Dr. Walter G. Efird III : Procedures in detail

BREAST AUGMENTATION

Breast Augmentation (Mammoplasty) is a surgical procedure to enhance the size and shape of a woman's breast. An implant is a shell, filled with either silicone or saline (salt-water solution), and is inserted behind each breast.

REASONS FOR BREAST AUGMENTATION

• to increase breast size
• to correct a reduction in breast volume after pregnancy
• to balance a difference in breast size
• as a reconstructive technique following breast surgery

ANESTHESIA

Breast augmentation is usually an outpatient procedure (you will go home the same day as your surgery). Breast augmentation can be performed with a general anesthesia so you'll sleep through the entire operation, or with a local anesthesia so you'll be relaxed - but awake.

THE SURGERY

The incision can be made either in the crease where the breast meets the chest, around the areola (the dark skin surrounding the nipple), or in the armpit. Incisions will be placed so resulting scars will be as inconspicuous as possible. Working through the incision, your breast tissue and skin will be lifted to create a pocket, either directly behind the breast tissue or underneath your chest wall muscle (the pectoral muscle).

The implants are then centered beneath your nipples. Surgery time is usually 1-2 hours. The incisions are stitched closed and may also be taped. A gauze bandage may be applied over your breasts to help with healing.

RECOVERY

Following surgery, you will feel tired and sore for a few days, but most of your discomfort can be controlled with medication. Within several days the gauze dressing (if you have them), may be removed, and you may be given a surgical bra. You may feel a burning sensation in your nipples for about two weeks, but this will subside as bruising fades.

Stitches are removed in 7-10 days, but the swelling in your breasts may take 3-5 weeks to disappear. You should be able to return to work within a few days. Your breasts will probably be sensitive to direct stimulation for 2-3 weeks, so you should avoid much physical contact.

HEALING

Scars will be firm and pink for at least 6 weeks. They remain the same size for several months, or even appear to widen. After several months, scars will begin to fade, although they will never disappear completely.

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BREAST REDUCTION

Women with very large breasts can experience several medical problems from the excessive weight - back and neck pain, skin irritation, skeletal deformities and breathing problems. Breast reduction removes fat, skin and tissue from the breasts, making them smaller and firmer, leaving the patient with better-shaped breasts in proportion with the rest of her body.

BEST CANDIDATES

Women who don't plan to breastfeed, are troubled with large, sagging breasts that restrict their activities and cause them physical discomfort.

PREPARING FOR SURGERY

You may have to have a mammogram prior to surgery. You will be advised to quit smoking and you may be advised to diet before surgery. Arrange for someone to drive you home after surgery, and to help you out for a few days.

ANESTHESIA

Breast reduction surgery is performed at an outpatient surgical facility - you will go home the same day. General anesthesia will be used so you will not be awake during the surgery. The surgery takes about two to four hours.

THE SURGERY

Several variables affect the breast reduction procedure: your age, the size and shape of your breasts, and the condition of your skin. Dr. Efird will make an anchor-shaped incision that circles the areola (the dark skin around the nipple), extends downward, and follows the natural curve of the crease beneath the breast. He will remove excess glandular tissue, fat and skin, and then move the nipple and areola into their new position. He then brings the skin from both sides of the breast down and around the areola, making the new shape of the breast.

Sometimes, if the breasts are very large, the nipples and areolas may have to be completely removed and grafted into a higher position. Stitches are located around the areola, in a vertical line extending downward, and along the lower crease of the breast.

RECOVERY

After surgery, you'll wear an elastic bandage or a surgical bra over gauze dressings. A small tube may be placed in each breast to drain blood and fluid for 1-2 days. The pain and discomfort you experience can be managed with medication. Bandages are removed 1-2 days after surgery. You will continue to wear the surgical bra for several weeks. Stitches are removed in 1-3 weeks.

HEALING

You may experience random, shooting pains for a few months. The swelling after surgery can cause loss of feeling in your nipples and breast skin, but this usually fades after six weeks. Avoid lifting or pushing heavy items for 3-4 weeks. Most patients return to work and social activities in about two weeks.  Although most swelling and bruising disappears in the first few weeks, it may be 6-12 months before your breasts retain their new shape. Breast reduction scars are permanent. They may remain lumpy and red for months, then gradually fade to thin white lines.

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BREAST LIFT (MASTOPEXY)

Breast lift or Mastopexy is a surgical procedure to reshape sagging breasts as a result of pregnancy, nursing or age.

BEST CANDIDATES

• Women with small, sagging breasts
• Women whose breasts have stretched skin and less volume due to pregnancy and nursing

PREPARING FOR SURGERY

You may have to have a mammogram prior to surgery. You will be advised to quit smoking several weeks prior to surgery. Arrange for someone to drive you after surgery and to help you out for a few days.

ANESTHESIA

Breast lift surgery is performed at an outpatient surgical facility - you will go home the same day. General anesthesia will be used so you will not be awake during the surgery. The surgery takes about 2-4 hours.

THE SURGERY

Several variables affect the breast lift procedure: your age, the size and shape of your breasts, and the condition of your skin. Dr. Efird will make an anchor-shaped incision following the natural contour of the breast. This incision outlines the area from which the breast skin will be removed and defines the new location for the nipple. After the excess skin has been removed, the nipple and areola are moved to the higher position. The skin surrounding the areola is then brought down and together to reshape the breast. Stitches are usually located around the areola, in a vertical line extending downwards from the nipple area, and along the lower crease of the breast.

RECOVERY

After surgery, you'll wear an elastic bandage or a surgical bra over gauze dressings. Your breasts will be bruised, swollen and uncomfortable for a few days, but this can be alleviated with medication. After a few days, the bandages or surgical bra will be replaced with a soft support bra which you will wear for 3-4 weeks. Stitches are removed in 1-2 weeks.

HEALING

The swelling after surgery can cause loss of feeling in your nipples and breast skin, but this usually fades after six weeks. Wait at least a week before returning to work, and avoid lifting anything over your head for 3-4 weeks. If you become pregnant, the operation should not affect your ability to breast-feed.

Breast lift scars are permanent. They may remain lumpy and red for months, then gradually fade to thin white lines.

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FACE LIFT

As people age, the effects of gravity, exposure to the sun and the stresses of daily life can be seen in their faces. Deep creases form by the nose and mouth, the jaw line “sags” and folds and fat deposits form around the neck. A facelift can improve the signs of aging by removing excess fat, tightening muscles and redraping the skin. The result is a younger and fresher look.

BEST CANDIDATES

A man or woman whose face and neck have begun to sag, but whose skin still has some elasticity.

PREPARING FOR SURGERY

If you smoke, stop smoking two weeks prior to and following surgery, since smoking prohibits blood flow which can affect the healing of your incisions, If your hair is very short, you may want to let it grow out long enough to hide the scars until they heal. Make arrangements for someone to drive you home and to help you out for a few days.

ANESTHESIA

Your surgery will be performed at an outpatient surgical facility. Facelifts are performed under local anesthesia, where you will be awake but relaxed and insensitive to pain, or general anesthesia, in which case you will sleep through the procedure.

THE SURGERY

A facelift usually takes several hours. Placement of incisions depends on your facial structure, but they usually begin above the hairline at the temples, extend in a natural line in front of the ear, and continue behind the earlobe to the lower scalp. If the neck needs work, a small incision may be made under the chin. The skin is separated from the fat and muscle. Fat is then trimmed or suctioned from around the neck and chin. The underlying muscle is then tightened, the skin is pulled back and the excess skin is removed. Stitches are used to secure the tissue and to close the incisions. After surgery, a small, thin tube is temporarily placed under the skin behind the ear to drain any blood and the head is wrapped loosely in bandages to minimize bruising and swelling.

RECOVERY

Discomfort after surgery is not significant and can be controlled with medication. You will probably experience some numbness of the skin which should disappear in a few weeks or months. For a couple of days after surgery, keep your head elevated and still to reduce swelling. The drainage tube is removed two days following surgery and bandages are removed in one to five days following surgery. At first, your face will be pale, bruised and puffy, but in a few weeks, your face will be looking normal. Stitches are removed after about five days. Stitches in the scalp may be left in for a few days longer.

HEALING

Take it easy for the first weeks after surgery because your skin will be tender and numb. Avoid strenuous activity for at least two weeks; avoid alcohol, steam baths and saunas for several weeks; limit exposure to the sun for several months. In the beginning, your face may look and feel strange due to the swelling. Bruising may last for two to three weeks, but by the third week, you should look and feel much better. Most patients are back at work within ten days to two weeks. You will have some scars from your facelift, but they are usually hidden by your hair or in the natural creases of your face and ears. They will fade with time and should become scarcely visible.

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FOREHEAD LIFT

A forehead lift or brow lift is a procedure that restores a more youthful, refreshed look to the area above the eyes. The procedure corrects drooping brows and improves the horizontal lines and furrows that can make a person appear angry, sad or tired.

To see what a forehead lift can do for your face, put your hands above your brows and outside the edges of your eyes and gently raise the skin upwards. Forehead lifts are an option if you have a sagging brow or deep furrows between the eyes.

This procedure is usually done between age forty and sixty-five, although it may be necessary at an earlier age. Incisions can be placed at the hairline, behind the hairline, or in some cases, above the brow or in the mid-forehead.

THE SURGERY

The main difference among the various options for forehead lifting consists of the placement of the incision. The original technique is the coronal incision, which is made slightly behind the natural hairline. An alternative is the pre-trichial incision which is similar to the coronal incision except that the mid-portion of the incision is made directly at the hairline. This incision generally heals favorably and has the advantage of lowering the hairline. The disadvantage could be noticeable scarring. An option is to place the incision within the mid-forehead creases. This is primarily used in men with deep pre-existing forehead lines.

The newest approach is endoscopic surgery. Several small one-half inch to one-inch incisions are placed just behind the hairline. Although this technique may require more surgery time it is less invasive and results in a smaller chance of temporary scalp numbness. This procedure takes between one to two hours to perform. It is most commonly performed under IV sedation.

RECOVERY

You will experience a certain amount of swelling and bruising in the 10-day period following surgery. In some patients, this condition may include the cheek and eye area as well as the forehead. You will be advised to keep your head elevated in order to reduce swelling. Cold compresses may further reduce swelling. As the incisions heal you may experience some numbness as well as itching, both of which will diminish with time. The sutures are usually removed within 7–10 days following surgery. If bandages have been used, they are removed in 1–3 days. For most patients, the recovery time will not exceed two weeks, but you may still be advised to avoid strenuous activities for longer periods. Any prolonged bruising can be camouflaged with makeup.

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LIPOSUCTION AND BODY CONTOURING

Liposuction is a surgical procedure that can help sculpt the body by removing unwanted fat from specific areas. Liposuction is not a substitute for dieting and exercise. However, it can remove stubborn areas of fat that don't respond to traditional weight-loss methods.

BEST CANDIDATES

Normal-weight men and women with firm, elastic skin who have pockets of excess fat in certain areas.

PREPARING FOR SURGERY

You will be advised to quit smoking several weeks prior to surgery. Arrange for someone to drive you home after surgery, and to help you at home for a few days.

ANESTHESIA

Liposuction is performed at an outpatient surgical procedure - you will go home the same day. General anesthesia will be used, so you will be asleep during the procedure.

THE SURGERY

The time required to perform liposuction depends on the size of the area and the amount of fat being removed. Through a tiny incision made by Dr. Efird, a narrow tube or canula is inserted and used to vacuum the fat layer that lies beneath the skin. The canula is pushed, then pulled, breaking up the fat cells and suctioning them out. The incisions are very small and placed as inconspicuously as possible.

RECOVERY

After surgery, you may experience some pain, burning, swelling, bleeding and temporary numbness. Pain can be controlled with medication though you may feel stiff and sore for several days. To control swelling you will be fitted with a snug elastic garment which you will wear for about four weeks.

HEALING

Healing is a gradual process. You should start walking as soon as possible to reduce swelling and to help prevent blood clots from forming in your legs. You should be able to return to work within a few days following surgery. Stitches are removed in 7-10 days. Strenuous activity should be avoided for about a month. Although most bruising and swelling disappears within three weeks, some swelling may remain for six months or more. You will be able to admire your new shape after about three months. A healthy diet and regular exercise will help you maintain your new shape.

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ABDOMINOPLASTY (TUMMY TUCK)

Abdominoplasty (tummy tuck) is a major surgical procedure that removes excess abdominal skin and fat, and tightens abdominal muscles, therefore reducing the appearance of a protruding abdomen.

BEST CANDIDATES

• Men and women in good shape but bothered by a large fat deposit or loose abdominal skin that doesn't respond to diet or exercise.
• Women who, as a result of pregnancies, have stretched abdominal muscles and skin beyond the point where they can return to normal.
• Older patients who have lost skin elasticity (sometimes as a result of major weight gain or loss).

PREPARING FOR SURGERY

As with any surgery, if you smoke, plan to quit at least 2 weeks prior to surgery. Avoid overexposure to the sun. Do not go on a stringent diet. Make arrangements for someone to drive you home after surgery, and to help you out for a few days.

ANESTHESIA

Your surgery will be performed at an outpatient surgical facility, during general anesthesia. You will be asleep for 1-3 hours.

THE SURGERY

A long incision will be made, usually from hipbone to hipbone, just above the pubic area. A second incision is made around the navel. Dr. Efird will separate the skin from the abdominal wall all the way up to your ribs, and lift a large flap of skin to reveal the vertical abdominal muscles. He will tighten the muscles by pulling them close together and stitching them, providing a firmer abdominal wall and narrower waistline. The skin flap is stretched down and the extra skin removed. A new hole is cut for the navel, which is then stitched in place. Dressings are applied, and a temporary tube is inserted to drain excess fluid.

RECOVERY

For several days, your abdomen will be swollen and sore, which can be alleviated by medication. You should start walking as soon as possible, though you may not be able to standup straight. Stitches are removed about one week following surgery. Your dressing will be replaced by a girdle, which should be worn for four weeks. Exercise will help you feel better because it reduces swelling, lowers the chance of blood clots and tones muscles. Vigorous exercise, however should be avoided. You may return to work after two weeks.

HEALING

For the first 3 to 6 months, it is normal for your scars to actually appear to worsen. It will take 9 to 12 months for your scars to flatten out and lighten. Scars will never completely disappear, but will be undetectable under most clothing, including bathing suits.

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BLEPHAROPLASTY (EYELID SURGERY)

Eyelid surgery (blepharoplasty) can remove the excess fat and drooping skin of the upper eyelids, minimize bags under the eyes and tighten the lower eyelid skin, resulting in a more alert and rested appearance.

BEST CANDIDATES

• Men and women who believe that their eyes are making them look tired, sad, or older than they really feel.
• Men and women whose upper eyelids have:

• excess skin that hides the natural fold of the upper eyelids.
• loose skin that hangs down from the upper eyelids.
• puffiness in the upper eyelids that creates a tired look.

• Men and women whose lower eyelids have:

• excess skin and fine wrinkles of the lower eyelids
• puffy “bags” and dark circles

ANESTHESIA

Eyelid surgery may be performed in a hospital, an outpatient surgical facility or in Dr. Efird's office. Eyelid surgery is usually performed under local anesthesia.

THE SURGERY

Your surgical procedure will depend on the amount of excess fat and skin in your eyelid areas, the position of your eyebrows and the condition of the muscles around your eyelids. For the upper eyelids, the incision usually begins within the natural crease of the eye's inside corner and extends slightly beyond the outside corner in to the crow's feet or laugh lines. For the lower eyelids, the incision usually is concealed just below the lower lashes. Then excess skin, muscle and fat are removed. Sometimes laser resurfacing or chemical peel is sometimes used in conjunction with eyelid surgery to minimize fine wrinkles near the eyes.

RECOVERY

Following surgery, you may experience some tightness around the eyes along with bruising and swelling. Any discomfort can be controlled with medication. For the first day, it's important to rest with your head elevated. Within the first week, bruising will reach its peak and then fade. You may also experience mildly blurred vision, excess tearing or dryness, light sensitivity or itching. After one week, you can begin to use makeup to conceal bruises, stitches will be dissolved or removed and you may resume most nonstrenuous activities.

HEALING

After several weeks, when most of the swelling has subsided, you will be able to see the final result. You may now resume vigorous exercise, bending and lifting. However, for several months, you need to treat the skin around your eyes with extra care. You should use sunblock on your eyelids and sunglasses to protect your eyes from the sun and wind.

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RHINOPLASTY (NOSE WORK)

Rhinoplasty is a surgical procedure to reshape the nose.

Rhinoplasty can:

• reduce or increase the size of your nose
• change the shape of the tip or the bridge
• narrow the span of the nostrils
• change the angle between your nose and your upper lip
• correct a birth defect or injury
• relieve some breathing problems

BEST CANDIDATES

Healthy people looking for improvement, not perfection, in the way they look. Teenagers should have completed their growth spurt (at least 14 or 15 for girls; older for boys), and should be socially and emotionally well adjusted.

PREPARING FOR SURGERY

Factors that can influence your surgery: structure of your nasal bones and cartilage, facial shape, skin thickness and age. Make arrangements for someone to drive you home after surgery, and to help you out for a few days.

ANESTHESIA

Your surgery will be performed at Dr. Efird's office or at an outpatient surgical facility with either local or general anesthesia. With local anesthesia, your nose will be numbed and you'll be lightly sedated. You'll be awake during the surgery, but relaxed and will feel no pain. With general anesthesia you'll be asleep during the operation.

THE SURGERY

During surgery, which takes a few hours, the skin of the nose is separated from its supporting framework of bone and cartilage, the desired shape is sculpted and the skin is then redraped over the framework. Incision are usually made just inside the nostrils. Sometimes, a small incision is made across the columella (the strip of tissue that separates the nostrils).

RECOVERY

After surgery, a splint is applied to maintain the new shape of your nose. Nasal packs may be placed inside your nostrils. For the first 24 hours, your face will feel puffy, your nose may ache and you may have a dull headache. For the first day, you will need to stay in bed with your head elevated. Swelling and bruising around your eyes will increase for two or three days. Cold compresses will reduce this swelling. Most swelling and bruising should disappear within two weeks. A little bleeding is common during the first few days. Nasal packing will be removed after a few days, and by the end of two weeks, all dressings, splints and stitches should be removed.

HEALING

Most patients are able to return to school or work a week after surgery. Avoid strenuous activity for 2 - 3 weeks. Avoid hitting or rubbing your nose, or getting it sunburned for 8 weeks. Subtle swelling may be present for months, especially in the tip.

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LASER RESURFACING

Laser resurfacing or “laser peel,” is when a carbon dioxide (CO²) laser is used to remove areas of damaged or wrinkled skin, layer by layer.

BEST CANDIDATES

• Patients who want to minimize the appearance of fine lines, especially around the mouth and eyes.
• Patients who want to improve facial scars.
• Patients with uneven facial pigmentation.

The ideal patient for laser resurfacing has fair, healthy, non-oily skin. Patients with olive, brown or black skin may be at increased risk for pigmentation changes.

PREPARING FOR SURGERY

Weeks prior to surgery, you will begin a pre-treatment plan, to prepare the skin for laser resurfacing. Make arrangements for someone to drive you home and to help you out for a few days.

ANESTHESIA

Your surgery will be performed at an outpatient surgical facility. Local anesthesia with sedation is used when treating localized areas of the face. You'll be awake, but relaxed and you will not experience any discomfort. For more extensive resurfacing, general anesthesia is used, in which case you will sleep through the procedure.

THE SURGERY

Laser resurfacing is performed using a beam of laser energy which vaporizes the upper layers of damaged skin at specific and controlled levels of penetration. The outer layers of damaged skin are stripped away. As new cells form during the healing process, a smoother, tighter, younger-looking skin surface appears. Depending on the size of the area being resurfaced, surgery takes anywhere from a few minutes to two hours. The activated laser is carefully passed back and forth over the skin until reaching a level that makes the wrinkle or scar less visible. After the procedure, your skin is treated with protective creams or ointments until healing is complete.

RECOVERY

After surgery, you will experience some swelling and discomfort that can be controlled with ice packs and medication. After a few days, crusts will form over the treated area. It is important not to pick the crusts, or scarring will result. Most crusts are gone by ten days post-operatively, but redness may persist for several weeks.

HEALING

Your new skin will probably remain bright pink to red in the weeks following surgery. However, prescribed medications may make the color subside more rapidly. Makeup can be applied after about two weeks to help conceal the pinkness, which can remain up to six months following surgery. It is important to protect your new skin from the sun. Regularly using sun protection will help to maintain your results and will reduce the chance of new sun damage. While in the sun, use a strong sun block with an SPF of 15 or higher, and shade your face with a hat or visor. Also, wear good quality sunglasses with UVA and UVB 100 percent filters.

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OTOPLASTY (EAR SURGERY)

Ear surgery, or otoplasty, is usually done to set prominent ears back closer to the head or to reduce the size of large ears. Besides protruding ears, there are a variety of other ear problems that can be helped with surgery. These include:

• “lop ear,” when the tip seems to fold down and forward.
• “cupped ear,” which is usually a very small ear.
• “shell ear,” when the curve in the outer rim, as well as the natural folds and creases, are missing.

Surgery can also improve large or stretched earlobes, or lobes with large creases and wrinkles.

ANESTHESIA

Ear surgery is usually performed in an outpatient surgical facility or in Dr. Efird’s office. If your child is young, general anesthesia may be recommended, so the child will sleep through the operation. For older children or adults, local anesthesia is more common, so you or your child will be awake but relaxed.

THE SURGERY

Ear surgery usually takes about two to three hours, although complicated procedures may take longer. The technique will depend on the problem. With one of the more common techniques, Dr. Efird makes a small incision in the back of the ear to expose the ear cartilage. He will then sculpt the cartilage and bend it back toward the head. Non-removable stitches may be used to help maintain the new shape. Occasionally, he will remove a larger piece of cartilage to provide a more natural-looking fold when the surgery is complete.

Another technique involves a similar incision in the back of the ear. Skin is removed and stitches are used to fold the cartilage back on itself to reshape the ear without removing cartilage. In most cases, ear surgery will leave a faint scar in the back of the ear that will fade with time. Even when only one ear appears to protrude, surgery is usually performed on both ears for a better balance.

RECOVERY

Adults and children are usually up and around within a few hours of surgery. The patient’s head will be wrapped in a bulky bandage immediately following surgery to promote the best molding and healing. The ears may throb or ache a little for a few days, but this can be relieved by medication. Within a few days, the bulky bandages will be replaced by a lighter head dressing similar to a headband. Stitches are usually removed, or will dissolve, in about a week. Any activity in which the ear might be bent should be avoided for a month or so. Most adults can go back to work about five days after surgery. Children can go back to school after about seven days if they’re careful about playground activity.

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CHIN AUGMENTATION

Chin augmentation is usually done to balance the face, by extending the chin in relationship to the nose. It can give balance to an otherwise less defined face or further augment an already existent chin structure.

BEST CANDIDATES

A man or woman with a weak or receding chin but with a normal dental bite.

THE SURGERY

One surgical approach is to make a cut inside the mouth along the lower gum. This gives access to the chin bone. A bone saw or chisel is used to make a second cut through the jaw bone. The jaw bone is moved forward to the desired position and wired or screwed in place. The cut is closed with stitches and a bandage is applied. Since the surgery is performed inside the mouth, you can’t see any scars.

When only a small amount of chin augmentation is needed to round out the chin, real bone or an implant made of silicone, Teflon or Dacron may be used. For this procedure, a cut is made either inside the mouth or outside under the chin. A pocket is created in front of the chin bone and under the muscles, and the implant is placed inside. The cut is closed with stitches and a bandage is applied. The resulting scar is barely visible. Surgery to correct bite problems can be done at the same time as chin surgery.

ANESTHESIA

Chin augmentation is performed under general or local anesthesia in an outpatient surgical facility or in Dr. Efird’s office. With local anesthesia, you’ll be awake during surgery, but relaxed and will feel no pain.

RECOVERY

There is minimal bruising and swelling for 7 – 10 days after surgery. Pain is minimal and can be easily managed with medication. Sleeping with your head elevated for 3 days after surgery will help reduce swelling and bruising.

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BIRTHMARKS

As might be expected, this type of abnormal skin coloration will appear at birth or in just a few weeks following birth. It's important to remember that most birthmarks are non-cancerous, though a physician should examine your child if he or she is born with abnormally colored skin or develops birthmarks shortly after birth. Certain birthmarks described below can pose health risks.

PIGMENTED BIRTHMARKS

The discoloration of the skin will appear smooth and flat. These spots are known by several names, including Mongolian spots — bruised or bluish in color, typically appearing on buttocks; cafe-au-lait spots — light brown; and typical moles, which are also called nevi. Moles should be monitored for bleeding, color, shape or size changes, or itching.

MACULAR STAINS

These appear anywhere on the body, appearing as mild red marks, but they are not elevated. Macular stains are the most common type of vascular (from blood vessels) birthmark. These marks can come in two forms: · Angel's kisses may appear on the forehead and eyelids, but will typically disappear early in childhood. · Stork bites will appear on the back of the neck and can last into adult years. Because these marks are often mild, there is no treatment necessary.

HEMANGIOMA

Hemangiomas are caused by many tiny blood vessels bunched together and vary in severity. Typically, this birthmark can be just that, a mark, or it can grow larger and larger until treated. Hemangiomas can grow very rapidly through the first year of a child's life.

There are two types of hemangiomas: strawberry hemangiomas, which are slightly raised, red birthmarks and can appear anywhere on the body; or cavernous hemangiomas, which are a deeper birthmark characterized by a bluish color. Most hemangiomas will go away on their own; roughly 50% resolve by age five, 70% by age seven and 90% by age nine.

Reasons to treat hemangioma include problems with functions (such as sight, eating, hearing or defecation), ulceration or pain. Hemangiomas can be treated in different ways, each of which carries its own risks. Corticosteroid medication, which can be injected or taken orally, is one option for treating hemangiomas. Risks associated with corticosteroid medication include high blood pressure, high blood sugar, poor growth, or cataracts. If corticosteroids fail, there are other medications that may be an option.

Certain hemangiomas can also be treated with lasers to stop them from growing. Risks associated with that treatment include ulceration and scarring. In some cases, a hemangioma can also be removed with surgery. Other times, a combination of these approaches is the most beneficial treatment.

PORT-WINE STAINS

Port wine stains are caused by abnormal development of blood vessels (capillaries) and last a lifetime. The port-wine stain (also known as nevus flammeus) appears as a flat, pink, red or purple mark, and occurs on the face, trunk, arms, or legs.

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BOTOX®

The cosmetic form of botulinum toxin, often referred to by its product name Botox®, is a popular non-surgical injection that temporarily reduces or eliminates from lines, forehead wrinkles, crow's feet near the eyes and thick bands in the neck. The toxin blocks the nerve impulses, temporarily paralyzing the muscles that cause wrinkles while giving the skin a smoother, more refreshed appearance.

Studies have also suggested that Botox® is effective in relieving migraine headaches, excessive sweating and muscle spasms in the neck and eyes. Ice or a topical anesthetic is used. There is not recovery or down time. Results last 3-4 months or sometimes longer.

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RESTYLANE®

COMPLETELY NATURAL

Restylane® is the first and only soft-tissue filler that is made of hyaluronic acid, which exists in the human body. It's non-animal based, biodegradable and completely biocompatible with the hyaluronic acid in your body. Because Restylane® is natural and non-animal based, risk of allergic reaction from animal-based diseases is virtually eliminated. That means you can receive Restylane® injections without the delay of allergy pre-testing, and you will see results almost immediately.

TIMELY TREATMENTS

Restylane® is injected in small amounts using an extremely ultra fine needle. A topical anesthetic and/or a nerve block are used to reduce discomfort. You may experience only temporary redness and swelling at the injection site, which generally disappears in just two to three days. Treatments generally take less than half-an-hour and are performed right here at The Efird Clinic.

LONG-LASTING RESULTS

How long can you expect the results to last from your Restylane® treatment? In most cases, six months or more. That means only two treatments a year. A touch-up treatment before the product has fully dissipated can further enhance these long-lasting results.

DIFFERENT FROM BOTOX® AND COLLAGEN

Botox® is a drug that blocks nerve transmission, temporarily relaxing underlying muscles. Bovine collagen is created from animals and therefore an allergy test is required prior to injections. Restylane® is a completely natural soft-tissue filler that contains no animal-derived material, requires no pre-injection allergy test and provides immediate, long-lasting results.

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CHEMICAL PEEL

Chemical peel uses a chemical solution to improve and smooth the texture of the facial skin by removing its damaged outer layers. It is helpful for those individuals with facial blemishes, wrinkles and uneven skin pigmentation. Trichloroacetic acid (TCA) and alphahydroxy acid (AHA) are used for this purpose. The precise formula used may be adjusted to meet each patient’s needs. Chemical peel is most commonly performed for cosmetic reasons – to enhance your appearance and your self-confidence.

Chemical peel may also remove pre-cancerous skin growths, soften acne facial scars and even control acne. Alphahydroxy acids (AHAs) such as glycolic, lactic, or fruit acids are the mildest of the peel formulas and produce light peels. These types of peels can provide smoother, brighter-looking skin for people who can’t spare the time to recover from a TCA peel. AHA peels may be used to treat fine wrinkling, areas of dryness, uneven pigmentation and acne. Various concentrations of an AHA may be applied weekly or at longer intervals to obtain the best result. An alphahydroxy acid, such as glycolic acid, can also be mixed with a facial wash or cream in lesser concentrations as part of a daily skin care regimen to improve the skin’s texture.

Trichloroacetic acid (TCA) can be used in many concentrations, but it is most commonly used for medium-depth peeling. Fine surface wrinkles, superficial blemishes and pigment problems are commonly treated with TCA.

All chemical peels carry some uncertainty and risk. Chemical peel is normally a safe procedure when it is performed by a qualified, experienced plastic surgeon. However, some unpredictability and risks such as infection and scarring, while infrequent, are possible. AHA peels may cause stinging, redness, irritation and crusting. However, as the skin adjusts to the treatment regimen, these problems will subside.

With a TCA peel, your healed skin will be able to produce pigment as always; the peel will not bleach the skin. However, TCA-peel patients are advised to avoid sun exposure for several months after treatment to protect the newly formed layers of skin. It may also produce some unintended color changes in the skin.

PEEL FORMULAS AT A GLANCE :

Alphahydroxy acid (AHA)

• Smooths rough, dry skin
• Improves texture of sun-damaged skin
• Aids in control of acne
• Can be mixed with bleaching agent to correct pigment problems
• Can be used as TCA pre-treatment

Considerations:

• A series of peels may be needed.
• As with most peel treatments, sunblock use is recommended.

Trichloroacetic acid (TCA)

• Smooths out fine surface wrinkles.
• Removes superficial blemishes.
• Corrects pigment problems.

Considerations:

• Can be used on neck or other body areas
• May require pre-treatment with Retin-A or AHA creams
• Treatment takes only 10 – 15 minutes
• Preferred for darker-skinned patients
• Peel depth can be adjusted
• Repeat treatment may be needed to maintain results
• Sunblock must be used for several months
• Healing is usually quick

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MICRODERMABRASION

Microdermabrasion is a non-surgical, non-invasive treatment for any skin area in need of exfoliation such as face, neck, hands and chest. Skin has a brighter, smoother appearance after just a few treatments.

Microdermabrasion is effective for:

• Reducing fine lines and minor scars
• Treating acne blemishes
• Removing sun and age spots
• Cleaning enlarged and clogged pores, blackheads and whiteheads
• Restoring a healthy, smooth feel to skin
• Helping fight signs of aging
• Treating hyperpigmentation

Microdermabrasion is safe, quick and proven effective for all skin colors and types. A precise stream of aluminum oxide crystals is directed through a hand piece onto the skin. This loosens and exfoliates the top layer of dead cells. The skin is simultaneously vacuumed to reveal a fresher, healthier looking you. Microdermabrasion promotes the production of new cells in the deepest layers of the dermis and stimulates the growth of collagen to further smooth and improve skin tone and appearance. Best results are achieved through a series of treatments and a regular maintenance program.

Treatments usually last 20–30 minutes for the face and longer if you include you upper chest and hands. Some patients may experience a tightness and redness of the skin, comparing it to the feeling of a mild sunburn. There is virtually no discomfort, down time or recovery. Patients typically experience some redness for about an hour after the procedure.

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LASER HAIR REMOVAL

The Efird Clinic now offers body hair removal that is virtually painless. The Pain-Free, Hair-Free™ treatment by Alma Lasers, offered by spas and physicians around the world, can now free you from daily shaving, painful plucking and expensive waxing to give you silky smooth and beautifully bare skin.

Pain-Free, Hair-Free™ is the next-generation of laser hair removal. It's an effective and permanent hair reduction solution that is simple and easy. It takes cutting-edge medical laser technology and combines it with the comfort and convenience of a trip to the spa. In fact, Pain-Free, Hair-Free™ uses new breakthrough technology that has been described as one of the most comfortable laser hair removal options available.

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SPIDER VEIN INJECTIONS

Spider veins are those small yet unsightly clusters of red, blue or purple veins that most commonly appear on the thighs, calves and ankles. They are small, thin veins that lie close to the surface of the skin. Spider veins are treated with sclerotherapy, a simple procedure where veins are injected with a sclerosing solution, which causes them to collapse and fade from view. This relatively painless procedure may also rememdy the bothersome symptoms associated with spider veins, including aching, burning, swelling and night cramps.

Spider veins usually take on one of three basic patterns. They may appear in a true spider shape with a group of veins radiating outward from a dark central point; they may be arborizing and will resemble tiny branch-like shapes; or they may be simple linear and appear as thin separate lines. Linear spider veins are commonly seen on the inner knee, whereas the arborizing pattern often appears on the outer thigh in a sunburst or cartwheel distribution.

A number of factors contribute to the development of spider veins, including heredity, pregnancy and other events that cause hormonal shifts, weight gain, occupations or activities that require prolonged sitting or standing, and the use of certain medications.

Varicose veins differ from spider veins in a number of ways. Varicose veins are larger – usually more than a quarter-inch in diameter, darker in color and tend to bulge. Varicose veins are also more likely to cause pain and be related to more serious disorders. For some patients, sclerotherapy can be used to treat varicose veins. However, often surgical treatment is necessary for this condition.

BEST CANDIDATES

People of any age may be good candidates for sclerotherapy, but most fall in the 30–60-year-old category. In some women, spider veins may become noticeable very early on – in the teen years. For others, the veins may not become obvious until they reach their 40s. If you are pregnant or breastfeeding, you may be advised to postpone sclerotherapy treatment. In most cases, spider veins that surface during pregnancy will disappear on their own within three months after the baby is born. Also, because it’s not known how sclerosing solutions may affect breast milk, nursing mothers are usually advised to wait until after they have stopped breastfeeding.

Spider veins in men aren’t nearly as common as they are in women. Men who do have spider veins often don’t consider them to be a cosmetic problem because the veins are usually concealed by hair growth on the leg. However, sclerotherapy is as effective for men who seek treatment.

WHAT TO EXPECT FROM SCLEROTHERAPY

Sclerotherapy can enhance your appearance and your self-onfidence, but it's unrealistic to believe that every affected vein will disappear completely as a result of treatment. After each sclerotherapy session, the veins will appear lighter. Two or more sessions are usually required to achieve optimal results. Schlerotherapy treats only those veins that are currently visible; it does nothing to permanently alter the venous system or prevent new veins from surfacing in the future.

Serious medical complications from sclerotherapy are extremely rare, however, they may occur. Risks include the formation of blood clots in the veins, severe inflammation, adverse allergic reactions to the sclerosing solution and skin injury that could leave a small but permanent scar.

A common cosmetic complication is pigmentation irregularity – brownish splotches on the affected skin that may take months to fade, sometimes up to a year. Another problem that can occur is “telangiectatic matting,” in which fine reddish blood vessels appear around the treated area, requiring further injections.

PREPARING FOR THE PROCEDURE

You’ll be instructed not to apply any type of moisturizer, sunblock or oil to your legs on the day of your procedure. You may want to bring shorts to wear during the injections, as well as your physician-prescribed support hose, and slacks to wear home. When scheduling your procedure, keep in mind that your legs may be bruised or slightly discolored for some weeks afterward. You probably won’t be comfortable wearing shorts, a swimsuit or a mini skirt until after your legs have cleared up a bit.

THE PROCEDURE

Sclerotherapy of spider veins is a relatively simple procedure that requires no anesthesia, so it will be performed in Dr. Efird’s office. A typical sclerotherapy session is relatively quick, lasting only about 15–45 minutes. You will be asked to lie down on the examination table and the skin over your spider veins will be cleaned with an antiseptic solution. While your skin is stretched taut, the sclerosing agent will be injected in the affected veins. Bright, indirect light and magnification help ensure that the process is completed with maximum precision.

Approximately one injection is administered for every inch of spider vein – anywhere from five to forty injections per treatment session. A cotton ball and compression tape is applied to each area of the leg as it is finished. You will feel small needle sticks and possibly a mild buring sensation. However, the needle used is so thin and the sclerosing solution is so mild that pain is usually minimal.

AFTER YOUR TREATMENT

In addition to the compression tape applied during the procedure, tight-fitting support hose may be prescribed to guard against blood clots and to promote healing. The tape and cotton balls can be removed after 48 hours. However, you may be instructed to wear the support hose for 72 hours or more. It's not uncommon to experience some cramping in the legs for the first day or two after the injections. This temporary problem usually doesn’t require medication. You should be aware that your treated veins will look worse before they begin to look better. When the compression dressings are removed, you will notice bruising and reddish areas at the injection sites. The bruises will diminish within one month. In many cases, there may be some residual brownish pigmentation which may take up to a year to completely fade.

GETTING BACK TO NORMAL

Although you probably won't want to wear any leg-baring fashions for about two weeks, your activity will not be significantly limited in any other way from sclerotherapy treatment. You will be encouraged to walk to prevent clots from forming in the deep veins of the legs. However, during the period of time to complete your treatment program, prolonged sitting and standing should be avoided, as should squatting, heavy weight lifting and “pounding” type exercises, including jogging. A one-month healing interval must pass before you may have your second series of injections in the same site. After each treatment, you will notice further improvement of your legs' appearance.

Most patients are pleased with the difference sclerotherapy makes. The skin of your legs will appear younger, clearer and more healthy-looking. Often, patients are surprised at the dramatic difference in appearance between a treated leg and an untreated one. Although sclerotherapy will obliterate the noticeable veins for good, it’s important to remember that treatment will not prevent new spider veins from emerging in the future. As time passes, you may find that you need “touch-ups” or full treatment for new veins that surface. But even if you choose not to have further sclerotherapy, your legs will look better than if you never had treatment at all.

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FACIAL

This personalized facial begins with a deep cleanse encouraging cell turnover. Steam and massage are used to help with product penetration. Skin is polished and prepared to receive a hydrating mask. A moisturizer is applied to rejuvenate tired, stressed, dry or mature skin.

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COLLAGEN/ELASTIN MASK

This tightening and firming mask is used with steam and can be used alone or added to an anti-aging facial for visible results.

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