PROCEDURES

ABDOMINOPLASTY (TUMMY TUCK)
Occasionally the belly and inner thigh skin are looser than we would like it to be. In these cases a tummy tuck or thigh lift is appropriate. Loose skin and fat are trimmed. The remaining skin is advanced into the bikini line or thigh crease. Depending on the looseness of the abdominal skin different amounts of tightening can be accomplished Stretch marks and scars extending above the belly button are improved by removing the excess stretched skin below the belly button. The abdominal muscles can be tightened if loosened by pregnancy. Typically post operative pain is mild: healing takes 1 to 2 weeks. Significant improvements can be seen by this time; scars hidden in the bikini line fade over 4 to 12 months. I have been incorporating a newer technique, the high lateral tension abdominoplasty. The outer waist skin is pulled to the middle and the outer thigh is lifted. A narrowing of the waist and tightening of the thigh is achieved.

BLEPHAROPLASTY (EYELID SURGERY)
Blepharoplasty is surgical modification of the eyelid. Excess tissue such as skin and fat are removed or repositioned, and surrounding muscles and tendons may be reinforced. It can be both a functional and cosmetic surgery.
The eyelids, eyebrows and laugh lines are the areas which first show signs of aging. Rejuvenation of these areas is increasingly sought after by the younger patient. Resurfacing with creams, peels, micro-dermabrasion and laser can push back the years as well as maintaining a smooth, youthful glow. Lower eyelid bags worsened by allergies and sinusitis can be “melted” away utilizing small incisions inside the eyelids. Fat taken from the stomach or waist injected into the grooves between the eyelid bags, nose and cheeks results in long lasting if not permanent improvement and smoothing. Excessive skin can be excised, eyebrows and outer eyelids can be elevated with small inconspicuous incisions. The position and shape of the eyebrows is very important. The feminine eyebrow sits above the orbital rim and arches. The point of highest arch is usually right above the outer rim. A higher arching brow is associated with a more youthful, attractive appearance. Drooping of the brow will cause skin to droop onto the upper lid. These procedures take less than two hours, can be performed even with light sedation and local anesthesia. Minimal pain allows you to return to indoor activities quickly. Bruising and swelling typically lasting 12 days requires use of reflective or tinted lenses to return to the public eye sooner. Chemical Peels and Topical Creams: Fine lines and wrinkling of the eyelid skin respond to retinoic acid creams. These can be applied three times weekly. Vitamins C and E have been shown to have significant antioxidant activity when applied with the proper carrier. Within a few months you will see gradual diminution of these lines and a healthier glow to your skin. Dark circles of the lower eyelids may respond to the addition of Hydroquinone based bleaching creams. More intense lightening is accomplished by application of TCA, phenol peels and laser/intense pulsed light treatments. Patients experience long lasting results with mild discomfort from these brief office procedures. Please see our products/ fillers page for our latest recommendations and ordering information. Let us help you with your rejuvenation/lightening program.

BODY CONTOURING
Surgical body contouring following major weight loss removes excess sagging fat and skin while improving the shape of the underlying support tissue. The result is a more normal appearance with smoother contours.

Dramatic weight loss has many benefits. But after weight reduction surgery, or any substantial amount of weight loss, the skin and tissues often lack the elasticity to conform to the reduced body size.

Body contouring procedures may include:
• Facelift: sagging of the mid-face, jowls, and neck
• Breast lift: sagging, flattened breasts
• Tummy tuck: apron of excess skin hanging over the abdomen
• Lower body lifts: sagging of the abdomen, buttocks, groin and outer thighs
• Medial thigh lift: sagging of the inner, outer and mid thigh
• Arm lift: sagging of the upper arms

BREAST AUGMENTATION (BREAST ENLARGEMENT)
Breast augmentation not only changes appearances, but has also positively affected how our patients feel about themselves.

Enlargement of the breast
During your consultation with Doctor Cenedese, options of size, shape and implant type will be reviewed. Our goal is to choose the best approach and implant for your breasts and body. Implants may be inserted around the areola (nipple), underneath the breast, through the axilla (armpit) or umbilicus. Implant placement behind the muscle is preferred by most patients. A more natural, sloping upper and outer breast shape is achieved.

Obtaining maximum cleavage is an important goal. The amount of cleavage that we can obtain is determined by the original distance between the breasts and pectoral muscle insertions. The larger the implants and the closer together they are placed increase the resulting amount of cleavage.

The procedure lasts under two hours. You can recover and go home within two hours. Most patients experience some pain but can return to their new lifestyle in a few days. The safety of breast augmentation has become posssible after 40 years of refining the technique and extensive product research.

Saline filled implants are placed through smaller incisions surrounding the areola or through the armpit or umbilicus. They are then filled with a special fill tube through a self sealing valve built into the silastic shell of the implant. I prefer smooth implants as opposed to textured implants as they feel softer. There are fewer infectious complications as opposed to textured implants. The saline implant results in a very soft breast. They are ideally suited for the women who begins with adequate breast tissues and desires a one to two cup increase in size. Saline implants can be inserted through the umbilicus resulting in a scar less breast. This procedure although somewhat more technically demanding results in a very natural appearance. Modifications in implant position are the most frequent reason for revision surgery. The axillary incision and approach requires more cutting of the central pectoral muscles to prevent the implant from being pushed back and out towards the axilla. We have seen several patients with implants which have been placed or forced up or out resulting in too wide a space between or high lying breasts. Implants tend to settle from one half to an inch over the first two years.

Patients requesting a more natural appearance will realize this as time passes. The umbilical or axillary approaches may necessitate an additional incision in another area if repositioning becomes necessary. High profile saline implants appear to ripple less. Unless your breast and chest are broad these are my preferred implant style. If there is inadequate tissue to cover the implant or you desire to increase more than two cup sizes I suggest the use of gel filled implants. When saline implants leak there is no pain but the breast will decrease in size over a few weeks. Replacement of a leaking saline implant if addressed within a month is fairly straight forward and nearly painless. The rate of leaking is higher than that of silicone gel filled implants.

Silicone gel implants on the other hand feel slightly firmer but more natural. The majority of my patients have been selecting silicone gel implants. This follows the European and South American trends where saline implants are rarely used.

Since it is difficult to properly place a silicone gel implant larger than 350 cc from the axilla I have been using a new technique which makes the peri-areolar incision even less prominent than in the past. The statistics collected by the manufacturers indicate these to leak less often than saline filled implants. Please refer to http://www.breastimplantsafety.org

Silicone gell implants have become accepted as patients are becomming more aware of their safety, natural feel and appearance. Gel implants have recently been approved by the FDA as safe for the average patient. Silicone gel implants have been used for 30 years. Advances in design and manufacturing have made the latest implants more resistant to leaking yet maintaining a natural feel. A leaking gel implant can be replaced without complicated surgery if addressed within a few months of leakage. Failure of a silicone implant is usually detected by a change in shape or firmness of the affected breast. Mammography, sonogram and MRI are helpful in confirming a suspected leak. Please refer to http://www.siliconegelimplant.com for more information.

BUTTOCK AUGMENTATION (“BRAZILIAN BUTT LIFT”)
Buttocks augmentation denotes the plastic surgery for correcting the defects and deformities of the buttocks; and for augmenting the size and contour of the buttocks. The procedures include the surgical emplacement of molded synthetic implants; fat transfer; and synthetic fillers such as elastomer. Buttocks lift surgery and buttocks implants are the two corrective procedures for resolving physical problems, and for aesthetically enhancing the buttocks. The buttocks implant surgery utilizes implants to increase the size and projection of the buttocks and so enhance its the woman’s appearance; post-operatively, the convalescence can be painful. Buttocks augmentation surgery (also butt lift, Brazilian butt lift) is achieved with liposuction and fat transfer to the areas of the buttocks that require contouring to achieve the desired correction. Because the adipose fat tissue injected to the patient is her own (autologous) the risk of infection is low. The “Brazilian Butt Lift” refers to elevating the sagging bottom of the buttocks with liposuction. A roll of fat can be removed from this area and the lower back thereby making the buttock rounder and higher. Fat harvested from your waist, thighs or belly is injected to the upper and outer buttocks to round and fill them out. The back of the thigh is also made to appear longer. Incisions are 3mm in length, hidden in the buttock/thigh crease. This procedure is usually combined with an outer thigh lipo sculpture thereby improving the appearance of buttock, thigh and leg. Sedation or general anesthesia can be used. Associated soreness and swelling of the buttocks resolves quickly. You can return to your usual activities in a few days. Sagging or loose skin in this area can also be addressed with a direct excision of the lower buttock skin and fat. The thigh skin is slid upwards, incisions are closed in the buttock/thigh crease. Buttock enhancement can be achieved with fat grafting. Sunken areas or dimples can be filled in and rounded out. This procedure can be performed with local anesthesia and sedation, permitting you to return to your gig in a few days. Significant augmentation of the buttock requires insertion of silicone gel implants through incision in the crease between the buttocks. The resultant scar is surprisingly inconspicuous. Inserting the implants into the muscles requires a full anesthesia with resulting moderate pain. Sitting is uncomfortable for 5-7 days post operative.

CHEMICAL PEEL
A chemical peel is a technique used to improve the appearance of the skin on the face, neck or hands. A chemical solution is applied to the skin that causes it to exfoliate and eventually peel off. The new, regenerated skin is usually smoother and less wrinkled than the old skin.

FACELIFT
A facelift, technically known as a rhytidectomy (literally, surgical removal of wrinkles), is a type of cosmetic surgery procedure used to give a more youthful appearance. It usually involves the removal of excess facial skin, with or without the tightening of underlying tissues, and the redraping of the skin on the patient’s face and neck. The technique has evolved from short incisions in front and behind the ears to longer incisions into the temple and neck hairline including elevating the muscle deep to the skin and the tissues overlying the facial bones. With the advancement of endoscopic techniques twenty years ago we are capable of performing face and brow lifts through shorter inconspicuous incisions in the hairline or inside the eyelids. The muscles and deeper tissues are thus elevated, stretched and sutured into position with special sutures. Not only does this decrease the visibility and shorten the scar, it also diminishes decreased sensitivity and swelling.

FILLERS & BOTOX® (NON INVASIVE FACIAL REJUVENATION)
Restylane, Juvederm, Radiesse and Botox are very popular and becoming more so. Dysport a new muscle relaxing agent, released a few months ago is proving to be reliable, safe and as effective as Botox. For treating forehead, central brow grimacing and crow’s feet around the eyes these Botulinum Toxin agents have become the mainstay of treatment. Botox has become the most popular muscle relaxer, on average lasting 3-4 months. It was originally approved by the F.D.A. to treat eyelid muscle spasm, and now approval has been extended to the area between the eyebrows. Forehead and eyelid wrinkles are improved by Botox injections in these areas. We have expanded applications to raise the outer eyebrows and the corners of the mouth. Chin furrows, “smoker’s” upper lip lines and jowls can be improved with Botox or Dysport injections. Patients are not usually satisfied with the duration of improvement and changes in the smile when used to diminish lip lines/wrinkles. Side effects ,usually lasting one to two days, occur in 1% to 2% or treatments typically subside without any treatment. Occasional bruising most often seen around the eyelids is easily covered with camouflage leg and body cover.
Please schedule a consultation to discuss any of these issues further.

Facial Fillers: With increased technology, chemists have developed longer lasting hyaluronic acid injectables. Restylane, Perlane and Juvederm are appropriate for medium depth lines around the mouth, eyelids, cheeks and to fill the lips. Smokers fine lip lines can be smoothed out as well as the corners of the mouth. This will turn up the corners to diminish a sad, drooping appearance. Radiesse, similar to Hydroxyapetite, the major constituent of bony tissues, can correct the smile lines from the mouth to the nose, the chin and between the brows, for over one year when combined with Botox in these areas. These products are relatively allergy free. Immediate results are noted with mild swelling which subsides overnight. Occasional bruising can be camouflaged with leg and body cover cream. You will look better that same evening. We have expanded the use of Radiesse and Sculptra to build up the hollows below the eyelids, cheek bones, jawline, temples and outer brows. Careful injection into the eyelids will lift the brows, fill out the lids and prevent the need for skin excision in mild cases of lid skin excess. This enlargement will last up to two years. Always keep in mind that an additional filling session at one to four months may be necessary to maintain long term results. These fillers stimulate your own collagen production improve the quality and appearance of the skin. This effect begins a month after injection and lasts up to two years. Please check with our staff one week in advance to ensure we have your choice available.

Permanent Fillers: This appealing group of procedures can give a permanent correction to the deeper folds surrounding the nose, mouth, lips, and between the brows. Cheek bones, the chin as well as the outer upper brow/eyelid can be augmented. Several different implant options are available including grafting of skin from an existing scar, facelift, eyelid or tummy tuck, otherwise discarded skin. Autologous tissue grafting(fat) continues to render the most long lasting natural appearing results. Silicone, Polymethylmethacrylate, Latex, Gortex and Alloderm have been used successfully to yield permanent correction of these areas, albeit with higher complication rates and occasional palpability. We are very excited about the re-introduction of Artefill. This permanent filler is an excellent choice for those seeking longterm correction of laugh lines, hollows below the eyelids and creases around the corners of the mouth. We can inject this gel to enhance the lips as well as augment the cheek bones, eyebrows and the jawline. Careful consideration of long term changes in facial anatomy must be made in planning the location and amount of correction. Facial tissues may droop leaving these permanent bulges in inappropriate locations. Conservative correction with follow up sessions obviate this potential undesirable result.

Through my studies, I have come to believe that facial skin care should include a Retinoic acid night cream to build collagen and reduce wrinkles, a Vitamin C cream for its antioxidant benefits and a good moisturizer/sunscreen. There is no cream no matter what the price which I have found to be more effective than these. Many of my patients suffer from hyper-pigmented (dark areas) skin conditions which will improve with a skin bleacher. Resistant dark pigmented areas (eg. below the lids) and scars can be lightened with Chemical Peels, Laser or Intense Pulsed Light treatments. For these reasons we offer to our patients the following: Retinoic Acid Rejuvenating Vitamin A Cream .025% and .05%. This exfoliating collagen inducer when applied nightly reduces fine lines by building new collagen and evens out discolorations. LUX- C Vitamin C and E Antioxidant Facial Serum. With two of the most effective antioxidants daily use prevents age and environmental damage to the skin.

GYNECOMASTIA (MALE BREAST REDUCTION)
Gynecomastia or Gynaecomastia is the abnormal development of large mammary glands in males resulting in breast enlargement. The condition can occur physiologically in neonates (due to female hormones from the mother), in adolescence, and in the elderly (Both in adolescence and elderly it is an abnormal condition associated with disease or metabolic disorders). In adolescent boys the condition is often a source of distress, but for the large majority of boys whose pubescent gynecomastia is not due to obesity, the breast development shrinks or disappears within a couple of years. The causes of common gynecomastia remain uncertain, although it has generally been attributed to an imbalance of sex hormones or the tissue responsiveness to them; a root cause is rarely determined for individual cases. The condition may also be caused by an imbalance of estrogenic and androgenic effects on the breast, resulting in an increased or unopposed estrogen action on breast tissue. Approximately 4 to 10% cases of gynecomastia are due to drugs. Spironolactone (Aldactone) is a common cause, inducing gynecomastia in 10% of those receiving it as a treatment for heart failure. Both Digoxin and Furosemide are also reported to cause the same condition. Although, chances of gynecomastia could be more if these two drugs are coadministered. Breast prominence can result from hypertrophy of breast tissue, chest adipose tissue (fat) and skin, and is typically a combination. Breast prominence due solely to excessive adipose is often termed pseudogynecomastia or sometimes lipomastia. Gynecomastia should be distinguished from muscle hypertrophy of the pectoralis muscles caused by exercise (e.g., swimming, bench press, etc.). These are often seen together. Gynecomastia is commonly treated with liposuction with 3-4 mm incisions lateral to the chest. This procedure performed with moderate sedation is completed in less than two hours. Swelling begins to subside in three days; visual decrease in chest size is noticeable in one week. Results improve over the next several months. Patients return to work in two days with moderate soreness. Work outs can be resumed within a few days. A compression band should be worn for one month. Occasional patients may require an incision surrounding the areola to remove firm breast tissue below the areola. This can be performed either concomitantly or after the liposuction.

LIP AUGMENTATION (LIP ENLARGMENT)
Lip augmentation has become very popular. Fulness of the lips is not only sensual but gives a more youthful appearance. Lips can be made fuller with injections or implants. We have several options to enhance the upper, lower or both lips exist. Injectable fillers including Juvederm and Restylane, last from several months to a year. Moderate swelling is detected for several days after injection. Fat taken from the waist or thighs during a small liposuction can give subtle but permanent enhancement. Marked swelling associated with this procedure can be diminished by injection of small amounts of fat. Alloderm (human collagen) or temporal fascia can be inserted into the lips through small incisions inside the mouth to achieve permanent enhancement. Contact us to arrange for a consultation to help to decide which option is best for you. Our approach to lip aesthetics has become more sophisticated. Filling and shaping the lips in the appropriate areas will give a more attractive and pouty appearance than just enlargement alone. We can fill one or both lips, central and outer areas, depending on the shape of your lips and the look that you like. Restylane and Juvederm are the most common lip injection fillers used today. The results last approximately 6 months. Fat suctioned from your waist or hips, injected into your lips, may last longer, and in many cases, fat injections result in permanent augmentation. Artefil and Radiesse may last longer but are not recommended for the lips. . Caution must be exercised as long these fillers can clump and produce lumps in the lips. The placement of Alloderm or synthetic implants is also an option for more permanent lip enhancement. Research combining fat with Restylane or Juvederm has shown to increase the longevity of these fillers. of Studying your lips and the photos of others helps us to shape your lips in the most desirable way. The various options and expected results will be reviewed during your consultation.

LIPOSUCTION (FAT REMOVAL)
Liposuction, also known as lipoplasty (“fat modeling”), liposculpture suction lipectomy or simply lipo (“suction-assisted fat removal”) is a cosmetic surgery operation that removes fat from many different sites on the human body. Areas affected can range from the abdomen, thighs and buttocks, to the neck, backs of the arms and elsewhere. Liposuction/liposculpture can make amazing changes to your body and self image. Liposculpture implies sculpting body areas by aspirating fat through small inconspicuous incisions. Body sculpting refers to a group of procedures designed to tighten skin as well as to remove fat. These include breast lift, tummy tucks, inner thigh and buttock lifts. Liposculpture is performed using local anesthesia and (tumescent) saline solution is infused through tiny incisions to liquefy the fat and decrease bleeding. A 3 mm cannula is used to smoothly remove the fat and sculpt the desired areas. Minimal pain and bruising allow you to return to exercise and work in 2-3 days. You begin to notice changes in one week. A compression garment is worn for one month. Two months after the procedure you will have achieved most of the improvement. Areas treated will not be problems again. Improving your eating and exercise habits will improve your contour. Often a lipo procedure will motivate you to take better care of yourself. You deserve to look and feel great! Liposculpture of the “double chin” area in the upper neck and lower facial jowls is highly successful in defining the jaw line and neckline. This relatively painless office procedure is accomplished with local anesthesia and mild sedation. Fat is suctioned away through 3mm incisions below the chin. Results are noticeable in one week. Significant improvements are seen by four weeks. 
This procedure will often give more results than a face/neck lift especially in the younger patient with excess fat or the wide face/neck. The fat harvested may be used to fill the hollows below the eyelids, cheeks and jaw line jowls. Contact our office to schedule an appointment for our Summer Special, liposuction for $2000/area. We have begun to use the Smart Lipo Sidelaze Laser to tighten neck and arm skin. Swelling and bruising have been minimized to 5-7 days with significantly improved results seen at one week.

Cellulaze is a new Laser designed to improve mild to moderate cellulite by flattening bulges, releasing depressions and thickening the skin of the thighs. Performed with a 1.5 mm Laser fiber under local anesthesia significant results are noticeable at 3 months lasting for over 3 years. No other treatment has been able to duplicate these results. More severe cellulite can be improved with lipo injection and liposculpture.

NECK AND LOWER FACE LIFT
Our options for treating the sagging neck and jowls have expanded with the use of liposuction and minimally invasive Laser technology. The jowls and double chin can be addressed with liposuction and internal Lasers for skin tightening. Utilizing small incisions below the chin the fat can be removed and the skin tightened. Liposuction in addition to removing the bulging fat produces skin tightening. Additional tightening may be accomplished by the concomitant use of the Precision Tx internal Laser. Long term correction is the case with low complication rates.

Procedures are accomplished using local anesthesia with mild sedation in less than two hours. Patients may return to most activities the same day with only mild discomfort. A compression bandage is worn for one week. Nerve injury causing weakness of the lower lip may occur with a return to full function in six to eight weeks. Similar results to face/neck lift surgery are achieved with the surgical procedure reserved for older men with significantly lax skin.

PENILE ENHANCEMENT
Penis enlargement procedures (sometimes euphemistically referred to as male enhancement procedures in spam email and television advertisements) are techniques used to make the human penis increase in girth, length, or hardness. Procedures range from manual exercises to stretching devices and surgical procedures, with reports of successes and failures around the world. While some of these are known to be outright hoaxes, other techniques have some measure of success. The media is filled with advertisements offering male enhancement pills. This resembles the craze ten years ago over penile enlargement surgery. These so called new discoveries are disappointing due to the fact that most men want their organ to be twice the size. It is difficult to imagine how a pill could enlarge the penis other than improving with erection. Penile enhancement surgery involves two procedures. Penile lengthening can be achieved by a small incision placed above the base of the penis. Ligaments anchoring the penile shaft to the pubic bone above are divided. The internal aspect of the penis is thus externalized. The skin is advanced as well producing an increase in length between 1 and 2 inches. Surgery lasting less than two hours is performed under sedation with local or full anesthesia. This procedure must be accompanied by the use of an external traction device to prevent scar tissue from retracting the externalized shaft. Men may return to work in as little as 2 days. I suggest that patients begin using a device to make sure they can comfortably wear it for up to 4 hours per day. Use of a device alone may result in gains up to 1/2 inch.

RHINOPLASTY (SURGERY OF THE NOSE)
The nose being the most dominant feature of our faces can be significantly improved with conservative changes. Our goal is to make the changes that will improve your appearance without making them obvious. Modest changes in the nasal bridge and tip change a person’s appearance dramatically. Dr. Cenedese will change your appearance without anyone else knowing. Bumps and irregularities of the nasal bridge are typically “filed” down. Breaking of bones in rarely necessary. Small incisions placed within the nose allow resection and repositioning of the wide and projecting nasal tip.

Difficulty breathing through the nose is caused by several conditions. Allergies and hay fever cause swelling of the nasal lining, therefore partially closing the airway. Oral antihistamines and nasal sprays usually temporarily correct most conditions. If these treatments are not effective, opening of the airway may be necessary by shifting the nasal septum or shrinking enlarged turbinates (nasal glands). Sinus conditions producing pressure in the face and headaches may be improved by shrinking and resection of these turbinates. Chronic stuffy nose as a result of allergies should be addressed prior to surgery by Accupuncture/Herbalist or allergy desensitization. Since some are particular about the appearance of the nose, minor revisions are sometimes required.

Nasal surgery is relatively painless. Swelling prevents noticeable results prior to one week. Some patients return to work in 5 days or less. Occasional bruising lasts 10 to 12 days. It usually takes six weeks to see the majority of changes. Tapes and a small splint are worn for one week.

VAGINOPLASTY (VAGINAL REDUCTION AND TIGHTENING SURGERY)
Vaginoplasty is a reconstructive plastic surgery procedure for correcting the defects and deformities of the vaginal canal and its mucous membrane, and of vulvo-vaginal structures that might be absent or damaged because of congenital disease (e.g. vaginal atresia) or because of an acquired cause (e.g. physical trauma, cancer). As such, the term vaginoplasty generally describes any such reconstructive and corrective vaginal surgery; and the term neovaginoplasty specifically describes the procedures of either partial or total construction or reconstruction of the vulvo-vaginal complex. Many ladies are dissatisfied with the appearance of their overly visible vaginal lips. The inner lips or labia minora are often stretched and hang excessively. These can be reduced with a careful trimming of this thin skin. Care must be taken not to expose or scar the clitoris at the top of the labia. Women who have given birth can notice that their vaginal canal has stretched out. Complaints from sexual partners are possible. This condition can be repaired by tightening the vaginal muscles and lining. We are introducing a new Radio frequency devise which tightens the vaginal skin without burning, surgery or downtime. Three to five monthly 20 minute sessions will tighten the vaginal skin a significant amount. Surgical correction lasts less than two hours, is associated with moderate discomfort for several days but heals very well. Careful examination by our gynecologic colleague prior to and their contributions during surgery allows our team to provide you with the best of our experience and expertise.