed of poly-L-lactic acid that stimulates collagen production to replaced lost volume.
• Volbella: Volbella is a hyaluronic acid filler that is softer than the other Juvederm products and is ideal for adding volume and shape to lips as well as correcting facial lines.
• Voluma: Voluma is a hyaluronic acid filler used most commonly for cheek augmentation to correct loss of volume due to aging.

Labiaplasty (also referred to as labia rejuvenation) is a cosmetic procedure that enhances the appearance of the vaginal lips. Women who have gone through pregnancy or those who have experienced a significant weight loss may have enlarged labia. In addition, some women are born with asymmetrical vaginal lips. Abnormal labia can result in an unsightly appearance, but more importantly, it can cause symptoms such as chronic irritations, discomfort during sex, and yeast or urinary tract infections.

Women who are unhappy with the appearance of their labia should not feel anxious or scared. Dr. Paul Critelli, board-certified plastic and reconstructive surgeon at UT Health East Texas Cosmetic Surgery Center works with patients to create natural results in a private and compassionate setting. In fact, women may find comfort in knowing that labia rejuvenation is one of the fastest growing cosmetic surgeries in the U.S. today.

About the surgery

Women who are considering labiaplasty should consult with a qualified cosmetic surgeon. In the past, before surgeons improved this procedure, the approach was to remove the excess tissue and skin deformity using an amputation method. Today, skilled surgeons use aesthetic reshaping techniques so that the labia are not only reduced in size, but also the nerves are protected in the process so that sexual feeling is not compromised. A surgeon with experience will preserve the natural color and contour and create a result that looks visually appealing with minimal to no scarring.

Surgical process

The most common approach surgeons take to perform labiaplasty is to use a device known as Iris Scissors. This fine, advanced surgical tool allows the surgeon to reshape the inner folds of the labia. In the process, a clean “V” shaped wedge is made to the vaginal lips, and is removed to reduce the size. The surgeon will carefully work to reshape and reconstruct the lips so that they meet the patient’s aesthetic goals. Dissolvable sutures are used to close the incision.

During/after surgery

Labiaplasty typically takes between 1-2 hours to complete, depending on how complex the surgical case is. It is performed under general anesthesia at UT Health Tyler and does not require an overnight stay. Women who undergo labia rejuvenation will need to avoid any activity that may cause swelling and bleeding, such as exercise, sexual activity, douching and the use of tampons. These activities can be resumed slowly around 4-6 weeks post-op. Women find that the results of this procedure look so natural that their self-confidence and self-image are improved drastically.

Labiaplasty is a surgery that is sometimes covered by medical insurance. This is generally the case if the condition is causing problematic symptoms. Schedule an appointment for a customized consultation with Dr. Critelli to determine the cost of your procedure.

FAQs

OB-GYN or cosmetic surgeon?

When researching the aesthetic surgery market, most patients will find that a large majority of cosmetic surgeons offer labiaplasty. While many OB-GYNs are capable of performing labia rejuvenation, the procedure is most often considered cosmetic. An OB-GYN will be able to surgically remove any excess that exists within the labia; however, a cosmetic surgeon will consider the aesthetics as well. This ensures that scarring is minimal, and that color, contour and symmetry look and feel natural.

Does it cause insensitivity?

As with any surgery, there may be numbness in the vaginal area after the procedure is completed. This is temporary as the skin and vaginal lips heal. In regards to sensitivity, it is important to understand that labia rejuvenation affects, for the most part, the vaginal lips only. Sensitivity is served by the clitoris. A skilled cosmetic surgeon that specializes in labiaplasty will work around this area so that a loss of sensitivity does not occur.

Does it affect intercourse?

Labiaplasty, when performed by a skilled surgeon, will only improve sexual intercourse. In many cases, this is because the excess skin and tissue that may have gotten in the way during sex before will now be removed. The clitoral region will be protected and the sensory nerves preserved so that sexual intercourse is not impacted in a negative way.

Before or after pregnancy?

In most cases, it is recommended that women wait to have labia rejuvenation until after all pregnancies are complete. However, if having enlarged labia is bothersome and causes physical symptoms and emotional hardship, then this surgery can most definitely be performed before a planned pregnancy. If the results of the surgery are compromised due to a post-surgical pregnancy, a second surgery can be discussed.

For patients who desire a slimmer figure, Dr. Paul Critelli offers liposuction, a cosmetic procedure that removes stubborn fat from areas of the body that are resistant to diet and exercise. Men and women most commonly remove fat from the stomach, hips, lower back, thighs, arms, chin and chest. The surgeon uses a tube-like tool called a cannula to loosen fat cells, and remove them from the body. This procedure helps patients achieve a slimmer contour, but should not be used as a solution for being overweight. Men and women considering liposuction should be at or near a stabilized, ideal weight.

Tumescent “Super-Wet” Lipo

Tumescent liposuction, known as the “Super-Wet” approach, is a suction-assisted (SAL) technique that uses a solution and power-aided motor to help remove stubborn fat. The surgeon injects the solution, made of saline, lidocaine and epinephrine (to control bleeding), into the problem areas. The surgeon then inserts the cannula attached to the motor to remove fat cells from the body at a controlled speed. The motor helps surgeons remove anywhere from several ounces to a few pounds of fat.

During/after surgery

Liposuction is an outpatient procedure performed either under general anesthesia at a surgery center, or for small areas in the office under local anesthetic. The procedure lasts about 30 minutes for each body part. It can be a stand-alone surgery, or combined with other procedures. However, the surgeon may suggest performing the surgery over a period of time for the safety of the patient. After surgery, patients are required to wear a compression garment to help the body adjust to its new shape. Bruising and swelling will subside within 1 week, but patients will not see final results for several months. Liposuction does leave a small scar, but it fades over time.

Expected cost

The average cost for liposuction depends on the technique and scope of the surgery. Schedule an appointment for a customized consultation with Dr. Critelli to determine the cost of your procedure.

FAQs

Is it safe?

While today’s surgical techniques are safe, patients can experience poor results from inexperienced surgeons. It is important for patients to do their research, and find an experienced surgeon that can help them achieve the best, most natural-looking results.

Permanent results?

The results of liposuction can be seen for many years following surgery if the patient follows a healthy diet and exercise program. Removed fat cells do not come back, but patients can still gain weight if their remaining fat cells grow.

Too much fat?

Yes, there can be too much fat. The American Society of Plastic Surgeons does not recommend removing more than 10 pounds of fat for the safety of the patient. Removing more than 10 pounds is considered high-volume liposuction, which increases the chances of complications from the surgery. Patients are advised to be near or at their ideal weight before undergoing liposuction.

Skin tightening?

While liposuction removes fat and improves contour and shape, it does not address sagging or drooping skin. If skin laxity is a concern, patients can talk to the surgeon during the consultation to discuss their options for improving skin texture, such as a tummy tuck, thigh, neck, arm or butt lift.

A body lift is a surgical procedure in which excess skin is trimmed away and ‘lifted’ to reshape the basic contours of the body. It is often recommended for patients who have lost a significant amount of weight, but still battle loose skin. Dr. Critelli believes that for many weight-loss patients, this gets in the way from completing their weight-loss transformation.

The procedure may be performed in conjunction with liposuction to remove excess fat. A lower body lift targets the mid-body section that includes the abdomen, lower back, buttocks, hips and thighs. It is a 360-degree treatment to improve the appearance of those who are already close to their weight goal or women who do not have plans of bearing any more children.

Surgical technique

A lower body lift is sometimes called a belt lipectomy as the incision is made around the belt area surrounding the lower torso. The incision is extended to the buttocks and thighs. Loose, saggy skin will be trimmed away and the remaining skin will be lifted and secured by sutures. Liposuction may be used if there’s excess fat. There are also cases when the fat harvested from liposuction is reinstated into the buttocks for an instant butt lift. These procedures may be combined in one session, or they may be staged depending on the patient’s circumstance.

During/after surgery

The lower body lift procedure is performed with general anesthesia and requires an overnight stay in a hospital or accredited surgical facility. Due to its nature, a spinal anesthesia may also be administered. The surgery lasts from five to eight hours depending on the number of procedures performed. Patients who have a lower body lift will experience a slow recovery process. Aside from extensive incisions, the body and skin need adequate time to adjust to their new positions created by the surgery. Most patients will need two to three weeks before returning to a light routine. It can take up to a full year for the final results of this surgery to appear.

Expected cost

The cost depends on the patient’s aesthetic goals as the number of procedures performed in one session. There are also cases when costs are driven up when the surgical sessions are staged into separate procedures. Schedule an appointment for a customized consultation with Dr. Critelli to determine the cost of your procedure.

FAQs

How bad is the scarring?

A lower body lift creates great results for patients, leaving the body tighter and smoother. Unfortunately, scarring is unavoidable with this surgery. For most patients, the scar will run around the torso and extend to the hips, buttocks and thighs. A skilled and trained plastic surgeon will make every effort to create clean, thin incision lines. These lines will produce scarring that will be patterned similar to a g-string. Once they heal, they will be concealed by undergarments.

Is this procedure painful?

This surgery is performed with general anesthesia. It is common during the post-operation period that the patient will feel pain and discomfort. The healing of wounds is also slow. The patient must limit movement during the first week to avoid the risk of stretching the incision line. This is the most common complication after surgery. Pain medications will be given to help the patient cope. A compression garment is also worn to help the patient in reducing discomfort.

Does insurance cover this?

If it is proven that this surgery is medically necessary to attain a better quality of life, some insurance providers may cover a portion of the cost. There is no guarantee that coverage will be applicable. Our billing and insurance coordinators will work with the insurance company to determine coverage benefits.

When to undergo surgery?

It is recommended that anyone who is considering a lower body lift should be at or near his or her goal weight. If the loose skin is caused by pregnancy, it is best to postpone this type of surgery until all additional pregnancies have been completed. Any additional episode of significant weight gain may compromise the results of the surgery.

Losing weight is a huge accomplishment that takes hard work and dedication. Some men throughout the East Texas area who lose 100 pounds or more, may love their sleeker look, but secretly may be struggling with loose skin. This is often a side effect of losing a significant amount of weight. Unfortunately, surgery is often the only remedy that can correct this.

Dr. Paul Critelli, board-certified plastic and reconstructive surgeon, offers a custom blend of skin removal surgeries specifically for men as they work towards completing their weight loss transformation. Sometimes, removing the loose skin is enough to allow them to complete this life-changing journey. Dr. Critelli consults with weight loss patients to determine what surgical techniques make the most sense. Loose skin can remain in the arms, abdomen and in the lower body. He will develop a surgical plan to meet the patient’s aesthetic goals. He will also determine if these procedures can be performed at once, of if they should be staged over time.

These procedures include:

• Arm lift: Loose skin is a common reminder that a significant weight loss has occurred. While some loose skin can be hidden, the arms, unfortunately, cannot. An arm lift removes loose skin that hangs from the underside of the upper arm to create a tighter, more toned arm appearance. The results following this surgery can oftentimes be very dramatic.
• Body contouring: Body contouring is the procedure name given to any surgery that removes skin and fat to create a more contoured look. This can take place for most body parts include the arms, breasts, abdomen, buttock, thighs and neck.
• Gynecomastia: Gynecomastia is a condition where excess tissue develops in the chest of a man giving the appearance of female breasts. Gynecomastia surgery can correct this condition and create a flatter, more toned chest. It uses a combination of liposuction and skin tightening to achieve a more masculine appearance.
• Lower body lift: A lower body lift addresses the lower body and removes loose and hanging skin following a weight loss. Skin can hang drastically after a massive weight loss. This surgery often uses a 360 incisional approach to remove skin from the stomach, hips, flanks, lower back, buttock and thighs. It is a procedure that provides major improvement, allowing men to wear more fitted clothing and resume a normal, active lifestyle.
• Thigh lift: A thigh lift addresses the upper and lower thighs, as well as the outer and inner thigh area. It trims away and removes hanging skin and then lifts the remaining skin for a more contoured leg appearance. This gives way for a man to be able to exercise, run and be more active following a weight loss.
• Tummy tuck: A tummy tuck is a procedure that tightens the abdominal wall. It is very common among weight loss patients who have loose skin that hangs in the lower abdomen. It is usually the first surgery a man will consider once his weight loss has been achieved.

During/after surgery

After weight loss surgery is sometimes not only a desire, but a necessity for men who have undergone a significant weight loss. For many men, it is the only way to achieve a tighter skin appearance and complete their weight loss goals. While scarring is a part of this process, the incisions are carefully placed so that they can often be concealed under clothing. The removal of loose and hanging skin makes such a huge impact for most men, that the scarring becomes secondary. This surgery does have a longer recovery period than most. It will depend on how many procedures were performed in one setting, as well as the extent of skin removal.

Expected cost

After weight loss surgery is a customized suite of surgical procedures that will be detailed in a surgical plan by Dr. Critelli. The cost will vary by surgical case depending on how many procedures were performed. Schedule an appointment for a customized consultation with Dr. Critelli to determine the cost of your procedure.

Sometimes scars heal unfavorably and may be improved upon by removing, reorienting, or camouflaging the scar by a number of different surgical procedures, many of which can be performed in the office.

Expected cost

Schedule an appointment for a customized consultation with Dr. Perro to determine the cost of your procedure.

Removal of skin cancers can leave patients with variably sized defects of the face and neck that may involve cartilage as well as nasal or oral mucosa. Proper and careful reconstruction of these defects allows for the best functional and cosmetic outcomes. Dr. Perro has repaired countless facial defects of variable complexity.

Expected cost

Schedule an appointment for a customized consultation with Dr. Perro to determine the cost of your procedure.

Individuals who lose a significant amount of weight will sometimes consider skin removal surgery to address problem areas that exist as the result of the weight-loss. The thighs, specifically, are an area that can be troublesome if excessive loose skin hangs on the outer and inner thighs. Tyler, TX plastic surgeon Dr. Paul Critelli, helps men and women complete their weight-loss transformation with this advanced body contouring surgery. Due to the popularity and success of bariatric surgeries, the number of thigh lift procedures performed has nearly quadrupled in just the last several years. Thighplasty trims the excess skin around the thighs and tightens the remaining underlying tissue to create a toned, softer appearance.

About the surgery

Thighplasty is performed to enhance the looks of the inner thigh and/or outer thigh. During this procedure, an incision will be made near the top of the thigh (along the crease where the torso meets the leg) and ends at the inner aspect of the thigh. A large amount of tissue is removed from the top inner thigh area while the remaining skin is pulled up, tightened, and secured with sutures. This process reshapes the thighs, providing them a tighter, more contoured appearance.

Combination procedures

A combination of lower body contouring procedures, in addition to a thigh lift, can be combined to create a tighter lower body. A thigh lift and a butt lift are the most common combination. Some patients who are advised to have an outer thigh lift will generally need to have their butt lifted as well. With this, the outer thighs are pulled up and tightened with an incision that is made along the bottom of the buttocks area. An incision can also be made around the lower back. This allows the surgeon to address the upper thighs, buttock and hips in one surgery. This is commonly known as a lower body lift.

During/after surgery

Thigh lift surgery is performed under general anesthesia at UT Health Tyler. The surgery takes an average of 2 to 3 hours to complete, but could take longer if combined with another procedure. The recovery period typically takes about 6-8 weeks. Scars will also be a part of the procedure. Proper scar care is needed for the scar to heal safely. Patients find their self-confidence improves after surgery with the enhanced contour of their thighs.

Expected cost

Schedule an appointment for a customized consultation with Dr. Critelli to determine the cost of your procedure.

FAQs

Cellulite gone?

Thigh lift is the best choice to achieve nicely contoured and slimmer legs. Because the procedure calls for skin tightening and liposuction in cases of excessive fat deposits, it also improves the appearance of cellulite or other skin irregularities on the upper legs.

After surgery workout?

Because this surgery is invasive, it is recommended that patients limit strenuous activities until fully recovered. Patients may go back to a normal (light) routine 3 to 4 weeks after surgery. Exercise should wait until about 6-8 weeks post-op. When all wounds are completely healed, patients may begin lower body moves such as lunges or squats.

Long-term results?

Patients who adhere to a healthy lifestyle that includes a proper diet and exercise routine will enjoy their surgical results for years. Pregnancy or any additional weight gain after this surgery could compromise the overall surgical effect. It is also advised that patients be at or near their goal weight before surgery.

Abdominoplasty, commonly known as a tummy tuck, is an ideal surgical treatment to remove the stubborn tummy “pouch” that’s otherwise resistant to diet or exercise. It is a popular procedure for women after pregnancy, and is usually recommended when there are no plans of having additional children. Dr. Paul Critelli is a cosmetic surgeon certified by the American Board of Plastic Surgery and also offers this procedure for both men and women who have stretched skin in the belly area after going through a major weight loss. Patients considering a tummy tuck should be close to their ideal weight. The majority of patients who undergo this treatment report a significant boost in their self-confidence because of the improvement made to their physical appearance.

Full tummy tuck

In patients who undergo a full tummy tuck, the incision is made from hip to hip just over the pubic area. This results in a scar line that is horizontal and can be hidden when wearing undergarments. It is commonly performed on women with significant skin folds after multiple pregnancies. This technique allows the surgeon access to a large portion of the abdomen while repositioning the belly button so that its placement appears natural. Liposuction is performed to remove excess fat preceding the skin tightening portion. The internal abdominal muscles are secured for a firm, toned appearance.

Mini tummy tuck

An alternative to the traditional technique is the mini tummy tuck, which is also known as a “Brazilian tummy tuck.” The difference is that ideally the patients that undergo this procedure are already in relatively good shape with a healthy skin tone, but still have loose skin on the lower abdomen. Unlike the full tummy tuck, the belly button is unaffected and the incision is smaller. Liposuction is used (if needed) to remove excess fat, and the loose skin is removed and pulled tight.

Extended tummy tuck

In cases when major skin tightening and body contouring is needed, an extended tummy tuck is recommended. This is a necessary technique for patients who have undergone a significant weight loss. It was developed after some patients noted that even after a full tummy tuck, the parts surrounding the abdomen still showed excessive folds of skin. The incision may extend around the navel, flank and lower back depending where skin tightening is necessary. Liposuction is still used and excess skin is trimmed then tightened. Similar to a full tummy tuck, the belly button is repositioned.

During/after surgery

A tummy tuck is done under general anesthesia. It is an outpatient procedure, but an overnight stay can be required specific to complex cases. As with any other surgery, abdominoplasty comes with risks so it’s best to discuss any health conditions you have prior to surgery. After surgery, pain medications are provided and a compression garment is worn. The patient will need to rest up to 48 hours. From then, it is recommended that patients make a concerted effort to move around to help blood circulation and reduce the risks of blood clot complications. Recovery may take up to 6 weeks.

Expected cost

The cost for a tummy tuck depends on a variety of factors, primarily on the technique recommended that will provide the best result of the patient’s condition. Schedule an appointment for a customized consultation with Dr. Critelli to determine the cost of your procedure.

FAQs

Lipo or abdominoplasty?

Tummy tucks are reserved for patients who have stretched, loose skin in the lower abdomen as a result of pregnancy or obesity. Liposuction, on the other hand, is for those who want to remove excess fat in the abdomen but still have a healthy skin tone. During the initial consultation, we will provide a thorough assessment and determine if liposuction alone is all that is needed, or if a tummy tuck will provide the best results.

Combination procedures?

Normally, abdominoplasty is performed to improve loose skin and excess fat around the abdomen area. However, sometimes other cosmetic procedures, such as breast augmentation or a breast lift are done to further improve the overall look and feel of the body. When this combination type surgery exists, it is known as a “mommy makeover”. It is very popular among women after pregnancy who wish to get their pre-pregnancy body and shape back to normal.

How bad are the scars?

Unfortunately, with a tummy tuck surgery, scars are unavoidable. However, extra measures are taken to make sure that scarring is minimal. With proper technique and minimal tension of the skin layer scars can heal favorably. The incision line is placed in areas that can be concealed by undergarments. Previous C-section scars will be incised in the same spot for the tummy tuck. During the healing process, we will provide a post-operative protocol that includes scar treatment to help assist the scars in becoming less visible.

Pregnancy after tummy tuck?

It is our recommendation that women who decide to have more children delay a tummy tuck procedure. The stretching of the skin as a result of another pregnancy can compromise the results of this procedure.